Self-management Strategies Research Articles

Identifying strategies for stress self-management of pharmacy students at Nguyen Tat Thanh University

Background:Stress in health science has been studied extensively. Pharmacy students have higher prevalence of stress than other health profession students. Stress has detrimental effects on students’ health and their academic performance. Coping strategies are specific efforts that individuals employ to manage stress. Objectives: This study is aimed to identify coping strategies for stress self-management of pharmacy students at Nguyen Tat Thanh University to suggest some strategies to improve teaching quality, learning environment, and consulting work. Methods:A cross-sectional study was conducted on 436 pharmacy students from years of admission 2014 to 2018. Coping strategies were assessed using a validated questionnaire. Results:“always” is the highest stress frequency. However, the lowest rate, slightly more than a quarter, was of the Y2017 student population (25,6%) and had the highest percentage at 33.7% for Y2015 students. The results showed that Problem Solving and Cognitive Restructuring were employed mostly whereas motional expression was the least common solution for stress management of Pharmacy students of Nguyen Tat Thanh University.

From existential uncertainty to a new mindset promoting recovery: Exploring the development of uncertainty experience in women with vulvar neoplasia – A qualitative longitudinal study

BackgroundWomen with vulvar neoplasia continue to experience uncertainty up to six months post-surgery. Uncertainty in illness is considered a significant psychosocial stressor, that negatively influences symptom distress, self-management strategies and quality of life. According to the Reconceptualized Uncertainty in Illness Theory, the appraisal of uncertainty changes positively over time in chronic illness. We aimed at exploring whether and how the experience of uncertainty develops in women with vulvar neoplasia.MethodsWe selected a purposive sample of seven women diagnosed with vulvar neoplasia in four Swiss and one Austrian women’s clinic. By means of a qualitative longitudinal study, we conducted 30 individual interviews at five points of time during one year after diagnosis. We applied Saldaña’s analytical questions for longitudinal qualitative research.ResultsFirst, participants experienced uncertainty as an existential threat, then an inherent part of their illness, and finally a certainty. Women initially associated the existential threat with a high risk for suffering from severe health deteriorations. Participants that could reduce their individually assessed risk by adopting health promoting behaviors, accepted the remaining uncertainty. From now on they reframed uncertainty into a certainty. This new mindset was based on a belief of promoting recovery and reducing the risk of recurrence.ConclusionsThe long-lasting and oscillating nature of uncertainty should receive attention in supportive oncology care. Uncertainty concerning existential issues is of special importance since it can inhibit a positive development of uncertainty experience.

Compound impact of cognitive and physical decline: A qualitative interview study of people with Parkinson's and cognitive impairment, caregivers and professionals.

Cognitive impairment is common in Parkinson's disease and is associated with poorer quality of life and increased caregiver distress, but little qualitative information is available on lived experiences of people with Parkinson's who also have cognitive impairment. The aim of this study was to explore the challenges of cognitive impairment in Parkinson's, triangulating the perspectives of people with Parkinson's, caregivers and healthcare professionals. Semistructured interviews were conducted with 11 people with Parkinson's and cognitive impairment, 10 family caregivers and 27 healthcare professionals, using purposive sampling in the United Kingdom (2019-2021). Cognitive impairment was identified by healthcare professionals and required subjective symptoms. Relevant cognitive diagnoses were recorded. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis. An overarching concept of the compound impact of cognitive and physical decline was developed, with six themes. Four themes describe the experience of living with cognitive impairment in Parkinson's: (1) Challenges in Daily Activities, (2) Psychological Impact and (3) Evolving Communication Difficulties together contributing to (4) Social Shift, encompassing a reduction in wider social activities but intensification of close relationships with increased dependence. A fifth theme (5) Living Well describes positive influences on these experiences, encompassing intrinsic motivation, self-management strategies and supportive relationships. Furthermore, underlying and shaping the whole experience was the sixth theme: (6) Preconceptions about Cognitive Impairment, describing fear and denial of symptomsand poor understanding of the nature of cognitive impairment in Parkinson's, with differences to other dementia pathologies. Cognitive impairment superimposed on the existing challenges of Parkinson's has a multifaceted impact and makes living with the condition arduous. Increased understanding of the experiences of this group and employing the identified facilitators for living well may be able to improve patient and caregiver experiences. Two people with Parkinson's and cognitive impairment and three caregivers contributed to the study. Between them they contributed throughout the entirety of the project, giving input at conceptualisation as well as advice and review of interview questions, participant information leaflets, recruitment, interpretation of findings and summaries of the project.

An investigation into perceived autonomy support, motivation and competence in chronic pain patients in Ireland: A cross-sectional study.

Autonomy supportive healthcare settings are associated with enhanced behaviour change and self-management strategies in individuals living with chronic disease. The level of autonomy support provided by healthcare professionals to individuals living with chronic pain in Ireland is unknown. A cross-sectional study was completed on participants living with chronic pain (>3 months) in Ireland. Participants (n = 389) completed an anonymous survey constructed of patient reported outcome measures relating to autonomy support (HCCQ), motivation (TSRQ), competence in physical activity (PCS), pain interference (BPI) and psychological factors (PHQ-9, GAD-7). Results showed the median HCCQ (H = 39.287, p < .001), Autonomous Motivation (H = 13.568, p = 0.019) and PCS (H = 30.701, p < .001) scores were significantly different when patients received care from different healthcare professionals. There was a negative correlation between PCS and pain severity (r = -0.32, <0.01), pain interference (r = -0.44, p = <0.01), PHQ-9 (r = -0.50, p = <0.01) and GAD-7 (r = -0.34, p = <0.01). This study has identified that perceived healthcare support in Ireland varies according to the healthcare professional leading pain care. Furthermore, higher levels of self-determination were associated with decreased depression and anxiety in individuals with chronic pain. Given the limited number of multidisciplinary team clinics to provide pain management programs, an alternative cost-effective community led solution is required. The results of this study indicate that allied health professionals may be well placed to fill this void. Future research exploring the barriers to providing healthcare supportive settings is required.

Adopting Telerehabilitation in Albania: Evaluating Acceptance, Preferences, and Impediments Among Physiotherapists and the Public

Background: COVID introduced a new approach to healthcare services. The pandemic showed that the need to rely on online services is very significant. Tele-rehabilitation, as the delivery of rehabilitation services via information and communication technologies, is a well-known concept for developed countries but not for Albania. Objective: To investigate acceptability, preferences, and needs in tele-rehabilitation by Albanian physical therapists and the general population. Methods: A cross-sectional observational study was conducted among physiotherapists and general population related to tele-rehabilitation in physiotherapy to verify how recognized and applied this field is today in Tirana, Albania. Results: The study involved 57 professionals, mostly aged 25-34, with 43 participants working in the private sector. The focus was on musculoskeletal and orthopedic issues, with 18 participants in each category. Opinions on tele-rehabilitation were divided, with 42% of physiotherapists in favor and another 42% remaining neutral. Most physiotherapists had no prior tele-rehabilitation experience, but about one-third found technology integration beneficial. Health information and education were widely supported, with 86% of participants in favor. Self-management strategies were endorsed by 77%. Among 173 non physiotherapists, the vast majority were females (94%) and mostly aged 25-34 (nearly half). About two-thirds had never used physiotherapy services. Attitudes towards tele-rehabilitation costs were uncertain for almost half of the participants. However, 58% recognized the potential of digital technology, with video conferencing seen as helpful by 52% and apps by 18%. Most participants preferred exercise prescriptions, self-management, and health information. Conclusion: The conclusion points towards the need for further education and infrastructural enhancements to fully realize tele-rehabilitation’s capabilities in improving healthcare accessibility in Albania. Keywords: Digital physical therapy, Perception, Rehabilitation, Telehealth.

Impact of Gender on Patient Experiences of Self-Management in Type 2 Diabetes: A Qualitative Study.

This study aims to identify gender disparities in knowledge, attitudes and behaviors related to self-management and control of Type 2 diabetes Mellitus (T2DM) among primary care patients. The research was conducted across multiple Spanish cities. The study involved 8 Primary Care Centres located in four distinct regions of Spain: East (Barcelona), Centre (Madrid), North (Pamplona and Zumaia) and South (Vélez-Málaga and Málaga). A total of 111 individuals diagnosed with T2DM, comprising 52 women and 59 men, participated in 12 group discussions at these primary healthcare centers from February to June 2015. Participation was voluntary, and all participants provided informed consent by signing the consent form. A qualitative hermeneutic phenomenological study with a maximum variation sample was done. Participant profiles were defined based on gender, age, place of residence, type of treatment, years living with T2DM and the presence or absence of a cardiovascular event. Thematic analysis was used to analyze the data. Participants were aware that diabetes is a chronic condition, with varied levels of concern regarding the diagnosis. Participants' locus of control influenced their perception of the disease's cause, with women attributing it to stress and emotional situations, while men linked it to risky behaviors. Self-management strategies were shaped by beliefs about diabetes, with both genders facing challenges in implementing recommended practices. Gender differences were also evident in caregiving roles, with men receiving more family support for diet adherence, while women prioritized family needs over their self-care. Participants expressed satisfaction with professional-patient interactions but highlighted the need for more accessible information and specialist care, suggesting support groups for women and clear health guidelines for men. Gender differences significantly influence how patients perceive and manage type 2 diabetes, with women experiencing greater concern and care burden compared to men. Effective diabetes management requires tailored support that addresses these gender-specific challenges. Enhancing healthcare services with clear guidelines and support groups can improve self-management outcomes in both men and women.

Initiating and Maintaining Complete Decongestive Therapy Self-Management of Lymphedema Among Breast Cancer Survivors: Descriptive Qualitative Study.

This study aimed to identify determinants that promote the initiation and maintenance of complete decongestive therapy (CDT) as well as effective strategies for mitigating barriers to self-management of lymphedema among breast cancer survivors. A descriptive and qualitative design was used. In-depth interviews were conducted with 13 breast cancer survivors who were managing breast cancer-related lymphedema. Interviews were transcribed verbatim. An iterative descriptive data analysis method was employed to examine the data, compare codes, challenge interpretations, and inductively identify themes. A realization that lymphedema requires daily self-management was the primary determinant leading breast cancer survivors to initiate CDT self-management. The determinants for maintaining daily CDT self-management included the perceived effectiveness of CDT, being willing to assume accountability, and perceived efficacy to undertake CDT. Developing strategies to integrate CDT regimens into daily life is key to maintaining CDT self-management of lymphedema. Three core concepts mediate initiation and maintenance of CDT self-management: understanding lymphedema as a chronic condition that can be managed with CDT self-management, being worried about lymphedema exacerbation, and having support from patient peers and family. Interventions should be tailored to promote the initiation and maintenance of CDT self-management. While clinicians provided knowledge-based and clinical skills-based information, patient peers provided daily life examples, and real-life implementation strategies for CDT self-management. Ongoing patient-provider and patient-peer communication functioned as effective support for maintaining CDT self-management. Reliable and realistic methods of symptom self-assessment are important for maintaining CDT at home.

"Good life is to be in peace and harmony with everything around us": a qualitative study on good living among the Kankuamo Indigenous people of Colombia

The Kankuamo people are one of the 102 native peoples of Colombia, who are developing strategies for individual and collective health self-management. This article aims to investigate, identify and analyze, collaboratively and interculturally, the factors that influence the well-being of the Kankuamo people, using the Capabilities Approach proposed by Amartya Sen. To this end, three focus groups were conducted with the participation of 37 people from the 15 communities of the Kankuamo reservation. The transcripts were analyzed by means of a thematic analysis. Three central themes for the well-being of the Kankuamo emerged from the focus groups: (i) harmony between nature and human beings, (ii) social coexistence and (iii) self-determination. These themes reflect the fundamental principles and values that guide the community towards a good life, expansion of their capabilities, harmony and holistic development. The results suggest that material aspects play a secondary role in the Kankuamo community's concept of good life, and confirm that it is fundamental to consider a collective vision of capabilities, not only individual ones, in indigenous contexts. Studies such as this one can contribute to the development of more contextually appropriate approaches to assess and measure the quality of life and well-being of Indigenous communities, including the Kankuamo people.

Empowered management for pelvic pain: The experiences of women with persistent pelvic pain participating in an online self-directed self-management program while they wait for interprofessional care.

Persistent pelvic pain is pain sensed in or around the pelvis and is often associated with negative cognitive, behavioral, sexual, and emotional consequences. The lack of interprofessional persistent pelvic pain management programs that address the complex interplay of biopsychosocial factors result in lengthy wait times and negative health outcomes. Limited access to evidence informed self-management educational resources contributes to poor coping strategies. Evidence shows that self-management education and strategies support patients while they wait for care. However, very few studies explore the patient's lived experience of participating in an online educational program designed for persistent pelvic pain. This study aims to understand the experience of women with persistent pelvic pain participating in an online, self-management education program ("Pelvic Pain Empowered Management" program) while awaiting care at an interprofessional pelvic pain clinic. A descriptive qualitative approach was used to explore the experiences of women participating in an online educational program designed for cis women with persistent pelvic pain. We conducted semi-structured interviews with 11 women, transcribed the data verbatim using NVivo software (NVivo 12, QSR International Pty Ltd.), and analyzed inductively using previously established methods. We identified four main themes relevant to women's experiences of the program: (1) the program shaped expectations around upcoming pelvic pain appointments, (2) the program content is relevant and resonates with people with lived experience of persistent pelvic pain, (3) the program enhanced understanding of persistent pelvic pain, and (4) the program empowered people with skills and strategies to better manage their persistent pelvic pain. Our findings highlight how self-directed online patient education can be leveraged while persistent pelvic pain patients wait for care to support them in setting expectations around care and in engaging in pain self-management.

Development of a Blended Physiotherapeutic Module for Young Adults with Non-Specific Chronic Low Back Pain: A Feasibility Study

Introduction: Non-Specific Chronic Low Back Pain (NSCLBP) is a prevalent non-communicable disease in India, burdening individuals psychologically and socially. Due to economic constraints, people prefer self-management rather than seeking professional advice. Therefore, their go-to search strategy for self-management is social media platforms. Many researchers have identified a lack of evidence in these social media videos. Aim: To develop and evaluate the feasibility of a blended physiotherapeutic module for young adults with NSCLBP. Materials and Methods: This feasibility study was conducted at Nitte Institute of Physiotherapy, NITTE (Deemed to be University), Deralakatte, Mangaluru, Karnataka, India from July 2023 to December 2023. This study involved three phases: identifying modifiable risk factors for exercise adherence in individuals with NSCLBP, developing a module, and evaluating its feasibility. Twenty-four young individuals with low back pain were given the blended physiotherapeutic module for four weeks, consisting of three sessions per week. The first two sessions were conducted online, and the following session was face-to-face. The data were analysed using SPSS software (SPSS Inc.; Chicago, IL) version 29.0.10. The collected data were summarised using Descriptive Statistics: frequency, percentage; mean, and Standard Deviation (SD). To compare the Quebec Back Pain Disability Scale (QBPDS) and Numerical Pain Rating Scale (NPRS) scores, repeated measures ANOVA was employed. The Bonferroni test was utilised for pairwise comparisons of QBPDS and NPRS scores. A p-value &lt;0.05 was considered significant. Results: In this study, the average percentage of individuals who performed exercises for four weeks was 22 (91.7%), indicating high adherence. There was a significant difference (p-value &lt; 0.05) in the QBPDS as well as the NPRS from baseline to weeks -2, 3, and 4. Conclusion: The developed blended physiotherapeutic module for NSCLBP individuals was found to be feasible. Positive results were identified in reducing pain and disability after two weeks. This study aids individuals struggling with physiotherapy exercises in a digitalised society, suggesting that future research could incorporate real-time movement analysis and regional language databases and software that should be validated.

Biomedical Dogmas Still Influence the Delivery of Exercise Therapy in Chronic Low Back Pain Management: Mixed-Methods Study.

Non-specific, chronic low back pain (NSCLBP) is a leading cause of disability, prompting long-term rehabilitation. Positive patient beliefs and expectations towards lasting exercise engagement play a crucial role for a successful management of this condition. The aim was to investigate beliefs, unmet needs and expectations of NSCLBP patients for exercise-related health behaviour change in the context of rehabilitative care. In a mono-centric mixed-methods study, we conducted semi-structured interviews with NSCLBP patients and care providers. We recruited in a rehabilitation clinic which is specialized in orthopaedics and internal medicine. Interviews were analysed deductively by combining health behaviour change theories with Donabedian's quality model of care. In a patient survey, disability (RMDQ), exercise behaviours, fear avoidance beliefs (FABQ), self-efficacy in chronic disease management (SES6G), process- and outcome-expectations (OEE-2) were queried and analysed descriptively. Twenty-two interviews were conducted and 40 questionnaires completed. Qualitative results revealed that NSCLBP patients had persistent biomedical perspectives on their health condition, marked by strong preferences for biomedical diagnostics and beliefs in the superiority of specific exercise regimes. Based on met expectations and positive movement experiences, patients' motivation was successfully fostered in the motivational phase of health behavior change. In the volitional phase, the postulated desire to receive self-management strategies was largely unmet. Psychosocial aspects of care were not widely accepted. The survey study sample showed a disability score (RMDQ) of M = 6.8 (±4.6). Mean scores of validated scales reflecting on attitudes, beliefs and expectations of chronic NSCLBP management were at FABQ-pa M = 15.4 (±6.0), FABQ-w M = 24.0 (±12.1), SES6G M = 6.4 (±2.3), and OEE-2 M = 2.7 (±0.5). In this sample, patients' understanding of NSCLBP was still dominated by biomedical dogmas and perspectives. Inpatient rehabilitation predominantly addressed expectations towards the motivational phase of exercise-related health behaviour change.

Managing diabetes and hypertension in western Kenya: A qualitative study of experiences of patients supported by the primary health integrated care for chronic conditions (PIC4C) model of care.

The Primary Health Integrated Care for Chronic Conditions (PIC4C) pilot project was launched in 2018 to strengthen prevention and control of four non-communicable conditions at primary health care level in western Kenya. We conducted a qualitative study to explore the extent to which PIC4C integrated services supported people with hypertension and/or diabetes towards timely diagnosis and referral, treatment, follow-up and adherence, from the perspective of those receiving care. Semi-structured interviews were conducted with a purposively sampled patient cohort at two time points, with the intention of capturing changes over time (total (n) = 43, completion of both interviews (n) = 37). We extracted existing survey data to describe socio-demographic characteristics and analyzed qualitative data thematically. We identified two cross-cutting contextual factors, individual's financial resources and their social situation, which shaped each stage of their interactions with PIC4C services. The PIC4C model successfully engaged people in accessing screening services to enable timely diagnosis and referred them to enter care. Free community level screening services and decentralization of care to lower level facilities reduced cost barriers for patients. However, retention in care and adherence to treatment were affected by the wider system context in which PIC4C was operating, including inconsistencies in medication availability and patients' limited financial capacity. Individually tailored advice from health care workers to work around some of these challenges supported self-management strategies. Further development of the service should focus on supporting health care workers to adopt flexible, contextually responsive approaches in order to support patients facing economic and other constraints to engage in (self) care.

A Concept Analysis of Self-Management of Physical Frailty.

This review aimed to clarify the concept of self-management in the context of physical frailty and to provide insights that support the development of interventions to prevent physical frailty. A concept analysis using thirty-three studies was performed, six attributes of the concept "self-management of physical frailty" were identified: {Cooperating with healthcare professionals or familiar persons}, {Investing and managing in resources}, {Acquisition and maintenance of individualized self-management strategies}, {Self-directed process}, {Goal setting and personalized action planning} and {Living with one's own health condition with a positive attitude}. Self-management of physical frailty can be defined as a process in which an individual independently sets goals and action plans, engages in strategies such as exercise and nutritional management, and lives with one's own health condition with a positive attitude by collaborating with healthcare professionals and others, in addition to utilizing resources. To support the process in which an individual independently sets goals and action plans, engages in strategies, self-management support based on learning theories that lead to cognitive, emotional, and behavioral changes is necessary.

Living with low muscle mass and its impact throughout curative treatment for lung cancer: A qualitative study.

To 1) explore the experience of patients with lung cancer with low muscle mass or muscle loss during treatment and the ability to cope with treatment, complete self-care, and 2) their receptiveness and preferences for nutrition and exercise interventions to halt or treat low muscle mass/muscle loss. This was a qualitative study using individual semi-structured interviews conducted using purposive sampling in adults with a diagnosis of non-small cell lung cancer (NSCLC) or small-cell lung cancer (SCLC), treated with curative intent chemo-radiotherapy or radiotherapy. Patients who presented with computed tomography-assessed low muscle mass at treatment commencement or experienced loss of muscle mass throughout treatment were included. Data were analysed using thematic analysis. Eighteen adults (mean age 73 ± SD years, 61% male) with NSCLC (76%) treated with chemo-radiotherapy (76%) were included. Three themes were identified: 1) the effect of cancer and its treatment; 2) engaging in self-management; and 3) impact and influence of extrinsic factors. Although experiences varied, substantial impact on day-to-day functioning, eating, and ability to be physically active was reported. Patients were aware of the overall importance of nutrition and exercise and engaged in self-initiated or health professional supported self-management strategies. Early provision of nutrition and exercise advice, guidance from health professionals, and support from family and friends were valued, albeit with a need for consideration of individual circumstances. Adults with NSCLC with or experiencing muscle loss described a diverse range of experiences regarding treatment. The types of support required were highly individual, highlighting the crucial role of personalised assessment of needs and subsequent intervention.

Navigating the COVID-19 pandemic: Experiences and self-management approaches adopted by people with interstitial lung disease.

People with interstitial lung disease (ILD) were deemed more vulnerable to the SARS-CoV-2 virus and isolated as a means of reducing risk of infection. This study examined the impact of the pandemic on daily life, psychological wellbeing and access to healthcare and identified approaches undertaken to remain safe. Four specialist clinics in tertiary centres in Australia (Victoria: two sites; New South Wales: one site; Western Australia: one site) recruited patients with ILD during an 8-week period from March 2021. Semi-structured telephone interviews were conducted with transcripts analysed using principles of grounded theory. Ninety participants were interviewed between April and December 2021. Participants were predominantly female, former smokers with an average age of 66years. IPF and connective tissue-ILD being the most common subtypes. Five main themes were identified: vulnerability reduced social interaction and isolation, access to healthcare services and support, staying active, emotional and psychological impact. Self-management strategies included staying active both physically and mentally. Self-management was key to managing the impact of the pandemic. In combination with advances in technology, implementation of strategies for monitoring wellbeing and support for self-management provides an opportunity to leverage the lessons learnt to ensure a more individualised model of care for people with ILD.

中医药防治PD的诊疗思路及自我管理策略

中医药防治PD的诊疗思路及自我管理策略

In action at work! Mental health self-management strategies for employees experiencing anxiety or depressive symptoms.

In action at work! Mental health self-management strategies for employees experiencing anxiety or depressive symptoms.

The Effectiveness of Teaching Self-Management to Students with Autism Spectrum Disorder on Their Self-Management, On-Task and Task Completion Skills

Introduction: Self-management strategies (SMS) consist of antecedent cue regulation, self-monitoring, self-instruction, self-evaluation, or self-reinforcement strategies. Students with autism spectrum disorder (ASD) can use these strategies especially in their daily life skills, academic skills, or in environments that require social skills. Method: In this study, the effect of self-management (SM) teaching on the acquisition and maintenance of SMS by students with ASD was examined. It was also aimed to determine how students acquire and maintain the behaviors of on-task and task completion by using strategies, and to what extent they generalize the strategies and target behaviors to different people/environments. The study was conducted using multiple probe design with probe conditions across subjects, one of the single-subject research models. Findings: The findings of the study showed that SM teaching was effective in helping students with ASD acquire SMS, and that students who used the strategies continued to use the strategies after the intervention. In addition, it was determined that students who used the SMS consisting of antecedent cue regulation, self-monitoring, self-evaluation, and self-reinforcement increased their on-task and task completion levels, maintained the gains after the intervention and generalized them to different people and environments. Social validity findings collected from the participants showed that they were positive about the use and effects of the SMS. Discussion: There was a significant increase in students' pre-teaching and post-teaching performances regarding target behaviors. The effectiveness of SM interventions was tried to be supported by the findings of the current study and was consistent with the results of the related study.

Development of remote person-centred care based on participatory design for people with chronic obstructive pulmonary disease and chronic heart failure -A Randomized Controlled trial.

Background: Person-centred care (PCC) is an approach based on ethical principles. To support operationalization of person-centred ethics in clinical practice a framework was developed by the Gothenburg Centre for Person Centred Care (GPCC). Both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are known for their high mortality and severe impact on activities in daily living. Therefore, self-management strategies are crucial to optimize care. Digital solutions have been suggested as a safe option to promote self-management of chronic conditions such as COPD and CHF. However, most digital solutions seem to be lacking the user-perspective in the development of the platform. The project aimed to develop and evaluate a remote PCC based on a participatory design for people with chronic obstructive pulmonary disease and chronic heart failure.&#x0D; Method: Public involvement is a cornerstone in PCC. Therefore, this study incorporates a participatory design that assumes that all users; patients, relatives and healthcare professionals (HCPs) are involved in the study design and development of the intervention (remote PCC). Extensive iterative consultations with the users took place during the development and design of the digital platform (7). An advisory group consisting of patient representatives, relatives, HCPs, system-developers and researchers was formed to provide advice and co-design all of the major elements of the study design. This study was a multicenter randomized trial conducted from 2018 through 2020. In total, 222 patients were recruited from nine primary care centers. Patients with a diagnosis of COPD and CHF were eligible. Participants were randomized into either usual care (n=112) or PCC on top of usual care (n=110). The primary endpoint was a composite score of change in general self-efficacy (GSE) and hospitalization or death 6 months after randomization, which was dichotomized into improved and deteriorated/unchanged. In addition, data from the 3-month follow-up were analyzed and a per-protocol analysis of those participants that used the intervention were conducted.&#x0D; Results: The patient representatives suggested that the platform should include functionalities such as the possibility of a two-way communication and reliable user-friendly information about their condition. The HCPs contributed with input concerning layout and technical functionalities. The effect study showed no significant between-group differences in the composite score at the 3- and 6 months follow-ups. There was, however, a significant difference between the study groups in the per-protocol analysis at three months (p=0.047). This effect was driven by a change in General Self Efficacy from baseline.&#x0D; Conclusion: The participatory designed remote PCC resulted in a generic digital platform in this study, the end-user input in the development process is probably mirrored in the increase in self-efficacy among those that used the platform. PCC by a combined digital platform and structured telephone support seems to be a safe option to support people with CHF and COPD to increase their self-efficacy. This study adds to the knowledge of involving users in the design and development process of interventions. Further research is needed in order to explore how to tailor different components in digital interventions and PCC to each unique patient.&#x0D;

Bipolarity in Older individuals Living without Drugs (BOLD): Protocol and preliminary findings

IntroductionAlthough clinical guidelines regard prophylactic medication as the cornerstone of treatment, it is estimated almost half of patients with bipolar disorder (BD) live without medication. This group is underrepresented in research but can provide indispensable knowledge on natural course, resilience and self-management strategies. We aim to describe the clinical phenotype of patients diagnosed with BD who have discontinued maintenance treatment. MethodsThe mixed-methods BOLD study included 58 individuals aged 50 years and over with BD that did not use maintenance medication in the past 5 years. A preliminary, quantitative comparison of clinical characteristics between BOLD and our pre-existing cohort of >220 older BD outpatients with medication (Dutch Older Bipolars, DOBi) was performed. ResultsBD-I, psychiatric comorbidities, number of mood episodes and lifetime psychotic features were more prevalent in BOLD compared to DOBi. BOLD participants had a younger age at onset and reported more childhood trauma. BOLD participants reported fewer current mood symptoms and higher cognitive, social, and global functioning. LimitationsOur findings may not be generalizable to all individuals diagnosed with BD living without maintenance medication due to selection-bias. ConclusionA group of individuals exists that meets diagnostic criteria of BD and is living without maintenance medication. They appear to be relatively successful in terms of psychosocial functioning, although they do not have a milder clinical course than those on maintenance medication. The high prevalence of childhood trauma warrants further investigation. Future analyses will examine differences between BOLD and DOBi per domain (e.g. cognition, physical health, psychosocial functioning, coping).