Associations between self-care advice and healing time in patients with venous leg ulcer- a Swedish registry-based study.

BACKGROUND: Venous leg ulcers take time to heal. It is advocated that physical activity plays a role in healing, and so does the patient's nutritional status. Additionally, malnutrition influences the inflammatory processes, which extends the healing time. Therefore, the staff's advising role is important for patient outcomes. Thus, this study aimed to investigate the associations between given self-care advice and healing time in patients with venous leg ulcers while controlling for demographic and ulcer-related factors. METHODS: The sample consisted of patients registered in the Registry of Ulcer Treatment (RUT) which includes patient and ulcer-related and healing variables. The data was analyzed with descriptive statistics. Logistic regression models were performed to investigate the influence of self-care advice on healing time. RESULTS: No associations between shorter healing time (less than 70 days) and the staff´s self-care advice on physical activity was identified, whilst pain (OR 1.90, CI 1.32-2.42, p < 0.001) and giving of nutrition advice (OR 1.55, CI 1.12-2.15, p = 0.009) showed an association with longer healing time. CONCLUSIONS: Neither self-care advice on nutrition and/or physical activity indicated to have a positive association with shorter healing time. However, information and counseling might not be enough. We emphasize the importance of continuously and systematically following up given advice throughout ulcer management, not only when having complicated ulcers.

Need for reassurance in self-care of minor illnesses.

AIMS AND OBJECTIVES: This study describes people's need for reassurance in self-care of minor illnesses. BACKGROUND: Self-care and active surveillance are advocated as important strategies to manage minor illnesses. Reassurance influences patient satisfaction and confidence in the practicing of self-care. DESIGN: This study is a descriptive and interpretive qualitative study. METHODS: Twelve persons with experience in self-care and receiving self-care advice were recruited, and data were collected using semi-structured interviews between September-December 2014. Data were analysed using qualitative content analyses. RESULTS: Having previous experience and the ability to actively manage symptoms using self-care interventions was described as reassuring. Participants became stressed and concerned when the symptoms persisted and interventions lacked the desired effect, which often resulted in a decision to consult. Participants wanted to feel that the nurse was an actual person, who was sympathetic, present and understanding, when they received self-care advice. The nurse's assessment and reasoning of the symptoms facilitated care-seekers' assessments of risk, and clear and concrete advice on how to manage the symptoms exerted a calming effect. Patients needed to trust that the nurse understood their situation to embrace the advice, and being invited to return created a feeling that the nurse had listened and taken them seriously. CONCLUSIONS: Reassurance has the potential to allay doubts and fears to build confidence, which influences self-care and consultation behaviour. Personal presence in the encounter, receiving an assessment and an explanation of the symptoms and precise advice are reassuring. RELEVANCE TO CLINICAL PRACTICE: The needs of nursing care may persist despite the absence of medical needs. The encounter between the nurse and care-seeker is a unique possibility for reassurance and confidence that a minor illness is self-limiting in its nature, and self-care interventions provide relief and comfort.

Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach.

BACKGROUND: Medication nonadherence negatively impacts the health outcomes of people with cancer as well as health care costs. Digital technologies present opportunities to address this health issue. However, there is limited evidence on how to develop digital interventions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving medication adherence. OBJECTIVE: The objective of this study was to co-design, develop, and preliminarily evaluate an innovative mobile health solution called Safety and Adherence to Medication and Self-Care Advice in Oncology (SAMSON) to improve medication adherence among people with cancer. METHODS: Using the 4 cycles and 6 processes of design science research methodology, we co-designed and developed a medication adherence solution for people with cancer. First, we conducted a literature review on medication adherence in cancer and a systematic review of current interventions to address this issue. Behavioral science research was used to conceptualize the design features of SAMSON. Second, we conducted 2 design phases: prototype design and final feature design. Last, we conducted a mixed methods study on patients with hematological cancer over 6 weeks to evaluate the mobile solution. RESULTS: The developed mobile solution, consisting of a mobile app, a web portal, and a cloud-based database, includes 5 modules: medication reminder and acknowledgment, symptom assessment and management, reinforcement, patient profile, and reporting. The quantitative study (n=30) showed that SAMSON was easy to use (21/27, 78%). The app was engaging (18/27, 67%), informative, increased user interactions, and well organized (19/27, 70%). Most of the participants (21/27, 78%) commented that SAMSON's activities could help to improve their adherence to cancer treatments, and more than half of them (17/27, 63%) would recommend the app to their peers. The qualitative study (n=25) revealed that SAMSON was perceived as helpful in terms of reminding, supporting, and informing patients. Possible barriers to using SAMSON include the app glitches and users' technical inexperience. Further needs to refine the solution were also identified. Technical improvements and design enhancements will be incorporated into the subsequent iteration. CONCLUSIONS: This study demonstrates the successful application of behavioral science research and design science research methodology to design and develop a mobile solution for patients with cancer to be more adherent. The study also highlights the importance of applying rigorous methodologies in developing effective and patient-centered digital intervention solutions.