The influencing contexts and potential mechanisms behind the use of online self-management support interventions: a realist evaluation (Preprint)

2021 ◽  
Author(s):  
Marscha Engelen ◽  
Betsie van Gaal ◽  
Hester Vermeulen ◽  
Rixt Zuidema ◽  
Sebastian Bredie ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Behavior Change ◽  
Realist Evaluation ◽  
Support Programs ◽  
Self Management ◽  
Management Support ◽  
Behavior Change Techniques ◽  
Qualitative Interview Study ◽  
Program Characteristics

BACKGROUND Self-management can increase self-efficacy and quality of life and improve disease outcomes in patients with chronic conditions. Effective self-management may also help to reduce the pressure on healthcare systems. However, patients need support in dealing with their disease and in developing skills to manage the symptoms, treatment, physical consequences, psychological consequences, and lifestyle changes associated with their condition. Online self-management support programs have helped patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA) but program use was low. OBJECTIVE This study aims to identify the patient-, disease- and program characteristics that determine whether patients use online self-management support programs or not. METHODS A realist evaluation methodology was used to give a comprehensive oversight of context (patient- and disease characteristics), mechanism (program characteristics), and outcome (program use). The relation between context (sex, age, education, employment status, living situation, self-management [measured using PAM-13], quality of life [measured using RAND-36], interaction efficacy [measured using PEPPI-5], diagnosis, physical comorbidity, and time since diagnosis) and outcome (program use) was analyzed through logistic regression analyses. The relation between mechanism (program design, implementation strategies, behavior change techniques) and outcome was analyzed through a qualitative interview study. RESULTS For this study, 68 non-users and 111 users of the online self-management support programs were included, of which 57% were diagnosed with CVD and 43% with RA. Younger age and a lower level of education were associated with program use. An interaction effect was found between program use and diagnosis (CVD or RA) and four quality of life subscales (social functioning, physical role limitations, vitality, and bodily pain). CVD patients with higher self-management and quality of life scores were less likely to use the program, while RA patients with higher self-management and quality of life scores were more likely to use the program. Interviews with ten non-users, ten low-users, and 18 high-users were analyzed to give insight into the relation between mechanisms and outcome. Program use was encouraged by an easy to use, clear, and transparent design and by recommendations from a professional and email reminders. Five behavior change techniques were identified as potential mechanisms to promote program use: tailored information, self-reporting behavior with delayed feedback, giving information on peer behavior, and modeling. CONCLUSIONS This realist evaluation showed that certain patient-, disease-, and program characteristics are associated with the use of online self-management support programs. These results can help developers of future online self-management support programs to tailor the interventions to increase use and effectiveness.

scholarly journals A Causal Relationship of Home Care Services on the Quality of Life among Survivors of Stroke in Thailand

2021 ◽  
Vol 18 (5) ◽  
Author(s):  
Patoomthip ADUNWATANASIRI ◽  
Siriorn SINDHU ◽  
Napaporn WANITKUN ◽  
Chukiat VIWATWONGKASEM
Keyword(s):  
Quality Of Life ◽  
Home Care ◽  
Functional Status ◽  
Home Care Services ◽  
Self Management ◽  
Stroke Survivors ◽  
Management Support ◽  
Policy Makers ◽  
Care Services

Survivors of stroke suffer impairments associated with a complex need of care from healthcare services after being discharged from hospital and returning home, and these impairments affect the quality of their lives. This cross-sectional study, aimed at evaluating the pathways linking home care services, patient factors, and quality of life (QOL), was carried out by conducting interviews and questionnaires with stroke survivors at their homes. Simple random sampling was used to select the settings for data collection, and multi-stage sampling was used to select the samples. In all, 317 stroke survivors admitted to 13 hospitals in rural and urban setting were selected for participation in the study. The data obtained were analyzed by using Structural Equation Modeling (SEM). The hypothetical model demonstrated a good fit (chi-square = 15.299, df = 9, p = 0.083, GFI = 0.98, CFI = 0.98, RMSEA = 0.047). Statistically significant explanatory variables for the home care service had a direct effect on perceived self-management support, functional status, and QOL (β = 0.39, 0.12 and 0.11, respectively), while number of community supporters had a significant positive indirect effect on QOL through functional status (β = 0.13). The variables accounted for 56 % of the variance in QOL. This finding could be used by policy makers to make important policy development in home care services and help improve health outcomes. In particular, it is also recommended that policy makers push for policies that encompass self-management support and community support groups among stroke survivors in community settings.

scholarly journals Digital Self-Management Support Tools in the Care Plan of Patients With Cancer: Review of Randomized Controlled Trials

10.2196/20861 ◽  
2021 ◽  
Vol 23 (6) ◽  
pp. e20861
Author(s):  
Danielle JM Adriaans ◽  
Angelique TM Dierick-van Daele ◽  
Marc Johannes Hubertus Maria van Bakel ◽  
Grard AP Nieuwenhuijzen ◽  
Joep AW Teijink ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Randomized Controlled Trials ◽  
Self Management ◽  
Controlled Trials ◽  
Management Support ◽  
Patients With Cancer ◽  
Randomized Controlled ◽  
Support Tools

Background Digital self-management support tools (DSMSTs)—electronic devices or monitoring systems to monitor or improve health status—have become increasingly important in cancer care. Objective The aim of this review is to analyze published randomized clinical trials to assess the effectiveness of DSMSTs on physical and psychosocial symptoms or other supportive care needs in adult patients with cancer. Methods Five databases were searched from January 2013 to January 2020. English or Dutch language randomized controlled trials comparing DSMSTs with no intervention, usual care, alternative interventions, or a combination and including patients aged ≥18 years with pathologically proven cancer in the active treatment or survivorship phases were included. The results were summarized qualitatively. Results A total of 19 publications describing 3 types of DSMSTs were included. Although the content, duration, and frequency of interventions varied considerably across studies, the commonly used elements included an assessment component, tailored symptom self-management support, an information section, a communication section, and a diary. Significant positive effects were observed on quality of life in 6 (out of 10) studies, on anxiety in 1 (out of 5) study and depression in 2 (out of 8) studies, on symptom distress in 5 (out of 7) studies, on physical activity in 4 (out of 6) studies, on dietary behavior in 1 (out of 4) study, and on fatigue in 2 (out of 5) studies. Moreover, significant negative effects were observed on anxiety in 1 (out of 5) study and depression in 1 (out of 8) study. Most interventions were web-based interventions; 2 studies used mobile apps, and 1 study used a game as a DSMST. The overall quality of the studies was found to be good, with 13 out of 19 studies classified as high quality. Conclusions This review suggests that DSMSTs have a beneficial effect on the quality of life. For effects on other patient outcomes (eg, anxiety and depression, symptom distress, physical activity, dietary behavior, and fatigue), the evidence is inconsistent and limited or no effect is suggested. Future research should focus on specific tumor types, study different types of interventions separately, and assess the effects of specific interventions at different stages of disease progression.

Research Implementing the Flinders Model of Self-management Support with Aboriginal People who have Diabetes: Findings from a Pilot Study

2008 ◽  
Vol 14 (1) ◽  
pp. 66 ◽  
Author(s):  
Malcolm W. Battersby ◽  
Jackie Ah Kit ◽  
Colleen Prideaux ◽  
Peter W. Harvey ◽  
James P. Collins ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Assessment Tool ◽  
Aboriginal People ◽  
Health Workers ◽  
South Australia ◽  
Management Program ◽  
Self Management ◽  
Management Support ◽  
Structured Interviews

A pilot program for Aboriginal people with diabetes on Eyre Peninsula, South Australia, aimed to test the acceptability and impact of using the Flinders model of self-management care planing to improve patient self-management. A community development approach was used to conduct a twelve-month demonstration project. Aboriginal health workers (AHWs) conducted patient-centred, self-management assessment and care planning. Impacts were measured by patient-completed diabetes self-management assessment tool, goal achievement, quality of life and clinical measures at baseline and 12 months. Impact and acceptability were also assessed by semi-structured interviews and focus groups of AHWs. Sixty Aboriginal people with type 2 diabetes stated their main problems as family and social dysfunction, access to services, nutrition and exercise. Problems improved by 12% and goals by 26%, while quality of life scores showed no significant change. Self-management scores improved in five of six domains. Mean HbA1c reduced from 8.74-8.09 and mean blood pressure was unchanged. AHWs found the process acceptable and appropriate for them and their patients. It was concluded that a diabetes self-management program provided by AHWs is acceptable, improves self-management and is seen to be useful by Aboriginal communities. Barriers include lack of preventative health services, social problems and time pressure on staff. Enablers include community concern regarding the prevalence and mortality associated with diabetes.

scholarly journals Digital Self-Management Support Tools in the Care Plan of Patients With Cancer: Review of Randomized Controlled Trials (Preprint)

2020 ◽  
Author(s):  
Danielle JM Adriaans ◽  
Angelique TM Dierick-van Daele ◽  
Marc Johannes Hubertus Maria van Bakel ◽  
Grard AP Nieuwenhuijzen ◽  
Joep AW Teijink ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Randomized Controlled Trials ◽  
Self Management ◽  
Controlled Trials ◽  
Management Support ◽  
Patients With Cancer ◽  
Randomized Controlled ◽  
Support Tools

BACKGROUND Digital self-management support tools (DSMSTs)—electronic devices or monitoring systems to monitor or improve health status—have become increasingly important in cancer care. OBJECTIVE The aim of this review is to analyze published randomized clinical trials to assess the effectiveness of DSMSTs on physical and psychosocial symptoms or other supportive care needs in adult patients with cancer. METHODS Five databases were searched from January 2013 to January 2020. English or Dutch language randomized controlled trials comparing DSMSTs with no intervention, usual care, alternative interventions, or a combination and including patients aged ≥18 years with pathologically proven cancer in the active treatment or survivorship phases were included. The results were summarized qualitatively. RESULTS A total of 19 publications describing 3 types of DSMSTs were included. Although the content, duration, and frequency of interventions varied considerably across studies, the commonly used elements included an assessment component, tailored symptom self-management support, an information section, a communication section, and a diary. Significant positive effects were observed on quality of life in 6 (out of 10) studies, on anxiety in 1 (out of 5) study and depression in 2 (out of 8) studies, on symptom distress in 5 (out of 7) studies, on physical activity in 4 (out of 6) studies, on dietary behavior in 1 (out of 4) study, and on fatigue in 2 (out of 5) studies. Moreover, significant negative effects were observed on anxiety in 1 (out of 5) study and depression in 1 (out of 8) study. Most interventions were web-based interventions; 2 studies used mobile apps, and 1 study used a game as a DSMST. The overall quality of the studies was found to be good, with 13 out of 19 studies classified as <i>high quality</i>. CONCLUSIONS This review suggests that DSMSTs have a beneficial effect on the quality of life. For effects on other patient outcomes (eg, anxiety and depression, symptom distress, physical activity, dietary behavior, and fatigue), the evidence is inconsistent and limited or no effect is suggested. Future research should focus on specific tumor types, study different types of interventions separately, and assess the effects of specific interventions at different stages of disease progression.

scholarly journals Quality of Life of Women After a First Diagnosis of Breast Cancer Using a Self-Management Support mHealth App in Taiwan: Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
I-Ching Hou ◽  
Hsin-Yi Lin ◽  
Shan-Hsiang Shen ◽  
King-Jen Chang ◽  
Hao-Chih Tai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Self Management ◽  
Control Group ◽  
Life Questionnaire ◽  
Management Support ◽  
Experimental Group ◽  
First Diagnosis

BACKGROUND There are over 2 million newly diagnosed patients with breast cancer worldwide with more than 10,000 cases in Taiwan each year. During 2017-2018, the National Yang-Ming University, the Taiwan University of Science and Technology, and the Taiwan Breast Cancer Prevention Foundation collaborated to develop a breast cancer self-management support (BCSMS) mHealth app for Taiwanese women with breast cancer. OBJECTIVE The aim of this study was to investigate the quality of life (QoL) of women with breast cancer in Taiwan after using the BCSMS app. METHODS After receiving a first diagnosis of breast cancer, women with stage 0 to III breast cancer, who were recruited from social networking sites or referred by their oncologists or oncology case managers, were randomized 1:1 into intervention and control groups. Intervention group subjects used the BCSMS app and the control group subjects received usual care. Two questionnaires—the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and the EORTC Breast Cancer-Specific Quality-of-Life Questionnaire (QLQ-BR23)—were distributed to subjects in both arms. Paper-based questionnaires were used at baseline; paper-based or Web-based questionnaires were used at 1.5-month and 3-month follow-up evaluations. All evaluations were self-assessed and anonymous, and participants were blinded to their allocation groups. Descriptive analysis, the Pearson chi-square test, analysis of variance, and the generalized estimating equation were used to analyze the data. Missing values, with and without multi-imputation techniques, were used for sensitivity analysis. RESULTS A total of 112 women were enrolled and randomly allocated to either the experimental group (n=53) or control group (n=59). The follow-up completion rate was 89.3% (100/112). The demographic data showed homogeneity between the two groups in age (range 50-64 years), breast cancer stage (stage II), marital status (married), working status (employed), and treatment status (receiving treatments). The mean total QoL summary scores from the QLQ-C30 (83.45 vs 82.23, <i>P</i>=.03) and the QLQ-BR23 (65.53 vs 63.13, <i>P</i>=.04) were significantly higher among the experimental group versus the control group, respectively, at 3 months. CONCLUSIONS This research provides support for using a mobile health care app to promote the QoL among women in Taiwan after a first diagnosis of breast cancer. The BCSMS app could be used to support disease self-management, and further evaluation of whether QoL is sustained is warranted. CLINICALTRIAL ClinicalTrials.gov NCT004174248; https://clinicaltrials.gov/ct2/show/NCT04174248

scholarly journals Quality of Life of Women After a First Diagnosis of Breast Cancer Using a Self-Management Support mHealth App in Taiwan: Randomized Controlled Trial

10.2196/17084 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e17084 ◽  
Author(s):  
I-Ching Hou ◽  
Hsin-Yi Lin ◽  
Shan-Hsiang Shen ◽  
King-Jen Chang ◽  
Hao-Chih Tai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Self Management ◽  
Control Group ◽  
Life Questionnaire ◽  
Management Support ◽  
Experimental Group ◽  
First Diagnosis

Background There are over 2 million newly diagnosed patients with breast cancer worldwide with more than 10,000 cases in Taiwan each year. During 2017-2018, the National Yang-Ming University, the Taiwan University of Science and Technology, and the Taiwan Breast Cancer Prevention Foundation collaborated to develop a breast cancer self-management support (BCSMS) mHealth app for Taiwanese women with breast cancer. Objective The aim of this study was to investigate the quality of life (QoL) of women with breast cancer in Taiwan after using the BCSMS app. Methods After receiving a first diagnosis of breast cancer, women with stage 0 to III breast cancer, who were recruited from social networking sites or referred by their oncologists or oncology case managers, were randomized 1:1 into intervention and control groups. Intervention group subjects used the BCSMS app and the control group subjects received usual care. Two questionnaires—the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and the EORTC Breast Cancer-Specific Quality-of-Life Questionnaire (QLQ-BR23)—were distributed to subjects in both arms. Paper-based questionnaires were used at baseline; paper-based or Web-based questionnaires were used at 1.5-month and 3-month follow-up evaluations. All evaluations were self-assessed and anonymous, and participants were blinded to their allocation groups. Descriptive analysis, the Pearson chi-square test, analysis of variance, and the generalized estimating equation were used to analyze the data. Missing values, with and without multi-imputation techniques, were used for sensitivity analysis. Results A total of 112 women were enrolled and randomly allocated to either the experimental group (n=53) or control group (n=59). The follow-up completion rate was 89.3% (100/112). The demographic data showed homogeneity between the two groups in age (range 50-64 years), breast cancer stage (stage II), marital status (married), working status (employed), and treatment status (receiving treatments). The mean total QoL summary scores from the QLQ-C30 (83.45 vs 82.23, P=.03) and the QLQ-BR23 (65.53 vs 63.13, P=.04) were significantly higher among the experimental group versus the control group, respectively, at 3 months. Conclusions This research provides support for using a mobile health care app to promote the QoL among women in Taiwan after a first diagnosis of breast cancer. The BCSMS app could be used to support disease self-management, and further evaluation of whether QoL is sustained is warranted. Trial Registration ClinicalTrials.gov NCT004174248; https://clinicaltrials.gov/ct2/show/NCT04174248

scholarly journals Internet-Based Self-Management Support After High-Altitude Climate Treatment for Severe Asthma: Randomized Controlled Trial

10.2196/13145 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e13145
Author(s):  
Thijs Beerthuizen ◽  
Lucia H Rijssenbeek-Nouwens ◽  
Sophia M van Koppen ◽  
Rishi J Khusial ◽  
Jiska B Snoeck-Stroband ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Usual Care ◽  
High Altitude ◽  
Asthma Control ◽  
Severe Asthma ◽  
Controlled Trial ◽  
Self Management ◽  
Management Support ◽  
Score Difference

Background In patients with severe asthma, high-altitude climate treatment has been shown to improve asthma control. However, asthma symptoms and limitations may increase after finishing inpatient rehabilitation programs and returning to sea level. Objective We assessed the effectiveness of a patient-tailored, internet-based, self-management strategy in addition to usual care after finishing high-altitude climate treatment. Methods We performed a randomized controlled trial with a 1-year follow-up in patients from a high-altitude asthma center in Davos, Switzerland. At the end of a 12-week multidisciplinary rehabilitation program, 62 adults with asthma were randomized to receive either internet-based self-management support in addition to usual care (n=33) or usual care only after discharge (n=29). The endpoints were changes in asthma-related quality of life according to the Asthma Quality of Life Questionnaire (AQLQ) (a higher score is better) and asthma control according to the Asthma Control Questionnaire (ACQ) (a lower score is better), with a minimally important difference of 0.5 points for both. Results Asthma-related quality of life and asthma control declined over time in the usual care strategy group, whereas there was a slower decline in the internet-based strategy group. For both endpoints, mixed-model analysis showed a significant positive effect in favor of internet-based self-management during follow-up (mean AQLQ score difference 0.39, 95% CI 0.092-0.69; P=.01 and ACQ score difference −0.50, 95% CI −0.86 to −0.15; P=.006), which was prominent among patients with uncontrolled asthma at discharge (AQLQ score difference 0.59, 95% CI 0.19-0.99; P=.003 and ACQ score difference −0.73, 95% CI −1.18 to −0.28; P=.002). Conclusions Internet-based self-management support was associated with a smaller decline in quality of life and asthma control as compared with usual care, especially in patients with lower asthma control, after completion of high-altitude climate treatment. Internet-based self-management support in adults with severe asthma seems feasible and effective to maintain quality of life and asthma control. Trial Registration The trial is registered in the Netherlands Trial Register (NTR1995).

Pain and fatigue

2015 ◽  
Author(s):  
Candy McCabe ◽  
Richard Haigh ◽  
Helen Cohen ◽  
Sarah Hewlett
Keyword(s):  
Quality Of Life ◽  
Best Practice ◽  
Management Strategies ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Routine Care ◽  
Self Management ◽  
Management Support ◽  
Holistic Treatment

Pain and fatigue are the prominent problems for those with a rheumatic disease, and are often underestimated by clinicians. Symptoms may fluctuate in quality and intensity over time and commonly will vary over the course of a day. For pain, clinical signs and symptoms will be dependent on the source of the pain and whether causative underlying pathology is identifiable or not. Fatigue may range from mild effects to total exhaustion and may include cognitive and emotional elements, with a complex, probably multicausal, pathway. Theoretical knowledge of potential mechanistic pathways for pain and fatigue should be used to inform assessment and treatment approaches. Best practice recommends a multidisciplinary and holistic treatment approach with the patient an active participant in the planning of their care, and self-management. Many patients with chronic musculoskeletal conditions will not achieve a pain-free or fatigue-free status. Medication use must therefore balance potential benefit against short- and long-term side effects. Rheumatology centres should offer specific fatigue and pain self-management support as part of routine care. Emphasis should be given to facilitating self-management strategies for both pain and fatigue to help the patient optimize their quality of life over years or a lifetime of symptoms. Interventions should include behaviour change and cognitive restructuring of pain/fatigue beliefs, as well as access to relevant self-help groups and charitable organizations. Referral for specialist advice from regional or national clinics on pain relief and management should be considered if pain interferes significantly with function or quality of life despite local interventions.

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