Self-management Support Research Articles

Self-Management Support (SMS) in Transition: The Case of Osteoporosis Management Support in a Chinese Hospital

AbstractSelf-management has become increasingly important with the growing population living with chronic conditions. Self-Management Support (SMS) provided in healthcare systems is essential for its success. While prior research mainly focuses on Western countries, this paper presents a study of SMS practices for osteoporosis management as part of a Whole Course Management (WCM) program recently implemented in the healthcare system in China, which features a new role called case manager in the hospital dedicated to SMS and related coordination. Based on interviews with 22 participants, including one case manager, two physicians, three nurses, seven patients, and nine caregivers, we highlight the importance of the role of case manager in promoting awareness of osteoporosis and self-management, integrated care coordination, and emotional support. At the same time, it also reveals challenges and promising directions to make SMS more effective, mainly in terms of self-management education, active patient involvement, and coordination among the care network. We ended by reflecting on our findings and discussing implications for SMS and the design of ICTs.

Seamless and Long-term Rehabilitation for Supporting Self-management and Return to College Life in a Young Case of Hypertrophic Cardiomyopathy with Post-resuscitation Encephalopathy：A Case Study

Seamless and Long-term Rehabilitation for Supporting Self-management and Return to College Life in a Young Case of Hypertrophic Cardiomyopathy with Post-resuscitation Encephalopathy：A Case Study

Contextual factors that influence adoption and sustainment of self-management support in cancer survivorship care: a practical application of theory with qualitative interviews

BackgroundSelf-management support (SMS) is a recommended component of cancer survivorship care that improves health-related quality of life and reduces healthcare utilisation. However, widespread implementation has been difficult to achieve, with a gap in the literature on system-wide implementation efforts. This study examines contextual factors perceived to influence SMS adoption and sustainment in cancer centres in the Republic of Ireland.MethodSemistructured interviews were conducted with 47 key informants from 20 cancer organisations across community and hospital settings. Participants were asked to report the level of adoption and sustainment of SMS at their organisation. This information was used to categorise organisations as low, medium or high implementers. We conducted cross-case analysis following the principles of Framework Analysis. Using the Consolidated Framework for Implementation Research as a menu of constructs, we examined factors influencing adoption and sustainment and variation in levels of implementation.ResultsNational policy, external accreditation, external financing opportunities and the presence of champions in organisations are influential early in the implementation process driving adoption. Healthcare provider-led programmes and evidence of SMS improving patient outcomes and aligning with an organisation’s priorities are necessary to secure buy-in, particularly among senior leadership. An organisational culture of entrepreneurship enables adoption and sustainment, with resources and a culture supporting staff well-being enabling sustainment.ConclusionWhile national policy is a driver, additional factors related to programme attributes and local contextual features such as the presence of champions, organisational readiness and culture influence implementation. The results may be used for future evaluations of SMS implementation in cancer survivorship care and to inform the development of tailored implementation strategies.

Delivery of Supported Self-Management in Primary Care Asthma Reviews: Insights From the IMP2ART Programme.

Supported self-management (SSM) for asthma reduces the risk of asthma attacks and improves asthma control and quality of life. SSM optimally includes patient-centred communication and behaviour change support, however, the extent to which this occurs in routine primary care is unclear. This project was nested within the IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme; a UK-wide trial evaluating an implementation strategy (including healthcare professional (HCP) training on behaviour change strategies and patient-centred care) to improve support for asthma self-management. To provide an understanding of how healthcare professionals deliver SSM in UK clinical practice; through assessing time spent on SSM strategies, how and to what extent patient-centred care and behaviour change discussions are delivered, and to explore whether factors such as mode of review or implementation support influence delivery. We conducted an observational study using video-recordings of 12 HCPs delivering routine face-to-face and telephone asthma reviews (n = 64) in a sample of general practices participating in the IMP2ART trial (implementation n = 4; control n = 6). Analytical methods included: ALFA Toolkit Multi-Channel Video Observation (to code and quantify tasks undertaken); the Patient-Centred Observation Form; and The Behaviour Change Counselling Index (to assess patient-centeredness and behaviour change counselling used by HCPs). HCPs mostly spent time during routine asthma reviews discussing: an individual's asthma condition and management (average of 27.8% of consultation time); collaboratively reviewing and completing a personalised asthma action plan (6.3%) and training for practical self-management activities (5.4%). Areas of patient-centred care delivery and behavioural discussions included: creating and maintaining relationships, discussing asthma action plans and medication reconciliation. Professionals in IMP2ART implementation group practices delivered more SSM strategies. Comparison of face-to-face and remote consultations found no significant differences in HCP delivery of SSM. HCPs in UK primary care spent half the time in both face-to-face and remote asthma reviews delivering components of SSM suggesting that either mode of delivery may be acceptable. Reviews carried out in IMP2ART implementation group practices demonstrated more behaviour change and collaborative SSM strategies compared to those in the control group. Asthma UK Centre for Applied Research (AUKCAR) PPI members were involved throughout, including project conception, providing feedback on participant-facing documents, and discussing implications of study findings.

Abstract 4128919: A Study Using Team Based Hypertension Care Focused on Black Patients to Inform a Future Randomized Trial

Background: Current telemedicine programs to manage hypertension are less effective in Black patients perhaps due to insufficient support for self-care skills and social needs. We describe a tailored program for Black patients emphasizing self-management support and social needs to inform future studies. Method: We piloted a 12-week telemedicine intervention comprising home blood pressure (BP) guided pharmacotherapy, frequent self-management support and social support using pharmacist, nurses, community health workers (CHW) and social workers (SW) among 20 patients in 2 clinics. At enrollment, we trained patients to use a BP monitor and a telemonitoring app that transmits BP real-time via a smartphone and provided a pill box to facilitate medication adherence. We asked patients to measure BP at least once daily and used 6 weeks average to guide pharmacotherapy. Trained nurses helped patients achieve self-care goals and provided 8-12 self-management support calls discussing hypertension, medication adherence, diet, physical activity, weight management, sleep, and BP measurement techniques. SWs and CHWs provided social support to address social needs such as food, transportation, and housing, and also offered home visits. Result: Eighteen patients completed the study of which 15 were Black, 2 White, and 1 Korean (9 were women). Mean age was 61.7 ± 11.8 years. Patients measured BP 10 ± 8.6 times/week and completed 8.3 ± 2.5 self-management calls. Over 12 weeks, SBP/DBP decreased by 16.5 ± 26.2/10.2 ± 18.5 mmHg without safety events (Table). There were 1.1 ± 0.8 (range 0-3) medication adjustments (dose or medication changes) per patient. Patients had 8 minor technical difficulties that were promptly resolved. 17 patients used pill boxes to improve medication adherence. Conclusion: Our tailored telemedicine program to manage hypertension is feasible among Black patients and offer valuable insights for future research.

Abstract 4126950: Program Evaluation of a Team-Based Telemedicine Hypertension Intervention by Patients

Background: We pilot tested a 12-week, team-based, telemedicine hypertension management intervention tailored for patients with greater social needs. Our study included home blood pressure (BP) guided pharmacotherapy, frequent self-management support, and social support by pharmacists, nurses, community health workers and social workers. Twenty patients, including 17 Black patients, from 2 clinics in NC participated. We conducted program evaluation to inform future research. Methods: After program completion, we conducted semi-structured interviews and administered validated surveys for program evaluation. We used Exploration, Preparation, Implementation, and Sustainment and Health Equity Implementation Frameworks to guide our study design. We utilized inductive and deductive coding methods, with thematic analysis to organize emergent themes. We used descriptive statistics to summarize survey results. We triangulated themes from interviews with survey results during analysis/results interpretation using concurrent embedded mixed methods (Qual + quant) for convergence/complementarity. Results: Nineteen patients completed the interviews and 18 completed the surveys. A patient withdrew from the study. Several themes emerged around acceptability, appropriateness, feasibility, and patient centeredness about the program (Table). Patients’ perceptions that the program was acceptable and measuring BP at home was easy were most salient. Program was found to be highly patient centered. Conclusions: Patients found our team-based telemedicine intervention acceptable, appropriate, feasible, and patient centered. The tailored telemedicine program holds promise for adoption by patients with greater social needs.

Investigating health professionals' perspectives and experiences of food security-related conversations in diabetes care.

Household food insecurity (FI) is a serious public health concern and disproportionately affects people living with chronic health conditions, undermining diabetes self-management. Little is known about healthcare professionals' (HCPs) experiences of supporting people affected by diabetes and FI, and no national guidelines incorporate consideration of FI within UK diabetes care. A qualitative study of NHS HCPs' consideration of FI within diabetes care, and the extent to which it informs their clinical practice, was undertaken. Fifteen HCPs providing self-management support to people with Type 1 or Type 2 diabetes in a Scottish Health Board took part in semi-structured interviews. Data were analysed using a thematic framework approach informed by the Capability, Opportunity, Motivation and Behaviour (COM-B) model of behaviour change. Although the potential impact of FI on diabetes self-management was recognised, this important consideration was not currently core to their clinical practice. Enablers and barriers identified included: personal feelings about raising the issue, lack of knowledge of available resources, the patient-practitioner relationship, and the wider socioeconomic environment. Practical suggestions to support HCPs included: specific training on communication, access to patient support information, use of a screening tool to assess FI, and building NHS-third sector links. Our findings provide insight into cognitive factors, emotional processes and environmental systems impacting on HCPs' practice supporting individuals with diabetes and FI. Research with affected patients is needed to gain a better understanding of how to provide support within NHS settings.

Beyond Hemoglobin A1c-Outcomes That Matter to Individuals With Type 1 Diabetes in Adopting Digital Health Interventions for Self-Management Support: Qualitative Study.

Type 1 diabetes is a demanding chronic condition that requires diligent blood glucose monitoring and timely insulin administration by patients who must integrate self-management into their daily lives. This study aimed to better understand what outcome measures are important to individuals living with type 1 diabetes (T1D) in Ontario, Canada, to help inform the development of type 1 diabetes virtual self-management Education and support (T1ME) trial. A qualitative approach was used, in which we conducted 6 focus groups with a total of 24 adult participants living with T1D (from age 18 to >65 years) in Ontario. Each focus group was semistructured in nature; participants were encouraged to talk openly about their experiences with T1D self-management and provide their perspectives on more focused topics such as technology and relationships with health care providers. An interpretive analysis helped us devise a framework for our results that centered around 6 main discussion themes: (1) adapting self-management to meet evolving needs, (2) looking "beyond A1c" toward more personalized indicators of glycemic management, (3) the benefits and challenges of adopting new T1D technology, (4) establishing trusting relationships with diabetes care providers, (5) perceived benefits of peer support, and (6) pre- and post-COVID-19 perspectives on virtual care. Our goal is for these findings to help facilitate the development of patient-oriented outcome measures that are in line with the unique needs and preferences of T1D patients in this new, more virtual landscape of clinical care, education, and self-management support.

"Let's embark on a joint health journey" - How Boundary Negotiating Artifacts Influence Patients' Psychological Ownership in Chronic Care

CSCW and HCI research has a standing discourse on boundary negotiating artifacts and psychological ownership. Both concepts are attributed the potential to address the spreading chronic disease pandemic and rising healthcare costs. While CSCW has attended only to boundary negotiating artifacts to study patient-provider collaboration, the psychological ownership discourse primarily focuses on the perception of ownership over digital objects. Despite studies in both discourses reporting promising results, the concepts have been studied separately. Accordingly, the ways boundary negotiating artifacts relate to psychological ownership in healthcare interactions remain unclear. In this research-through-design study, we evaluate the Digital Companion as a technology-based boundary negotiating artifact. Our field study with 27 patients shows how the Digital Companion fosters psychological ownership in weight management by bridging domains and closing the loop between patient self-management and medical support in consultations. By understanding how boundary negotiating artifacts foster psychological ownership, we gain deeper insights into how patients assume and share ownership of their therapy plans. Our analysis uncovers the emergence of perceived shared ownership as BNAs create concordance between patients and physicians.

Organizational Support in Career Self-Management: A Systematic Literature Review

The present study consists of a systematic literature review, based on the PRISMA model, with the objective of analyzing the relationship between organizational support and career self-management in order to address the gaps in the existing literature. Specifically, it seeks to answer whether organizational support influences career self-management behaviors and whether the inverse also occurs. To systematize the scientific knowledge on this topic over the past 13 years (2010–2023), three databases were consulted: Web of Science, Scopus, and Core. This research resulted from the combination of the keywords “career self-management” and “organizational support: and involved the screening of 353 studies. For the systematic literature review, a total of six studies were identified that met the established eligibility criteria. The main conclusions of this study are that organizational support, in the form of perceived organizational support, human resource management practices/perception of human resource management practices, and leader–member exchanges, appears to positively influence career self-management, as well as the inverse. Such evidence can be observed through the direct and indirect relationships established between the variables. This relationship leads, for example, to workers being more satisfied with their careers while also becoming more committed to the organization. Overall, this systematic literature review provides practical implications for organizations and their workers. It is suggested that future research should explore the relationship between career self-management and organizational support, as well as other potential mediators of this relationship.

Supporting cancer-related fatigue self-management: A conversation analytic study of nurse counsellor and cancer survivor consultations

PurposeCancer-related fatigue (CRF) is a prevalent and distressing symptom experienced by people affected by cancer. A breakdown of the clinician-patient partnership and suboptimal clinician communication has been identified as a significant barrier to implementing into clinical practice effective self-management strategies for CRF. This study examined the use and impact of communication practices employed by trained cancer nurse counsellors when providing CRF self-management support to cancer survivors. MethodsInteractions from 41 telehealth consultations between three nurse counsellors and 23 cancer survivors in a CRF self-management support clinic in Queensland, Australia were recorded and analysed using conversation analysis methods. ResultsAnalysis found that in instances where nurses established the agenda of a consultation from the outset of a session (e.g., focusing on fatigue self-management support), cancer survivors displayed clearer understandings of their self-management role, the tasks, and goals of a session; and displayed less difficulty engaging in supportive care discussions. Furthermore, clinicians used formulation practices, such as summarising dialogue, to sustain focus on fatigue during consultations, and to close discussion matters not ostensibly pertinent to fatigue self-management planning supporting the goals of the CRF SMS clinic consultations. ConclusionFor supportive care sessions targeting fatigue management, clinicians should ideally focus discussion on CRF support early, by clearly introducing the agenda at the outset of the consultation while also asking for client agreement. Periodically summarising patient's talk allows clinicians to maintain a focus on matters relevant for self-management fatigue planning and provide support within the typically constrained timeframes allocated for addressing CRF.

Determinants of the effectiveness of education and training in Indonesian migrant workers

This study explores the effectiveness of education and training programs for Indonesian migrant workers, who often seek employment abroad due to limited opportunities and low wages in their home country. The increasing numbers of migrant workers, combined with their significant economic contributions, highlight the need for effective training to enhance their self-reliance and reduce the likelihood of returning to overseas work. Employing a mixed-methods approach, the research identifies key determinants of program success, including financial literacy, self-management, motivation, and social support. The findings reveal that while macro-level policies are still insufficient, effective mapping and guidance at the micro level show promising results. Successful training programs positively impact the workers' independence, with those who acquire essential skills more likely to pursue entrepreneurship upon returning to Indonesia, rather than seeking further employment abroad. The study underscores the importance of incorporating financial and digital literacy, along with entrepreneurship training, into the curriculum to foster long-term economic independence for Indonesian migrant workers.

'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.

Right Information, Right Care, Right Patient, Right Time: Community Preferences to Inform a Self-Management Support Tool for Upper Respiratory Symptoms.

During and after the COVID-19 pandemic, communities must cope with several conditions that cause similar upper-respiratory symptoms but are managed differently. We describe community reactions to a self-management toolkit for patients with upper respiratory symptoms to inform mobile e-health app development. The toolkit is based on the '4R' (Right Information, Right Care, Right Patient, Right Time) care planning and management model. The 4R Cold, Flu and COVID-19 Information Tool (4R-Toolkit) along with a brief evaluation survey were distributed in three ways: through a Bronx NY Allergy/Asthma clinic, through the Bronx Borough President's Office listserv, and through peer recruitment. The survey assessed respondents' perceptions of the 4R-Toolkit's accessibility, preferences for sharing symptoms with clinicians, social media use, and e-health literacy. We obtained a diverse sample of 106 Bronx residents, with 83% reporting personal or a social contact with symptoms suggestive of COVID-19. Respondents varied in the information sources they preferred: computer (39%); smart phone (28%); paper (11%) and no preference (22%). Most (67%) reported that social media had at least some impact on their healthcare decisions. Regardless of media preferences, respondents were positive about the 4R-Toolkit. Out of 106 respondents, 91% believed the 4R-Toolkit would help people self-manage upper respiratory symptoms and 85% found it easy to understand. Respondents strongly endorsed retention of all 4R-Toolkit content domains with 81% indicating that they would be willing to share symptoms with providers using a 4R-Toolkit smartphone app. The 4R-Toolkit can offer patients and community members accurate and up-to-date information on COVID-19, the common cold, and the flu. The user-friendly tool is accessible to diverse individuals, including those with limited e-health literacy. It has potential to support self-management of upper respiratory symptoms and promote patient engagement with providers.

Future proof competencies for nurses working in primary care; a mixed methods study

Abstract Background Healthcare services, also those provided by nurses, are challenged by the increasing care demands of an ageing population and people with chronic conditions. To improve care efficiency and quality, now and in the future, nurses must have competencies regarding self-management support of patients, electronic communication, preventive care, and engaging relatives in care. This study aimed to assess primary care registered nurses’ (RNs) time allocation to these competencies and their perceived needs for further development of these competencies. Methods A mixed methods design was used, involving a nationwide survey (n = 303) and focus groups (12 participants), both with RNs working in community care services or general practitioners (GPs) practices. Survey data were analysed descriptively, and focus group transcripts underwent qualitative thematic analysis. Results The majority of RNs invest significant time in client self-management support (90%), preventive care (82%), and involving relatives in care (74%). RNs also recognized an increasing demand for these competencies in the future and the need to motivate patients and relatives to self-manage their health. Furthermore, RNs reported that competencies regarding electronic communication skills will become extra important in the future, yet currently only 37% dedicate substantial time to this. RNs face challenges in effectively utilizing electronic communication with patients and thus need opportunities to improve digital skills. Additionally, RNs desire enhanced collaboration with other healthcare professionals, such as GPs and medical specialists. Conclusions RNs’ limited time allocation and perceived inadequacy in electronic patient communication, underscore the importance of targeted training in this area, and prioritizing this by healthcare organizations. In addition, fostering collaboration between nursing staff and other healthcare professionals could support future proof nursing in primary care. Key messages • Nurses demonstrate resilience in addressing healthcare challenges, emphasizing client care, prevention and family engagement. • Training nurses in competencies for electronic communication with patients is essential to meet the anticipated increase in demand for this aspect in their practice.

Short-term effects on physical activity level with web-based self-management support in people with COPD: a randomised controlled trial

We aimed to evaluate short-term effects of a web-based self-management support on objectively measured physical activity (PA) compared to usual care in people with chronic obstructive pulmonary disease (COPD). We conducted a pragmatic randomised controlled trial including people with stable COPD within primary healthcare. Participants were randomised to intervention group, IG (access to the COPD Web, an interactive website to support self-management with focus on PA), or to control group, CG (usual care). Primary outcome at 3 months was change in accelerometry-measured daily steps analysed with ANCOVA, and secondary outcomes were self-reported PA, disease-related symptoms, and quality of life. Missing data in intention-to-treat (ITT) analyses were multiply imputed. One hundred and forty-six participants (n = 73/group), mean (SD) age 69.5 (6.7) years, FEV1pred 60.7 (19.1)% were included. The ITT analysis showed no significant difference in steps between the groups: 1295 steps (95% CI: [−365, 2955], p = 0.12), while the complete case analysis (n = 98) revealed a significant difference of 1492 steps (95% CI: [374, 2609], p = 0.01) in favour of IG. A significant increase in self-reported PA was seen in IG in both the ITT and complete case analysis. In summary, access to the COPD Web was insufficient to increase short-term PA level compared to usual care. However, among participants with complete step data, a clinically relevant effect on daily steps exceeding the minimal important difference was observed, partly explained by higher baseline PA than among dropouts. This indicates that access to the COPD Web may increase PA levels for some people with COPD.

Participants' Perspectives on Diabetes Self-Management Programming at Church: Faith-Placed Versus Faith-Based Approach.

The purpose of the study was to explore Hispanic adults' experiences participating in the Building a Healthy Temple diabetes self-management education and support (DSMES) cluster randomized trial and collect their insights on intervention approach, delivery, content, impact, and suggested improvements for future DSMES programs delivered at church. Focus groups were conducted with participants from both intervention arms, that is, faith-based (FB) group and faith-placed group. Participating churches were predominantly Hispanic and located in San Antonio, Texas. Focus groups were audiotaped and transcribed verbatim. Inductive content analysis was performed with the assistance of NVivo software to code and categorize emerging themes. A total of 138 adult participants took part in the current study. Participants in both groups highly valued the church setting for its convenient location and support system and reported positive changes in diabetes-related beliefs, knowledge, skills, behaviors, and health outcomes. FB participants appreciated the incorporation of spiritual teachings and facilitation by lay leaders, which created a sense of empowerment and improved outlook on living with diabetes. Church holds promise as a setting for DSMES program delivery in Hispanic communities. Church-based DSMES programs using a FB approach may further facilitate program adoption and sustainability.

Health-related quality of life of people with depression: pre-post intervention compared with age-matched general population in Vietnam

BackgroundIn Vietnam, there is a paucity of health-related quality of life (HRQoL) research on people with depression as well as a lack of evidence on supported self-management (SSM) intervention for depression on HRQoL. This study aimed to compare the HRQoL of people with depression and age-matched people in the Vietnamese population, evaluate the effects of Tele-SSM intervention on HRQoL, and examine the association between the changes in HRQoL score and mental health well-being (depression, anxiety, and stress).MethodsThis study was a pre- and post-study involving Vietnamese adults aged 18–64 who had depression symptoms (score ≥ 5 points in the PHQ-9). Participants (N = 58) completed Tele-SSM—a supported self-management intervention incorporating cognitive behavioral therapy and non-violent communication and using a task-shifting approach. To compare with the general population, we conducted a 1-to-1 matching by age with an EQ-5D-5L valuation study with a nationally representative sample of the Vietnamese general population.ResultsHRQoL was significantly impaired in people with depression compared to the age-matched general population. Regarding health profile, participants reported the most difficulties in usual activities, pain/discomfort, and anxiety/depression dimensions. Significant improvements were observed in HRQoL scores post-intervention compared to pre-intervention in both EQ-VAS scores (from 59.84 to 79.48) and utility scores (from 0.79 to 0.90). These results remained lower than the age-matched general population (EQ-VAS score = 83.28, utility score = 0.96). Depression was associated with lower HRQoL while controlling for stress, anxiety symptoms and sociodemographic characteristics.ConclusionsThese results indicate that HRQoL is significantly impaired in people with depression and contribute to providing empirical evidence of Tele-SSM intervention in improving HRQoL. Further randomized controlled trials should be conducted to evaluate the effectiveness and cost-effectiveness of the Tele-SSM intervention.

"It Is What It Is" - The Lived Experience of Women With Breast Cancer Undergoing Axillary Lymph Node Dissection.

The lived experience of women undergoing axillary procedures as part of their breast cancer (BC) treatment remains unexplored. This lack of in-depth understanding could hamper implementation of person-centred care, which is concerning because BC is the most common form of cancer in women. The aim of this study was therefore to explore the lived experiences of women undergoing axillary lymph node dissection (ALND) due to BC. Twelve women with a mean age of 59 years were interviewed about their lived experiences of axillary procedures as part of their BC treatment. The interviews were recorded, transcribed verbatim, and analysed using a phenomenological hermeneutical method. This narrative method enabled the researchers to reinterpret the worlds of the women with BC, as reflected in the data. The naïve understanding, ie, the meaning of the text as a whole, revealed that the participants were in a process of accepting and adapting to their life after ALND involving adjuvant chemotherapy and/or hormonal therapy. Thus, six main themes emerged in the thematic structural analysis illustrating the meaning of acceptance and adaptation when suffering from BC and undergoing a treatment trajectory, ie, establishing coherence, adjusting to treatment, safeguarding social belonging, re-defining oneself, feeling vulnerable, and accepting one's circumstances. If healthcare professionals provided structure and consistency, the women's treatment and lived experiences made sense; the women experienced more certainty, freedom, and meaningful social interactions. Uncertainty occurred when the women became lost in their own sense-making process, leading to low self-efficacy. There is a need for a paradigm shift in surgical care from viewing women with BC as anatomical constructions in need of repair to deeply understanding that they are persons with an illness who require ongoing self-management support.

Digital Health Tools and Behavioral Strategies to Increase Engagement With Diabetes Self-Management Education and Support: Design and Feasibility of DM-BOOST.

The purpose of the study was to describe the development and feasibility of implementing the DM-BOOST program in support of an established diabetes self-management education and support (DSMES) program. A patient panel of 4 adults with type 2 diabetes (T2DM) codesigned DM-BOOST. DM-BOOST is a patient-focused program that includes peer-written text messages about diabetes self-management behaviors and digital health training to improve patient portal use and initiate goal setting prior to a scheduled DSMES appointment. Adults with T2DM and A1C ≥8.0% participated in a 6-month feasibility pilot. Participants were randomly assigned (1:1) to receive either DM-BOOST or usual care. Outcomes included DSMES engagement (scheduled and attended DSMES appointments) and changes in diabetes self-efficacy and treatment satisfaction. Pilot participants (n = 60) were 60.0% female with mean age 45.5 years (SD 8.3) and A1C 10.1% (SD 1.8%). All DM-BOOST participants (30/30, 100%) had DSMES appointments scheduled compared to 86.7% of usual care (26/30). DM-BOOST participants had fewer DSMES appointment no-shows/cancellations (3/30, 10%) compared to usual care (10/26, 35%). There was greater improvement in diabetes self-efficacy in the DM-BOOST group compared to usual care and no difference in treatment satisfaction. DM-BOOST, leveraging peer-written text messaging and digital health training, increased DSMES engagement. Implementation of DM-BOOST was determined to be feasible, with several system-level barriers identified, including obtaining provider referrals and scheduling appointments. An effectiveness trial of DM-BOOST is needed to evaluate the impact on clinical outcomes.