Self-management Of Long-term Conditions Research Articles

DIALOR (DIgitAL cOaching for fRailty): protocol for a single-arm mixed-methods feasibility study of a digital health coaching intervention for older people with frailty in primary care

BackgroundMultidomain interventions in older adults offer the best opportunity to prevent, delay or reverse existing symptoms in the earlier stages of frailty and improve independence but can be costly, and...

Supported self-management in long-term conditions in an African context.

There is a need to develop locally derived African solutions. Self-management strategies for long-term health conditions should be developed, considering traditional holistic African health systems.

Self-administration of medicines in secondary schools and colleges by students living with medical conditions: content analysis of school medicine policies in England

Abstract Introduction Every school in England is required to have a policy to support students with a medical condition under statutory guidance issued by the Department for Education.[1] The guidance promotes self-administration of medicines where possible, supervised by an adult. Transition from paediatric to adult healthcare during adolescence should be a process of gradually transferring control and responsibility from parents and other responsible adults to the young person taking the medicine. There are several barriers that might prevent autonomy, but effective self-management of long-term conditions at school is essential for wellbeing and learning.[2] Aim To explore secondary school/college medicine policies displayed online for content regarding the self-administration of medicines by students. Methods This was a group project involving six MPharm students. Each student was assigned one or two of the nine regions of England to explore, covering all regions, and they used search engines to find school websites with accessible health/medicine policies. The group employed purposive sampling within their Region to achieve a diverse sample of schools (e.g. nursery age to college; urban and suburban; public and private/fee-paying). An online data collection form was developed by the group to facilitate consistent, directed content analysis of school health/medicine policies (quantitative and qualitative). The topics reflected issues of interest from their literature review e.g. which medicines were mentioned by name in the policy, and arrangements for bringing long-term medicines to school. One topic within the form was to search for content relating to self-administration of medicines. For this abstract, within the wider study, the policies were subjected to directed content analysis to find any statements relating to self-administration. Results The students analysed 50 school policies across England (3 East Midlands; 1 East of England; 8 London; 7 North East; 8 North West; 10 South East; 4 South West; 4 West Midlands; 5 Yorkshire & Humber). Eighteen of the 25 secondary school/college policies included statements about self-administration of medicines. Many (n=13) were comprehensive, stating that young people with medical conditions should assume complete responsibility under parental supervision. Others (n=4) specified partial self-administration for diabetes, asthma or severe allergies. The remaining school, however, specified that their students could not keep or carry any essential medicines, apart from salbutamol inhalers. Conclusion Most schools have adopted a positive approach to self-administration of medicines consistent with the recommendations of statutory guidance. There is, however, some variation in this approach and a minority of schools that do not promote self-medication and thus still prefer to keep medication stored away from the student. This study highlights a context not commonly studied in pharmacy practice, which is a strength, but has a limitation of a small sample that might not reflect the whole situation in England. Another limitation is possible omission of information by the student researchers, where independent validation by another person would be ideal but not practical in the scope of the short-term study. Pharmacists are well-placed to offer support to schools, and to be a resource for teachers, students and families, and this topic merits further exploration.

Using FLO text-messages to enhance health behaviours and self-management of long-term conditions in South-Asian patients.

Cultural and communication differences faced by South-Asian (SA) ethnic minority groups have led to challenges in the delivery of health care and complex management of long-term conditions (LTCs). We aim to explore the use of text-messaging in SA communities, through the Florence (FLO) health messaging system utilised within U.K. health sectors, to enhance positive health behaviours and self-management. A mixed-methods approach was used for this study involving two phases. Phase 1 includes the administration of the patient activation measure to assess SA patient level of skills, knowledge, and confidence to self-manage their LTC; whilst in Phase 2 semi-structured interviews were conducted, exploring the experiences of users and non-users of FLO text messaging to promote self-management behaviours. Forty participants (Florence users (n = 20) and non-users (n = 20)) completed the patient activation survey once after using FLO, and took part in interviews. Differences were noted to exist between the two groups (p < .01). Users appeared to have higher activation levels and better self-management behaviours (p < .01 (p = .00). Interviews elicit participants' perceptions of the text messaging system, along with key themes relative to behavioural constructs: socio-demographical factors; influencing behaviour changes, self-management, and uptake of text messages amongst SA ethnic minorities. Text messaging and mHealth are being extensively used amongst general populations to monitor and enhance health. The study of SA patient experiences and their use of text messages within the United Kingdom (UK) remains scarce. Therefore, results from the study identify health beliefs that influence patient engagement with digital health interventions and their self-management. Developing policies and culturally appropriate education guidelines for healthcare practitioners can allow for the provision of culturally sensitive interventions tailored in terms of normative, cultural, and religious beliefs; which in turn will address crucial aspects including SA patient information and educational needs supporting their self-management journey.

The Impact of Cybervictimization on the Self-Management of Chronic Conditions: Lived Experiences.

Cybervictimization of people with long-term conditions is a disturbing phenomenon with a documented impact on health and well-being. These experiences are primarily examined using quantitative methods, focusing on children and young people. However, research centered on the cybervictimization of adults with chronic conditions is scarce, with limited qualitative input from the victims as experts in their own experiences. This study aims to understand the impact of cybervictimization on the self-management of long-term conditions among adults with chronic conditions and disabilities in the United Kingdom. This paper reports the findings from the qualitative phase of a phenomenologically informed mixed methods study. The biographical disruption concept was used to conceptualize the study. In-depth semistructured interviews were conducted with 13 participants with chronic conditions who experienced cybervictimization. A codebook was developed, and a zigzag approach to thematic analysis was used to define and refine themes. Ethical considerations and risk assessment were ongoing during the research process because of the sensitivity of the topic and cases of harassment. Cybervictimization has direct and indirect impacts on the self-management of chronic conditions. This impact was verified across 6 overarching themes that emerged from this study. First, biomedical events included overall health deterioration because of existing conditions, new diagnoses, and subjective physical complaints. Second, the impact on mental health was perceived through psychological consequences and psychiatric disorders that developed after or during this traumatic experience. Third, the multilevel impact theme focused on disrupting the strategies for coping with health conditions and involved unplanned changes to victims' health management priorities. Fourth, the impact of complexity reflected the perceived uniqueness in each case, intersectionality, struggle to obtain formal support, and subsequent health complications. Fifth, social network involvement comprised the effects of social isolation, victim blaming, and deception. Finally, the disability discrimination theme focused on prejudice, issues on inclusion, and hostility in society, with subsequent effects on well-being. People with long-term conditions experienced different forms of cybervictimization, all disruptive with various effects on health. Disability discrimination was a prominent finding to be further investigated. This paper reports the impact as themes to guide further research and practice, with the recognition that long-term conditions and impairments are not a homogeneous group. Despite the devastating consequences, there are positive points that strengthen potential interventions. Awareness-raising campaigns, training of support channels, and multidisciplinary research are recommended to tackle this issue and initiate change.

PA20 Assessing the value of transition readiness assessment clinics within a dermatology service

Abstract Successful transition of healthcare from paediatric to adult services is a key component of developmentally appropriate healthcare for young people with long-term conditions. Poor preparation for transfer and shifting social roles results in up to 25% of young individuals regularly missing follow-up visits and poor treatment adherence once transferred to adult services. Transition clinics were developed as an intervention to support young people in navigating the journey from paediatric to adult care. The Ready Steady Go (RSG) tool was implemented by Southampton Children’s hospital and endorsed by the Royal College of Paediatrics and Child Health and the National Institute for Health and Care Excellence for use in transition clinics. It considers the developmentally appropriate healthcare domains of self-management of long-term conditions, independence and self-advocacy, sexual health, mental health and emotional wellbeing, and activities of daily living (ADLs). The role and success of the RSG tool in many medical specialties has been documented. However, it has not yet been routinely implemented within dermatology departments. The aim of this project was to assess the additional value of the use of the RSG tool by a paediatrician with expertise in adolescent health, in a transition readiness assessment clinic piloted within a dermatology service. Notes of all patients attending the transition clinic between January and December 2022 were reviewed. Details of any interventions provided during the RSG-guided clinical appointment were compared with interventions previously received by the same patients in their routine dermatology appointments over the preceding 24 months. Intervention types included the assessment of independence, verbal advice, written leaflets, links to websites and direction to self-help services. Sixteen patients were seen in the transition clinic and included in the analysis. All patients were seen without their parents for at least part of the consultation. With the use of the RSG tool, 100% of patients received one or more intervention concerning self-management of their long-term condition, self-advocacy and ADLs vs. 44%, 81% and 75% in their previous clinic attendances for each of these domains, respectively. Eighty-seven per cent of patients received advice on sexual health/family planning, and 87% received information on mental health help with use of the RSG tool in the transition clinic, where 0% and 37% patients, respectively, had received information about these domains at previous dermatology appointments. All patients successfully achieved transition, with 44% having attended their first adult dermatology appointment, while the remaining 56% have their adult appointments still pending at time of writing. This study highlights the value and yield of a transition-readiness assessment for paediatric dermatology patients. During this presentation, we will discuss the RSG tool and the practicalities of implementing its use in dermatology services.

The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce—randomised controlled trial

BackgroundLarge-scale trials of multidomain interventions show that modifying lifestyle and psychological risk factors can slow cognitive decline. We aim to determine if a lower intensity, personally tailored secondary dementia prevention programme for older people with subjective or mild objective memory decline, informed by behaviour change theory, reduces cognitive decline over 2 years.MethodsA multi-site, single-blind randomised controlled trial recruiting 704 older adults at high dementia risk due to mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Participants are randomised using 1:1 allocation ratio to the APPLE Tree intervention versus control arm (dementia prevention information), stratified by site. The intervention explores and implements strategies to promote healthy lifestyle, increase pleasurable activities and social connections and improve long-term condition self-management. Two facilitators trained and supervised by a clinical psychologist deliver ten, 1-h group video call sessions over 6 months (approximately every fortnight), video-call ‘tea breaks’ (less structured, facilitated social sessions) in intervening weeks and individual goal-setting phone calls every 2 weeks. From 6 to 12 months, participants meet monthly for ‘tea breaks’, with those not attending receiving monthly goal-setting phone calls. Participants receive a food delivery, pedometer and website access to cognitive training and information about lifestyle modification. Follow-ups for all outcome measures are at 12 and 24 months. The primary outcome is cognition (Neuropsychological Test Battery (NTB) score) at 24 months. Secondary outcomes are quality of life, cost per quality-adjusted life year (QALY) and wellbeing and lifestyle factors the intervention targets (diet, vascular risk, body weight, activity, sleep, anxiety, depression, social networks and loneliness, alcohol intake and smoking). Participants from purposively selected sites participate in qualitative process evaluation interviews, which will be analysed using thematic analytic methods.DiscussionIf effective, the intervention design, involving remote delivery and non-clinical facilitators, would facilitate intervention roll-out to older people with memory concerns.Trial registrationISRCTN17325135. Registration date 27 November 2019

Shared medical appointments in English primary care for long-term conditions: a qualitative study of the views and experiences of patients, primary care staff and other stakeholders

BackgroundShared medical appointments (SMAs) or group consultations have been promoted in primary care to improve workload pressures, resource-use efficiency and patient self-management of long-term conditions (LTCs). However, few studies have explored stakeholders’ perspectives of this novel care delivery model in the English NHS context, particularly patients’ views and experiences of SMAs.MethodSemi-structured interviews were used to explore the perspectives of stakeholders (21 patients, 17 primary care staff, 2 commissioners and 2 SMA training providers) with and without SMA experience from a range of geographical and socio-economic backgrounds in the North East and North Cumbrian region of England. Thematic analysis was conducted to examine perceptions around impact on patient care and outcomes and barriers and facilitators to implementation.ResultsThree main themes were identified: ‘Value of sharing’, ‘Appropriateness of group setting’, ‘Implementation processes’. Patients experiences and perceptions of SMAs were largely positive yet several reported reservations about sharing personal information, particularly in close-knit communities where the risk of breaching confidentiality was perceived to be greater. SMAs were considered by patients and staff to be inappropriate for certain personal conditions or for some patient groups. Staff reported difficulties engaging sufficient numbers of patients to make them viable and having the resources to plan and set them up in practice. Whilst patients and staff anticipated that SMAs could deliver high quality care more efficiently than 1:1 appointments, none of the practices had evaluated the impact SMAs had on patient health outcomes or staff time.ConclusionStakeholder experiences of SMA use in English primary care are largely similar to those reported in other countries. However, several important cultural barriers were identified in this setting. Further work is needed to better understand how patient and staff perceptions, experiences and engagement with SMAs change with regular use over time. Concerns regarding staff capacity, additional resource requirements and numbers of eligible patients per practice suggest SMAs may only be feasible in some smaller practices if facilitated by primary care networks. Further mixed-method evaluations of SMAs are needed to inform the evidence base regarding the effectiveness, efficiency and feasibility of SMAs long-term and subsequently their wider roll-out in English primary care.

Identifying individual enablers and barriers to the use of digital technology for the self-management of long-term conditions by older adults

Evidence suggests that much of the digital technology available and provided to older adults to enable self-management of long-term conditions is under-utilised. This research focuses on three conditions prevalent amongst older adults: diabetes, dementia and chronic kidney disease and explores the individual enablers and barriers to the use of digital self-management technology. The paper reports findings from a series of three systematic reviews of qualitative research (qualitative evidence syntheses). These reviews informed the design of a Delphi study. The first round of the Delphi involving 15 expert interviews is reported. The findings highlight common themes across the three conditions: how technology is used; barriers to use; assessing individual needs when selecting technology; support requirements; multi-functional self-management technologies; trust, privacy and data sharing; achieving accessible and aspirational design. Some emerging recommendations have been suggested to guide the design, and provision of technology to older adults. These will extended and refined through subsequent rounds of the Delphi method.

P078 International impact of a co-produced training video: self-examination of tender and swollen joints for people with rheumatoid arthritis

Background/AimsPatients with rheumatoid arthritis (RA) need support to understand and manage their condition. The COVID-19 pandemic rapidly transformed outpatient clinical consultations from face-to-face towards remote models. This increased the emphasis placed upon self-assessment of joints and disease activity, strengthening the need for patient education materials. We planned to develop a video to support patient research participants to monitor disease activity remotely using the REMORA app. We altered the video’s scope and made it open access to meet the need created by changes in service delivery models.MethodsA video demonstrating self-examination of tender and swollen joints in RA was co-produced with patients and the multi-disciplinary team. A nurse consultant introduces key concepts, (how to identify and examine tender and swollen joints, which joints to include, etc), coaches a patient through self-examination, and answers key questions. Materials co-produced to support implementation into practice include a joint count manikin and table, an advertising poster, and blogs. Collaboration with international research colleagues has led to the production of a version dubbed in German. Subtitles are available in German and Hindi. Online feedback was sought via a survey. Ethical approval was not required as all contributors acted as equal members of the research team.ResultsThe 15-minute video, supporting materials and survey were uploaded to YouTube in February 2021 [tinyurl.com/REMORAvideo]. 1,000 hits were received in week one, reaching >12,500 after eight months. 20% of viewers are UK-based, 15% from the USA, 10% from India. 26% of views used English subtitles, 0.2% German, 0.1% Hindi. 124/125 people engaging with the ‘like/dislike’ function on YouTube, ‘liked’ the video. 48 people fed-back online (26 patients, 22 clinicians). Patient ages were: 18-35(5%), 36-55(62%), 56-75(29%), 76 + (5%), the majority of whom were female (19/21[91%]). Before watching, 14/17(82%) patients rated themselves as ‘poor’-‘fair’ at self-examination: after watching, the same number rated themselves as ‘good’-‘excellent’. 19/21(90%) and 17/21(81%) patients respectively either somewhat or strongly agreed with the statements ‘I now feel confident to self-examine for’ ‘tender’ or ‘swollen’ joints. 19/21(90%) of patients and 13/17(77%) clinicians either somewhat or strongly agreed with the statement that ‘the video fulfilled my expectations’. 18/21(86%) patients and 12/17(71%) clinicians would recommend the video. To date, several national organisations have engaged with the video. It supports the BSR ePROMS platform and national audit. The National Rheumatoid Arthritis Society plans to incorporate it into the ‘Know your DAS app’, and it will contribute to an NHSX playbook of digital best practice.ConclusionThis co-produced training video for people with RA, originally intended to support a remote monitoring app, has been well-received, with much wider-reaching international impact than anticipated. This demonstrates the need for materials collaboratively designed with patients to support patient self-management of long-term conditions, in the digital era.Disclosure C.A. Sharp: None. K. Staniland: None. T. Cornell: Corporate appointments; T.C. is an employee of Abbvie, working as a Rheumatology Nurse Consultant. Shareholder/stock ownership; T. C. is a shareholder of shares in Abbvie. W.G. Dixon: Consultancies; WGD has received consultancy fees from Abbvie and Google, unrelated to this work.

Nutritional care the patient’s perspective: Data from a national survey of patients with diseased related malnutrition

The NHS long term plan seeks to encourage greater self-management of long-term conditions, which is an important concept in the context of the finite healthcare professional resource. Disease-related malnutrition (DRM) affects over 3million people in the UK with most living in the community and is one such condition where patients could, in part, self-manage. Self-screening for malnutrition risk is validated and reliable using the Malnutrition Universal Screening Tool (‘MUST’). Supporting patients with first line management strategies could aid adherence to treatment interventions.

Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach.

BackgroundTechnology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic).ObjectiveThe aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop.MethodsWe recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues.ResultsThe stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout.ConclusionsThis study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing.

Being more than “just a bog-standard knee”: the role of person-centred practice in physiotherapy: a narrative inquiry

Purpose The aim of this study was to understand how physiotherapeutic encounters were experienced over time by one service user and the extent to which the encounters were person-centred. Methods This narrative inquiry study had one participant purposively sampled due to their extensive experience of physiotherapy in healthcare systems in the United Kingdom. Data were collected through interviews and analysed using Clandinin and Connelly’s three-dimensional framework. Results Time-related aspects of physiotherapeutic encounters were noted in the evolutionary journey of physiotherapy practice. Personal and social aspects were evident in the words and attitude of the physiotherapists. The influence of place was noted in the role that external forces and the environment played in shaping how physiotherapy was experienced. Conclusions These narratives remind physiotherapists and healthcare providers to reflect on the role they play in shaping the experience of service users and whether those experiences are considered to be person, therapist, or institution centred. Those training pre-registration physiotherapy students need to consider giving students the opportunity to develop and reflect on their philosophy of practice early in the curriculum to enhance the experience of service users in the long-term. IMPLICATIONS FOR REHABILITATION It is important for therapists to consider preconceived ideas of what a service user may want, and to listen to them as unique people, with a future journey ahead of them to understand what is truly important to them. Physiotherapists need to reflect on the role they play and the words they use in shaping the experience of care for service users, and whether this is perceived as being person or therapist centred. Physiotherapists who are more person-centred in practice were better placed to promote self-management of long-term conditions. Providing pre-registration physiotherapists with the opportunity to develop their own value-based philosophy of practice during training may enhance the experiences of their service users in the future.

Artificial intelligence-powered remote monitoring of patients with chronic obstructive pulmonary disease.

Artificial intelligence-powered remote monitoring of patients with chronic obstructive pulmonary disease.

Employer perspectives concerning the self-management support needs of workers with long-term health conditions

PurposeLong-term health conditions are a significant occupational and global burden and can undermine people's ability to work. Workplace support for self-management of long-term conditions has the potential to minimise adverse work effects, by enhancing health and work outcomes. No data exist about employers' views concerning supporting workers with long-term conditions to self-manage.Design/methodology/approachThe exploration of employers' views involved recruiting 15 participants with responsibilities for workplace health, well-being and safety responsibilities, who participated in a semi-structured interview about self-management and support. Data were analysed using a qualitative six-stage thematic analysis technique.FindingsSelf-management support is not purposely provided to workers with long-term conditions. Support in any form rests on workers disclosing a condition and on their relationship with their line-manager. While employers have considerable control over people's ability to self-manage, they consider that workers are responsible for self-management at work. Stigma, work demands and line-manager behaviours are potential obstacles to workers' self-management and support.Practical implicationsWorkplace discussions about self-managing long-term conditions at work should be encouraged and opened up, to improve health and work outcomes and aligned with return-to-work and rehabilitation approaches. A wider biopsychosocial culture could help ensure workplaces are regarded as settings in which long-term conditions can be self-managed.Originality/valueThis study highlights that employer self-management support is not provided to workers with long-term conditions in a purposeful way. Workplace support depends on an employer knowing what needs to be supported which, in turn, depends on aspects of disclosure, stigma, work demands and line management.

Exploring determinants of self-management in adults with severe mental illness: a qualitative evidence synthesis

AimsTo systematically review and synthesise qualitative evidence about determinants of self-management in adults with SMI. The goal is to use findings from this review to inform the design of effective self-management strategies for people with SMI and LTCs.BackgroundPeople living with serious mental illness (SMI) have a reduced life expectancy by around 15–20 years, mainly due to the high prevalence of long-term physical conditions such as diabetes and heart disease. People with SMI face many challenges when trying to manage their physical health. Little is known about the determinants of self-management – managing the emotional and practical issues – of long-term conditions (LTCs) for people with SMI.MethodSix databases, including CINAHL and MEDLINE, were searched to identify qualitative studies that explored people's perceptions about determinants of self-management in adults with SMI (with or without comorbid LTCs). Self-management was defined according to the American Association of Diabetes Educator's self-care behaviours (AADE7). Determinants were defined according to the Capabilities, Opportunity, Motivations and Behaviours (COM-B) framework. Eligible studies were purposively sampled for synthesis according to the richness of the data (assessed using Ames et al (2017)'s data richness scale), and thematically synthesised.ResultTwenty-six articles were included in the synthesis. Seven studies focused on self-management of LTCs, with the remaining articles exploring self-management of SMI. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the additional burden of SMI; living with comorbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; routine, structure and planning. Capabilities for self-management were linked to people's perceptions about the support they received for their SMI and LTC from healthcare professionals, family and friends. Opportunities for self-management were more commonly expressed in the context of social and environmental factors. Motivation for self-management was influenced by beliefs and attitudes, whilst being closely related to the burden of SMI.ConclusionThe themes identified from the synthesis suggest that capabilities, opportunities and motivations for self-management can be negatively influenced by the experience of SMI, whilst social and professional support, improved access to resources, and increased involvement in care, could promote self-management. Support programmes for people with SMI and LTCs need to account for these experiences and adapt to meet the unique needs of this population.

Improving health behaviors in patients with peripheral arterial disease – A pilot study of supported self-management

This pilot study reports the feasibility of a future randomized controlled trial (RCT) investigating the effect of supported self-management through low-intensity psychological intervention in patients with peripheral arterial disease (PAD) resulting in claudication. The study protocol, measurement instrument, data collection, and analysis were evaluated. Clinical outcome measures include depression and anxiety scores, smoking cessation, activity (step count), weight, and quality of life. Both Quantitative and Qualitative data were collected to evaluate participant experience and the clinical impact of a supported self-management intervention delivered in a routine clinical setting. Participants received an initial one to one assessment with a health psychologist. Demographic data and baseline clinical outcome measures were recorded. These included Hospital Anxiety and Depression Scale score (HADS), health-related quality of life questionnaire (EQ-5D-3L), number of cigarettes smoked daily, weight/BMI, and daily step count. Participants each received an activity tracker to record daily step count and were followed up weekly to provide psychological input, including goal setting, overcoming barriers, and preventing relapse. Quantitative data collection was scheduled at baseline, 3 and 6 months (final follow-up). At the final follow-up, participants provided qualitative feedback reflecting upon their experience of the intervention and its impact. Descriptive statistical analysis and simple paired samples t-test were employed in data evaluation. The sample size was small (n=30). Twenty-three participants were followed up to 6 months. Depression scores improved with statistical significance from baseline to 6-month follow-up. Eight participants stopped smoking (47% reduction); a further 9 greatly reduced their intake. A borderline statistically significant increase of daily step count was achieved between baseline and 6-month follow-up. In addition, positive weight loss trends were observed in a predominantly obese or overweight cohort. The qualitative feedback highlighted participants understood and embraced the information delivered regarding the importance of health behavior change. Participants were able to link tailored action plans with what mattered to them with the help of the Health Psychologist. This study embraces the contemporary ideology of enabling self-management of long-term conditions to improve clinical outcomes. As a pilot study, we have shown that an expanded, randomized controlled trial is both safe and feasible. A positive trend in clinical outcomes suggests this patient group may benefit from supported self-management through low-intensity psychological intervention, where other forms of early intervention have historically faltered.

A Theory on the Components of Depression Self-Management in Older Adults

Depression is the most prevalent mental illness in older adults and is expected to increase with population aging. Health care policy in higher income countries increasingly promotes the self-management of long-term conditions, including depression. Scant research has considered how older adults understand and practice self-management. In this article, we present the findings of a grounded theory study which sought to explain how older community-based adults experience and self-manage depression. Interviews and observations were conducted with 32 older adults with a formal diagnosis of moderate depression. Participants responded to a diagnosis of depression by Taking stock, Accessing support, and Reclaiming self-identity. Their efforts were influenced by perspectives on age and depression, access to the health care system, and individual capacity for self-management. Improved understanding of how to facilitate self-management strategies may enable older adults to remain independent and healthier for longer, while moderating the risk of a chronic condition worsening.

Peer-to-Peer Health Communication in Older Adults' Online Communities: Protocol for a Qualitative Netnographic Study and Co-Design Approach.

BackgroundOnline communities provide an environment in which people with similar health concerns can interact and access content that can support the self-management of long-term conditions (LTCs). Recently, the importance of online social networks as sources of health information and social support has been brought into focus with the emergence and widespread societal impacts of COVID-19. Although online communities exist for older adults, little is known about the specific health and self-care topics that older people discuss in such environments and how these relate to users’ support needs and outcomes. A better understanding of users’ needs and peer-to-peer communication in these communities is necessary to inform the design of information and communication technology (ICT) interventions that are relevant to older people and their peer supporters.ObjectiveThis study aims to use a two-phase, web-based ethnographic (netnography) and co-design approach to explore specific health care and self-care topics that older adults discuss in a UK-based online community and how peer supporters respond to these queries with informational and/or social support and engage with stakeholders to define the needs and requirements for new ICT-based interventions capable of reducing social isolation and facilitating LTC self-management support.MethodsThe first phase of the research will involve a qualitative netnographic analysis of posts in discussion forums in a publicly accessible online community. The second phase will involve co-design workshops with health care consumers (ie, older adults and carers) and service providers to determine the needs and requirements for new ICT-based interventions and digital innovations. Constructivist grounded theory will be used in the first phase; in the second phase, the co-design workshops will be audiorecorded and analyzed thematically.ResultsThis research project is in progress. Permission was obtained from the website administrator to use materials from the social media forum; data collection for the first phase began in April 2020. The second phase of the study is expected to begin in late 2020. This study is due to be completed by the end of 2021.ConclusionsThis study is the first, to the best of our knowledge, to combine qualitative netnography with an iterative co-design framework to specify the needs and requirements for new ICT-based interventions. The findings from this study will inform the next phase of the multiphase knowledge translation project and will provide insights into the potential of online peer health communities to reduce social isolation and facilitate chronic illness self-management support and self-care.International Registered Report Identifier (IRRID)PRR1-10.2196/19834

Self-Efficacy of Older People Using Technology to Self-Manage COPD, Hypertension, Heart Failure, or Dementia at Home: An Overview of Systematic Reviews.

Although telehealth research among the general population is voluminous, the quality of studies is low and results are mixed. Little is known specifically concerning older people and their self-efficacy to engage with and benefit from such technologies. This article reviews the evidence for which self-care telehealth technology supports the self-efficacy of older people with long-term conditions (LTCs) living at home. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) guidelines, this overview of systematic reviews focused on four LTCs and the concept of "self-efficacy." Quality was appraised using R-AMSTAR and study evaluation was guided by the PRISMS taxonomy for reporting of self-management support. Heterogeneous data evidencing technology-enhanced self-efficacy were narratively synthesized. Five included articles contained 74 primary studies involving 9,004 participants with chronic obstructive pulmonary disease, hypertension, heart failure, or dementia. Evidence for self-care telehealth technology supporting the self-efficacy of older people with LTCs living at home was limited. Self-efficacy was rarely an outcome, also attrition and dropout rates and mediators of support or education. The pathway from telehealth to self-efficacy depended on telehealth modes and techniques promoting healthy lifestyles. Increased self-care and self-monitoring empowered self-efficacy, patient activation, or mastery. Future research needs to focus on the process by which the intervention works and the effects of mediating variables and mechanisms through which self-management is achieved. Self-efficacy, patient activation, and motivation are critical components to telehealth's adoption by the patient and hence to the success of self-care in self-management of LTCs. Their invisibility as outcomes is a limitation.