Self-management Program Research Articles

Validation of Psychometric Properties of Partners in Health Scale for Heart Failure

Background: Congestive heart failure (CHF) is a complex chronic disease, and it is associated with a second comorbid condition in more than half of cases. Self-management programs can be specific to CHF or generic for chronic diseases. Several tools have been validated for CHF. Presently, there are no established generic instruments that are validated for measuring self-management in CHF. Objective: This study aims to evaluate the internal reliability and construct validity (psychometric properties) of the Partners in Health (PIH) scale for patients with congestive heart failure, a generic chronic disease self-management tool. Methods: The study included 210 adult CHF patients [120 with heart failure with reduced ejection fraction (HfrEF), 90 with preserved ejection fraction (HfpEF)], from Community Cardiology Outpatients in West Melbourne, Australia, who were treated in community cardiology and were included between May 2022 and Jan 2024. The screened patient population were diagnosed with CHF and were eligible for an SGLT-2 inhibitor. Cohort analysis used the Bayesian confirmatory factor analysis to evaluate the a priori four-factor structure. Omega coefficients and 95% credible intervals (CI) were used to assess internal reliability. Results: In the CHF (HFrEF) and preserved ejection fraction (HFpEF) cohorts, participants’ mean [standard deviation (SD)] age was 66.8 (13.5) and 71.3 (9.76) years. Description of study sociodemographics highlighted that 88% and 52% of patients were male, there was a BMI > 50% in both cohorts, eGFR > 60 mL/min were 59% and 74%, and LVEF < 40% and > 50% were 99% and 100%, respectively. Model fit for the hypothesised model was adequate (posterior predictive p = 0.073) and all hypothesised factor loadings were substantial (>0.6) and significant (p < 0.001). Omega coefficients (95% CI) for the PIH subscales of Knowledge, Partnership, Management and Coping were 0.84 (0.79–0.88), 0.79 (0.73–0.84), 0.89 (0.85–0.91) and 0.84 (0.79–0.88), respectively. Conclusion: This study is original in confirming the dimensionality, known-group validity, and reliability of the PIH scale for measuring generic self-management in outpatients with CHF syndrome.

The Effect of Telerehabilitation-Based Self-Management Programme on Individuals With Scleroderma.

Our study endeavoured to develop an online self-management programme facilitated by an interdisciplinary team and to assess its impact on the quality of life, sleep patterns, pain perception, and fatigue levels among individuals diagnosed with scleroderma. Twenty-nine individuals with scleroderma completed the programme. The study spanned 8weeks during which participants received weekly 45-min video sessions. Assessment tools included the Scleroderma Health Assessment Questionnaire (SHAQ) for disease severity and pain intensity, the Self-Efficacy Scale for Chronic Disease Patients for self-management evaluation, the Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality, the Fatigue Severity Scale for measuring fatigue severity, and the Short Form-12 Quality of Life Scale (SF-12) for evaluating quality of life. Self-management score increased significantly, while fatigue score decreased significantly. Feedback from participants indicated a positive perception of the programme and its content, suggesting its usefulness in managing their condition. Feedback from participants indicated a positive perception of the programme and its content, suggesting its usefulness in managing their condition. The self-management programme, developed collaboratively by an interdisciplinary team and implemented via telerehabilitation, yielded beneficial outcomes concerning self-management skills and fatigue severity among individuals with scleroderma. Strengthening the interdisciplinary composition of the study team by incorporating diverse healthcare professionals may enhance future investigations. Additionally, we advocate for the repetition of the study employing randomised methodologies and implementing long-term follow-up assessments to further elucidate the programme's efficacy and sustainability over time.

Efficacy of an Online Self-Management Program for Chronic Burn Pain: A Randomized Controlled Trial of the Take Charge of Burn Pain Program

This randomized controlled trial investigated the effectiveness of an online self-management program, "Take Charge of Burn Pain (TCBP)," for 96 individuals living with chronic burn pain. Participants were randomly assigned to either the 7-week TCBP program integrating cognitive-behavioral therapy techniques, pain education, and self-management strategies or an attention control group focused on general burn recovery information. Assessments conducted at baseline, post-treatment, and 2 and 5-month follow-ups included measures of pain severity, pain interference, pain self-efficacy, posttraumatic stress disorder symptoms, and depression. Compared to the control group, participants in the TCBP program demonstrated greater reductions in pain severity (mean difference: -1.24, 95% CI: -1.93 to -0.55, p = 0.0007) and pain catastrophizing (mean difference: -5.41, 95% CI: -10.33 to -0.49, p = 0.0318) post-treatment when adjusting for key variables. At the two-month follow-up, the TCBP group showed significant improvements in pain interference (P = 0.0123), self-efficacy (P = 0.0269), functional abilities (P = 0.0014), and social role participation (P = 0.0498) compared to the control group. Treatment effects were not sustained at five-month follow-up. Participants in both groups reported high levels of satisfaction with the online intervention, with the majority finding the program helpful, easy to use, and willing to recommend it to others with pain. Findings suggest preliminary support for short-term benefits of TCBP for managing certain facets of chronic burn pain. This underscores the need to refine digital approaches to maintain and promote long-term improvements. The potential of self-guided online psychological interventions to enhance pain coping strategies for burn survivors persists.

Volunteer Peer Support for Chronic Pain Self-Management: A Qualitative Study of Benefits and Barriers.

Pain self-management is a key ingredient in chronic pain management. Peer support has been shown to be effective in helping patients self-manage other chronic conditions and may be a promising approach to implementing pain self-management programs more broadly without placing additional demands on clinicians. The Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) trial tested peer-supported chronic pain self-management. Although peers may be paid staff or volunteers, the ECLIPSE intervention was delivered by volunteer peer coaches, to test a low-resource model that could be easily implemented if effective. Trial results showed no statistically significant differences between intervention and control participants on key outcomes, and intervention adherence was low. To understand participants' experiences with peer coaching to help explain trial results. Semi-structured qualitative interviews with participants and peer coaches. Veterans with chronic musculoskeletal pain. Benefits to intervention participation included connecting with fellow veterans, receiving encouragement and hope, and improving pain self-management. Peer coaches described benefits unique to their role: facilitating their own pain self-management, having a "positive distraction," and a sense of "giving back." Barriers included difficulties reaching participants; resistance to focusing on the curriculum, including prioritizing socializing and being unwilling to set pain management goals; and phone delivery, which impeded communication and rapport-building. Participants described benefitting from the ECLIPSE intervention. Challenges, mostly related to engagement, were also described and may help explain trial results. The low-resource nature of the intervention may have exacerbated these difficulties. Volunteer coaches typically receive less training than paid peers and may have been less prepared to handle challenges; moreover, as volunteers, peer coaches likely had competing demands that left less time for coaching. Future research should seek to identify whom to target for peer-led versus other types of interventions to maximize benefit and use of resources.

HEAL-D Online: Exploring the potential for the spread and adoption of a virtual culturally tailored diabetes self-management programme for adults of African and Caribbean heritage.

People of African and Caribbean heritage in the UK have a higher prevalence of Type 2 Diabetes (T2D) and poorer health outcomes than white Europeans. Healthy Eating and Active Lifestyles for Diabetes Online (HEAL-D Online) is a co-designed, culturally tailored T2D self-management programme for black African and Caribbean adults, which, due to online delivery, is well positioned for spread. This qualitative evaluation uses the Exploration-Preparation-Implementation-Sustainment (EPIS) framework to explore factors affecting scale-up from delivery and commissioning perspectives. Semi-structured interviews were conducted with nine commissioners and providers of T2D services from three English areas with varying population characteristics to explore scale-up. Focus groups were held with 15 people of African and Caribbean heritage with T2D lived experience to explore the impact of a digital model of participation. Data were analysed using thematic analysis, with themes mapped onto the EPIS framework exploration phase constructs to consider the outer and inner contextual factors for planning implementation. Six EPIS constructs were identified by commissioners and providers as key in scaling HEAL-D Online. People with T2D lived experience explored the online mode of delivery, using the patient advocacy construct as the analytical lens. In delivering an online T2D programme, two themes were identified: (1) aligning course content with people's preferences; (2) practicalities to ensure online delivery was acceptable and accessible to the community. HEAL-D Online was acceptable with the potential to help address health inequalities. The EPIS framework provided a structure to understand factors in planning scale-up for an intervention targeting underserved communities.

Effects of the transtheoretical model-based self-management program on behavioral change in persons with epilepsy: Study protocol for a randomized controlled trial.

Self-management applications are cost-effective and scalable for epilepsy treatment. However, there is a limited long-term quantitative evidence regarding their effectiveness. The Transtheoretical Model (TTM) offers a psychological framework that tailors self-management plans to the individual's stage of behavioral change. This approach aims to address utilization needs, reduce information overload, minimize the adverse effects of self-management, and enhance the overall effectiveness of interventions for individuals with epilepsy. This will be a randomized, double-blind, the clinical trial involving two groups of adults diagnosed with epilepsy. In addition to treatment as usual (TAU), the intervention group will receive an intervention program constructed from TTM combined with self-management as part of the treatment plan. The control group will receive TAU only. Prior to the intervention, the participants will undergo an initial assessment to determine their current stage of behavioral change to facilitate the implementation of targeted behavior support strategies. Additionally, participants will receive weekly 30-minute educational videos on epilepsy. The goal is to enroll 160 adults who have been diagnosed with epilepsy for at least six months and are receiving medication. Data collection will encompass an assessment of C-ESMS, HADS, QOLIE-31, and LSSS. These parameters will be evaluated at baseline, as well as during follow-up periods at 1, 3, and 6 months post-intervention. Existing self-management interventions for people with epilepsy primarily focus on knowledge and psychological factors. Discrepancies in research design, intervention plans, and patient characteristics have contributed to inconsistent outcomes in previous studies. This study seeks to advance the field by integrating the TTM with empirically supported self-management practices. The delineation of behavioral change stages within the TTM framework is expected to form a structured intervention protocol. This study will inform standardized, evidence-based epilepsy care practices.

Evaluating a New Short Self-Management Tool in Heart Failure Against the Traditional Flinders Program

Background/Objective: Heart failure (HF) is a complex syndrome, with multiple causes. Numerous pathophysiological pathways are activated. Comprehensive and guideline-derived care is complex. A multidisciplinary approach is required. The current guidelines report little evidence for chronic disease self-management (CDSM) programs for reducing readmission and major adverse cardiovascular events (MACE). CDSM programs can be complex and are not user-friendly in clinical settings, particularly for vulnerable patients. The aim of this study was to investigate whether a simplified one-page CDSM tool, the SCReening in Heart Failure (SCRinHF), is comparable to a comprehensive Flinders Program of Chronic Disease Management, specifically in triaging self-management capabilities and in predicting readmission and MACE. Methods: SELFMAN-HF is a prospective, observational study based on community cardiology. Eligible patients, consecutively recruited, had HF with left ventricular ejection fraction <40% and were placed on sodium–glucose co-transporter-2 inhibitors (SGLT2-i) within 3 months of recruitment. SGLT2-i is the newest of the four HF treatment pillars; self-management skills are assessed at this juncture. CDSM was assessed and scored independently via the long-form (LF) and short-form (SF) tools, and concordance between forms was estimated. The primary endpoint is the 80% concordance across the two CDSM scales for predicting hospital readmission and MACE. Results: Of the 117 patients, aged 66.8 years (±SD 13.5), 88 (75%) were male. The direct comparisons for SF versus LF patient scores are as follows: “good self-managers”, 13 vs. 30 patients (11.1% vs. 25.6%); “average”, 46 vs. 21 patients (39.3% vs. 17.9%), “borderline”, 20 vs. 31 patients (17.1% vs. 26.5%), and “poor self-managers” (vulnerable), 38 vs. 35 patients (32.5% vs. 29.9%). These findings underscore the possibility of SF tools in picking up patients whose scores infer poor self-management capabilities. This concordance of the SF with the LF scores for patients who have poor self-management capabilities (38 vs. 35 patients p = 0.01), alongside readmission (31/38 vs. 31/35 p = 0.01) or readmission risk for poor self-managers versus good self-managers (31/38 vs. 5/13 p = 0.01), validates the simplification of the CDSM tools for the vulnerable population with HF. Similarly, when concurrent and predictive validity was tested on 52 patients, the results were 39 (75%) for poor self-managers and 14 (27%) for good self-managers in both groups, who demonstrated significant correlations between SF and LF scores. Conclusions: Simplifying self-management scoring with an SF tool to improve clinical translation is justifiable, particularly for vulnerable populations. Poor self-management capabilities and readmission risk for poor self-managers can be significantly predicted, and trends for good self-managers are observed. However, correlations of SF to LF scores across an HF cohort for self-management abilities and MACE are more complex. Translation to patients of all skill levels requires further research.

A scoping review of nursing interventions for reducing the negative impacts of domestic violence among women

BackgroundIncidences of domestic violence against women are increasingly every years. Domestic violence has the negative impacts on physical problems, psychological problems, and can even cause death. Nurses have a role for providing interventions to reduce the impact of domestic violence on women.AimThe purpose of this study is to explore methods of nursing interventions in reducing the traumatic effect of domestic violence among women.MethodThis study used a scoping review method. The literature used in this study from CINAHL, PubMed, and Scopus databases. Search articles used the keywords domestic violence, impact, women, and victims. PRISMA Extension for Scoping Reviews are used for selecting articles. The inclusion criteria for the articles in this study were that the sample was female victims of sexual violence, randomized control trial or quasi-experimental research design, and last 10 years for publications period (2013–2022).ResultFrom three databases, we found 579 articles. After elimination-based inclusion and exclusion criteria, we found 10 articles discussing the effect of nursing interventions in reducing the impact of domestic violence on female victims. Most of the studies from USA and the range of respondents in the articles is 112–1250 respondents. The methods used in providing nursing interventions are classified into three, namely self-management programs, counseling programs, social support programs. The activities carried out in nursing interventions in the form of psychoeducation, relaxation, meditation, and also discussions about solving problems encountered. All articles show that nursing interventions are effective in reducing the impact of domestic violence on women.ConclusionNurses have an important role to provide comprehensive nursing care to victims of domestic violence by paying attention to various aspects, namely physical, psychological, and spiritual aspects to improve safety and comfort of patients.Implication for NursingThis study is the basis for nurses to provide comprehensive nursing care to reduce the impact of domestic violence among women victims of domestic violence.

Participant and group facilitator perspectives on a novel culturally tailored diabetes self-management program for African Americans

BackgroundAfrican Americans with type 2 diabetes experience disparities in their care and diabetes health-related outcomes. Diabetes self-management programs such as Healthy Living with Diabetes (HLWD) are important but do not account for the unique cultural experiences of African Americans. Also, a culturally tailored program focused on addressing sociocultural beliefs and providing race-congruent peer support, Peers LEAD (Peers Supporting Health Literacy, Self-Efficacy, Self-Advocacy, and Adherence) was implemented in two midwestern cities to improve medication adherence but does not include diabetes self-management topics included in HLWD. In an attempt to fill the gaps from both HLWD and Peers LEAD, Peers EXCEL (Peers’ Experience in Communicating and Engaging in Healthy Living) was designed to integrate both programs.MethodsOur study explored the perceptions of African American participants and facilitators of the separate HLWD and Peers LEAD programs, on the proposed new Peers EXCEL program using focus groups and interviews. Findings were analyzed by research assistants trained in qualitative research using deductive and inductive open coding approaches.ResultsParticipants appreciated the cultural fit of Peers EXCEL for African American communities which is a feature that was lacking in HLWD. They shared the need to include topics such as the relationships between systemic racism and diabetes.ConclusionParticipants’ feedback of Peers EXCEL reveals the importance of including various community members’ perspectives in the design of new diabetes self-management programs tailored for African Americans.

Virtual Coach-Guided Online Acceptance and Commitment Therapy for Chronic Pain: Pilot Feasibility Randomized Controlled Trial.

Veterans are disproportionately affected by chronic pain, with high rates of pain diagnoses (47%-56%) and a 40% higher rate of prevalence of severe pain than nonveterans. This is often accompanied by negative functional outcomes and higher mortality. Combined with research suggesting medical treatments for chronic pain are often insufficient, there is an urgent need for nonmedical pain self-management programs. An interactive online platform to deliver an efficacious treatment for chronic pain such as acceptance and commitment therapy (ACT) could be a valuable option to assist veterans with pain care at home. This study aims to evaluate the virtual coach-guided Veteran ACT for Chronic Pain (VACT-CP) online program compared to a waitlist and treatment as usual (WL+TAU) control group through a small pilot feasibility randomized controlled trial. The primary aim was to evaluate the feasibility and acceptability of VACT-CP and study procedures, such as ease of recruitment, treatment receptivity, attrition and retention, sustained participation, system usability, and assessment of trial procedures. Secondary aims explored differences in the VACT-CP and WL+TAU groups on pre- and posttest (week 7) outcome measures for pain, mental health, functioning, and ACT processes. Veterans with chronic pain were recruited and randomized to either the VACT-CP (n=20) or the WL+TAU (n=22) group in a parallel group trial design. Self-report surveys were administered to participants at baseline (week 0), at the intervention midpoint (week 3), immediately after the intervention (week 7), and at the 1-month follow-up (week 11). We used Wilcoxon signed rank tests with the intention-to-treat sample to describe changes in secondary outcomes from pre- to postintervention within each group. Study procedures showed good feasibility related to recruitment, enrollment, randomization, and study completion rates. Participants reported that VACT-CP was easy to use (System Usability Scale: mean 79.6, SD 12.8; median 82.5, IQR 70-87.5); they completed an average of 5 of the 7 total VACT-CP modules with high postintervention satisfaction rates. Qualitative feedback suggested a positive response to program usability, content tailoring, veteran centeredness, and perceived impact on pain management. Although the pilot feasibility trial was not powered to detect differences in clinical outcomes and significant findings should be interpreted with caution, the VACT-CP group experienced significant increases in chronic pain acceptance (P<.001) and decreases in depressive symptoms (P=.03). VACT-CP showed encouraging evidence of feasibility, usability, and acceptance, while also providing promising initial results in improving a key process in ACT for chronic pain-chronic pain acceptance-after online program use. A full-scale efficacy trial is needed to assess changes in clinical outcomes. ClinicalTrials.gov NCT03655132; http://clinicaltrials.gov/ct2/show/NCT03655132. RR2-10.2196/45887.

Caregiving Challenges from Persistent Pain Among Family Caregivers to People with Dementia.

Many family caregivers to people with dementia experience persistent physical pain. Though caregivers' pain is associated with poor caregiving outcomes, there is little research on how pain challenges caregiving to yield poor outcomes. This study developed a typology of caregiving challenges from pain among family caregivers to people with dementia. We conducted semi-structured, in-depth interviews with 25 family caregivers living with persistent pain and caring for people with dementia. We inductively analyzed data via a thematic analysis approach, wherein we identified and categorized caregiving challenges stemming from caregivers' pain. We then analyzed how challenges were related to one another and their consequences for caregiving outcomes. Analysis revealed three interrelated categories of caregiving challenges from living with pain: 1) physical (e.g., difficulty lifting care recipient), 2) psychological/emotional (e.g., worry about future care if their pain condition worsens), and 3) familial/relational (e.g., resentment towards family without pain for not helping with care). Caregivers reported that these challenges compounded one another in ways that made both caregiving and pain management more difficult. Moreover, challenges led to caregivers delaying or skipping care tasks. The nature of challenges and their connection to caregiving outcomes were dependent on various supporting factors, such as whether caregivers reported benefits from their own pain (e.g., greater empathy). The resulting typology informs a conceptual model to guide future translational research on caregivers' pain, including illuminating promising intervention targets of pain self-management programs for family caregivers to people with dementia.

MHealth-Based Self-Management Program for Patients With Rheumatoid Arthritis: A Pilot Randomized Controlled Study.

Rheumatoid arthritis (RA) is a chronic autoimmune disease that gradually limits physical function and decreases quality of life (QOL). We evaluated an mHealth-based self-management program to help patients with RA improve their physical and psychological health, self-efficacy, physical activity, and QOL. The sample included 73 experimental and 69 control participants. A pilot randomized controlled design was employed to identify the effectiveness of an 8-week mHealth-based self-management program, which comprised educational modules regarding disease management and exercise, cognitive training, and motivational support through mobile messages and periodic phone calls. Knowledge of the health effects of RA, disease activity, perceived health, depression, self-efficacy for controlling symptoms, physical activity, and QOL were evaluated pre- and postintervention and after the 4-week follow-up period. This pilot study indicates that the mHealth-based program for people with RA is feasible. The mHealth self-management program improved patients' knowledge of RA, depression, self-efficacy for controlling symptoms, physical activity, and perceived health; however, disease activity and QOL did not significantly change. This pilot study demonstrates the potential of mHealth intervention as an effective program for strengthening self-management capacities in patients with RA. Trial Registration: KCT0007523.

Effectiveness of Self-Management Programs Among Athletes With Patellofemoral Pain Syndrome: Protocol for a Systematic Review.

Patellofemoral pain syndrome is a highly prevalent overuse knee injury in athletic populations associated with pain and functional limitations, exacerbated by activities such as running, pivoting, cycling, and jumping. Self-management programs empowering athletes to take an active role in controlling their symptoms for chronic musculoskeletal conditions such as patellofemoral pain syndrome have grown in popularity. However, the efficacy of self-management programs specifically for athletes with patellofemoral pain syndrome is unclear due to limited and heterogeneous evidence. The systematic review study will evaluate the effectiveness of self-management programs on pain and function, in athletes with patellofemoral pain syndrome. PubMed/MEDLINE, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases will be systematically searched using terms related to "patellofemoral pain syndrome," "self-management," and "athletes." Interventional studies that are randomized and nonrandomized controlled trials will be included, comparing self-management programs to other treatments or control conditions among athletes with patellofemoral pain syndrome. Four reviewers will independently screen studies, extract data using the COVIDENCE software, and assess the quality of the study and evidence using the Pedro scale of risk of bias tool and GRADE approach, respectively. If feasible, a meta-analysis will be performed using the RevMan (version 5.4; the Cochrane Collaboration). The systematic review is currently in the search phase, with the authors refining search strings for the selected databases. The final search strings are expected to be ready by March 2024, and the review is projected to be completed by July 2024. This systematic review protocol outlines a rigorous methodology for evaluating the effectiveness of self-management programs among athletes with patellofemoral pain syndrome. The findings will inform clinical practice and guide the development of tailored interventions to optimize outcomes for athletes with patellofemoral pain syndrome. PROSPERO CRD42023492746; https://tinyurl.com/c5jze9ca. PRR1-10.2196/58340.

'Towards a conceptualization of nurses' support of hospitalised patients' self-management-A modified Delphi study'.

To determine patients', nurses' and researchers' opinions on the appropriateness and completeness of the proposed conceptualization of nurses' support of hospitalised patients' self-management. A modified Delphi study. We conducted a two-round Delphi survey. The panel group consisted of patients, nurses and researchers. The conceptualization of nurses' support of hospitalised patients' self-management presented in the first Delphi round was based on previous research, including a scoping review of the literature. Data was analysed between both rounds and after the second round. Results are reported in accordance with the guidance on Conducting and Reporting Delphi Studies (CREDES). In the first round all activities of the proposed conceptualization were considered appropriate to support the patients' self-management. Panel members' comments led to the textual adjustment of 19 activities, the development of 15 new activities, and three general questions related to self-management support during hospitalisation. In the second round the modified and the newly added activities were also deemed appropriate. The clarification statements raised in the first Delphi round were accepted, although questions remained about the wording of the activities and about what is and what is not self-management support. After textual adjustments and the addition of some activities, the proposed conceptualization of nurses' support in patients' self-management while hospitalised have been considered appropriate and complete. Nevertheless, questions about the scope of this concept still remains. The results provide a starting point for further discussion and the development of self-management programs aimed at the hospitalised patient. The results can be considered as a starting point for practice to discuss the concept of nurses' support for hospitalised patients' self-management and develop, implement and research self-management programs specific for their patient population. Results are reported in accordance with the guidance on Conducting and Reporting Delphi Studies (CREDES). Patients were involved as expert panellist in this Delphi study. Impact statement What problem did the study address? Self-management support during hospitalisation is understudied, which undermines the development of evidence-based interventions. What were the main findings? A panel, consisting of patients, nurses and researchers, agreed on the appropriateness of a conceptualization of nurses' support of inpatients' self-management, and identified some points for discussion, mainly related to the boundaries of the concept self-management. Where and on whom will the research have an impact? This study is crucial for generating conceptual understanding of how nurses support patients' self-management during hospitalisation. This is necessary for policy, clinical practice, education, and research on this topic.

Barriers and facilitators to self-management of chronic conditions reported by women: a systematic review of qualitative studies

ObjectivesThis systematic review aims to identify, appraise and synthesise the findings of published qualitative research exploring the barriers and facilitators to self-management of chronic conditions reported by women.DesignA systematic literature...

Women Veterans as caregivers: Characteristics and comparisons with women non-veterans using BRFSS

Veterans frequently need assistance because of injuries and chronic conditions, but also serve as caregivers to family and friends. Our aim was to describe the prevalence of characteristics and experiences of women veterans who serve as caregivers and compare them with non-veteran women. We measured caregiving prevalence caregiving among women veterans (N = 4,179) and women non-veterans (n = 160,307) using population-based data from 48 jurisdictions in the Behavioral Risk Factor Surveillance System from 2021 to 2022. We calculated weighted prevalence estimates and adjusted prevalence ratios [PR] for the association between veteran status and three health outcomes adjusted for age, race and ethnicity, and caregiving activities. Similar proportions (∼23%) of women veterans (n = 1,000) and non-veterans (n = 36,929) were caregivers. Among women caregivers, veterans were more likely than non-veterans to have had a chronic health condition (63 vs. 57%), disability (39 vs. 35%), and current frequent mental distress (27 vs. 22%), although all were quite prevalent in both groups. In adjusted models, the only significant difference was in current frequent mental distress among women veterans compared with non-veteran women caregivers age 18–44 (PR = 1.49, 95%CI: 1.20 − 1.85). Women veterans provide similar care as non-veteran women. However, younger women veteran caregivers more frequently experience mental distress, suggesting the importance of routine assessment of caregiving status to initiate support. This may be a result of military experiences (e.g., combat, trauma) and related comorbidities (e.g., traumatic brain injury, PTSD) that could enhance caregiving burden, making caregiver support, chronic disease self-management programs, and mental health services priorities for women veteran caregivers.

Effectiveness of a self-management program for anticoagulated patients to improve their knowledge about treatment and time in therapeutic range.

Oral anticoagulation self-control programs have demonstrated efficiency and cost-effectiveness over recent years. This study aimed to evaluate the effectiveness of a training intervention focused on patients with antivitamin K anticoagulants included in a self-care program. For this, we made a quasi-experimental study, pretest and post-test, using a validated questionnaire with 2 measures, before and after an educational intervention about oral anticoagulation focused on patients that will initiate the self-control program in consultation. To check the patient's adherence and coagulation level, we evaluated the Rosendaal time in therapeutic rank, both before and after the intervention. One hundred fifty patients were included since the start of the self-monitoring program in our center in 2016. The mean age was 49 years (standard deviation [SD] = 17.24). The distribution by gender was 76 women and 69 men (52.4%-47.6%). The mean score for the first test was 14.61 (SD = 3.26) and the mean score for the second test was 17.01 (SD = 2.14) (P <.001). We also measured Rosendaal time in therapeutic rank, a parameter that indicates stabilization in international normalized ratio determinations and quality of the anticoagulation management. Values before and after interventions were also statistically significant (67.46 vs 70.53, P <.001). Patients' knowledge improved after the training session, with statistical significance. Despite intentional sampling, the population was homogeneous. Scoring data dispersion in the second test was significantly lower than in the first one. Time on therapeutic rank values was better after the training. We intend to adapt its content to the rest of anticoagulated patients to enhance and improve their follow-up.

Transarterial Embolization for Musculoskeletal Pain Management: AJR Expert Panel Narrative Review.

Musculoskeletal embolization has emerged in recent years as a treatment for chronic joint pain, as the inflammatory cascade responsible for such pain has become better understood. Studies have demonstrated a complex interplay between joint inflammation and synovial hypervascularity that causes growth of new unmyelinated nerve fibers responsible for pain. Embolization targets joint hypervascularity, to disrupt the inflammatory cycle and provide pain relief. The standard treatment algorithm for chronic joint pain is well-established and entails escalating therapeutic options that include exercise, self-management programs, analgesic medications, intra-articular injections, and finally surgical replacement or release. Genicular artery embolization (GAE), targeting abnormal vasculature around the knee joint, is the most heavily studied musucloskeletal embolization procedure, reflecting the high worldwide prevalence and increasing incidence of knee osteoarthritis. GAE is now supported by multiple prospective studies, including randomized control trials comparing GAE versus sham treatment. Embolization has also extended outside of the knee joint to include the shoulder (treatment of adhesive capsulitis or secondary stiff shoulder), elbow (medial/lateral epicondylitis), hip (osteoarthritis, great trochanteric pain syndrome), and ankle (plantar fasciitis). This AJR Expert Panel Narrative Review discusses the current status of transarterial embolization for musculoskeletal pain management, focusing on treatment of knee osteoarthritis and chronic shoulder pain.

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.

Inclusion of Long Covid patients in the care trajectory post-Covid-19: evidence from Belgium

Abstract Background Evidence suggests that 10-30% of COVID-19 infected people develop persistent symptoms that can be diagnosed as Long Covid. Most Long Covid cases are in patients with a mild acute COVID-19 infection and are mainly treated in primary health care. In July 2022, a care trajectory (CT) post-Covid-19 was launched in Belgium, in which Long Covid patients can benefit from reimbursement of treatment costs when consulting health professionals in primary health care for their rehabilitation. Patients are included in this CT mainly through their general practitioner (GP) and depending on patients’ care needs, treatment is organized in a monodisciplinary or multidisciplinary way. Methods A population-based study on data collected by the Belgian network of Sentinel General Practitioners (SGP) on all Long Covid patients consulting their GP during March-December 2023. Information on inclusion in the CT post-Covid-19 was also registered. Descriptive statistics were performed. Results End of 2023 in Belgium, GPs initiated the CT post-Covid-19 for more than 1000 patients, this mainly for monodisciplinary treatment, less than 10% of included patients received multidisciplinary follow-up. By the SGP, among the registered Long Covid sufferers (N = 14), a total of six cases were included in the CT post-Covid-19. Of these cases, the majority were female, of older age, higher educated and had one or two chronic conditions. Most had a mild or moderate prior COVID-19 infection and all were vaccinated multiple times against COVID-19. Symptoms lasted one year or more for 83.3% of included patients. Treatment focused mainly on self-management, energy management and physical exercise programs, mainly in collaboration with physiotherapists. Conclusions This study yields recent data on patients included in the CT post-COVID-19 in primary care in Belgium. It is important to focus on guidance, follow-up and rehabilitation of Long Covid sufferers by healthcare professionals in Belgium. Key messages • Long Covid patients included in the care trajectory post-Covid-19 in Belgium experience years of debilitating symptoms after their prior COVID-19 infection. • The establishment of the care trajectory post-Covid-19 for Long Covid patients in primary care since July 2022 stimulated collaboration between care givers in Belgian primary health care.