Interprofessional follow-up for people at risk of type 2 diabetes in primary healthcare - a randomized controlled trial with embedded qualitative interviews.

OBJECTIVE: To examine the effects of an empowerment-based interprofessional lifestyle intervention program among people at risk of type 2 diabetes on knowledge, skills, and confidence in self-management, health, psychological well-being, and lifestyle characteristics, and to explore the participants' perceptions of participating in the intervention. DESIGN AND METHODS: In line with the Medical Research Council complex interventions research methods framework, we conducted a randomized controlled trial with embedded qualitative interviews in primary healthcare clinics in Norway between 2019-2021. Of the patients at risk (The Finnish Diabetes Risk Score Calculator (FINDRISC) ≥15 or Body Mass Index (BMI) ≥30) 142 accepted the invitation, and 14 participants from the intervention group participated in individual interviews after the 12-month follow-up. Our primary outcome was the Patient Activation Measure (PAM-13). Secondary outcomes were EQ-5D-5L, EQ-VAS, WHO-Overall health, WHO-Overall QOL, weight, height, waist circumference, and regularity of physical activity. We used thematic analysis to analyse the qualitative data. RESULTS: There was no clinically relevant differences of neither the primary nor the secondary endpoints between intervention and control group. As to the qualitative data, we identified two distinct features: 'Meaningful perspectives on lifestyle changes' and 'Lifestyle change is not a linear process due to challenges faced along the way' putting ownership of their choices in life into picture. CONCLUSION: The negative results of the RCT stand in contrast to the findings given by the participants voices, perceiving the intervention as a key eye opener placing their health challenges in perspective. How to interpret these seemingly conflicting findings of participants being seen, heard, and understood, helping them to take more conscious ownership of their choices in life, and at the same time demonstrating no improvements in symptoms or measures, is a dilemma that needs further exploration. We should be careful to implement interventions that do not demonstrate any effects on the quantitative outcomes.

Experiences of an interprofessional follow-up program in primary care practice.

BACKGROUND: An integrative cooperation of different healthcare professional is a key component for high quality health services. With an aging population and many with long-term conditions, more health tasks and follow-up care are being transferred to primary care and locally where people live. Interprofessional collaboration among providers of different professional designations will be of increasing importance to optimizing primary care capacity in years to come. There is a call for further exploration of models of interprofessional collaboration that might be applicable in Norwegian primary care. The aim of this study was to explore experiences of interprofessional collaboration between primary care physicians and nurses working in primary care by applying an intervention for people with type 2 diabetes. Specifically, this study was designed to strengthen and gain deeper insight into interprofessional collaboration between primary care physicians and nurses in primary care settings. METHODS: We applied Interpretive Description as a research strategy. The participants within this study were primary care physicians and nurses from four different primary care practices in the western and eastern parts of Norway. We used semi-structured telephone interviews for collecting the data between January and September 2021. RESULTS: The analysis revealed two key features of the primary care physicians and the nurses experience with interprofessional collaboration in primary care practices. The first involved managing the influence of discrepancies in their expectations of IPC and the second involved becoming aware of the competence they developed that allowed for better complementarity consultation. CONCLUSIONS: This study indicates that interprofessional collaboration in primary care practice requires that primary care physicians and nurses clarify their expectations and, in turn, determine how flexible they can become in changing their usual primary care practices. Moreover, findings reveal that nurses and primary care physicians had discrepancies in expectations of how interprofessional collaboration should be carried out in primary care practice. However, both the nurses and primary care physicians appreciated the blending of complementary competencies and skills that facilitated a more collaborative care practice. They experienced that this interprofessional collaboration represented an essential quality improvement in the primary care services. TRIAL REGISTRATION: The trial is registered 03/09/2019 in ClinicalTrials.gov (ID: NCT04076384).

Epistemic discourses concerning the competence developed in a norwegian master's degree program in health science.

It has been claimed that various discourses related to competence influence higher education, but there is limited understanding of the discourses underlying competence development. The specific aim of this study was to explore epistemic discourses concerning the development of competence of health professionals with a master's degree in health science. Accordingly, the study was qualitative and adopted discourse analysis. Twelve participants, all of whom were Norwegian health professionals aged between 29 and 49 years, participated in this study. Four participants were in the final stage of study for their master's degree with three months left before completion, four had completed their degree two weeks before their participation, and four had been working for one year after the completion of their degree. Data were collected in three group interviews. Three epistemic discourses were revealed: (1) a critical thinking competencies discourse, (2) a scientific thinking competencies discourse, and (3) a competence-in-use discourse. The former two discourses were considered the dominant discourses and indicated that a knowing "that" discourse connected the specialized competence of different health professionals with a wider field of competence. This wider field transcended the boundaries of various health disciplines and represented a novel competence developed through a synergizing process between critical and scientific thinking competencies, which seems to drive continued competence development. A competence-in-use discourse was formed in the process. This discourse can be viewed as a unique outcome that contributes to health professionals' specialized competence and suggests that a knowing "how" discourse was also an underlying background discourse.

Increase in Newborns Ventilated Within the First Minute of Life and Reduced Mortality After Clinical Data-Guided Simulation Training.

INTRODUCTION: Birth asphyxia-related deaths is a major global concern. Rapid initiation of ventilation within the "Golden Minute" is important for intact survival but reported to be challenging, especially in low-/middle-income countries. Helping Babies Breathe (HBB) is a simulation-based training program for newborn resuscitation. The aim of this HBB quality improvement (QI) intervention was to decrease time from birth to ventilation and document potential changes in perinatal outcomes. METHOD: Prospective observational QI study in a rural Tanzanian hospital, October 1, 2017, to August 31, 2021, first-year baseline, second-year QI/simulation intervention, and 2-year postintervention. Trained research assistants observed wide-ranging information from all births (N = 12,938). The intervention included monthly targeted HBB simulation training addressing documented gaps in clinical care, clinical debriefings, and feedback meetings. RESULTS: During the QI/simulation intervention, 68.5% nonbreathing newborns were ventilated within 60 seconds after birth compared with 15.8% during baseline and 42.2% and 28.9% during the 2 postintervention years (P < 0.001). Time to first ventilation decreased from median 101 (quartiles 72-150) to 55 (45-67) seconds (P < 0.001), before increasing to 67 (49-97) and 85 (57-133) seconds after intervention. More nonbreathing newborns were ventilated in the intervention period (12.9%) compared with baseline (8.5%) and the postintervention years (10.6% and 9.4%) (P < 0.001). Assumed fresh stillborns decreased significantly from baseline to intervention (3.2%-0.7%) (P = 0.013). CONCLUSIONS: This QI study demonstrates an increase in nonbreathing newborns being ventilated within the Golden Minute and a significant reduction in fresh stillborns after introduction of an HBB QI/simulation intervention. Improvements are partially reversed after intervention, highlighting the need for continuous simulation-based training and research into QI efforts essential for sustainable changes.

What school nurses receive for themselves that influences their remaining in practice: A qualitative study.

BACKGROUND: Previous research indicates a link between what nurses receive for themselves and their remaining in practice. In Norway, school nurses tend to remain in practice, but what it is they receive for themselves has been scarcely studied. The aim of this study, therefore, was to describe and interpret what it is school nurses receive for themselves that influences their remaining in practice. METHOD: The study has a qualitative design with a hermeneutic approach. Data were collected through individual interviews on two separate occasions with 15 Norwegian school nurses. The data were analysed using a phenomenological hermeneutic method. RESULTS: Two themes demonstrate what it is the school nurses receive for themselves: (1) 'Gaining interesting workdays for yourself' and (2) 'Attaining pleasure for yourself'. Each theme has two sub-themes. The first theme involved the school nurses 'having an attractive scope of practice' and 'having varied tasks'. The second theme involved 'being trusted' and 'being given a response'. The study themes can be comprehensively understood as an expression of what the school nurses identify as the main locus of the good work-life. The school nurses' remaining seems to revolve around what it is they receive on their own behalf: an affirmation for their ordinary life and what they do as a nurse. CONCLUSION: This study highlights that what school nurses receive on their own behalf may influence their remaining in practice. It adds to previous research with a more specific understanding of nurses remaining in practice by stating that in identifying the main locus of the good work-life, the school nurses received affirmation for their ordinary life and what they do as a nurse. Thus, it is important that nurses identify the main locus of a good work-life for themselves, as receiving affirmation for what they do in their ordinary workdays may influence their remaining in practice. REGISTRATION OF CLINICAL TRIAL AND REGISTRATION IDENTIFICATION NUMBER: The study was approved by the Norwegian Centre for Research Data (project 59195). National Research Ethics Committee approval was not required, as the study only involved health professionals and did not ask for sensitive information.

Health Care Professionals' Experiences of Facilitating Patient Activation and Empowerment in Chronic Illness using a Person-Centered and Strengths-Based Self-Management Program.

OBJECTIVE: Patients with chronic illness who are empowered and activated are more likely to engage in self-management in order to stabilise their condition and enhance their quality of life. This study aimed to explore Health Care Professional's (HCP) assessment of a person-centered intervention called 'The Bodyknowledging Program' (BKP) for the facilitation of empowerment and patient activation in the context of chronic illness. METHODS: This study employed a qualitative process evaluation after programme completion. Data was collected through focus-groups and individual interviews with HCPs and content analysis was used in the analysis. RESULTS: Four themes were identified: 1) Shifts towards the patient-perspective, 2) The value of a patient-centered conceptual framework, 3) Patient activation through dialogue based support and 4) Challenging competencies. Discussion: This study introduces 'The Bodyknowledging Program' as a useful tool to uncover patients' needs and to activate and empower them to take more responsibility for their health through self-care management. The usability of the new intervention depends on HCP's ability to develop their counselling skills and changing their approach towards utilising patients' individual resources in the promotion of their health.

What school nurses strive to achieve for themselves in order to remain in practice: A qualitative study.

AIM: This study aims to describe and interpret what it is school nurses strive to achieve for themselves in order to remain in practice. DESIGN: A qualitative study with a hermeneutic approach. METHOD: The data were collected by means of in-depth interviews with 15 Norwegian school nurses on two separate occasions and analysed using a phenomenological hermeneutic method. RESULTS: The analysis resulted in the following themes: (1) trusting your own professional ability, (2) aspiring to appreciation and (3) accomplishing self-care. These themes were reflected in the school nurses' choices and actions and were regarded as an expression of what was of value to them as a nurse. Thus, the nurses' realizing what they strived to achieve for themselves can comprehensively be understood as a good of higher value for their remaining in nursing practice.

Neonatal Resuscitation Skill-Training Using a New Neonatal Simulator, Facilitated by Local Motivators: Two-Year Prospective Observational Study of 9000 Trainings.

Globally, intrapartum-related complications account for approximately 2 million perinatal deaths annually. Adequate skills in neonatal resuscitation are required to reduce perinatal mortality. NeoNatalie Live is a newborn simulator providing immediate feedback, originally designed to accomplish Helping Babies Breathe training in low-resource settings. The objectives of this study were to describe changes in staff participation, skill-training frequency, and simulated ventilation quality before and after the introduction of "local motivators" in a rural Tanzanian hospital with 4000-5000 deliveries annually. Midwives (n = 15-27) were encouraged to perform in situ low-dose high-frequency simulation skill-training using NeoNatalie Live from September 2016 through to August 2018. Frequency and quality of trainings were automatically recorded in the simulator. The number of skill-trainings increased from 688 (12 months) to 8451 (11 months) after the introduction of local motivators in October 2017. Staff participation increased from 43% to 74% of the midwives. The quality of training performance, measured as "well done" feedback, increased from 75% to 91%. We conclude that training frequency, participation, and performance increased after introduction of dedicated motivators. In addition, the immediate constructive feedback features of the simulator may have influenced motivation and training quality performance.

Usability and value of a digital learning resource in nursing education across European countries: a cross-sectional exploration.

BACKGROUND: Higher education is responsible for providing education that meets international benchmarks relevant to the needs of the international community. Due to the increase of digital tools in higher education, the possibility of sharing learning resources across nations has expanded. In the current project, a Norwegian university invited universities in Spain and the United Kingdom to adapt and translate e-learning resources originally developed for Norwegian nursing students for use within their respective Bachelor in Nursing programmes. AIM: The aim of the current study was to gain insights into the usability and value for learning of e-compendiums shared and implemented across three European universities. METHODS: The study adopted a descriptive cross-sectional design and included nursing students from the University of Nottingham, Valencia Catholic University, and the University of Stavanger. Data were collected in Autumn 2017 through a questionnaire adapted from the validated "Centre for Excellence in Teaching and Learning Reusable Learning Object evaluation questionnaire" The questionnaire consisted of 19 items that included two aspects: e-compendiums' value for learning and e-compendiums' usability. The different study sites were compared using a binary logistic regression analysis. Subgroups of students were compared based on their gender and age. RESULTS: A total of 480 nursing students participated in the study. The e -compendiums were overall positively rated, especially for reinforcing and retaining knowledge. Compared to the students from the University of Stavanger, students from Valencia Catholic University rated the e-compendiums more positively in most aspects of learning. Students from University of Nottingham found the e-compendiums to be more important for learning engagement compared to students at the Norwegian study site, and no differences were found in any other aspects of learning. Younger students rated the interactivity and visual components as more important compared to older students. CONCLUSIONS: Students from the University of Nottingham and Valencia Catholic University seem to accept the e-compendiums despite the fact that they were originally developed for use in another country. We argue that, when sharing e-learning resources across countries, an adaptation and translation process that includes a multicultural and multidisciplinary perspective should be carried out.

Health-care professionals' assessment of a person-centred intervention to empower self-management and health across chronic illness: Qualitative findings from a process evaluation study.

BACKGROUND: Person-centred care (PCC) empowers patients to manage their chronic illness and promote their health in accordance with their own beliefs, values and preferences. Drawing on health-care professional's (HCP's) experiences implementing an empowerment-focused, person-centred intervention called the Bodyknowledging Program (BKP), we undertook a process evaluation that aimed to assess the impact on patient health and well-being. METHODS: We used individual in-depth interviews and semi-structured focus groups comprising n = 8 interprofessional HCP who facilitated intervention sessions with n = 58 patients situated in Norwegian specialist care sites. Content analysis was used to analyse the data and summarize major themes. RESULTS: Health-care professional interviews revealed four main ways in which the intervention operated in support of health-related patient outcomes: (i) addressing the whole person; (ii) hope and affirmation; (iii) expanding recovery; and (iv) social support and revitalized relationships. The intervention provided new tools for patients to understand the social, emotional and physical impact of their illness. Health-care professional reported new insights to facilitate patient engagement and to promote patients' health. CONCLUSIONS: The Bodyknowledging Program facilitated patient engagement through the promotion of patient-centred care while developing the patients' ability to exploit their own resources for effectively managing their health within illness. The process evaluation supported the underlying theoretical basis of the intervention and was suggestive of its potential transferability elsewhere.

Self-realisation-What does this mean for school nurses to remain in nursing practice?

AIMS AND OBJECTIVES: To describe and interpret what it means for school nurses to realise themselves so that they remain in nursing practice. BACKGROUND: Self-realisation seems to influence on nurses remaining in nursing practice. School nurses report aspects (i.e. autonomy and professional development) which can be linked to self-realisation as important for themselves, but few studies describe what it means for school nurses to realise themselves so that they remain in practice. DESIGN AND METHOD: This study used a qualitative design, conducting two individual in-depth interviews with 15 school nurses. The interviews were analysed with a phenomenological hermeneutic method. The COREQ checklist has been used in reporting this study. RESULTS: The following themes were emerged: (a) being attentive to yourself, (b) acting true to yourself and (c) making independent choices. CONCLUSION: This study offers insight into what it means for school nurses to realise themselves so that they remain in nursing practice, that is to practise their originality and take a stand for what they consider important. Self-realisation was embedded within nursing practice and consequently seems to impact on nurses remaining in practice. RELEVANCE TO CLINICAL PRACTICE: Nurses who practise their originality and take a stand for what they identify as important realise self. This implies being themselves and practising nursing in a way they find relevant. Nursing leaders who encourage nurses to articulate what this entails facilitate their self-realisation. A clinical practice where nurses can be attentive and act true to themselves, and have opportunities to make independent choices, will be a practice where nurses can realise self. We suggest that clinical practice which emphasises opportunities for nurses' self-realisation may facilitate their remaining in practice.

Norwegian PhD students' discourses about practice-relevant research in the field of health and social work.

Aim: The aim of this study was to explore the discourses of PhD students concerning the performance of practice-relevant research in health and social work. Design: An explorative, qualitative design and a discourse analytical approach were used to collect data. Methods: Participants were recruited from a national research school for practice-relevant research in Norway. Group interviews with ten PhD students (five health and five social work professionals) with extensive, wide-ranging work experience as practitioners were used to collect data. The data were analysed by discourse analysis. Results: The analysis revealed three discourses: (a) the professional knowledge discourse; (b) the promoting partnership discourse; and (c) the using research knowledge discourse. The discourses are explicit concerning how systematically formed practice-relevant research in health and social work is linked to dominant discourses about knowledge in the scientific field. Professional knowledge, promoting partnership and using research knowledge are fundamental features of practice-relevant research.

Home Programme to Improve Hand Function for Children with Bilateral Cerebral Palsy: Beneficial but Challenging.

Aim: To explore parents' and occupational therapists' experiences with a home program using goal-directed training to improve hand function in daily activities for children with bilateral cerebral palsy.Methods: The study had a qualitative exploratory design that included two focus group interviews. One group consisted of five parents, the other of three occupational therapists. Data were analyzed by qualitative content analysis. The intervention consisted of daily goal-directed training, with a dose of 25-33 hours for eight weeks. Weekly visits from the occupational therapists were provided.Results: Three themes were identified; 1) Home training promotes parent awareness and the child's mastery, 2) Home training is challenging and exhausting over time, and 3) Parent support is necessary, and the child's involvement is important. The parents reported improvements in the children's use of hands in daily activities.Conclusion: The findings indicate that the home program was beneficial but challenging, and that motivation is a key factor for implementing home-based intervention. Ongoing support to the parents, as well as strengthening the children's involvement may enhance motivation. Future research should focus on developing strategies to increase motivation, and on exploring a "hybrid" model for home training divided between home and kindergarten or school.

Self-management and health related quality of life in persons with chronic obstructive pulmonary disease.

PURPOSE: Although it is well-known that persons with COPD experience lower health related quality of life (HRQoL), little is known about the importance of self-management related domains on HRQoL in persons with COPD. Therefore, the purpose of this study is to examine associations between self-management related domains and HRQoL, adjusting for sociodemographic and clinical characteristics, self-efficacy, and sense of coherence. METHODS: Cross-sectional data of 225 persons with COPD, recruited from a hospital register, were analyzed. Self-management related domains were measured using the Health education impact questionnaire (heiQ) and HRQoL was measured using the St. George's Respiratory Questionnaire (SGRQ). Multiple linear regression analysis was used. RESULTS: The final models showed significant associations between the self-management domains constructive attitudes and approaches and emotional distress and HRQoL. Dyspnea, number of comorbidities, self-efficacy, and the various self-management related domains explained 51.3 to 55.1% of the variance in HRQoL. CONCLUSIONS: The findings suggest that addressing self-management related domains, in addition to self-efficacy, dyspnea, and comorbidities, may be of importance for enhancement of HRQoL in persons with COPD.

Reconfiguring clinical communication in the electronic counselling context: The nuances of disruption.

AIM: This study expands on an earlier study about diabetes nurses' experiences of the Guided Self-Determination intervention in face-to-face consultations among people with type 2 diabetes. This current study investigates Guided Self-Determination in an electronic format with the aim to explore what can be learned about the written form for health communication from the perspectives of diabetes nurses in primary care. DESIGN: The study has an explorative, qualitative design. METHOD: Four diabetes nurses were individually interviewed after completing the electronic intervention. The analysis was guided by Interpretive Description. RESULTS: Small sample size apart, the rich empirical data and quality of dialogue point to the interviewees' earlier contact, comfort and trust with the researcher. The written electronic communication could disrupt nurses' possibilities for using basic and advanced communication skills. Findings also indicate that written electronic communication can foster thoughtful responses to patients and increase possibilities for a transparent counselling delivery process.

The influence of an eHealth intervention for adults with type 2 diabetes on the patient-nurse relationship: a qualitative study.

BACKGROUND: A constructive patient-nurse relationship is beneficial in self-management support approaches. Research indicates eHealth interventions hold a potential for self-management support for adults with type 2 diabetes. However, eHealth may change the patient-nurse relationship. No studies to date have addressed how eHealth self-management support interventions with written asynchronous communication can influence the relationship between patients and nurses. AIM: The aim of this study was to explore how an eHealth intervention based on the Guided Self-Determination program (eGSD) influences the patient-nurse relationship from the perspective of patients participating and the nurses conducting the intervention. METHODS: A qualitative approach with individual semi-structured interviews was used. Ten patients with type 2 diabetes who completed the eGSD and four nurses who delivered the intervention participated. The data were transcribed verbatim, and qualitative content analysis was used to analyse the text. RESULTS: The findings revealed two themes: 'eGSD facilitates a reciprocal understanding and a flexibility in the relationship' and 'eGSD creates a more fragile relationship', reflecting ambiguous experiences with the eGSD. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: The findings indicate that eGSD influences the patient-nurse relationship by facilitating reciprocal understanding and flexibility. Both patients and RNs acknowledged these outcomes as beneficial. Nevertheless, familiar in-person consultations were expressed as integral for the patient-nurse relationship. As written communication in eHealth is a novelty, it demands new knowledge and expertise that RNs must master. Findings from this study may therefore be acknowledged when developing and implementing eHealth interventions. Education programs in written eHealth communication, as well as guidelines and frameworks on how to professionally and effectively conduct eHealth services while maintaining supportive patient-nurse relationships, should be a priority for institutions that educate healthcare personnel, health institutions and other stakeholders.

Effects of a COPD self-management support intervention: a randomized controlled trial.

BACKGROUND: This study examines the effects of the COPD-specific health promoting self-management intervention "Better living with COPD" on different self-management-related domains, self-efficacy, and sense of coherence (SOC). METHODS: In a randomized controlled design, 182 people with COPD were allocated to either an intervention group (offered Better living with COPD in addition to usual care) or a control group (usual care). Self-management-related domains were measured by the Health Education Impact Questionnaire (heiQ) before and after intervention. Self-efficacy was measured by the General Self-Efficacy Scale (GSE) and SOC was measured by the 13-item Sense of Coherence Scale (SOC-13). Effects were assessed by ANCOVA, using intention-to-treat (ITT) analysis and per-protocol analysis (PPA). RESULTS: The PPA and the ITT analysis showed significant positive changes on Constructive attitudes and approaches (heiQ) (ITT: P=0.0069; PPA: P=0.0021) and Skill and technique acquisition (heiQ) (ITT: P=0.0405; PPA: P=0.0356). Self-monitoring and insight (heiQ) showed significant positive change in the PPA (P=0.0494). No significant changes were found on the other self-management domains (heiQ), self-efficacy (GSE), or SOC (SOC-13). CONCLUSION: Better living with COPD had a significant positive short-term effect on some self-management-related domains, and could be an intervention contributing to the support of self-management in people with COPD. However, further work is needed to establish the clinical relevance of the findings and to evaluate the long-term effects.

New Possibilities in Life with Type 2 Diabetes: Experiences from Participating in a Guided Self-Determination Programme in General Practice.

Research suggests that guided self-determination programmes can support self-management of diabetes by empowering self-determined goal setting and competence building. As most research in this area has focused on people with type 1 diabetes, knowledge is lacking on how adults with type 2 diabetes mellitus experience participation in such programmes. This study reports the modelling phase of a complex intervention design that explored the experiences of adults with type 2 diabetes who participated in a nurse-led guided self-determination programme in general practice and examines how the programme affected patients' motivation to self-manage diabetes. The qualitative design with semistructured interviews included 9 adults with type 2 diabetes who participated in the programme. Qualitative content analysis was used to analyse the data. The findings indicate that the participants experienced new life possibilities after participating in the programme, which seemed to have a positive influence on their motivation for self-management. Through reflections about how to live with diabetes, the participants reinterpreted their life with diabetes by gradually developing a closer relationship with the disease, moving towards acceptance. The fact that dialogue with the nurses was seen to be on an equal footing helped support the participants to become more self-determined.

Written reflection in an eHealth intervention for adults with type 2 diabetes mellitus: a qualitative study.

BACKGROUND: Individuals with type 2 diabetes mellitus (T2DM) are responsible for the daily decisions and actions necessary to manage their disease, which makes self-management the cornerstone of diabetes care. Many patients do not reach recommended treatment goals, and thus it is important to develop and evaluate innovative interventions that facilitate optimal motivation for adequate self-management of T2DM. OBJECTIVE: The aim of the current study was to explore how adults with T2DM experience using reflection sheets to stimulate written reflection in the context of the Guided Self-Determination (GSD) eHealth intervention and how written reflection might affect their motivation for self-management of T2DM. METHODS: We used a qualitative design in which data were collected through individual interviews. The sample consisted of 10 patients who completed the GSD eHealth intervention, and data were analyzed using qualitative content analysis. RESULTS: The qualitative content analysis yielded 2 main themes. We labeled the first theme as "Written reflection affects awareness and commitment in diabetes self-management", which reflects 2 subthemes, namely, "Writing creates space and time for autonomous reflection" and "Writing influences individuals' focus in diabetes self-management". We labeled the second theme as "Written reflection is perceived as inapplicable in diabetes self-management", which reflects 2 subthemes, namely, "Responding in writing is difficult" and "The timing of the writing is inappropriate". CONCLUSION: Our findings indicate that written reflection in the context of the GSD eHealth intervention may be conducive to motivation for diabetes self-management for some patients. However, it seems that in-person consultation with the diabetes nurse may be necessary to achieve the full potential benefit of the GSD as an eHealth intervention. We advocate further development and examination of the GSD as a "blended" approach, especially for those who consider written reflection to be difficult or unfamiliar.

Symptom burden and self-management in persons with chronic obstructive pulmonary disease.

Purpose: Self-management is crucial for effective COPD management. This study aimed at identifying associations between self-management and sociodemographic characteristics, clinical characteristics, and symptom burden in people with COPD. Patients and methods: In this cross-sectional study with 225 participants diagnosed with COPD grades II-IV, multiple linear regression analysis was conducted, using sociodemographic and clinical characteristics and symptom burden (COPD Assessment Test) as the independent variables and the eight self-management domains of the Health Education Impact Questionnaire (heiQ) as the outcome variables. Results: Higher symptom burden was significantly associated with worse scores in all self-management domains (p<0.003), except for self-monitoring and insight (p=0.012). Higher disease severity (p=0.004) and numbers of comorbidities (p<0.001) were associated with more emotional distress, and women scored higher than men on positive and active engagement in life (p=0.001). Higher score in pack-years smoking was associated with lower score in health-directed activities (p=0.006) and self-monitoring and insight (p<0.001), and participation in organized physical training was associated with higher score in health-directed activities (p<0.001). The final models explained 3.7%-31.7% of variance (adjusted R2) across the eight heiQ scales. Conclusion: A notable finding of this study was that higher symptom burden was associated with worse scores in all self-management domains, except for self-monitoring and insight. In addition, sex, disease severity, comorbidity, pack-years smoking, and participation in organized physical training were associated with one or two self-management domains. The study contributes to improved understanding of self-management in COPD. However, the explained variance levels indicate that more research needs to be done to uncover what else explains self-management domains in COPD.