A Theory of Transitions Influencing Diabetes Self-management Among Emerging Adults With Type 1 Diabetes.

Emerging adults with type 1 diabetes are experiencing numerous transitions, potentially affecting diabetes self-management. For example, when transitioning to college, these emerging adults may experience changes in their daily routines and usual reminders or triggers for habitual behavior such as checking blood glucose levels. In turn, these emerging adults may omit checking glucose levels, impacting decisional and adaptational diabetes self-management behavior associated with their insulin dose or bolus. Thus, we propose a theory on transitions influencing daily routines, diabetes self-management habitual behavior triggers, and, in turn, diabetes self-management habitual and decisional/adaptational behaviors for emerging adults with type 1 diabetes.

"The constant worry": Urinary incontinence self-management in rural women: A qualitative study.

Urinary incontinence (UI) is experienced by approximately 60% of women in the United States and has a negative impact on self-esteem, sexual function, social participation, and quality of life. Rural women, who are underrepresented in the UI literature, face many health disparities and unique barriers to accessing care. The purpose of this qualitative descriptive study was to explore UI self-management behaviors in rural women with UI, including the contextual factors that influence their approach to self-management. This study recruited rural women, ages 30-60 years, using purposive sampling via social media. Demographic information was collected. A semi-structured interview guide was used to conduct individual, in-depth interviews via Zoom. Interview data were analyzed using qualitative description. Sections of interview text were coded using a priori and emergent codes, grouped into categories, and distilled into themes. A total of 31 participants (mean age = 47.2 years) met inclusion/exclusion criteria, enrolled, and completed the study. Qualitative analysis revealed rural as a cross-cutting theme and five major themes: self-management behaviors, familial influence, medical encounters, talking about UI, and resource scarcity. Participants described the rural environment as having a substantial impact on their approach to UI self-management. Specifically, rural social enmeshment made seeking care for UI in rural communities challenging. Findings shed light on how the rural environment influences various aspects of UI self-management in midlife women. Diverse perspectives in UI self-management are needed to advance knowledge in this field.

Methodologies Used in Studies of Self-Management Interventions for Urinary Incontinence in Adult Women: An Integrative Review.

BACKGROUND: Urinary incontinence (UI) affects approximately 60% of women in the United States and negatively impacts self-esteem, sexual function, participation in social activities, and quality of life (QOL). Self-management interventions show promise for improving UI symptoms and QOL. Previous reviews of UI self-management studies have focused on outcomes for older women. However, the literature lacks a synthesis of methodologies of these studies. PURPOSE: The purpose of this integrative review was to synthesize and evaluate methodologies used in studies of self-management interventions for UI in adult women. METHODS: Using an integrative review approach, a search of PubMed, CINAHL, and Embase was conducted yielding 1404 results, 23 of which met inclusion criteria. Data abstracted from each article included author(s), year of publication, study design and purpose, sample, country and setting, measures of UI symptoms, and intervention description. RESULTS: Findings showed methodological differences, particularly in design, assessment of UI subtypes, measures of UI symptoms, and intervention components. Multicomponent self-management interventions were used in 18 studies and 1 component used in 5 studies. Education, pelvic floor muscle exercises, and bladder training were the intervention components most frequently used, either alone or in combination; however, intervention components were not consistently aligned with the UI subtypes. Analysis of ethical matters revealed areas for improvement, specifically in reporting privacy and confidentiality and in methods to obtain informed consent. CONCLUSIONS: Results highlight opportunities to improve the rigor of methodologies used in studies of self-management interventions for UI in adult women.

"Ask, 'When You Do This, How Much Pain Are You In?'": Content Preferences for a Conversational Pain Self-Management Software Application.

The purpose of the current study was to examine older adults' preferences for conversational pain management content to incorporate in an interactive application (app) for pain self-management. Conversational statements and questions were written as a script to encourage evidence-based pain self-management behaviors. The content was converted from text to female chatbot speech and saved as four groups of MP3 files. A purposive sample of 22 older adults participated in a guided interaction through the MP3 files. One-on-one interviews were conducted to garner participants' conversational content preferences. Overall, participants want the conversational content to increase health care provider engagement in pain management communication. Older adults preferred the inclusion of conversational statements and questions for monitoring the multifaceted dimensions of pain, treatment accountability, guidance for alternative treatments, and undesirable effects from pain treatments. The design of mobile health apps must incorporate the needs and preferences of older adults. [Journal of Gerontological Nursing, 49(1), 11-17.].

Interventions for Rural Caregiver Health: An Integrative Review.

Few health behavior interventions exist for rural caregivers of persons with dementia (PWD) in the United States. Of interventions that have been studied, little is known about health outcomes that are included in interventions and which interventions are most effective on health outcomes. An integrative literature review of intervention studies for rural caregiver health throughout the United States was undertaken with an emphasis on concepts related to health promotion, self-management, self-care, and/or self-efficacy. Findings from this review indicated multicomponent interventions that included self-care strategies were associated with improvements of caregiver psychosocial health outcomes of depression, burden, self-efficacy, social support, and self-rated health. Sleep problems and endurance potential were the only physical health outcomes measured. To prevent adverse physical health outcomes, interventions with attention to rural context are needed that emphasize health promotion with a focus on health behaviors and health outcome measurement in rural caregivers of PWD. [Research in Gerontological Nursing, 15(2), 101-108.].

Female teachers' child abuse reporting role in Oman: Results from focus groups.

BACKGROUND: Schoolteachers are in a good position to identify and report suspected child abuse and neglect cases; however, they still fail to report all the cases. Recently, the Sultanate of Oman, which is a collectivistic culture, mandated schoolteachers to report any suspected case. However, there is a lack of evidence known to us about the factors associated with Omani teachers' reporting behavior. Such evidence is needed to inform the interventions that are designed to enhance teachers' reporting behavior. OBJECTIVE: The current study was designed to address this gap by exploring the factors that affect Omani schoolteachers reporting behavior of suspected child abuse and neglect cases. PARTICIPANTS AND SETTING: A total of 26 participants were recruited from five basic education schools in the Muscat governorate in Oman. METHODS: This is a descriptive qualitative study. Five focus group discussions were conducted. Thematic coding was used for data analysis. RESULTS: Three themes were discerned from the data analysis. The factors that affect Omani schoolteachers as described by the participants were: 1) reporting within an environment of educational resource scarcity; 2) reporting within an environment of competing female social roles and their professional reporting role; and 3) reporting within an environment of complex and diverse abuse and neglect cases. CONCLUSIONS: Our findings highlight the role of culture in reporting behavior. Implications for research and practice are discussed.

A web-based intervention is feasible for supporting weight loss and increased activity in rural women with arthritis.

Rural women have well documented health disparities, with higher prevalence of obesity and chronic conditions, including arthritis. Change in weight and actigraph-recorded data were examined in a subset of 63 of 82 women with physician-diagnosed arthritis who completed a 30-month web-based clinical trial. Repeated measures analyses showed women lost weight from baseline to six months, slowly regained at 18 and 30 months, ending with a lower weight than baseline F(1,62)=40.89, p<0.001, η2p =0.40. Of 53 women with complete data, activity increased at six months, decreased at 18 months, and increased at 30 months F(1,52)=4.14, p =.04, η2p=0.07. Women showed improved change in weight and activity from baseline at six, 18 and 30 months. This study adds support that web-based programs may promote weight loss and activity in a hard-to-reach, underserved population of midlife and older rural women with arthritis.

Mobile health assisted self-monitoring is acceptable for supporting weight loss in rural men: a pragmatic randomized controlled feasibility trial.

BACKGROUND: Addressing overweight and obesity among men at-risk for obesity-related diseases and disability in rural communities is a public health issue. Commercial smartphone applications (apps) that promote self-monitoring for weight loss are widely available. Evidence is lacking regarding what support is required to enhance user engagement with and effectiveness of those technologies. Pragmatically comparing these apps effectiveness, including rural men's desired forms of support when using them, can lead to greater weight loss intervention impact and reach. This study assessed the feasibility and acceptability of a mobile technology application applied differently across two groups for weight loss. METHODS: In a two-armed, pragmatic pilot feasibility study, 80 overweight and obese men aged 40-69 were randomized using a 1:1 ratio to either an enhanced Mobile Technology Plus (MT+) intervention or a basic Mobile Technology (MT) intervention. The MT+ group had an enhanced smartphone app for self-monitoring (text messaging, discussion group, Wi-Fi scale) whereas the MT group received a basic app that allowed self-monitoring logging only. Assessments were collected at baseline, 3 and 6 months. App logs were analyzed to track engagement and adherence to self-monitoring. Acceptability was assessed via focus groups. Analysis included descriptive statistics and qualitative content analysis. RESULTS: Of 80 men recruited, forty were allocated to each arm. All were included in the primary analysis. Recruitment ended after 10 months with a 97.5 and 92.5% (3 month, 6 month) retention rate. Over 90% of men reported via survey and focus groups that Lose-It app and smart scale (MT+) was an acceptable way to self-monitor weight, dietary intake and physical activity. Adherence to daily app self-monitoring of at least 800 dietary calories or more (reported respectively as MT+, MT) was positive with 73.4, 51.6% tracking at least 5 days a week. Adherence to tracking activity via recorded steps four or more days weekly was positive, 87.8, 64.6%. Men also adhered to self-weighing at least once weekly, 64, 46.3%. At 6 months, an observed mean weight loss was 7.03 kg (95% CI: 3.67, 10.39) for MT+ group and 4.14 kg (95% CI: 2.22, 6.06) for MT group, with 42.9 and 34.2% meeting ≥5% weight loss, respectively. No adverse events were reported. CONCLUSIONS: This National Institutes of Health-funded pilot study using mobile technologies to support behavior change for weight loss was found to be feasible and acceptable among midlife and older rural men. The interventions demonstrated successful reductions in weight, noting differing adherence to lifestyle behaviors of eating, monitoring and activity between groups, with men in the MT+ having more favorable results. These findings will be used to inform the design of a larger scale, clinical trial. TRIAL REGISTRATION: The trial was prospectively registered with ClinicalTrials NCT03329079 . 11/1/2017.

Mobile technology intervention for weight loss in rural men: protocol for a pilot pragmatic randomised controlled trial.

INTRODUCTION: Men who are overweight or obese in the rural Midwestern USA are an unrepresented, at-risk group exhibiting rising rates of cardiovascular disease, poor access to preventive care and poor lifestyle behaviours that contribute to sedentary lifestyle and unhealthy diet. Self-monitoring of eating and activity has demonstrated efficacy for weight loss. Use of mobile technologies for self-monitoring eating and activity may address rural men's access disparities to preventive health resources and support weight loss. Our pilot trial will assess the feasibility and acceptability of two mobile applications for weight loss in rural men to inform a future, full-scale trial. METHODS AND ANALYSIS: A 6-month randomised controlled trial with contextual evaluation will randomise 80 men using a 1:1 ratio to either a Mobile Technology Plus (MT+) intervention or a basic Mobile Technology (MT) intervention in rural, midlife men (aged 40-69 years). The MT+ intervention consists of a smartphone self-monitoring application enhanced with discussion group (Lose-It premium), short message service text-based support and Wi-Fi scale. The MT group will receive only a self-monitoring application (Lose-It basic). Feasibility and acceptability will be evaluated using number of men recruited and retained, and evaluative focus group feedback. We seek to determine point estimates and variability of outcome measures of weight loss (kg and % body weight) and improved dietary and physical activity behaviours (Behavioral Risk Factor Surveillance System (BRFSS) physical activity and fruit and vegetable consumption surveys, data from Lose-It! application (kcal/day, steps/day)). Community capacity will be assessed using standard best practice methods. Descriptive content analysis will evaluate intervention acceptability and contextual sensitivity. ETHICS AND DISSEMINATION: This protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB# 594-17-EP). Dissemination of findings will occur through ClinicalTrials.gov and publish pilot data to inform the design of a larger clinical trial. TRIAL REGISTRATION NUMBER: NCT03329079; preresults. Protocol V.10, study completion date 31 August 2020. Roles and responsibilities funder: NIH/NINR Health Disparities Section 1R15NR017522-01.

Intervention Components Targeting Self-Management in Individuals with Multiple Chronic Conditions: An Integrative Review.

Multiple chronic conditions (MCC) are becoming increasingly common and self-management (SM) interventions to address MCC are emerging. Prior reviews have broadly examined SM interventions in MCC; however, interventional components were not thoroughly described. Components of SM interventions that have been delivered to individuals with MCC were identified. A review of CINAHL, Cochrane, PubMed, PsycINFO, Scopus, and Embase was completed. This search yielded 13,994 potential studies; 31 studies among those 13,994 studies met inclusion for analysis. The literature is multidisciplinary and describes a wide variety of interventional strategies implementing various combinations of components. A descriptive analysis of the studies' components, application of the components, delivery methods, and primary outcomes demonstrated clear variations between programs. The most common components noted in the 31 studies were education, action planning/goal setting, self-monitoring, and social/peer support. The variation in SM programs limits conclusive evidence for which components are recommended to improve self-management in individuals with MCC.

Feasibility of Synchronous Online Focus Groups of Rural Breast Cancer Survivors on Web-Based Distress Self-Management.

PURPOSE: To obtain rural breast cancer survivors' perceptions of CaringGuidance™ After Breast Cancer Diagnosis, a web-based, psychoeducational, distress self-management program, and explore the feasibility of gathering survivors' perceptions about CaringGuidance using online focus groups (OFGs). PARTICIPANTS & SETTING: 23 survivors of early-stage breast cancer, a mean of 2.5 years postdiagnosis, living in rural Nebraska. METHODOLOGIC APPROACH: Participants reviewed the CaringGuidance program independently for an average of 12 days prior to their designated OFG. The extent of participants' pre-OFG review was verified electronically. Four synchronous, moderated OFGs were conducted. Demographic and OFG participation data were used to assess feasibility. Transcripts of OFGs were analyzed using directed content analysis. FINDINGS: All enrolled women participated in their designated OFG. Five themes of the quality and usability of CaringGuidance were identified. Recommendations were used to modify CaringGuidance prior to the pilot efficacy trial. IMPLICATIONS FOR NURSING: The findings contribute to nurses' knowledge and guide assessment and interventions pertaining to psychosocial needs of rural women with breast cancer, OFGs, and qualities rural women seek in web-based psychological interventions.

Web-Based Interventions Alone or Supplemented with Peer-Led Support or Professional Email Counseling for Weight Loss and Weight Maintenance in Women from Rural Communities: Results of a Clinical Trial.

Objective. This trial compared the effectiveness of a web-based only (WO) intervention with web-based supplemented by peer-led discussion (WD) or professional email counseling (WE) across 3 phases to achieve weight loss and weight maintenance in women from underserved rural communities. Methods. 301 women (BMI of 28-45 kg/m2) randomly assigned to groups participated in guided weight loss (baseline to 6 months), guided weight loss and maintenance (6 to 18 months), and self-managed weight maintenance (18 to 30 months). Results. Retention was 88.7%, 76.5%, and 71.8% at 6, 18, and 30 months, respectively. Intent-to-treat analyses demonstrated no group differences in change in weight within any phases. At 6 months, observed mean (SD) weight loss was 5.1 (6.0) kg in WO, 4.1 (5.6) kg in WD, and 6.0 (6.3) kg in WE, with 42%, 38%, and 51%, respectively, meeting ≥ 5% weight loss. These proportions dropped by a third after phase 2 with no further change during phase 3. Conclusion. Web-based interventions assisted women from rural communities in achieving 6-month weight loss, with weight regain by half at 30 months. No group differences were potentially due to the robust nature of the web-based intervention. Trial Registration. This trial is registered with ClinicalTrials.gov NCT01307644.

Acceptability of mHealth Technology for Self-Monitoring Eating and Activity among Rural Men.

OBJECTIVE: To examine rural men's use and perceptions of mobile and wireless devices to self-monitor eating and physical activity (mHealth). DESIGN AND SAMPLE: Men in this 3-week pilot study used FitBit One® to log daily food intake and monitor activity. A companion application (app) allowed activity monitoring of fellow participants. Health-related text messages were received 1-3 times daily. A purposive sample of 12 rural men (ages 40-67) was recruited by community leaders. MEASURES: (1) baseline heart rate, blood pressure, and BMI, (2) FitBit One® usage, (3) investigator-generated surveys on acceptability of mHealth, and (4) focus group on experience with mHealth. RESULTS: Men were overweight (n = 3) or obese (n = 9) and 9 of 12 were hypertensive. Nine of twelve wore FitBit One® all 21 days. Eleven of 12 men logged food, with 9 of 12 doing this at least 15 of 21 days. Self-monitoring and daily text messaging increased awareness of energy intake and output. Companion app's food log needed targeting for rural foods. Rotating seasons (occupational, religious, recreational) and weak cellular signals created contextual barriers to self-monitoring eating and activity. CONCLUSIONS: FitBit One® and text messaging were perceived as useful among the rural men, while the companion apps require adaptation to reflect dietary norms.

The influence of cognitive decline on rural identity: perspectives of older women.

PURPOSE: The purpose of this study was to examine the perspectives of community-dwelling rural, older women concerning the meaning of cognitive decline and to ascertain how cognitive decline affects their lives and the lives of those around them. DESIGN: An ethnographic design guided 1 year of cultural immersion in a rural, farming county in Nebraska. METHOD: Four life history interviews, participant observations, field notes, and cultural artifacts were collected for case-focused analysis. FINDINGS: Cognitive decline was believed to threaten one's social identity as a "good woman" because of three strongly held beliefs that (1) the rural lifestyle protected health, (2) demands of the farm were more important than personal health needs, and (3) mainstream health care services were unnatural and insensitive, and therefore best avoided. Using mainstream health care also resulted in the loss of informal social support, which existed as a protective social silence and helped sustain older women's rural identity. The older women feared developing cognitive decline and believed the loss of one's life purpose would be the outcome of the condition. CONCLUSIONS: Holistic nursing actions that preserve older women's rural identity and social support may increase the likelihood that women accept rural health care aimed at treating cognitive decline.

A case report of historical trauma among American Indians on a rural Northern Plains reservation.

This case report describes historical trauma on a rural American Indian reservation and outlines participatory action approaches for nurses. The prevalence of historical trauma often goes unnoticed by healthcare professionals because of its multifaceted nature and subsequent lack of provider understanding. Nurses accustomed to looking only for physical and psychosocial signs of trauma may not specifically understand how to align significant historical trauma events with prevention, education, and healthcare delivery. Nursing interventions developed through participatory action and directed at individual, family, and community levels of care are most effective in treating and preventing cumulative effects of historical trauma.