Evaluation of the nurse-assisted eHealth intervention 'eHealth@Hospital-2-Home' on self-care by patients with heart failure and colorectal cancer post-hospital discharge: protocol for a randomised controlled trial.

BACKGROUND: Patients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care. METHODS: A randomised controlled trial with an embedded evaluation of intervention engagement and cost-effectiveness will be conducted to investigate the effect of eHealth intervention after hospital discharge on the self-efficacy of self-care. Eligible patients with HF or CRC will be recruited before discharge from two Norwegian university hospitals. The intervention group will use a nurse-assisted intervention-eHealth@Hospital-2-Home-for six weeks. The intervention includes remote monitoring of vital signs; patients' self-reports of symptoms, health and well-being; secure messaging between patients and hospital-based nurse navigators; and access to specific HF and CRC health-related information. The control group will receive routine care. Data collection will take place before the intervention (baseline), at the end of the intervention (Post-1), and at six months (Post-2). The primary outcome will be self-efficacy in self-care. The secondary outcomes will include measures of burden of treatment, health-related quality of life and 30- and 90-day readmissions. Sub-study analyses are planned in the HF patient population with primary outcomes of self-care behaviour and secondary outcomes of medication adherence, and readmission at 30 days, 90 days and 6 months. Patients' and nurse navigators' engagement and experiences with the eHealth intervention and cost-effectiveness will be investigated. Data will be analysed according to intention-to-treat principles. Qualitative data will be analysed using thematic analysis. DISCUSSION: This protocol will examine the effects of the eHealth@ Hospital-2-Home intervention on self-care in two prevalent patient groups, HF and CRC. It will allow the exploration of a generic framework for an eHealth intervention after hospital discharge, which could be adapted to other patient groups, upscaled, and implemented into clinical practice. TRIAL REGISTRATION: Clinical trials.gov (ID 301472).

Cancer-related fatigue and treatment burden in surgically treated colorectal cancer patients - A cross-sectional study.

OBJECTIVE: This cross-sectional study aimed to describe cancer-related fatigue (CRF) in colorectal cancer (CRC) patients who were surgically treated with curative intent, identify subgroups at risk of elevated fatigue levels and explore associations between CRF and treatment burden. BACKGROUND: CRF is a prominent symptom among cancer patients. In patients treated for CRC, CRF is associated with adjuvant treatments, low quality of life and reduced ability to self-manage. METHODS: One hundred thirty-four patients with CRC treated at a Norwegian university hospital between 2016-2018 were included. The Schwartz Cancer Fatigue Scale-6 and the Patient Experience with Treatment and Self-management questionnaires were applied for data collection. Statistical analyses included descriptive statistics and non-parametric approaches to analyse correlations and identify differences between groups. The study adhered to STROBE Statement checklist for reporting of cross-sectional studies. RESULTS: Median fatigue level was 10.0 (range: 7.0-13.0). Physical fatigue was higher than perceptual fatigue, with medians of 6.0 (interquartile range [IQR]: 3.0-13.0) and 4.0 (IQR: 3.0-12.0), respectively. Higher fatigue levels were associated with age <60 years, advanced cancer and adjuvant treatments. Increased CRF was significantly associated with higher treatment burden on seven of the nine dimensions, adjusted for demographic and clinical variables. The association of fatigue and treatment burden was stronger in survivors <60 years, with advanced cancer, 6-12 months since surgery or who had more comorbid conditions. CONCLUSIONS: This study showed patients at risk of experiencing CRF following CRC treatment. It established proof of associations between CRF and treatment burden and identified subgroups of CRC patients where this association was stronger. RELEVANCE TO CLINICAL PRACTICE: Screening of CRF in CRC patients can help clinicians provide individualized treatment and care to manage CRF. Clinicians should consider the association between CRF and treatment burden, especially in subgroups of CRF patients.

Factors influencing treatment burden in colorectal cancer patients undergoing curative surgery: A cross-sectional study.

OBJECTIVE: To describe the severity of treatment burden in surgically treated colorectal cancer (CRC) patients and examine associations between treatment burden and demographic and clinical variables. METHODS: This cross-sectional study recruited 134 patients diagnosed with Dukes' stage A-C CRC between 2016 and 2018 who underwent curative surgery. The Patient Experience with Treatment and Self-management (PETS) questionnaire assessed treatment burden domains of 'workload', 'stressors' and 'impact' between 6 weeks and 18 months after primary surgery. RESULTS: Highest scores were observed for difficulty with healthcare services (median score 33.3), physical and mental fatigue (median score 30.0) and medical information (median score 26.8). Younger age, low education level or no cohabitants were significantly associated with higher workload PETS scores (p < 0.05, 0.013, p = 0.047, respectively). Higher PETS stressors scores were significantly associated with younger age (p = 0.006), lower education level (p = 0.016), and high comorbidity (p = 0.013). Higher PETS impact scores were significantly associated with the female sex (p = 0.050), younger age (p = <0.001-0.003), lower education (p = 0.003), no cohabitants (p = 0.003), high comorbidity (p = 0.003) and cancer stage Dukes A (p = 0.004). CONCLUSIONS: A seamless and supportive healthcare system beyond hospitalisation targeting CRC subpopulations in danger of high treatment burden may improve patients' self-management experience.

Relationship between aerobic fitness and academic performance: the mediational role of executive function.

BACKGROUND: This cross-sectional study investigated whether the relationship between aerobic fitness and academic performance was mediated by executive functioning. METHODS: A total of 378 children (9-10 years old) from nine primary schools in Stavanger, Norway were included. The children's aerobic fitness was measured by a 10-minute interval-running test; executive function was tested by four cognitive tests (Stroop, Trail Making, Verbal Fluency and Backwards Digit Span). A composite score for executive functions was computed and used in analyses. Academic achievement in reading, mathematics and English was determined using Norwegian national standardized tests. RESULTS: Bivariate correlation analysis showed the following significant associations: mathematic achievement with executive functions (r=0.48, P=0.001), aerobic fitness with mathematics (r=0.13, P=0.012) and executive functions (r=0.17, P=0.001). A regression-based mediation analysis (PROCESS) with executive function as a mediator variable was conducted. Mediation analysis showed that the relationship between aerobic fitness and mathematic achievement was mediated by executive functions (P<0.001). CONCLUSIONS: Findings revealed an indirect effect of executive function on the positive relationship between aerobic fitness and mathematic achievement.

Associations between emotional instability, coping, and health outcomes among patients with non-cardiac chest pain.

The main aim of this study was to examine the relationship of emotional instability with illness worry and perceived limitations due to chest pain, and investigate to what degree any associations are mediated by the following chest pain-related coping styles: acceptance, seeking emotional support, seeking instrumental support, and avoidance. Self-reported measures from 94 participants with non-cardiac chest pain were collected. The results showed a relationship between emotional instability, illness worry, and perceived limitations due to chest pain. Moreover, this relationship was mediated by the coping styles avoidance and acceptance.

Exercise: A Path to Wellness During Adjuvant Chemotherapy for Breast Cancer?

BACKGROUND: Breast cancer treatment can represent a threat to a patient's wellness. The role of exercise in perceived wellness in women with breast cancer merits further study. OBJECTIVE: The objective of this study was to describe how exercise is perceived by women to influence their physical and psychosocial wellness at the time they were receiving chemotherapy. METHODS: Five focus group interviews with a total of 27 women with early-stage breast cancer were conducted. Prior to the focus groups, the women had participated in an exercise intervention during chemotherapy treatment. RESULTS: Three themes emerged from the analysis: exercise shapes feelings of psychological wellness; exercise stimulates feelings of physical wellness; and exercise influences social wellness. The women reported feeling stronger in a psychological sense after exercising, that the strength exercise improved their upper-limb functioning, and that engaging in exercise triggered social support and interactions. CONCLUSIONS: Exercise during breast cancer treatment is perceived to enhance the patients' wellness on several dimensions and in particular psychological wellness. Exercise might support the patients' efforts to restore their sense of wellness and enhance their level of daily life functioning. IMPLICATIONS FOR PRACTICE: Cancer nurses should promote exercise as a wellness-fostering intervention during chemotherapy treatment. Focusing on how exercise can contribute to feelings of wellness may help women with breast cancer choose exercise as a health-promoting activity that contributes to their recovery.

Factors perceived to influence exercise adherence in women with breast cancer participating in an exercise programme during adjuvant chemotherapy: a focus group study.

AIMS AND OBJECTIVES: To explore factors influencing exercise adherence among women with breast cancer while following an exercise programme. BACKGROUND: Earlier research shows that women with breast cancer decrease physical activity following the cancer diagnosis and that adhering to exercise interventions can be a challenge. Research is needed to identify motivational factors and barriers for exercise adherence among women during treatment for breast cancer. DESIGN: This was a qualitative study to explore patient's perceptions of the challenges to exercise adherence during a randomised, controlled trial. METHODS: Twenty-seven women with early-stage breast cancer were purposively sampled for focus group interviews during 2011-2012 from their participation in the exercise intervention group during 2010-2012. Five focus groups were performed, and data analysis was completed using the systematic text condensation method. RESULTS: During the focus group study, five main themes were identified, which described factors participants perceived to influence their adherence to exercise during chemotherapy: 'side effects of breast cancer treatment as a barrier to exercise', 'restoring and maintaining normality in daily life motivates exercise', 'other valued activities compete with exercise', 'constructive support enhances exercise' and 'positive beliefs about efficacy and outcomes motivate exercise'. CONCLUSION: Adherence to exercise in women with breast cancer is challenged by internal and external conditions and may be improved by attention to the impact of treatment side effects and by supporting patient self-efficacy towards changing health behaviour. RELEVANCE TO CLINICAL PRACTICE: Nurses should be aware that exercise adherence could be a challenge among women with breast cancer. They should help identify obstacles to exercise for women and ways to overcome them, as well as support them in their beliefs that they are capable of changing their health behaviour.

Effects of scheduled exercise on cancer-related fatigue in women with early breast cancer.

While physical activity during cancer treatment is found beneficial for breast cancer patients, evidence indicates ambiguous findings concerning effects of scheduled exercise programs on treatment-related symptoms. This study investigated effects of a scheduled home-based exercise intervention in breast cancer patients during adjuvant chemotherapy, on cancer-related fatigue, physical fitness, and activity level. Sixty-seven women were randomized to an exercise intervention group (n = 33, performed strength training 3x/week and 30 minutes brisk walking/day) and a control group (n = 34, performed their regular physical activity level). Data collection was performed at baseline, at completion of chemotherapy (Post1), and 6-month postchemotherapy (Post2). Exercise levels were slightly higher in the scheduled exercise group than in the control group. In both groups, cancer-related fatigue increased at Post1 but returned to baseline at Post2. Physical fitness and activity levels decreased at Post1 but were significantly improved at Post2. Significant differences between intervention and control groups were not found. The findings suggest that generally recommended physical activity levels are enough to relief cancer-related fatigue and restore physical capacity in breast cancer patients during adjuvant chemotherapy, although one cannot rule out that results reflect diminishing treatment side effects over time.

Perceptions of healthcare professionals' support, shock anxiety and device acceptance among implantable cardioverter defibrillator recipients.

AIMS: To investigate the extent to which perceived support from healthcare professionals and shock anxiety is related to device acceptance among implantable cardioverter defibrillator recipients. BACKGROUND: Device acceptance can be influenced by several factors, one of which is shock anxiety associated with poor device acceptance. Reduced shock anxiety, as well as increased device acceptance, has been reported after psycho-educational programmes. As healthcare professionals appear to play a significant role in providing support and education during regular follow-up visits, they may constitute an important social support system that could be another factor influencing device acceptance. However, little is known about the relationship between perceived support from healthcare professionals and device acceptance among recipients. DESIGN: A cross-sectional survey design. METHODS: A sample comprising implantable cardioverter defibrillator recipients completed questionnaires assessing perceived support from healthcare professionals, shock anxiety and device acceptance. Demographic and clinical data were collected by self-report and from medical records in September-October 2010. RESULTS: The descriptive results indicated that approximately 85% of the recipients experienced high device acceptance. Regression analysis demonstrated that constructive support from healthcare professionals was positively associated with device acceptance and moderated the negative relationship between shock anxiety and device acceptance. Non-constructive support and shock anxiety had a negative statistical association with device acceptance. CONCLUSIONS: Healthcare professionals may represent a valuable constructive support system that can enhance device acceptance among implantable cardioverter defibrillator recipients, partly by preventing shock anxiety from leading to poor device acceptance. Non-constructive communication on the part of healthcare professionals could hinder device acceptance.

Perceived support from healthcare professionals, shock anxiety and post-traumatic stress in implantable cardioverter defibrillator recipients.

AIMS AND OBJECTIVES: To investigate (1) the extent to which shock anxiety and perceived support from healthcare professionals are related to post-traumatic stress disease (PTSD) symptoms and (2) the extent to which perceived support from healthcare professionals moderates the relationship between shock anxiety and PTSD symptoms in implantable cardioverter defibrillator recipients. An additional aim was to describe the level of PTSD symptoms and perceptions of support from healthcare professionals. BACKGROUND: Studies examining PTSD symptoms among implantable cardioverter defibrillator recipients are still sparse. In addition, little is known about how perceived support from healthcare professionals is related to PTSD symptoms. DESIGN: Cross-sectional survey design. METHODS: Recipients (n = 167) with implantable cardioverter defibrillator attending an outpatient device clinic completed questionnaires assessing shock anxiety, PTSD symptoms and perceived support from healthcare professionals. RESULTS: The results indicated that between ten and 15% of the recipients experienced moderate to severe symptoms of PTSD. Although a majority perceived constructive support from healthcare professionals, 12% perceived nonconstructive support. Regression analysis demonstrated that shock anxiety and perceived nonconstructive support from healthcare professionals had a statistically significant (p < 0·01) association with PTSD symptoms. Moreover, the results suggest that associations between shock anxiety and PTSD symptoms were significantly (p < 0·01) moderated by perceived nonconstructive support from healthcare professionals. Young age, short time since implantation and secondary prevention indication were also significantly associated with PTSD symptoms. CONCLUSIONS: The results indicate that nonconstructive support from healthcare professionals can increase the tendency to develop PTSD symptoms, particularly in those who experience shock anxiety. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals should pay more attention to the way in which they communicate information to the recipients during follow-up visits. Clinically based strategies and interventions targeting shock anxiety and PTSD symptoms should be carried out.

The relationship between diabetes-related distress and clinical variables and perceived support among adults with type 2 diabetes: a prospective study.

BACKGROUND: Diabetes-related distress is a prevalent emotional state experienced among people living with type 2 diabetes. It has predominantly been studied in relation to diabetes management and metabolic control and to some extent in relation to perceived social support. Little is known about the relative prospective contribution of clinical variables and perceived support on diabetes-related distress. OBJECTIVE: To investigate the predictive influence of clinical variables and perceived support from health care professionals and family on diabetes-related distress. DESIGN: The study has a prospective, longitudinal design. SETTINGS: The participants were recruited from seven general practitioners in the south western part of Norway and from members of the Norwegian Diabetes Association. PARTICIPANTS: The sample comprised 296 people with type 2 diabetes. Inclusion criteria were: adults (30-70 years) diagnosed with type 2 diabetes who were willing and able to complete a questionnaire written in Norwegian. METHODS: Data were collected by postal questionnaires assessing perceived support from health care professionals and family and diabetes-related distress measured by the Problem Areas in Diabetes Scale at two time points separated by an interval of one year (October 2008 and 2009). Clinical data were collected by self-report. The follow-up group, for which both assessment data were available, constituted our sample comprising 296 adults. RESULTS: Descriptive results and findings from correlations and prospective multivariate associations indicate small changes in diabetes-related distress over a period of one year. In total, multiple regression analyses showed that clinical variables were very weak predictors of diabetes-related distress, whereas perceived social support emerged as statistically significant although a moderate predictor of distress. Among the support variables, only 'constructive support from health care professionals' and 'non-supportive family behaviour' accounted for changes in diabetes-related distress. CONCLUSIONS: Findings suggest that diabetes-related distress among adults with type 2 diabetes is relatively stable over time and may be difficult to alter. Health care professionals should therefore be aware that stimulating people to change is challenging and complex. Moreover, they should devote more attention to non-clinical factors such as social support when addressing diabetes-related distress.

Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors.

AIMS AND OBJECTIVES: To examine research findings regarding predictors of adherence to exercise programmes in cancer populations. BACKGROUND: Cancer patients are advised to participate in daily exercise. Whether they comply with the recommendations for physical activity or not remains unclear. DESIGN: A systematic review and meta-analysis. METHODS: Empirical articles published in English between 1995 and 2011 were searched in electronic databases and in reference lists, using the search terms 'adherence', 'predictors', 'exercise', and 'cancer' in varying combinations. Twelve of 541 screened abstracts met the inclusion criteria. The included studies' eligibility considering predictors of exercise adherence were reviewed. A quality assessment process evaluating the studies methodological quality was performed. Eight of the reviewed studies were considered eligible for a meta-analysis involving Pearson's r correlations. RESULTS: Exercise stage of change, derived from the transtheoretical model of behaviour change (TTM) was found to be statistically significant and a strong predictor of exercise adherence. In addition, the theory of planned behaviour (TPB) construct; intention to engage in a health-changing behaviour and perceived behavioural control, demonstrated significant correlations with exercise adherence. CONCLUSIONS: The review identified that both the TPB and the TTM frameworks include aspects that predicts exercise adherence in cancer patients, and thus contributes to the understanding of motivational factors of change in exercise behaviour in cancer populations. However, the strengths of predictions were relatively weak. More research is needed to identify predictors of greater importance. RELEVANCE TO CLINICAL PRACTICE: Surveying the patients' readiness and intention to initiate and maintain exercise levels, as well as tailoring exercise programmes to individual needs may be important for nurses in order to help patients meet exercise guidelines and stay active.

Shock anxiety among implantable cardioverter defibrillator recipients with recent tachyarrhythmia.

BACKGROUND: Shock anxiety has been documented irrespective of shock exposure in implantable cardioverter defibrillator (ICD) recipients. The presence of tachyarrhythmia may lead to an anticipation of receiving a shock and thereby give rise to shock anxiety. The aims were to assess: (1) the level of shock anxiety in a sample of ICD recipients, (2) the relationship between such anxiety and shock exposure, and (3) the relationship between recent tachyarrhythmia and shock anxiety. METHODS: ICD recipients (n = 167) completed the Florida Shock Anxiety Scale measure of shock anxiety. The recipients were divided into three groups: (1) Recipients with no documented tachyarrhythmia over the previous 12 months (n = 56), (2) recipients with documented tachyarrhythmia over the previous twelve months (n = 54), and (3) recipients with any history of shocks (n = 57). RESULTS: Of the recipients, 44% experienced some form of shock anxiety, whereas 15% reported general shock anxiety. Analyses of covariance revealed that recipients with recent tachyarrhythmia (F = 7.675 df = 9/100, P = 0.007) as well as recipients with a shock history (F = 9.976, df = 9/103, P = 0.002) reported higher levels of shock anxiety than recipients with no recent tachyarrhythmia. CONCLUSION: This study indicates that although a substantial proportion of the ICD recipients experienced some form of shock anxiety, only a relatively small proportion reported general shock anxiety. ICD recipients with recent tachyarrhythmia, in addition to recipients with shock history, appear to be at greater risk for development of shock anxiety. This implies that these recipients may profit from clinical-based strategies and interventions targeting shock anxiety.

The relationship between clinical indicators, coping styles, perceived support and diabetes-related distress among adults with type 2 diabetes.

AIM: This article is a report of a cross-sectional study examining the degree to which clinical indicators, coping styles and perceived support from healthcare professionals and family are related to diabetes-related distress. BACKGROUND: Many people with type 2 diabetes experience high levels of distress stemming from concerns and worries associated with their disease. Diabetes-related distress has predominantly been studied in relation to diabetes management and metabolic control, and to some extent in relation to coping styles and perceived social support. To date, little is known about the relative contribution of clinical indicators, coping styles and perceptions of social support to perceived distress among people with type 2 diabetes. METHODS: A sample comprising 425 Norwegian adults, aged 30-70, with type 2 diabetes, completed questionnaires assessing coping styles, perceived social support from health professionals and family and diabetes-related distress assessed by the Problem Areas in Diabetes Scale. Demographical and clinical data were collected by self-report. Data were collected in October 2008. FINDINGS: Results from the regression analyses showed a greater variance in emotional distress accounted for by coping styles (21·3%) and perceived support (19·7%) than by clinical indicators (5·8%). CONCLUSION: FINDINGS may indicate that healthcare providers should pay more attention to non-clinical factors such as coping styles and social support, when addressing diabetes-related distress. They should also be aware that interventions based on psychosocial approaches may primarily influence distress, and not necessarily metabolic control.

Evaluating the Mindfulness-based Coping Program: An Effectiveness Study Using a Mixed Model Approach.

Since more than 450 million people worldwide suffer from mental disorders, interventions that promote mental health have been called for. Mindfulness-based coping (MBC) is an intervention based on coping skills from cognitive behavioral therapy integrating mindfulness practices. The aim of this study was to examine the effectiveness of the MBC program for psychiatric outpatients. The study employed a mixed research method with a qualitative approach using semi-structured patient interviews and clinical assessments from patients' therapists and a quantitative approach using instruments measuring mindful coping, mental ill health, and life satisfaction. The study sample included 38 psychiatric outpatients from a district psychiatric outpatient service in Norway. Results suggested that although use of the different skills varied, participants had a positive experience with the program and positive changes in psychological functioning were observed. Findings provide knowledge regarding the design of interventions integrating mindfulness to promote more adequate psychological coping.

Motivation for diet and exercise management among adults with type 2 diabetes.

AIM: The aim of this study was to investigate diet and exercise management and how indicators of intrinsic motivation such as ability expectations and values are associated with diet and exercise management among adults with type 2 diabetes. BACKGROUND: Motivational problems are probably one of the main reasons for poor diabetes management. However, the mechanisms involved in the motivation for adequate self-management are still unclear. DESIGN AND METHODS: A cross-sectional design including a postal questionnaire that investigated diet and exercise management as well as intrinsic motivational factors such as ability expectations and values related to these behaviours was used to collect the data. A sample comprising 425 adults with type 2 diabetes aged between 30 and 70 completed the questionnaire. RESULTS: Reported diet management was more in accordance with recommendations than reported exercise management. Yet results indicated equally high ability expectations and positive values for exercise and diet management. Moreover, results demonstrated that ability expectations and values explained more variance in exercise (21.6%) than in diet management (7.6%). CONCLUSIONS: The modest association between intrinsic motivational factors and diet management may imply that there are important extrinsic factors that play a significant role in determining dietary behaviour. The combination of lower exercise activity than recommended and high ability expectations and values for such activity may reflect that subjective exercise norms are formed individually in accordance with what most people recognise as the appropriate level of physical activity. Finally, results may indicate that there is potential for improving exercise management by stimulating intrinsic motivation as well as by more clearly communicating recommendations for such management.

Life values and self-regulation behaviours among adults with type 2 diabetes.

AIM: The aim of this study was to identify life values in adults with type 2 diabetes and to describe their experiences of how these values may influence self-regulation behaviours. BACKGROUND: Daily self-regulation behaviours have been described as challenging, because the individuals try to find a balance between them and life values. However, little is known about how life values may influence the motivation for necessary self-regulation behaviours. DESIGN AND METHODS: A descriptive/explorative qualitative design that included focus groups was used to collect data. The sample consisted of 19 adults with type 2 diabetes. Data were analysed using qualitative content analysis. RESULTS: The findings revealed six themes: maintaining health and longevity, a feeling of bodily well-being, preserving a positive body image, self-determination, maintaining the ability to work and belonging. The results reflect the fact that many life values have a major influence on self-regulation behaviours. CONCLUSIONS: The findings indicate that several of the life values can conflict with self-regulation behaviours, which in turn may influence the motivation for self-regulation of type 2 diabetes. Some of these values could be considered to be related to self-worth, which is regarded as an important motivational component for engaging in a task. Moreover, this study highlights the fact that goals related to self-regulation behaviours were formulated in more general than in specific terms. RELEVANCE TO CLINICAL PRACTICE: This study may help health professionals to understand how adults' life values influence their motivation for adequate self-regulation. The findings indicate that the existing support structures should make an effort to learn about people's life values and take them into account when giving advice about self-regulation behaviours. Moreover, people with type 2 diabetes should be supported by health professionals to set more specific self-regulation goals that are consistent with their life values.

Perceived support from healthcare practitioners among adults with type 2 diabetes.

AIM: This paper is a report of a study of how adults with type 2 diabetes perceive different attributes of support provided by healthcare practitioners and how various attributes of support can influence people's motivation to self-manage their disease. BACKGROUND: Motivational problems seem to be a major reason for poor diabetes management. According to well-known theories of motivation, expectations of being able to perform certain behaviours are a key element. Different attributes of support from healthcare practitioners are likely to influence such expectations. To date, no researchers have specifically examined how people with type 2 diabetes perceive different attributes of support from healthcare practitioners and how these may influence their motivation to manage their disease themselves. METHODS: A descriptive/explorative qualitative design and focus groups were used to collect data. The sample consisted of 19 adults with type 2 diabetes, and the data were collected in 2007 and analysed using qualitative content analysis. FINDINGS: Five themes were identified, reflecting perceived attributes of support from healthcare practitioners: (1) an empathetic approach, (2) practical advice and information, (3) involvement in decision-making, (4) accurate and individualized information and (5) ongoing group-based support. CONCLUSION: Healthcare practitioners may strengthen the self-management motivation among adults with type 2 diabetes by enhancing expectations of being able to perform the necessary diabetes care, and through the provision of empathetic, individualized, practical and ongoing group-based support.

The role of perceived parental socialization practices in school adjustment among Norwegian upper secondary school students.

BACKGROUND: Lack of adjustment or school failure is a concern to educators, educational and school psychologists as well as parents, but few studies have focused on school adjustment during late adolescence. Moreover, studies have yet to explore associations between parenting and school adjustment among upper secondary school students. AIM: The primary objective of this study is to explore the relative and unique influence of parental support, behavioural control and psychological control (overprotection and autonomy granting) in school adjustment among upper secondary school students. SAMPLE: The sample consisted of 564 students (15-18 years of age) in vocational and general educational courses from one upper secondary school in western Norway. METHOD: The study was conducted as a survey. All data were based on adolescent reports, except for absence data, which were provided by the school. RESULTS: The results showed that perceived parental practices accounted for moderate, but statistically significant amounts of variance in different aspects of school adjustment. CONCLUSIONS: The findings indicate that perceived parental socialization practices are only moderately associated with school adjustment among upper secondary school students. This probably reflects the fact that the influence of specific parenting practices declines as children and young adolescents mature into late adolescent students.

Antecedents and outcomes of intervention program participation and task priority change among school psychology counselors: a latent variable growth framework.

A three-year national intervention program introduced into the School Psychology Service (SPS) in Norway with the aim of increasing systemic level work among SP counselors was investigated. Latent variable growth models based on longitudinal data from 195 SP counselors gave no significant mean level change in systemic level work. This concurred with GLM analyses based on data from a sample of 20 schools. However, retrospective self-reported significant positive mean level change for systemic level work was detected among the SP counselors. Intervention program participation was associated with individual change in systemic level work. Self-efficacy beliefs about systemic level work, and school-related etiology beliefs predicted individual change to a certain degree. Comparison of two rival models gave no support for a hypothesized interaction among intervention program participation and beliefs in their effects on systemic level work. Open-ended questions indicated that individual level workload and the perceived expectations from the schools may have concern for a successful effect of the intervention program in addition to the hypothesized ones. Individual change in systemic level work was positively associated with individual change in job satisfaction.