Understanding Of Self-management Research Articles

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.

Exploring community-dwelling stroke survivors' experiences of receiving a nurse-led theory-based stroke self-management programme: A qualitative study.

International evidence-based guidelines recommend self-management support for stroke survivors to improve their health outcomes. We developed a 4-week nurse-led stroke self-management programme (SSMP) and conducted a randomised controlled trial to assess its effects. This paper reports the findings of a qualitative study nested within the randomised controlled trial to explore stroke survivors’ experiences of SSMP participation. Semi-structured interviews were conducted with all adult participants who were clinically diagnosed with a first or recurrent ischaemic or haemorrhagic stroke, residing at home, communicable in Cantonese, had a Montreal Cognitive Assessment score below the second percentile, and participated in at least 1 SSMP session. All interviews were conducted in Cantonese, lasted approximately 45 minutes, and were audio-recorded. Interview data were transcribed verbatim and analysed thematically. Sixty-four stroke survivors (mean age 66.33 years, SD 12.34) were recruited, and 59 were interviewed via phone immediately after completion of SSMP. Three themes were derived. Overall, participants were satisfied with the SSMP. Their understanding of self-management was improved, and they recognised its importance in recovery. Their confidence in self-management was also enhanced through the use of multifaceted strategies. Suggestions were made to enhance their participation experiences, including increased home visits and group sessions, making group session attendance optional and arranging them more accessibly, meeting the survivors who shared their survival experiences in the videos, and access to the videos online. This study concurred that the SSMP enhanced stroke survivors’ self-efficacy in self-management. Rearrangement of the programme format and enhancements in accessibility could be further examined to enable more effective stroke self-management.

Improving Mental Health during the COVID-19 Pandemic through Online Psychoeducation

The COVID-19 pandemic alters many aspects of everyday life that we have grown accustomed to. The enactment of various new policies to curb the spread of the disease, i.e., social distancing, work and study from home, restrictions on large-scale activities and restriction in travelling, compel each one of us to adjust. Not to mention the fear of being infected with COVID-19. These conditions led to various psychological problems such as anxiety, low hope, and negative emotions. Efforts to improve people’s mental health are urgently needed. One such step is to increase one’s understanding of self-management in facing psychological problems due to COVID-19. This study aims to improve the community’s mental health, namely the residents of Blotan hamlet during the COVID-19 pandemic through online self-management psychoeducation. To test the effectiveness of psychoeducation, this study used a one-group pre and post-test design. A total of 31 subjects participated in the activity in full. We can infer the effectivity through the anxiety score, hope, and positive emotions on the pre and post-test measurements. The results found that self-managed psychoeducation facing psychological problems during the pandemic significantly increased positive emotions (t = -2,753, df = 30, and p <.05). As for the measurement of anxiety and hope, there was no significant change due to the subject’s anxiety score and hope were already in the medium category.

Self-Management as Socially Embedded Endeavor

When we first anticipated the research project concluded with this special issue, about eight years ago, it seemed timely and appropriate to investigate the opportunities and the challenges of self-management in mental health care. At the time self-management was well on the rise in general health care, offering both empowerment to patients and efficiency and cost-effectiveness to the health care system. It seemed a most promising approach in an era that celebrates individualistic self-reliance. And we were sure about our insight that self-management in mental health care would deserve comprehensive investigation because ‘the self’ that was supposed to do the management would itself be the core problem in psychiatric and psychosomatic conditions. Now that the project is over and done with some changes seemed to have happened in the general appreciation of individualism and of the dominant kind of management. As we are writing this during the COVID-19 crisis – locked up at home obeying the instruction to keep physical distance – these changes seem to accelerate. We cannot do it alone. And we shouldn’t think of self-regulation in terms of decisive control. Solidarity and entrustment markedly strike home. It may be that we have picked up the Zeitgeist in our research or have played a role ourselves in bringing about these changes. Either way, the results discussed in this issue certainly resonate with a transformation that might be in progress. In this concluding paper we want to highlight two novel features of our understanding of self-management as it turned out to find articulation in our investigations. One feature concerns a shift in our understanding of management, a shift away from decisive control towards an embedded facilitation. We can follow this shift along three lines of analysis, which concern different scaffolding resources: environmental cues, language and caregivers. The other feature concerns the acknowledgement of a potentially persistent ambiguity of the self as an element of self-management. The preceding papers display the conceptualization of this ambiguity along five different dimensions of ‘the self’: responsible agency, experiential subjectivity, personal integrity, narrative authority and existential concern.

The Taxonomy of Everyday Self-management Strategies (TEDSS): A framework derived from the literature and refined using empirical data

ObjectiveTo extend our understanding of self-management by using original data and a recent concept analysis to propose a unifying framework for self-management strategies. MethodsLongitudinal interview data with 117 people with neurological conditions were used to test a preliminary framework derived from the literature. Statements from the interviews were sorted according to the predefined categories of the preliminary framework to investigate the fit between the framework and the qualitative data. Data on frequencies of strategies complemented the qualitative analysis. ResultsThe Taxonomy of Every Day Self-management Strategies (TEDSS) Framework includes five Goal-oriented Domains (Internal, Social Interaction, Activities, Health Behaviour and Disease Controlling), and two additional Support-oriented Domains (Process and Resource). The Support-oriented Domain strategies (such as information seeking and health navigation) are not, in and of themselves, goal focused. Instead, they underlie and support the Goal-oriented Domain strategies. Together, the seven domains create a comprehensive and unified framework for understanding how people with neurological conditions self-manage all aspects of everyday life. ConclusionsThe resulting TEDSS Framework provides a taxonomy that has potential to resolve conceptual confusion within the field of self-management science. Practice ImplicationsThe TEDSS Framework may help to guide health service delivery and research.

Prerequisites for patient self-management learning at hospital discharge – an observational multiple case study

Introduction : In recent years much attention has been given to care transitions between healthcare settings and to re-hospitalizations. This is not without reason. Errors in medication, therapy, and in follow-up of tests and procedures following hospitalization are not uncommon and the associated costs are profound. Putting effort on increasing patients’ knowledge on disease control and symptom management has shown an effect on decreased re-hospitalization rates. Yet, little is known about how the information aimed to prepare patients are given to patients during hospital discharge, and how the information make sense to the patients. This study aims to explore how the hospital discharge process provides a learning environment for patients’ understanding of their self-management. Theory/Methods : This study uses observational multiple-case study design. The cases – three wards of internal medicine from different hospital types: one regional, one general and one university hospital, all located in the county council of Stockholm, Sweden – were selected to allow inclusion of patients with varying diagnoses and backgrounds. The observations primarily focused on the discharge encounters but included other events where patient self-management learning was considered to either take place or be discussed: medical distribution, bedside rounds, formal/informal meetings between patients and healthcare professionals. After the observed discharge encounters, patients and their present next-of-kin who agreed to participate in the study, and thereafter the discharging healthcare professional were interviewed. Semi-structured interview guides were used. Data was analysed using cross-case synthesis in which the case under study at each units first were analysed separately, using content analysis, where after the analyses were compared and cross-case conclusions drawn. Results : The wards were overall similar in the prerequisites for patient understanding of self-management in the hospital discharge process. Patient understanding of self-management were supported or constrained during the medical distribution by the registered nurses, the bedside rounds and the discharge encounters. Each of these encounters provided opportunities for the patients to learn about self-management, and for the healthcare professionals to gain and provide information to support the patients’ self-management. Patients were not involved in the decisions preceding discharge. The bed-side rounds overall focused on giving informations to patients and not on involving patients in the communication. The short hospital stays were considered as barriers for patient self-management learning; the patients were too stressed at the discharge encounters to grasp the information and the healthcare professionals lacked time to grasp the patients’ situation and needs. The healthcare professionals used several pedagogical efforts to facilitate patient understanding. The efforts were however not a conscious thought-through strategy and the professionals expressed uncertainty whether the patients had understood the information or not. Upon discharge, patients received a plain language written discharge note and medication list. The oral information followed the structure of the discharge letter, omitting self-management activities. Patients’ made several efforts to facilitate their understanding, they checked that they had understood the healthcare professional, asked for clarification and confirmed when they had understood. Discussion : The discharge letter constituted the base of the discharge information, as both the oral and written information given by the physician sprung out of the letter. As we found that the discharge letter overall had a retrospective focus it only gives patients limited understanding of self-management activities post-discharge. Much time and effort was put into providing patients with accurate information and to facilitate the practical details of the discharge. However, only a small amount of effort was given to involve patients in the decisions, to ensure that patients had understood the information and had the skills to manage the self-management needed. Evidence suggests that information alone does not promote patient adherence to medications. A targeted, person-centred communication, in order to reach common ground for decision-making, is far from realized in healthcare. In contrast we found that patients were not actively involved in the planning of their discharge, and that sensemaking rarely came through in the discharge encounters. Conclusion : The information given at discharge was driven by the needs of the staff of communicating information, rather than patients´ needs or level of understanding. Simple use of pedagogical teaching and patients’ involvement in the decisions preceding discharges with the aim of ensuring patient understanding has the potential to enhance patient self-management knowledge, whereas a system accountability overlapping the gaps could provide patients with comfort to put knowledge into action.

Negotiating role management through everyday activities: narratives in action of two stroke survivors and their spouses

Purpose: To manage social roles is a challenging part of self-management post-stroke. This study explored how stroke survivors act as role managers with their spouses in the context of everyday activities.Method: Two stroke survivors with a first time stroke living at home with a spouse were included. Data were generated through participant observations at their own environment at 3, 6, 9, 15 and 21 months post-discharge. The narrative analysis focused on the actions of participants.Results: Daily activities can be understood as an arena where role management and a meaningful live is negotiated and co-constructed with others. Everyday activities gave stroke survivors and their spouses insight into stroke survivors’ capacities in daily situations. This was sometimes empowering, and other times conflicting when a spouse had negative perceptions of the abilities of the stroke survivors.Conclusion: The findings add to the current understanding of self-management and role management with regard to how these are situated in everyday activities. Daily activities can help both spouses to reflect and understand about self-management, role management and comanagement in daily life. Moreover, observing stroke survivors in everyday situations provides professionals with concrete pictures of stroke survivors’ performance and self-management in interaction with their spouses.Implications for RehabilitationSelf-management is a dynamic process in which individuals actively manage a chronic condition and finally live a meaningful life with a long-term chronic condition; self-management can be divided into medical, role, and emotional management; comanagement is when individuals activate resources and use the capacities of other persons to manage a situation together.Self-management is situated in everyday activities. Everyday activities give stroke survivors ánd their partners impressions about stroke survivors’ self-management abilities post-stroke in an everyday context.Everyday activities give stroke survivors ánd their partners an arena where role management and a meaningful life are negotiated and coconstructed through doing.Observing stroke survivors in everyday situations provides professionals a concreter picture of stroke survivors’ self-management and comanagement with their partners than can be obtained from an informal interview.

Meaning of self-management from the perspective of individuals with traumatic spinal cord injury, their caregivers, and acute care and rehabilitation managers: an opportunity for improved care delivery.

BackgroundThe trend of decreasing length of stay in rehabilitation facilities has led to individuals with spinal cord injury (SCI) entering the community with unmet needs and fewer self-care skills to prevent secondary complications. The implementation of a self-management program for individuals with SCI for the management of these complex needs, including secondary complications, may be one option to fill these care gaps. A greater understanding of the meaning of self-management may facilitate the development of a tailored self-management program in this population. Thus, the current research aims to understand the meaning of self-management in traumatic SCI from the perspectives of individuals with traumatic SCI and their caregivers as well as acute care/trauma and rehabilitation managers.MethodsA descriptive qualitative approach was used. Semi-structured telephone interviews were conducted with 26 individuals with traumatic SCI, their family members/caregivers, and managers from acute care/trauma and rehabilitation centres. Inductive thematic analysis was applied.ResultsThe meaning of self-management in SCI related to two overarching themes of internal and external responsibility attribution and revealed differences between the meaning of self-management in SCI among individuals with traumatic SCI and their caregivers versus managers. Overall, the meaning of self-management among the SCI and caregiver participants related principally to internal responsibility attribution. For the manager participants, the meaning of self-management was much narrower and the overarching theme of internal responsibility attribution that was observed among the SCI-caregiver dyads was not as widely expressed by this group.ConclusionsInterventions that are co-created by users and health care professionals are associated with positive physical and mental health outcomes. Thus, the understanding of self-management from these varying perspectives could be applied to the development of a tailored self-management program that is relevant to individuals with traumatic SCI and their caregivers. This may involve the development of a program that uses some of the structure of traditional chronic disease self-management programs, in accordance with the beliefs held by the managers, but also incorporates elements of wellness/health promotion interventions, in accordance with the beliefs held by the SCI and caregiver participants.

French view on the causes of dissolution of SFRY: The case of the extreme left

Within this text, the interpretations of the dissolution of the SFRY by the most prominent representatives of the 'extreme left' are presented and analyzed. Introductory part contains essential and interpretive elements, while the rest of the text will disseminate and explain, with the aid of the research technique critical discourse analysis, the key elements that determine different standpoints of the 'extreme left' with regard to the dissolution of the SFRY. It is persuasively shown that the difference in the angle of view are caused by their different ideological characters, as well as historically founded differences with regard to their view on the existence of Yugoslavia, understanding of self-management, 'titoism', as well as the character of revolutionary Party. When this ideological frame is inserted into this equation, it becomes understandable why certain 'intellectual circles' when thinking on the dissolution of SFRY put emphasis on imperialism and economic questions, nationalism and the issues of identity, or finally on Stalinist bureaucracy and the conditioning of this process by social classes.

Creativity and power: A qualitative, exploratory study of student learning acquired in a community nursing setting that is applied in future settings

Nursing students undertake clinical placements in a wide range of clinical areas as part of their preparation for professional practice, offering students the opportunity to learn about the clinical context and the work that nurses do. This descriptive study explores the implicit learnings that occur for students in a community nursing placement and whether they transfer the knowledge they gain in the community setting into practice in other settings. Participants in this research study described implicit learning from a community nursing context which they were able to utilise in their current practice. Three major themes emerged. Firstly, participants recognised that power relationships manifest differently in a community based setting. This manifest in a recognition of patient autonomy and a creative approach to enhancing the patient’s power. The second, related theme involved the enabling of self-determination through collaborative decision making between nurse and the person receiving care. The third theme was the development of an understanding of self-management which manifest in appropriate referrals and what the participants considered high quality discharge planning. This recognition of practice beyond technical, rationalist manifestations suggests that students grasped the unarticulated, implicit dimensions of the community nurse role through their experiences in a community nursing placement.

Creativity and Power: a qualitative, exploratory study of student learning acquired in a community nursing setting that is applied in future settings.

Abstract Nursing students undertake clinical placements in a wide range of clinical areas as part of their preparation for professional practice, offering students the opportunity to learn about the clinical context and the work that nurses do. This descriptive study explores the implicit learnings that occur for students in a community nursing placement and whether they transfer the knowledge they gain in the community setting into practice in other settings. Participants in this research study described implicit learning from a community nursing context which they were able to utilise in their current practice. Three major themes emerged. Firstly, participants recognised that power relationships manifest differently in a community based setting. This manifest in a recognition of patient autonomy and a creative approach to enhancing the patient's power. The second, related theme involved the enabling of self-determination through collaborative decision making between nurse and the person receiving care. The third theme was the development of an understanding of self-management which manifest in appropriate referrals and what the participants considered high quality discharge planning. This recognition of practice beyond technical, rationalist manifestations suggests that students grasped the unarticulated, implicit dimensions of the community nurse role through their experiences in a community nursing placement.

Reflections on the ethical dilemmas involved in promoting self-management

Due to their understanding of self-management, healthcare team members responsible for depressed older persons can experience an ethical dilemma. Each team member contributes important knowledge and experience pertaining to the management of depression, which should be reflected in the management plan. The aim of this study was to explore healthcare team members’ reflections on the ethical dilemmas involved in promoting self-management among depressed older persons. A qualitative design was used and data were collected by means of focus group interviews. The results revealed one main theme: ‘Lack of trust in the community health care system’s commitment to bringing about effectiveness and change, based on three themes; ‘Struggling to ensure the reliable transfer of information about depressed older persons to professionals and family members’, ‘Balancing autonomy, care and dignity’ and ‘Differences in the understanding of responsibility’. Lack of engagement on the part of and trust between the various professional categories who work in the community are extremely counterproductive and have serious implications for patient dignity as well as safety. In conclusion, ethical dilemmas occur when staff members are unable to act in accordance with their professional ethical stance and deliver an appropriate standard of care.

Self‐Management in Pediatric Inflammatory Bowel Disease

This clinical report aims to review key self-management and adherence issues in pediatric inflammatory bowel disease (IBD) and to provide recommendations for health care providers regarding evidence-based assessment and treatment approaches to promote optimal self-management. Self-management difficulties in the form of nonadherence to treatment regimens are common in pediatric IBD and are influenced by various disease-related, individual, family, and health professional relationship factors. To promote adaptive self-management, health care providers are encouraged to adopt a long-term preventive orientation, which includes routine screening of barriers to self-management and nonadherence in the context of routine clinic appointments. The use of a multimethod approach to assessment that incorporates objective measures (eg, pill counts or bioassays) may be particularly advantageous. Individualized treatment approaches that incorporate evidence-based practices, such as providing written treatment plans and offering opportunities to practice and receive feedback on skills, may help to ameliorate minor self-management concerns; however, more severe or chronic self-management problems may require a referral for behavioral health intervention. Additional research to broaden our understanding of self-management in domains beyond medication adherence and to evaluate the effect of clinic-based interventions is imperative.

P108 Healthcare Professionals Perceptions of Self Management in COPD – Important, Challenging and Misunderstood

IntroductionThere is increasing focus on the importance of self management (SM) within COPD. Literature from other chronic diseases highlights the challenges of implementing SM and the lack of specialist training...

Self management and patient understanding of diabetes in the older person

AimTo examine knowledge and management of diabetes by older people.MethodsA representative sample of 1047 people with Type 2 diabetes, aged 75 years and over, were asked a series of questions relating to their diabetes management and their understanding of self management. The impact of cognitive impairment and socio-economic status were assessed.ResultsThe majority of people, 1015 (96.9%), were under the care of a health professional and 1018 (97.2%) were taking insulin, tablets, controlling their diet or a combination. Cognitive impairment (Mini-Mental State Examination ≤ 23) was found in 235 (22.5%) people. Recent eye, foot and dietician assessment was reported by 813 (77.7%), 836 (79.7%) and 326 (31.1%) people, respectively. A quarter overall and 70% of those taking insulin tested their blood glucose. In the insulin group, 78 (54.2%) reported hypoglycaemia and those with cognitive impairment gave more incorrect responses when asked about diabetes management. Socio-economic status made very little difference to any of these outcomes.ConclusionsMost older people with diabetes, regardless of their socio-economic status, are under the care of a healthcare professional and use medication or diet to manage their disease. Large numbers also attend foot and eye examinations. However, over one fifth of older people with diabetes have cognitive impairment. Older people had a reasonable understanding of their diabetes management but this was worse in those people with cognitive impairment.Diabet. Med. 28, 117–122 (2011)

Struggling with behavior changes: a special case for clients with diabetes.

Health professionals expect clients with diabetes to change multiple behaviors as a way to decrease the risk of complications of the disease. The purpose of this study was to gain an in-depth understanding of the client's response to lifestyle change expectations. Using the transtheoretical model of change as framework for this study, clients were asked to address the level of difficulty they encountered when making lifestyle changes relating to their diabetes. Ten clients who participated in a taped telephone survey and a videotaped focus group reported that most change was difficult but not impossible. Most clients admitted that maintaining changes was a continuing battle. Both the transcripts and focus group revealed a wide variation in the clients' understanding of self-management. It was evident that successful management involves a fairly high level of cognition as well as willingness to change. Successful management involves thinking through and comprehending how diet, exercise, and medication relate to blood glucose levels. This preliminary study will be used as the basis for a more inclusive study that will focus on developing interventions that relate directly to helping clients change behavior.

An analysis of self-management

We discuss topics related to a theoretical analysis of self-management, including theories of self-management, self-reinforcement and self-management, antecedent stimuli for self-management, teaching of self-management behaviors, and applications of self-management. Our analysis indicates that self-management's roots in behavioral explanations of phenomena are solid, but that there are important issues yet to be examined in developing a thorough understanding of self-management. We argue that self-management behaviors almost certainly must be examined in relation to the contexts in which they occur and the consequences that they produce.

Psychology as a first course in science for 8th graders

An introductory science program based on the principles of the psychology of self-management was taught by an 8th-grade science instructor and evaluated using a variation on multiple baseline procedures. One-hundred-twenty eighth graders were assigned to pilot experimental and control groups. The results suggested that self-management instruction was associated with significantly greater understanding of self-management and behavioral principles, as well as basic science processes. In contrast to the current literature, it was also found that female studens achieved equally well as males in understanding basic science processes after participating in the self-management course.