scholarly journals Apps for Older People’s Pain Self-Management: Perspectives of Primary Care and Allied Health Clinicians

Pain Medicine ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 686-694 ◽  
Author(s):  
Priyanka Bhattarai ◽  
Toby Newton-John ◽  
Jane L Phillips
Keyword(s):  
Primary Care ◽  
Older People ◽  
Older Patients ◽  
Allied Health ◽  
Management Strategies ◽  
Data Access ◽  
Careful Consideration ◽  
Self Management ◽  
Semistructured Interview ◽  
Time Data

Abstract Background Chronic arthritic pain is one of the major causes of physical suffering and disability among older people. Primary care and allied health clinicians use various approaches to help their older clients better manage their arthritic pain. The growing uptake of technology among older people offers the potential for clinicians to integrate an arthritic pain app into their patients’ self-management plans. This study explored the perspectives of Australian primary care and allied health clinicians regarding the use of pain self-management apps to help their older patients/clients better manage their arthritic pain. Methods Qualitative design using a semistructured interview approach. Interviews were conducted via telephone with primary and allied health clinicians (N = 17) across Australia. Results The overarching theme underlying participants’ views on integration of apps into older people’s pain self-management strategy was that this approach is an idealistic but uniquely challenging endeavor. Four subthemes emerged, namely: 1) self-management apps are a potentially useful tool but require careful consideration; 2) clinicians’ involvement is crucial yet potentially onerous; 3) no single app is right for every older person with arthritic pain; and 4) patient data access is beneficial, but caution is needed for real-time data access. Discussion The predominant clinician perspective of integrating apps into their older patients/clients’ pain self-management strategies was that this approach is an idealistic but uniquely challenging endeavor. Apps were seen as having potential to support various aspects of patients’ self-management behaviors; however, there were notable concerns with regards to the challenges inherent in this approach for both clinicians and older users (patients/clients).

scholarly journals Engaging older people in an internet platform for cardiovascular risk self-management: a qualitative study among Dutch HATICE participants

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019683 ◽  
Author(s):  
Tessa van Middelaar ◽  
Cathrien R L Beishuizen ◽  
Juliette Guillemont ◽  
Mariagnese Barbera ◽  
Edo Richard ◽  
...  
Keyword(s):  
Primary Care ◽  
Older People ◽  
Computer Literacy ◽  
The Elderly ◽  
Self Management ◽  
Daily Routine ◽  
Semistructured Interview ◽  
User Friendliness ◽  
Increased Risk ◽  
Internet Platform

ObjectivesTo study older peoples’ experiences with an interactive internet platform for cardiovascular self-management, to assess which factors influence initial and sustained engagement. To assess their views on future use within primary care.DesignQualitative semistructured interview study, with thematic analysis.SettingPrimary care in the Netherlands.ParticipantsPeople ≥65 years with an increased risk of cardiovascular disease who used the ‘Healthy Ageing Through Internet Counselling in the Elderly’ internet platform with remote support of a coach. Participants were selected using a purposive sampling method based on gender, age, level of education, cardiovascular history, diabetes, duration of participation and login frequency.ResultsWe performed 17 interviews with 20 participants, including three couples. In the initial phase, platform engagement was influenced by perceived computer literacy of the participants, user-friendliness, acceptability and appropriateness of the intervention and the initial interaction with the coach. Sustained platform use was mainly facilitated by a relationship of trust with the coach. Other facilitating factors were regular automatic and personal reminders, clear expectations of the platform, incorporation into daily routine, social support and a loyal and persistent attitude. Perceived lack of change in content of the platform could work both stimulating and discouraging. Participants supported the idea of embedding the platform into the primary care setting.ConclusionsHuman support is crucial to initial and sustained engagement of older people in using an interactive internet platform for cardiovascular self-management. Regular reminders further facilitate sustained use, and increased tailoring to personal preference is recommended. Embedding the platform in primary healthcare may enhance future adoption.Trial registration numberISRCTN48151589; Pre-results.

scholarly journals From “Step Away” to “Stand Down”: Tailoring a Smartphone App for Self-Management of Hazardous Drinking for Veterans

10.2196/16062 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e16062
Author(s):  
Daniel Blonigen ◽  
Brooke Harris-Olenak ◽  
Eric Kuhn ◽  
Keith Humphreys ◽  
Christine Timko ◽  
...  
Keyword(s):  
Primary Care ◽  
Mobile App ◽  
Hazardous Drinking ◽  
Self Management ◽  
Primary Care Visit ◽  
Semistructured Interview ◽  
Veterans Health ◽  
Health Administration ◽  
Primary Care Population ◽  
Measurement Based Care

Background US military veterans who screen positive for hazardous drinking during primary care visits may benefit from a mobile app. Step Away is an evidence-based mobile intervention system for the self-management of hazardous drinking. However, Step Away was not designed for veterans, and differences between veterans and civilians could limit the reach and effectiveness of the app with this population. Objective The primary objective of this study was to repurpose Step Away to address the needs and preferences of the veteran primary care population. The Method for Program Adaptation through Community Engagement (M-PACE) model was used to guide the adaptation process. This model can serve as a generalizable approach that other researchers and intervention developers can follow to systematically tailor mobile health tools for a new population. Methods Veteran patients who screened positive for hazardous drinking during a primary care visit (n=12) and peer providers employed by the US Veterans Health Administration (n=11) were recruited to systematically review Step Away and provide feedback on its content and presentation via Web-based surveys and a semistructured interview. Participant feedback was reviewed through an iterative process by key stakeholders who adjudicated which suggested modifications to the app could enhance engagement and effectiveness with veterans while maintaining program integrity. Results Usability ratings of the individual modules of Step Away were uniformly positive across patients and peers, as was the perceived utility of the app overall. Personalized feedback on the health consequences and costs of drinking, options for customization, and the measurement-based care capabilities of the app were viewed as facilitators of engagement. Conversely, lengthy text, small font, and a lack of interactive features were viewed as potential barriers with the older primary care population. Modifications to create a veteran version of the app (Stand Down: Think Before You Drink) included altering the appearance of the app to incorporate more veteran-centric content, adding links and options for resources and activities for veterans, and reducing the amount of text and adding veteran-specific references and common concerns and triggers for drinking in this population. Conclusions The M-PACE model provided a systematic approach to repurpose Step Away to fit the needs and preferences of veteran primary care patients who engage in hazardous drinking. Stand Down may serve as an innovative, low-cost means of expanding access to care for veterans who engage in hazardous drinking.

scholarly journals How do older adults understand and manage distress? A qualitative study

2019 ◽  
Author(s):  
Alice Moult ◽  
Tom Kingstone ◽  
Carolyn Chew-Graham
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Older People ◽  
Help Seeking ◽  
Management Strategies ◽  
Healthcare Services ◽  
Ethical Review ◽  
Structured Interviews ◽  
Management Options ◽  
Community Groups

Abstract Background Anxiety and depression are prevalent in older adults, however, older people may be reluctant to seek medical help and may manage their own mood problems. Due to stigma, older adults are more likely to perceive and/ or recognise their mood problems as distress. Whilst previous literature has focused on how younger adults self-manage mood problems, little research has explored how older people self-manage distress. The study reported here seeks to address this gap through qualitative methods. Methods This study was approved by Keele University’s ethical review panel. Older adults who self-identified as distressed, depressed or anxious within the previous 12 months were recruited from community groups in North Staffordshire, England. Data were generated through semi-structured interviews and analysed thematically using constant comparison methods. A public and patient involvement and engagement group contributed to development of the research questions and methods, and offered their perspectives on the findings. Results Data saturation was achieved after 18 interviews. Key themes were: experiences of distress, actions taken, help-seeking from healthcare services and perceptions of treatments offered in primary care. Various forms of loss contributed to participants’ distress. Participants initiated their own self-management strategies which included: pursuing independent activities, seeking social support and attending community groups and church. Five participants reported having consulted a GP when distressed but described a lack of acceptable treatments offered. Conclusions To support older adults who are distressed, primary care healthcare professionals need to explore patients’ existing ways of managing mood problems, provide information about a range of management options and consider the use of sign-posting older adults to community resources.

scholarly journals Healthy Aging from the Perspectives of 683 Older People with Multiple Sclerosis

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Elizabeth M. Wallack ◽  
Hailey D. Wiseman ◽  
Michelle Ploughman
Keyword(s):  
Multiple Sclerosis ◽  
Older People ◽  
Healthy Aging ◽  
Oldest Old ◽  
Management Strategies ◽  
Self Management ◽  
Social Connections ◽  
Aged People ◽  
Lifestyle Choices ◽  
Design And Methods

Purpose.The aim of this study was to determine what factors most greatly contributed to healthy aging with multiple sclerosis (MS) from the perspective of a large sample of older people with MS.Design and Methods.Participants (n=683; >55 years of age with symptoms >20 years) provided answers to an open-ended question regarding healthy aging and were categorized into three groups, 55–64 (young), 65–74 (middle), and 75 and over (oldest old). Sociodemographic actors were compared using ANOVA. Two independent raters used the framework method of analyzing qualitative data.Results.Participants averaged 64 years of age(±6.2)with MS symptoms for 32.9 years(±9.4). 531 participants were female (78%). The majority of participants lived in their own home (n=657) with a spouse or partner (n=483). Participants described seven themes: social connections, attitude and outlook on life, lifestyle choices and habits, health care system, spirituality and religion, independence, and finances. These themes had two shared characteristics, multidimensionality and interdependence.Implications.Learning from the experiences of older adults with MS can help young and middle aged people with MS plan to age in their own homes and communities. Our data suggests that older people with MS prioritize factors that are modifiable through targeted self-management strategies.

scholarly journals Usual primary care of older people in New Zealand: association between practice characteristics and practice activities

2017 ◽  
Vol 9 (1) ◽  
pp. 78 ◽  
Author(s):  
Leah Palapar ◽  
Laura Wilkinson-Meyers ◽  
Thomas Lumley ◽  
Ngaire Kerse
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Older People ◽  
Older Patients ◽  
Home Visits ◽  
Assessment Tools ◽  
Future Research ◽  
Practice Characteristics ◽  
Care Practices ◽  
Primary Care Practices

ABSTRACT INTRODUCTION Information on the processes used by primary care practices to help identify older patients in need of assistance are limited in New Zealand. AIM To describe the processes used to promote early problem detection in older patients in primary care and the practice characteristics associated with the use of these proactive processes. METHODS Sixty practices were randomly selected from all primary care practices in three regions (52% response rate) and surveyed in 2010 to identify characteristics of practices performing the following activities: using assessment tools; auditing the practice; conducting specific clinics; providing home visits; and providing active patient follow-up. Practice level variables were examined. RESULTS Only 4 (7%) of 57 practices did not perform any of the activities. We found the following associations in the many comparisons done: no activities and greater level of deprivation of practice address (p = 0.048); more activities in main urban centres (p = 0.034); more main urban centre practices doing home visits (p = 0.001); less Canterbury practices conducting specific clinics for frail older patients (p = 0.010); and more Capital and Coast practices following-up patients who do not renew their prescriptions (p = 0.019). DISCUSSION There are proactive processes in place in most New Zealand practices interested in a trial about care of older people. Future research should determine whether different types of practices or the activities that they undertake make a difference to older primary care patients’ outcomes.

scholarly journals From “Step Away” to “Stand Down”: Tailoring a Smartphone App for Self-Management of Hazardous Drinking for Veterans (Preprint)

2019 ◽  
Author(s):  
Daniel Blonigen ◽  
Brooke Harris-Olenak ◽  
Eric Kuhn ◽  
Keith Humphreys ◽  
Christine Timko ◽  
...  
Keyword(s):  
Primary Care ◽  
Mobile App ◽  
Hazardous Drinking ◽  
Self Management ◽  
Primary Care Visit ◽  
Semistructured Interview ◽  
Veterans Health ◽  
Health Administration ◽  
Primary Care Population ◽  
Measurement Based Care

BACKGROUND US military veterans who screen positive for hazardous drinking during primary care visits may benefit from a mobile app. Step Away is an evidence-based mobile intervention system for the self-management of hazardous drinking. However, Step Away was not designed for veterans, and differences between veterans and civilians could limit the reach and effectiveness of the app with this population. OBJECTIVE The primary objective of this study was to repurpose Step Away to address the needs and preferences of the veteran primary care population. The Method for Program Adaptation through Community Engagement (M-PACE) model was used to guide the adaptation process. This model can serve as a generalizable approach that other researchers and intervention developers can follow to systematically tailor mobile health tools for a new population. METHODS Veteran patients who screened positive for hazardous drinking during a primary care visit (n=12) and peer providers employed by the US Veterans Health Administration (n=11) were recruited to systematically review Step Away and provide feedback on its content and presentation via Web-based surveys and a semistructured interview. Participant feedback was reviewed through an iterative process by key stakeholders who adjudicated which suggested modifications to the app could enhance engagement and effectiveness with veterans while maintaining program integrity. RESULTS Usability ratings of the individual modules of Step Away were uniformly positive across patients and peers, as was the perceived utility of the app overall. Personalized feedback on the health consequences and costs of drinking, options for customization, and the measurement-based care capabilities of the app were viewed as facilitators of engagement. Conversely, lengthy text, small font, and a lack of interactive features were viewed as potential barriers with the older primary care population. Modifications to create a veteran version of the app (<i>Stand Down: Think Before You Drink</i>) included altering the appearance of the app to incorporate more veteran-centric content, adding links and options for resources and activities for veterans, and reducing the amount of text and adding veteran-specific references and common concerns and triggers for drinking in this population. CONCLUSIONS The M-PACE model provided a systematic approach to repurpose Step Away to fit the needs and preferences of veteran primary care patients who engage in hazardous drinking. Stand Down may serve as an innovative, low-cost means of expanding access to care for veterans who engage in hazardous drinking.

scholarly journals Self-Management Strategies for Stress and Anxiety Used by Nontreatment Seeking Veteran Primary Care Patients

2017 ◽  
Vol 182 (7) ◽  
pp. e1747-e1754 ◽  
Author(s):  
Robyn L. Shepardson ◽  
Jennie Tapio ◽  
Jennifer S. Funderburk
Keyword(s):  
Primary Care ◽  
Management Strategies ◽  
Self Management ◽  
Primary Care Patients

scholarly journals Understanding how patients establish strategies for living with asthma: a qualitative study in UK primary care as part of IMP2ART

2020 ◽  
Vol 70 (694) ◽  
pp. e303-e311 ◽  
Author(s):  
Luke Daines ◽  
Susan Morrow ◽  
Sharon Wiener-Ogilvie ◽  
Caroline Scott ◽  
Liz Steed ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Cognitive Skills ◽  
Action Plan ◽  
Management Strategies ◽  
Asthma Patient ◽  
Self Management ◽  
Children With Asthma ◽  
Prompt Action

BackgroundIn the context of a variable condition such as asthma, patient recognition of deteriorating control and knowing what prompt action to take is crucial. Yet, implementation of recommended self-management strategies remains poor.AimTo explore how patients with asthma and parents/carers of children with asthma develop and establish recommended self-management strategies for living with asthma, and how clinicians can best support the process.Design and settingA qualitative study in UK primary care.MethodPatients with asthma and parents/carers of children with asthma from 10 general practices were purposively sampled (using age, sex, and duration of asthma) to participate in focus groups or interviews between May 2016 and August 2016. Participants’ experiences of health care, management of asthma, and views on supported self-management were explored. Interviews and focus group sessions were audio-recorded and transcribed verbatim. Iterative thematic analysis was conducted, guided by the research questions and drawing on habit theory in discussion with a multidisciplinary research team.ResultsA total of 49 participants (45 patients; 4 parents/carers) took part in 32 interviews and five focus groups. Of these, 11 reported using an action plan. Patients learnt how to self-manage over time, building knowledge from personal experience and other sources, such as the internet. Some regular actions, for example, taking medication, became habitual. Dealing with new or unexpected scenarios required reflective abilities, which may be supported by a tailored action plan.ConclusionPatients reported learning intuitively how to self-manage. Some regular actions became habitual; dealing with the unexpected required more reflective cognitive skills. In order to support implementation of optimal asthma self- management, clinicians should consider both these aspects of self-management and support, and educate patients proactively.

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