Self-management Support Strategies Research Articles

SELF-MANAGEMENT SUPPORT STRATEGIES BASED ON THE RNAO GUIDELINES IN AECOPD PATIENTS: A RANDOMISED CONTROLLED TRIAL

Abstract Abstract Chronic disease management is a key intervention for the management of AECOPD patients. We conducted a Chinese-based trial according to RNAO’s chronic disease management guidelines.The aim of this study was topply an evidence-based guideline practice protocol for self-management in patients with chronic disease to improve the clinical outcomes, as well as reduce the economic costs for patients discharged with AECOPD.In this study, the “Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients”, published by RNAO, was used as a practice guideline to be applied in the follow-up of patients discharged from COPD to understand patients’ post-discharge self-management ability, pulmonary function, and readmission within one year, and to compare the cost-effectiveness for patients after discharge. The follow-up of both groups was conducted over time, and the patients’ self-management ability and pulmonary function in the observation group were effectively improved at month 6 and month 12 and was significantly different in comparison with the control group (P< 0.05). The observation group showed significant differences in readmission rates and economic costs at month 12 as compared to the control group (P< 0.05).Application of the guideline’s chronic disease self-management support strategies could stabilize patients’ blood oxygenation levels, better maintain pulmonary function, significantly improve patients’ self-management ability, and reduce patients’ medication costs. Keywords: COPD;Chronic disease self-management; RCT; economic analysis

Feasibility and pilot testing of a personalized eHealth intervention for pain science education and self-management for breast cancer survivors with persistent pain: a mixed-method study.

Here, we describe the development and pilot study of a personalized eHealth intervention containing a pain science education program and self-management support strategies regarding pain and pain-related functioning in female survivors of breast cancer. First, we aimed to evaluate the eHealth intervention's acceptability, comprehensibility, and satisfaction; second, we aimed to assess its preliminary efficacy. A mixed-method study design was used. Breast cancer survivors with persistent pain were recruited. After 6weeks of engagement with the eHealth intervention, acceptability, comprehensibility, and satisfaction were measured quantitatively with a self-constructed questionnaire and described qualitatively using focus groups. A joint display was used to present the meta-interferences between data. Efficacy was assessed via mixed effects models with repeated measures (outcomes assessed at baseline, 6weeks, and 12weeks). Twenty-nine women with persistent pain after breast cancer surgery participated. Overall, the eHealth program was well received and experienced as easy to use and helpful. The eHealth intervention seems useful as an adjunct to comprehensive cancer aftercare. Efficacy estimates suggested a significant improvement in pain-related functioning, physical functioning, and quality of life. A personalized eHealth intervention appears valuable for persistent pain management after breast cancer surgery. A large controlled clinical trial to determine effectiveness, and a full process evaluation, seems warranted.

Impacts of the Building a Healthy Temple Diabetes Self-Management Education and Support Program (BHT DSMES)

ObjectivesType 2 diabetes disproportionally affects Hispanics, calling for effective diabetes self-management education and support (DSMES) strategies. Churches are promising settings for DSMES delivery in predominately Hispanic communities. Health programs are “faith-placed” (FP) if churches are used as a place for intervention delivery and “faith-based” (FB) if spirituality is incorporated. BHT DSMES integrates spirituality with DSMES in Hispanic churches for diabetic participants in Texas. The study aimed to compare impacts of a FB vs FP approach on diabetes outcomes.MethodsThis cluster-randomized controlled trial, conducted between 2017 and 2020, consisted of 271 participants from 16 churches randomly assigned to the FB Group (church = 9, n = 146) or FP Group (church = 7, n = 125). The FB Group, led by trained church lay leaders, received a Health Sermon, 6-session DSMES, and 7-session Healthy Bible Study. The FP Group, led by outside health professionals, received a 6-session DSMES and 7-session partial attention control curriculum. Key outcome measures included glycated hemoglobin (HbA1c), waist circumference (WC), diabetes self-efficacy, diabetes self-care activities, and diabetes distress. Data were collected at baseline, 6, 9, and 12 months (mo). Following an intent-to-treat principle, linear mixed-effect models were used to determine intervention effect on key outcomes. Models controlled for age, gender, and baseline measure.ResultsThe FB Group had a significantly lower HbA1c at 6 mo (−0.3%, p < 0.05), and a lower WC at 12 mo (−2.9 cm, p = 0.05) than the FP Group. Within-group analysis shows that the FB intervention led to a decreased HbA1c at 6 mo, and WC reductions at 9 and 12 mo. Although no between group differences were observed, compared to baseline, both the FB and FP Groups significantly increased diabetes self-efficacy and diabetes self-care activity score and decreased diabetes distress score post-intervention.ConclusionsBoth the FB and FP interventions had favorable changes in diabetes self-efficacy, diabetes self-care behavior, and diabetes distress. Integrating spirituality with DSMES led to a reduced WC and better blood glucose control among predominately Hispanic churchgoers with diabetes.Funding SourcesThis study is funded by the American Diabetes Association Innovative Clinical or Translational Science Award.

Comparing Self-Management Programs with and without Peer Support among Patients with Chronic Obstructive Pulmonary Disease: A Clinical Trial.

Rationale: Self-management support (SMS) is an essential component of care for patients who have chronic obstructive pulmonary disease (COPD), but there is little evidence on how to provide SMS most effectively to these patients. Peer support (i.e., support provided by a person with a similar medical condition) has been successfully used to promote self-management among patients with various chronic conditions, yet no randomized studies have focused on testing its effects for patients with COPD. Objectives: To assess whether adding peer support to healthcare professional (HCP) support to help patients with COPD self-management results in better health-related quality of life (HRQoL) and less acute care use. Methods: A two-arm randomized controlled trial was performed at one academic and one community hospital and their affiliate clinics. The study population included patients aged ⩾40 years who had been diagnosed with COPD by a physician and were currently receiving daily treatment for it. Two self-management support strategies were compared over 6 months. One strategy relied on the HCP for COPD self-management (HCP support); the other used a dual approach involving both HCPs and peer supporters (HCP Plus Peer). The primary outcome was change in HRQoL measured by the St. George's Respiratory Questionnaire at 6 months (range, 0-100, lower is better; four-point meaningful difference). Secondary outcomes included COPD-related and all-cause hospitalizations and emergency department visits. Analysis was conducted under intention to treat. Results: The number of enrolled participants was 292. Mean age was 67.7 (standard deviation, 9.4) years; 70.9% of participants were White, and 61.3% were female. St. George's Respiratory Questionnaire scores were not significantly different between the study arms at 6 months. HCP Plus Peer arm participants had fewer COPD-related acute care events at 3 months (incidence rate ratio, 0.68; 95% confidence interval [CI], 0.50-0.93) and 6 months (incidence rate ratio, 0.84; 95% CI, 0.71-0.99). Conclusions: Adding peer support to HCP support to help patients self-manage COPD did not further improve HRQoL in this study. However, it did result in fewer COPD-related acute care events during the 6-month intervention period. Clinical trial registered with www.clinicaltrials.gov (NCT02891200).

Self-Management Support with Yoga on Psychological Health and Quality of Life for Breast Cancer Survivors.

The purpose of this study was to identify whether the improvement of self-management support (SMS) combined with yoga can improve anxiety, depression, stress, and quality of life in female breast cancer survivors. The SMS combined with yoga group and control group (yoga only) were comprised of 21 and 20 participants, respectively. The SMS with yoga and yoga programs were provided to each group for 8 weeks. Data obtained from self-report questionnaires included details of anxiety, depression, stress, and quality of life. The levels of anxiety, depression, and stress significantly decreased in both the SMS with yoga and control groups (p < 0.05). Moreover, the quality of life improved significantly in the SMS with yoga group (p < 0.001). Among the five quality-of-life domains (physical, social/family, emotional and functional well-being, and breast cancer subscale), social/family well-being in the SMS with yoga group was significantly higher than that in the yoga-only group (p = 0.011). Conclusions: The results show that yoga is a beneficial activity for the psychological health of breast cancer survivors. Our findings suggest that SMS strategies can improve quality of life.

Health care providers\u2019 understanding of self-management support for people with chronic low back pain in Ethiopia: an interpretive description

BackgroundHealthcare providers play a key role in supporting people with chronic low back pain to self-manage their condition. The study aimed at exploring how health care providers understand and conceptualize self-management and how they provide self-management support for people with chronic low back pain in Ethiopia.MethodsHealth care providers who have supported people with low back pain, including medical doctors and physiotherapists, were approached and recruited from three hospitals in Ethiopia. This study employed an interpretive descriptive approach using semi-structured interviews.FindingsTwenty-four participants (7 women; 17 men) with a median age of 28 (range 24 to 42) years and a median of 9.5 years (range 1 to 11 years) of helping people with chronic low back pain were interviewed. Seven major themes related to health care providers’ understanding of self-management support for people with chronic low back pain in Ethiopia emerged. The findings show that self-management was a new concept to many and health care providers’ had a fragmented understanding of self-management. They used or suggested several self-management support strategies to help people with CLBP self-manage their condition without necessarily focusing on enhancing their self-efficacy skills. The participants also discussed several challenges to facilitate self-management support for people with chronic low back pain. Despite the lack of training on the concept, the providers discussed the potential of providing self-management support for people with the condition.ConclusionsSelf-management was a new concept to health care providers. The providers lack the competencies to provide self-management support for people with chronic low back pain. There is a need to enhance the health care providers’ self-management support competencies through training.

An Interpretive Description of Sociocultural Influences on Diabetes Self-Management Support in Nigeria

The purpose of this study is to explore how Nigeria’s social and cultural environment influences professional diabetes self-management support practices. This interpretive descriptive study is based on two diabetes clinics in southeastern Nigeria. Nineteen healthcare providers, including nurses, were purposely selected and engaged in participant observation and interviews. Concurrent data generation and analysis facilitated iterative constant comparative analysis. Findings show significant factors influencing diabetes self-management support include belief in the supernatural origin of diabetes, individual–family interdependence, myths and limited understanding of diabetes, lack of health insurance, poverty, and the rigidity of a hierarchical acute care model of diabetes services. Thus, there is an urgent need to adapt diabetes self-management support strategies to fit people’s contexts. By doing so, specific challenges in the healthcare system can directly be addressed while capitalizing on identified strengths and adapting select strategies that constructively foster person-centered and culturally appropriate care.

A web-based life-style, exercise and activity intervention for people with progressive multiple sclerosis: Results of a single-arm feasibility study

BackgroundPeople with progressive Multiple Sclerosis often struggle to access appropriate and inclusive support for regular physical activity. The Lifestyle, Exercise and Activity Package (LEAP-MS) intervention, is a co-designed web-based physical activity intervention for people with progressive Multiple Sclerosis (MS). It consists of two key components; (1) web-based physical activity coaching with physiotherapists using self-management support strategies and 2) an interactive web-based platform including a physical activity information suite, an activity selection and planning tool and a participant-physiotherapist messaging system. We aimed to evaluate recruitment, retention and uptake, in a single arm feasibility study. MethodsParticipants with primary or secondary progressive MS with an Expanded Disability Status Scale score of 6 to 8 were recruited. Assessments included the MS Impact Scale (MSIS-29) and measures of participation at baseline, three and six months. All participants received the intervention which consisted of up to six web-based physiotherapy- led physical activity coaching sessions alongside access to web-based education and activity suites. Recruitment, retention and uptake data were summarised. Pre-defined progression criteria were used to guide feasibility assessment. Clinical outcome data were analysed descriptively. ResultsFifty-eight percent (21/36) of those submitting expressions of interest were recruited; 76% completed follow-up. Pre-specified progression criteria for retention were met but recruitment did not meet progression criteria. The intervention achieved set fidelity criteria. At three months, 12 participants (75%) reported improvements in routine activities after the intervention. MSIS-29 physical scores improved by an average of eight points (95% CI -12.6 to -3.3). Improvements were also seen in MSIS-29 psychological scores and fatigue. Some improvements were maintained at six months. ConclusionsThe LEAP-MS intervention is feasible and associated with improvements in MSIS-29 scores. The intervention facilitated partnership working between physiotherapists and people with progressive MS. Users developed valuable skills in supported self-management by focussing on enhancing physical activity to support overall wellbeing. This work has laid the foundations for a large-scale evaluation of a co-designed intervention with potential for far reaching impact on the lives of people with progressive MS.

Comparative Efficacy of Strategies to Support Self-Management in Patients with Asthma: A Systematic Review and Network Meta-Analysis

There is limited evidence about which composite feature of asthma self-management strategies is the best and should be adopted into practice. To compare the efficacy of different strategies to support self-management, based on the newly developed framework, in patients with asthma. We searched PubMed, EMBASE, CENTRAL, CINAHL, and PsycInfo from 1993 to December 2019. We identified randomized controlled trials that explored effects of strategies to support self-management in adult patients with asthma. We conducted network meta-analyses using a random effects model with usual care as the common comparator. Surface under the cumulative ranking curve methods were used to rank different support strategies. Thirty-five trials (5195 patients) were included and classified on the basis of our newly created TIP framework: Theme, Intensity, and Provider/Platform. We identified 6 features from the included trials, each represented by 1 element of the TIP framework: (1) behavioral support more than once a month by e-Health; (2) behavioral support more than once a month by health care personnel (HCP); (3) behavioral support less often than or equal to once a month by HCP; (4) education support less often than or equal to once a month by e-Health; (5) education support less often than or equal to once a month by HCP; and (6) psychosocial support less often than or equal to once a month by HCP. Behavioral support more than once a month by e-Health showed significant improvement in asthma control when compared with the other 2 support strategies, which was confirmed by the highest surface under the cumulative ranking of 97.6%. However, the surface under the cumulative ranking for behavioral support less often than or equal to once a month by HCP suggested that it has the potential to be the best intervention to reduce the risk of hospitalization (89.1%) and emergency department visit (84.2%). Different features of asthma self-management support strategies work best on unique outcomes.

A community-based nurse-led medication self-management intervention in the improvement of medication adherence in older patients with multimorbidity: protocol for a randomised controlled trial

BackgroundOlder patients suffering from multimorbidity are at high risk of medication nonadherence. It has been well established that self-management support is an effective strategy to enhance medication adherence for patients with chronic conditions. However, little is known about the effect of the medication self-management intervention in older patients with multimorbidity. This paper presents the protocol for a study that aims to evaluate the effectiveness of a nurse-led medication self-management intervention in improving medication adherence and health outcomes for community-dwelling older patients with multimorbidity.MethodsThe study protocol follows the recommendations of the Standard Protocol Items: Recommendations for Interventional Trials 2013 statement. This study is a multicentre, single-blind, two-arm randomised controlled trial. Older patients with multimorbidity will be recruited from three community health centres in Changsha, China. A total of 136 participants will be randomly allocated to receive usual care or usual care plus the medication self-management intervention. The intervention will be delivered by community nurses. The 6-week intervention includes three face-to-face education sessions and two weekly follow-up phone calls. Participants in the control group continue to receive all respects of usual care offered by community healthcare providers, including chronic disease management, drug prescription, referral to hospital specialists, health education and consultations regarding patients’ diseases and treatments during centre visits. The primary outcome is medication adherence as measured by the 5-item Medication Adherence Report Scale. Secondary outcomes include medication self-management capacity (medication knowledge, medication beliefs, medication social support, medication skills, and medication self-efficacy), treatment experiences (medication treatment satisfaction and treatment burden), quality of life, and utilisation of healthcare services. All outcomes will be measured at baseline, immediately post-intervention, and at 3-month post-intervention.DiscussionThis study will provide evidence about the effectiveness of a medication self-management intervention, delivered by nurses, for older patients with multimorbidity and adherence problems. It is expected that the results of the study, if proven effective in improving patients’ adherence and health outcomes, will provide evidence-based self-management support strategies for healthcare providers in routine chronic disease management in community settings.Trial registrationThe trial is registered at ChiCTR.org.cn (ChiCTR2000030011; date February 19, 2020).

Closing Gaps in Lifestyle Adherence for Secondary Prevention of Coronary Heart Disease

The secondary prevention (SP) of coronary heart disease (CHD) has become a major public health and economic burden worldwide. In the United States, the prevalence of CHD has risen to 18 million, the incidence of recurrent myocardial infarctions (MI) remains high, and related healthcare costs are projected to double by 2035. In the last decade, practice guidelines and performance measures for the SP of CHD have increasingly emphasized evidence-based lifestyle (LS) interventions, including healthy dietary patterns, regular exercise, smoking cessation, weight management, depression screening, and enrollment in cardiac rehabilitation. However, data show large gaps in adherence to healthy LS behaviors and low rates of enrollment in cardiac rehabilitation in patients with established CHD. These gaps may be related, since behavior change interventions have not been well integrated into traditional ambulatory care models in the United States. The chronic care model, an evidence-based practice framework that incorporates clinical decision support, self-management support, team-care delivery and other strategies for delivering chronic care is well suited for both chronic CHD management and prevention interventions, including those related to behavior change. This article reviews the evidence base for LS interventions for the SP of CHD, discusses current gaps in adherence, and presents strategies for closing these gaps via evidence-based and emerging interventions that are conceptually aligned with the elements of the chronic care model.

Self-management support training for undergraduate and graduate entry healthcare professional students: an integrative review

Objectives Current research explores the patient and healthcare professional role in self-management; however, it is unclear what healthcare students are taught about supporting self-management as part of their pre-registration training. As the next generation of healthcare professionals, what and how students are taught is of importance if they are to competently and effectively implement supporting self-management in their future practice. The purpose of this review was to identify the self-management support strategies taught to undergraduate and graduate entry healthcare students. Methods A systematically undertaken integrative review of literature sourced from four health databases. Included studies described the education provided to undergraduate and graduate entry healthcare students about self-management support; studies were critically appraised using Joanna Briggs Institute critical appraisal tools. Data were extracted and tabulated to i) provide an overall summary of included studies, and ii) identify educational method and type of learning, and strategies taught to students based on Lorig and Holman’s list of core patient self-management skills. Results Twelve of 1,209 studies were included. A variety of methods and approaches to learning were used. Eight taught strategies were identified as informational (six strategies) or emotional (two strategies). Discussion While informational strategies are fundamental, and, as the review highlights, effective for a foundational knowledge in supporting self-management; teaching such informational strategies in isolation could set students up to act as the “expert” in any exchange with patients. More emphasis on teaching of emotional strategies in undergraduate and graduate curricula could more effectively enable students to better support patient self-management into the future.

The Process of Self-Management: A Qualitative Case Study Reporting on Cancer Survivors' and Program Staff's Experiences Within One Self-Management Support Intervention.

Background. Cancer survivors must manage a range of adverse symptoms and side effects postdiagnosis. These effects often co-occur with preexisting comorbid conditions. Recognizing the complex chronicity of the disease, self-management support interventions have been developed to promote cancer survivors' knowledge, skills, and confidence to self-manage their health. Though shown to be beneficial, the processes underlying self-management have yet to be explicated. Aim. To explore how a community-based self-management support intervention fosters cancer survivors' knowledge, confidence, and skills to self-manage their health. Method. A qualitative case study adopting multiple viewpoints was utilized. Seventeen cancer survivors who participated in a self-management support intervention (referred to as a cancer coaching program) were interviewed and six program staff took part in a focus group. Transcripts from the interviews and focus group were analyzed using a hybrid inductive-deductive approach guided by principles of qualitative description. Results. Cancer survivors and program staff offered complementary perspectives that enhanced our understanding of how the self-management support intervention fosters cancer survivors' knowledge, confidence, and skills to self-manage their health. Four themes captured strategies necessary to promote self-management: (1) looking beyond the disease: the importance of holistic person-centered care, (2) cocreating plans: the key to effective and meaningful self-management support, (3) fostering activation via tailored, targeted, and expert-sourced information and resources, and (4) having dependable and impartial emotional support. Within each theme, pertinent self-management support strategies were described by cancer survivors and program staff. Discussion and Conclusion. Findings offer an understanding of how one community-based self-management support intervention promotes self-management and highlight valuable self-management support strategies that could be incorporated into existing and future interventions.

What is the answer to the challenge of multimorbidity in New Zealand?

The increasing prevalence of multimorbidity, a growing ageing population and lack of success in addressing the negative effect of socioeconomic and cultural determinants of health are major challenges for New Zealand's primary care sector. Self-management support strategies, personalised care planning, integrated care and shared health records have all been proposed as mechanisms to address these challenges. The organisation of the health system, however, remains largely unchanged, with limited accommodation and few funding concessions made for the requirements of these different approaches and tools. As a result, the primary care system is no longer a good match for the population it serves. With one in four New Zealanders reporting multimorbidity, and people aged >65 years predicted to double in number by 2050, this article argues that over the next decade, New Zealand requires a health system focused on incorporating self-management support, personalised and integrated care and shared health records. This will require further educating of not only health professionals, but also patients in the purpose behind these approaches. In addition, it will mean transitioning to a primary care system more suited to the needs of people with long-term conditions. The key gain from a radical redesign will be a more equitable health system focused on a broader range of health needs.

Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice.

BackgroundPrimary health professionals are well positioned to support the delivery of patient self-management in an evidence-based, structured capacity. A need exists to better understand the active components required for effective self-management support, how these might be delivered within primary care, and the training and system changes that would subsequently be needed.Objectives(1) To examine self-management support interventions in primary care on health outcomes for a wide range of diseases compared to usual standard of care; and (2) To identify the effective strategies that facilitate positive clinical and humanistic outcomes in this setting.MethodA systematic review of randomized controlled trials evaluating self-management support interventions was conducted following the Cochrane handbook & PRISMA guidelines. Published literature was systematically searched from inception to June 2019 in PubMed, Scopus and Web of Science. Eligible studies assessed the effectiveness of individualized interventions with follow-up, delivered face-to-face to adult patients with any condition in primary care, compared with usual standard of care. Matrices were developed that mapped the evidence and components for each intervention. The methodological quality of included studies were appraised.Results6,510 records were retrieved. 58 studies were included in the final qualitative synthesis. Findings reveal a structured patient-provider exchange is required in primary care (including a one-on-one patient-provider consultation, ongoing follow up and provision of self-help materials). Interventions should be tailored to patient needs and may include combinations of strategies to improve a patient’s disease or treatment knowledge; independent monitoring of symptoms, encouraging self-treatment through a personalized action plan in response worsening symptoms or exacerbations, psychological coping and stress management strategies, and enhancing responsibility in medication adherence and lifestyle choices. Follow-up may include tailored feedback, monitoring of progress with respect to patient set healthcare goals, or honing problem-solving and decision-making skills. Theoretical models provided a strong base for effective SMS interventions. Positive outcomes for effective SMS included improvements in clinical indicators, health-related quality of life, self-efficacy (confidence to self-manage), disease knowledge or control. An SMS model has been developed which sets the foundation for the design and evaluation of practical strategies for the construct of self-management support interventions in primary healthcare practice.ConclusionsThese findings provide primary care professionals with evidence-based strategies and structure to deliver SMS in practice. For this collaborative partnership approach to be more widely applied, future research should build on these findings for optimal SMS service design and upskilling healthcare providers to effectively support patients in this collaborative process.

Time to change the paradigm? A mixed method study of the preferred and potential features of an asthma self-management app.

We explored the potential of asthma apps to support self-management and identified preferred features that enable users to live with asthma. We recruited patients from five UK practices and social media; observed their usage of our app, administered a questionnaire and interviewed a purposive sample of patients and professionals to explore preferred features. Thematic analysis of interview was synthesised with quantitative data. A total of 111 patients used our app for 3 months. We interviewed 15 patients and 16 professionals. Participants were interested in a broad range of self-management support strategies, including action plans, monitoring with feedback, allergy/weather warnings and tailor-made running coaching. Professionals wanted to integrate patients' logs with practice records, though were concerned about data overload and risk of patient dependency. We propose a paradigm shift - from apps developed to provide features that are easy to implement technologically, to an approach in which apps are designed to deliver theoretically grounded preferred components.

How do we strengthen the health workforce in a rapidly developing high-income country? A case study of Abu Dhabi's health system in the United Arab Emirates

BackgroundThe United Arab Emirates (UAE) is a rapidly developing high-income country that was formed from the union of seven emirates in 1971. The UAE has experienced unprecedented population growth coupled with increased rates of chronic diseases over the past few decades. Healthcare workers are the core foundation of the health system, especially for chronic care conditions, and the UAE health workforce needs to be fully prepared for the increased rates of chronic diseases in the adult population. Abu Dhabi is the largest emirate in terms of land mass and population size, and the purpose of this paper was to assess how the health system has been using the Chronic Care Model to improve its capacity to reach out to all patients in the population.Case presentationThe Abu Dhabi health workforce has twice the number of doctors (52.4 vs. 23.2 per 10 000 population) and nurses (134.7 vs. 50.4 per 10 000 population) compared to the entire UAE health workforce. In addition to an overreliance on expatriate workers, there is an excess of some specializations such as general medicine and gynecology and a severe undersupply of other specialties including trauma and injury, and medical oncology. The digital infrastructure and skills of the health workforce need to be improved to minimize the proportion of the appointment time required to complete administrative tasks for a health insurance system and maximize the doctor-patient face-to-face interaction time for consultation and lifestyle counseling.ConclusionsA greater emphasis needs to be placed on developing self-management support strategies using a combination of nurse health educators and community-based patient-led health programs. The UAE Vision 2021 includes developing a world-class healthcare system, and full implementation of the Chronic Care Model seems to facilitate the detailed planning and preparation of healthcare services and workers required to achieve this goal.

Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews

ObjectivesSelf-management support aims to give people with chronic disease confidence to actively manage their disease, in partnership with their healthcare provider. A meta-review can inform policy-makers and healthcare managers about...

Can models of self-management support be adapted across cancer types? A comparison of unmet self-management needs for patients with breast or colorectal cancer.

There is an increased focus on supporting patients with cancer to actively participate in their healthcare, an approach commonly termed 'self-management'. Comparing unmet self-management needs across cancer types may reveal opportunities to adapt effective self-management support strategies from one cancer type to another. Given that breast and colorectal cancers are prevalent, and have high survival rates, we compared these patients' recent need for help with self-management. Data on multiple aspects of self-management were collected from 717 patients with breast cancer and 336 patients with colorectal cancer attending one of 13 Australian medical oncology treatment centres. There was no significant difference between the proportion of patients with breast or colorectal cancer who reported a need for help with at least one aspect of self-management. Patients with breast cancer were significantly more likely to report needing help with exercising more, while patients with colorectal cancer were more likely to report needing help with reducing alcohol consumption. When controlling for treatment centre, patients who were younger, experiencing distress or had not received chemotherapy were more likely to report needing help with at least one aspect of self-management. A substantial minority of patients reported an unmet need for self-management support. This indicates that high-quality intervention research is needed to identify effective self-management support strategies, as well as implementation trials to identify approaches to translating these strategies into practice. Future research should continue to explore whether self-management support strategies could be adapted across cancer types.

Smart Devices for Older Adults Managing Chronic Disease: A Scoping Review.

BackgroundThe emergence of smartphones and tablets featuring vastly advancing functionalities (eg, sensors, computing power, interactivity) has transformed the way mHealth interventions support chronic disease management for older adults. Baby boomers have begun to widely adopt smart devices and have expressed their desire to incorporate technologies into their chronic care. Although smart devices are actively used in research, little is known about the extent, characteristics, and range of smart device-based interventions.ObjectiveWe conducted a scoping review to (1) understand the nature, extent, and range of smart device-based research activities, (2) identify the limitations of the current research and knowledge gap, and (3) recommend future research directions.MethodsWe used the Arksey and O’Malley framework to conduct a scoping review. We identified relevant studies from MEDLINE, Embase, CINAHL, and Web of Science databases using search terms related to mobile health, chronic disease, and older adults. Selected studies used smart devices, sampled older adults, and were published in 2010 or after. The exclusion criteria were sole reliance on text messaging (short message service, SMS) or interactive voice response, validation of an electronic version of a questionnaire, postoperative monitoring, and evaluation of usability. We reviewed references. We charted quantitative data and analyzed qualitative studies using thematic synthesis. To collate and summarize the data, we used the chronic care model.ResultsA total of 51 articles met the eligibility criteria. Research activity increased steeply in 2014 (17/51, 33%) and preexperimental design predominated (16/50, 32%). Diabetes (16/46, 35%) and heart failure management (9/46, 20%) were most frequently studied. We identified diversity and heterogeneity in the collection of biometrics and patient-reported outcome measures within and between chronic diseases. Across studies, we found 8 self-management supporting strategies and 4 distinct communication channels for supporting the decision-making process. In particular, self-monitoring (38/40, 95%), automated feedback (15/40, 38%), and patient education (13/40, 38%) were commonly used as self-management support strategies. Of the 23 studies that implemented decision support strategies, clinical decision making was delegated to patients in 10 studies (43%). The impact on patient outcomes was consistent with studies that used cellular phones. Patients with heart failure and asthma reported improved quality of life. Qualitative analysis yielded 2 themes of facilitating technology adoption for older adults and 3 themes of barriers.ConclusionsLimitations of current research included a lack of gerontological focus, dominance of preexperimental design, narrow research scope, inadequate support for participants, and insufficient evidence for clinical outcome. Recommendations for future research include generating evidence for smart device-based programs, using patient-generated data for advanced data mining techniques, validating patient decision support systems, and expanding mHealth practice through innovative technologies.