Gender differences in loneliness, anger, depression, self-management ability and biomarkers of chronic illness in chronically ill mid-life adults in Appalachia.

AIMS: This study describes gender differences and relationships among loneliness, anger, depression, self-management ability and biomarkers of chronic illness in chronically ill mid-life adults in Appalachia. BACKGROUND: Loneliness predicts poor health, functional decline, and mortality in adults. Though self-management ability is linked to improved health outcomes, a gap existed when examining how loneliness impacts self-management ability (SMA). METHODS: This cross-sectional study recruited 90 patients from a primary care center. Instruments measured loneliness, anger, depression, and SMA. Measures were taken for BMI, blood pressure, and glucose. Descriptive and hierarchical multiple regression was used to test hypotheses. RESULTS: Participants were majority female (68%), white (89%), married (52%), employed (66%), and impoverished (70%). They were moderately lonely (M = 41.29, SD 12.13) and men were lonelier than women (p < .01). Men and women did not differ on anger, depressive symptoms, or SMA. Anger (5.64, SD 7.32) and depressive symptoms (M = 5.89, SD 5.54) were low. Loneliness positively correlated with anger (r = 0.415, p < .01) and depression (r = 0.558, p < .01), and inversely related to subscales of SMA (p < .01) [taking initiative (TI), investment behavior (IB), variety (V), multifunctionality (MF), self-efficacy (SE), and positive frame of mind (PM)]. After controlling for age, anger, and depression, loneliness was explanatory for poorer SMA (R squared change = 0.32, F change (1, 67) = 47.67, p < .001). CONCLUSIONS: Loneliness impacts SMA and should be included in the care planning or study of chronically ill adults who struggle with self-management.

A Pilot One Group Feasibility, Acceptability, and Initial Efficacy Trial of LISTEN for Loneliness in Lonely Stroke Survivors.

Loneliness is a prevalent problem for adult stroke survivors, and a known contributor to hypertension, secondary stroke, functional decline, poorer quality of life, and mortality in older adults. LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a theoretically based behavioral health intervention designed to target loneliness, in a sample of lonely survivors of ischemic stroke. Objectives: To assess the feasibility and acceptability of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes) in lonely stroke survivors and to evaluate the initial efficacy of LISTEN for loneliness, depressive symptoms, neurological quality of life, and blood pressure in a sample of lonely survivors of ischemic stroke. Methods: The study design was framed using the psychoneuroimmunology paradigm and employed a prospective non-randomized one group design. Six adult stroke survivors were recruited from a Neurology outpatient clinic. Once consented and enrolled, participants attended 5 sequential weekly group sessions of LISTEN. Evaluations, field notes, and video recordings of each session were used to assess feasibility and acceptability of LISTEN. Quantitative data was collected at enrollment and at 1, 6, and 12 weeks post last LISTEN session to assess initial efficacy on loneliness (revised UCLA loneliness scale), depressive symptoms (PHQ-9), neurological quality of life (NeuroQoL), and blood pressure. SPSS was used for descriptive and comparative data analysis to examine within subject changes. Results: LISTEN was feasible to deliver in the selected clinical setting and participants rated LISTEN as highly useful, organized, and clear with an overall rating as excellent for loneliness. Participants reported significant decline in loneliness and improved scores on three subscales of the NeuroQoL; executive function, positive affect and well-being, and satisfaction with social roles. Recruiting stroke survivors for the trial was time intensive for the study team. Conclusions: Larger randomized trials of LISTEN in stroke survivors are needed to build evidence for the longer term effectiveness of LISTEN on loneliness, depressive symptoms, and quality of life. Future study designs will include planning to diminish barriers to recruitment.

The effectiveness of mI SMART: A nurse practitioner led technology intervention for multiple chronic conditions in primary care.

AIMS: Used as integrated tools, technology may improve access and outcomes of care. A new intervention that integrates multiple technologies called mI SMART has been developed, implemented, and evaluated by Nurse Practitioners. The aim of this paper is to present the initial effectiveness of a web-based, structure of sensors and mobile devices designed to overcome the known health determinant of access to care for rural, chronically ill patients by using technology. METHODS: The study was conducted at a community primary-care clinic that provides free healthcare to impoverished adults. Adults with at least one chronic condition, a minimum of 3rd grade reading level, and without dementia/psychosis were recruited. Participants were given a Nexus7 tablet and Bluetooth self-monitoring devices. The intervention lasted for 12 weeks. Blood glucose, blood pressure, and weight were collected using the provided Bluetooth devices and means were evaluated with paired-samples t-tests before and after the intervention. RESULTS: Thirty participants were majority female, white, married, high-school educated or less, earning less than $20,000 per annum, and had multiple chronic conditions. Pre-intervention glucose, systolic blood pressure, diastolic blood pressure, weight and Body Mass Index were all reduced after the 12-week intervention. CONCLUSIONS: The mI SMART intervention is efficacious for use in improvised adults living in rural areas with multiple chronic conditions. As previously reported, the intervention was also shown to be feasible and acceptable to patients. The next step is a larger randomized controlled trial.

Using Multidisciplinary Focus Groups to Inform the Development of mI SMART: A Nurse-Led Technology Intervention for Multiple Chronic Conditions.

Used as integrated tools, technology may improve the ability of healthcare providers to improve access and outcomes of care. Little is known about healthcare teams' preferences in using such technology. This paper reports the findings from focus groups aimed at evaluating a newly developed primary care technology platform. Focus groups were completed in academic, outpatient, and community settings. Focus groups were attended by 37 individuals. The participants included professionals from multiple disciplines. Both prescribing (N = 8) and nonprescribing healthcare team members (n = 21) completed the focus groups and survey. The majority were practicing for more than 20 years (44.8%) in an outpatient clinic (62%) for 20-40 hours per week (37.9%). Providers identified perceived obstacles of patient use as ability, willingness, and time. System obstacles were identified as lack of integration, lack of reimbursement, and cost. The positive attributes of the developed system were capability for virtual visits, readability, connectivity, user-friendliness, ability to capture biophysical measures, enhanced patient access, and incorporation of multiple technologies. Providers suggested increasing capability for biophysical and symptom monitoring for more common chronic conditions. Technology interventions have the potential to improve access and outcomes but will not be successful without the input of users.

The Use of Video Conferencing for Persons with Chronic Conditions: A Systematic Review.

The purpose of this paper is to present a systematic review of studies that used Video Conferencing (VC) intervention for common chronic conditions. Chronic conditions account for the majority of poor health, disability, and death, and for a major portion of health-care expenditures in the United States. Innovative methods and interventions are needed to enhance care and management, improve access to care, improve patient outcomes, narrow health disparities and reduce health-care costs. Video Conferencing could be particularly relevant in improving health, care management, access and cost in the care of chronic illnesses. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 27 articles measuring video conferencing, at least one chronic illness, and patient outcomes for adults living in a community setting. While VC has been found to be feasible and effective, a low number of randomized controlled trials limit evidence. In addition, studies in this review were not designed to address the question of whether access to care in rural areas is improved through VC. Hence, more research is needed.

Using Gene Expression Analysis to Examine Changes in Loneliness, Depression and Systemic Inflammation in Lonely Chronically Ill Older Adults.

PURPOSE: The purpose of this study was to evaluate the effectiveness of LISTEN (Loneliness Intervention) on loneliness, depression, physical health, systemic inflammation, and genomic expression in a sample of lonely, chronically ill, older adults. METHODS: This was a prospective, longitudinal randomized trial of LISTEN, a novel intervention based on theories of narrative and cognitive restructuring to target specific aspects of loneliness. Twenty-three older, lonely, chronically ill adults were recruited from a family medicine clinic in West Virginia. Participants were randomized to two groups, 13 in LISTEN group (Loneliness Intervention) and 10 in attention control (healthy aging education). Participants attended an enrollment session where they completed consent, survey data (including sociodemographics and chronic illness diagnoses), baseline physical measures, and blood sampling for gene expression analysis. After completing the 5 weekly sessions, all participants attended a 12 week post data collection meeting (17 weeks post-baseline) for survey completion, physical measures and blood sampling. RESULTS: The results of this study show that the LISTEN intervention improves measures of physical and psychosocial health. Specifically, subjects enrolled in LISTEN showed reductions in systolic blood pressure, as well as decreased feelings of loneliness and depression. These changes may be due, in part, to a reduction in systemic inflammation, as measured by interleukin-2. CONCLUSION: This study provides support for the use of LISTEN in reducing loneliness in chronically ill, older adults. Further, while some of our results are inconclusive, it provides rationale to expand our study population to evaluate the relationship between loneliness and systemic inflammation. In the future, enhancing knowledge about the relationships among loneliness, chronic illness, systemic inflammation, and gene expression of these particular targets, and how these relationships may change over time with intervention will inform translation of findings to clinical settings.

The Feasibility and Acceptability of LISTEN for Loneliness.

PURPOSE: The purpose of this paper is to present the initial feasibility and acceptability of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a new intervention for loneliness. Loneliness is a significant stressor and known contributor to multiple chronic health conditions in varied populations. In addition, loneliness is reported as predictive of functional decline and mortality in large samples of older adults from multiple cultures. Currently, there are no standard therapies recommended as effective treatments for loneliness. The paucity of interventions has limited the ability of healthcare providers to translate what we know about the problem of loneliness to active planning of clinical care that results in diminished loneliness. LISTEN was developed using the process for complex intervention development suggested by the Medical Research Council (MRC) [1] [2]. METHODS: Feasibility and acceptability of LISTEN were evaluated as the first objective of a longitudinal randomized trial which was set in a university based family medicine center in a rural southeastern community in Appalachia. Twenty-seven older adults [(24 women and 3 men, mean age: 75 (SD 7.50)] who were lonely, community-dwelling, and experiencing chronic illness, participated. Feasibility was evaluated by tracking recruitment efforts, enrollment, attendance to intervention sessions, attrition, and with feedback evaluations from study personnel. Acceptability was assessed using quantitative and qualitative evaluation data from participants. RESULTS: LISTEN was evaluated as feasible to deliver with no attrition and near perfect attendance. Participants ranked LISTEN as highly acceptable for diminishing loneliness with participants requesting a continuation of the program or development of additional sessions. CONCLUSIONS: LISTEN is feasible to deliver in a primary healthcare setting and has the potential to diminish loneliness which could result in improvement of the long-term negative known sequelae of loneliness such as hypertension, depression, functional decline, and mortality. Feedback from study participants is being used to inform future trials of LISTEN with consideration for developing additional sessions. Longitudinal randomized trials are needed in varied populations to assess long-term health and healthcare system benefits of diminishing loneliness, and to assess the potential scalability of LISTEN as a reimbursable treatment for loneliness.

Study protocol: mobile improvement of self-management ability through rural technology (mI SMART).

BACKGROUND: There are 62 million Americans currently residing in rural areas who are more likely to have multiple chronic conditions and be economically disadvantaged, and in poor health, receive less recommended preventive services and attend fewer visits to health care providers. Recent advances in mobile healthcare (mHealth) offer a promising new approach to solving health disparities and improving chronic illness care. It is now possible and affordable to transmit health information, including values from glucometers, automated blood pressure monitors, and scales, through Bluetooth-enabled devices. Additionally, audio and video communications technologies can allow healthcare providers to conduct many parts of a physical exam remotely from varied settings. These technologies could remove geographical distance as a barrier to care and diminish the access to care issues faced by patients who live rurally. However, currently there is lack of studies that provide evidence of feasibility, acceptability, and effectiveness of mHealth initiatives on improved outcomes of care, a needed step to make the translation to implementation studies in healthcare systems. The purpose of this paper is to present the protocol for the first study of mI SMART (mobile Improvement of Self-Management Ability through Rural Technology), a new integrated mHealth intervention. METHODS: Our objective is to provide evidence of feasibility and acceptability for the use of mI SMART in an underserved population and establish evidence for the refinement of mI SMART. The proposed study will take place at Milan Puskar Health Right, a free primary care clinic in the state of West Virginia. The clinic provides health care at no cost to uninsured, low income; adults aged 18-64 living in West Virginia. We will enroll 30 participants into this feasibility study with plans of implementing a longitudinal randomized, comparative effectiveness design in the future. Data collection will include tracking of barriers and facilitators to using mI SMART on patient and provider feedback surveys, tracking of patient-provider communications, self-reports from patients on quality of life, adherence, and self-management ability, and capture of health record data on chronic illness measures. DISCUSSION: We expect that the mI SMART intervention, refined from participant and provider feedback, will be acceptable and feasible. We anticipate high patient-provider satisfaction, enhanced patient-provider communication, and improved health related quality of life, adherence to treatment, and self-management ability. In addition, we hypothesize that patients who use mI SMART will demonstrate improved physical outcomes such as blood glucose, blood pressure, and weight.