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1.
Medicine (Baltimore) ; 99(6): e19021, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028412

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) has a significant impact on quality of life and is costly to the health care system. It has been demonstrated that a self-management program improves quality of life, but programs are not universally available and telehealth interventions can provide home-based support, but have mixed results. AIM: The aims of this study are to (1) assess the feasibility and acceptability of a 6 weeks' educational program related to self-management with remote monitoring for Lebanese COPD patients; (2) pre-test its impact on quality of life, emergency visits, and rate of rehospitalization, and (3) to make recommendations for a future randomized trial. METHODS: Validated questionnaires will be adapted to meet the context of our study in terms of acceptability, adoption, adequacy, fidelity, cost, and coverage. The impact of this program on quality of life will be measured with the COPD assessment test (CAT) and the COPD clinical questionnaire (CCQ), and the Hospital Anxiety and Depression (HAD) scale will be used to measure anxiety. All measures will be delivered pre- and post-intervention. To evaluate the impact of our program on the rate of hospitalization and emergency visits, the number of hospitalizations and emergency room visits during the year preceding the intervention will be collected from the hospital register of each participant. DISCUSSION: This study is the first to evaluate the application of telehealth to optimize COPD management in Lebanon. The results of this study will provide evidence regarding the efficacy and feasibility of this approach for Lebanese patients with moderate to severe COPD.


Assuntos
Doença Pulmonar Obstrutiva Crônica/terapia , Autogestão , Telemedicina/métodos , Adulto , Protocolos Clínicos , Estudos de Viabilidade , Feminino , Humanos , Líbano , Masculino , Satisfação do Paciente , Qualidade de Vida , Autogestão/métodos , Inquéritos e Questionários
2.
Hu Li Za Zhi ; 67(1): 113-119, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960403

RESUMO

The article describes the author's nursing experience providing psychiatric homecare to a patient with chronic schizophrenia using the concept of resilience. Holistic nursing assessments were conducted via clinical observations during home visits every two weeks from May 24th to September 20th, 2018. Through these assessments, the main health problems of the patient were defined as ineffective self-health management, ineffective coping skills, and insufficient resilience. The nursing interventions implemented were designed to establish the patient's capacity to effectively and correctly self-manage health status, achieve emotional accommodation, and reduce parent-child conflicts. In order to enhance the resilience of the patient, the patient was guided to review important support resources over the course of illness, to detect the barriers of returning society, to apply the beneficial skills of health management, and then extend the status of employment and to enhance self-fulfillment.


Assuntos
Resiliência Psicológica , Esquizofrenia/enfermagem , Psicologia do Esquizofrênico , Adaptação Psicológica , Serviços de Assistência Domiciliar , Humanos , Autogestão/psicologia
3.
JAMA Netw Open ; 3(1): e1919954, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995214

RESUMO

Importance: The number of patients presenting to emergency departments (EDs) for psychiatric care continues to increase. Psychiatrists often make a conservative recommendation to admit patients because robust outpatient services for close follow-up are lacking. Objective: To assess whether the availability of a 45-day behavioral health-virtual patient navigation program decreases hospitalization among patients presenting to the ED with a behavioral health crisis or need. Design, Setting, and Participants: This randomized clinical trial enrolled 637 patients who presented to 6 EDs spanning urban and suburban locations within a large integrated health care system in North Carolina from June 12, 2017, through February 14, 2018; patients were followed up for up to 45 days. Eligible patients were aged 18 years or older, with a behavioral health crisis and a completed telepsychiatric ED consultation. The availability of the behavioral health-virtual patient navigation intervention was randomly allocated to specific days (Monday through Friday from 7 am to 7 pm) so that, in a 2-week block, there were 5 intervention days and 5 usual care days; 323 patients presented on days when the program was offered, and 314 presented on usual care days. Data analysis was performed from March 7 through June 13, 2018, using an intention-to-treat approach. Interventions: The behavioral health-virtual patient navigation program included video contact with a patient while in the ED and telephonic outreach 24 to 72 hours after discharge and then at least weekly for up to 45 days. Main Outcomes and Measures: The primary outcome was the conversion of an ED encounter to hospital admission. Secondary outcomes included 45-day follow-up encounters with a self-harm diagnosis and postdischarge acute care use. Results: Among 637 participants, 358 (56.2%) were men, and the mean (SD) age was 39.7 (16.6) years. The conversion rates were 55.1% (178 of 323) in the intervention group vs 63.1% (198 of 314) in the usual care group (odds ratio, 0.74; 95% CI, 0.54-1.02; P = .06). The percentage of patient encounters with follow-up encounters having a self-harm diagnosis was significantly lower in the intervention group compared with the usual care group (36.8% [119 of 323] vs 45.5% [143 of 314]; P = .03). Conclusions and Relevance: Although the primary result did not reach statistical significance, there is a strong signal of potential positive benefit in an area that lacks evidence, suggesting that there should be additional investment and inquiry into virtual behavioral health programs. Trial Registration: ClinicalTrials.gov identifier: NCT03204643.


Assuntos
Terapia Comportamental/métodos , Serviço Hospitalar de Emergência , Transtornos Mentais/terapia , Admissão do Paciente/estatística & dados numéricos , Telemedicina/organização & administração , Adulto , Medicina do Comportamento/métodos , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , North Carolina , Autogestão/educação , Resultado do Tratamento , Adulto Jovem
5.
Hu Li Za Zhi ; 66(6): 4, 2019 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-31802448

RESUMO

The diabetes population continues to grow worldwide both in terms of overall numbers and rate of increase. It is estimated that 642 million people will suffer from diabetes by 2040 (International Diabetes Federation, 2017). Diabetes was ranked the fifth main cause of death in Taiwan in 2017. (Department of Statistics, Ministry of Health and Welfare, Taiwan, ROC, 2019). Because of differences in the population in terms of disease cognition and disease control behaviors, despite recent advances in medicine and treatment efficacy, many diabetes patients continue to suffer from complications caused by improper blood sugar control, leading to a considerable number of subsequent health problems. Healthcare professionals, especially nurses, have critical roles to play in the health management of diabetes and metabolic-syndrome patients. In both the acute healthcare system and community homecare units, glycemic-related management of diabetes is important. We invite diabetes experts from academic and clinical practice units to share their professional knowledge and practical experiences, emphasizing patient-centered self-management principles. Related articles are expected to draw readers' attention to diabetes-related issues in order to gain new knowledge and skills related to blood sugar management.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus/terapia , Autogestão , Humanos , Taiwan
6.
Hu Li Za Zhi ; 66(6): 13-19, 2019 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-31802450

RESUMO

Diabetes is one of the most prevalent chronic diseases affecting public health. The Taiwan government implemented the Diabetes Shared Care Program to deliver continuous medical care and provide health education in order to help clients with diabetes learn self-management. However, rural older adults with diabetes often have poor access to medical resources and thus face obstacles to obtaining and using the services of this program. This paper introduces the current status of the Diabetes Shared Care Program, discusses the concept of self-management education and support for diabetes cases, and proposes community-based strategies, including (1) provide DSMES (diabetes self-management education and support) with multi-types of services, (2) increase non-professional personnel training, and (3) provide culture-congruent health education, in order to strengthen the diabetes self-management capabilities of rural older adults.


Assuntos
Diabetes Mellitus/terapia , Educação de Pacientes como Assunto , População Rural , Autogestão/educação , Idoso , Humanos , População Rural/estatística & dados numéricos , Taiwan
7.
BMC Health Serv Res ; 19(1): 688, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604433

RESUMO

BACKGROUND: The main purpose of health service systems is to improve patients' quality of life (QoL) and to ensure equitable access to health services. However, in reality, nearly half of knee osteoarthritis (OA) patients present to the health system do not have access to health services, and their QoL remains poor. These circumstances raise important questions about what (if any) factors can improve health care accessibility and QoL for knee OA patients. METHODS: A multicenter, cross-sectional survey was performed with 618 knee OA patients who received care at 16 hospitals in Thailand. Structural equation modeling (SEM) was conducted to investigate the association of health service factors and patient factors with access to health services and QoL. RESULTS: The QoL of knee OA patients was very poor (mean score = 33.8). Only 2.1% of the knee OA patients found it easy to obtain medical care when needed. Approximately 39.4% of them were able to access appropriate interventions before being referred for knee replacement. More than 85% of orthopedic health services had implemented chronic disease management (CDM) policy into practice. However, the implementation was basic, with an average score of 5.9. SEM showed that QoL was determined by both health system factors (ß = .10, p = .01) and patient factors (ß = .29, p = .00 for self-management and ß = -.49, p = .00 for disease factors). Access to health services was determined by self-management (ß = .10, p = .01), but it was not significantly associated with QoL (ß = .00, p = 1.0). CONCLUSIONS: This study provides compelling information about self-management, access to health services and QoL from the individual and health service system perspectives. Furthermore, it identifies a need to develop health services that are better attuned to the patient's background, such as socioeconomic status, disease severity, and self-management skills.


Assuntos
Acesso aos Serviços de Saúde/normas , Osteoartrite do Joelho/cirurgia , Qualidade de Vida , Artroplastia do Joelho/psicologia , Artroplastia do Joelho/normas , Doença Crônica , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Osteoartrite do Joelho/psicologia , Autogestão/estatística & dados numéricos , Tailândia
8.
Res Nurs Health ; 42(6): 500-508, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31587327

RESUMO

Two minds theory (TMT) offers a new approach to changing health behavior. Here, TMT is applied to self-management of Type 1 diabetes. TMT can be conceptualized as a cycle where a stimulus produces an immediate Intuitive system response leading to health behavior, followed by a conscious narrative system response that is temporally delayed. Narrative responses do not produce behaviors directly but instead lead to conscious beliefs about past events and behavioral intentions for the future, both of which become part of the material considered by the intuitive system in selecting future behaviors. Because of the temporal delay between intuitive behavior and narrative interpretation, and the nonconscious nature of intuitive thought, there is often a gap between intentions and behaviors. This has implications for nursing practice. First, nurses should consider that patient-reported impressions of the past or future are fundamentally narrative system responses and understand that these may be less predictive of behavior than biopsychosocial measures that are more temporally immediate. Second, nurses can use TMT to inform new strategies for behavior change interventions. For diabetes self-management, nurses can encourage individuals to leverage environmental cues to prompt self-management (tricking the intuitive system), provide rewards for self-management (training the intuitive system), or engage the narrative system via planning, reframing, or attention practices for healthier future decisions. Overall, the TMT addresses the gap between intentions and behavior and should be further developed to inform behavioral health interventions.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Comportamentos Relacionados com a Saúde , Autogestão , Humanos , Intenção , Teoria de Enfermagem
11.
JAMA ; 322(14): 1371-1380, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31593271

RESUMO

Importance: Patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations have high rehospitalization rates and reduced quality of life. Objective: To evaluate whether a hospital-initiated program that combined transition and long-term self-management support for patients hospitalized due to COPD and their family caregivers can improve outcomes. Design, Setting, and Participants: Single-site randomized clinical trial conducted in Baltimore, Maryland, with 240 participants. Participants were patients hospitalized due to COPD, randomized to intervention or usual care, and followed up for 6 months after hospital discharge. Enrollment occurred from March 2015 to May 2016; follow-up ended in December 2016. Interventions: The intervention (n = 120) involved a comprehensive 3-month program to help patients and their family caregivers with long-term self-management of COPD. It was delivered by nurses with special training on supporting patients with COPD using standardized tools. Usual care (n = 120) included transition support for 30 days after discharge to ensure adherence to discharge plan and connection to outpatient care. Main Outcomes and Measures: The primary outcome was number of COPD-related acute care events (hospitalizations and emergency department visits) per participant at 6 months. The co-primary outcome was change in participants' health-related quality of life measured by the St George's Respiratory Questionnaire (SGRQ) at 6 months after discharge (score, 0 [best] to 100 [worst]; 4-point difference is clinically meaningful). Results: Among 240 patients who were randomized (mean [SD] age, 64.9 [9.8] years; 61.7% women), 203 (85%) completed the study. The mean (SD) baseline SGRQ score was 62.3 (18.8) in the intervention group and 63.6 (17.4) in the usual care group. The mean number of COPD-related acute care events per participant at 6 months was 1.40 (95% CI, 1.01-1.79) in the intervention group vs 0.72 (95% CI, 0.45-0.97) in the usual care group (difference, 0.68 [95% CI, 0.22-1.15]; P = .004). The mean change in participants' SGRQ total score at 6 months was 2.81 in the intervention group and -2.69 in the usual care group (adjusted difference, 5.18 [95% CI, -2.15 to 12.51]; P = .11). During the study period, there were 15 deaths (intervention: 8; usual care: 7) and 339 hospitalizations (intervention: 202; usual care: 137). Conclusions and Relevance: In a single-site randomized clinical trial of patients hospitalized due to COPD, a 3-month program that combined transition and long-term self-management support resulted in significantly greater COPD-related hospitalizations and emergency department visits, without improvement in quality of life. Further research is needed to determine reasons for this unanticipated finding. Trial Registration: ClinicalTrials.gov Identifier: NCT02036294.


Assuntos
Hospitalização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Autogestão , Cuidado Transicional , Idoso , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos
12.
BMC Health Serv Res ; 19(1): 662, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31514743

RESUMO

BACKGROUND: Pre-gestational and gestational diabetes mellitus are common complications in pregnancy affecting one in six pregnancies. The maternity services are under significant strain managing the increasing number of complex pregnancies. This has an impact on patients' experience of antenatal care. Therefore, there is a clear need to address pregnancy care. One possible solution is to use home-based digital technology to reduce clinic visits and improve clinical monitoring. METHODS: The aim of this study was to evaluate the antenatal services provided to pregnant women with diabetes who were monitored at the joint metabolic and obstetric clinic at the Southern Health and Social Care Trust in Northern Ireland. RESULTS: The questionnaires were completed by sixty-three women, most of whom had gestational diabetes mellitus. Most of the participants were between 25 and 35 years of age (69.8%), had one or more children (65.1%) and spent over 2 h attending the clinics (63.9%); 78% of women indicated that their travel time to and from the clinic appointment was over 15 min. Over 70% of women used smartphones for health-related purposes. However, only 8.8% used smartphones to manage their health or diabetes. Less than 25% of the women surveyed expressed concerns about using digital technology from home to monitor various aspects of their health in pregnancy. CONCLUSIONS: Overall, pregnant women who had or developed diabetes in pregnancy experience frequent hospital visits and long waiting times in the maternity clinics. Most of these pregnant women are willing to self-manage their condition from home and to be monitored remotely by the healthcare staff.


Assuntos
Diabetes Gestacional/terapia , Maternidades , Monitorização Fisiológica/métodos , Complicações na Gravidez/terapia , Autogestão , Telemedicina , Adulto , Diabetes Gestacional/fisiopatologia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Irlanda do Norte , Gravidez , Complicações na Gravidez/fisiopatologia , Autogestão/estatística & dados numéricos
14.
Postgrad Med ; 131(8): 566-571, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31524035

RESUMO

Background: Compared with traditional outpatient follow up, short message service (SMS) provides more convenience for diabetes self-management. However, the feasibility, effectiveness, and satisfaction of SMS intervention remain unclear.Methods: A systematic retrieval of databases, including PubMed, EMBASE, and Cochrane Library, was used to evaluate the effect of SMS on the diabetes glycemic control. Complete quantitative reports on the changes of glycosylated hemoglobin (HbA1c) before and after intervention were collected. The study type was limited to randomized controlled trials (RCTs).Results: 13 RCTs were identified as eligible for this subject. Overall result revealed a statistical decline of HbA1c by -0.62% (95% CI -0.82 to -0.41). The longest intervention duration was 12 months with the noteworthy improvement of HbA1c by -1.63% (-2.27 to -0.99). Compared with control groups, five trials quantitatively demonstrated a significant decline in fasting plasma glucose (FPG) by -0.45 (95% CI -0.7 to -0.19) and -1.05 (95% CI -1.35 to -0.75) in 2-h postprandial blood glucose (2hPBG).Conclusions: This meta-analysis demonstrated that text message intervention indeed leads to a decline in HbA1c and improvement of blood glucose control. No convincing evidence was found on quality of life improvement, satisfaction, body mass index (BMI), blood lipid levels, the frequency of hypoglycemia, self-monitoring of blood glucose or complications reduction.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Autogestão/métodos , Mensagem de Texto , Glicemia , Automonitorização da Glicemia , Índice de Massa Corporal , Hemoglobina A Glicada , Humanos , Hipoglicemia/induzido quimicamente , Lipídeos/sangue , Satisfação do Paciente , Período Pós-Prandial , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Artigo em Inglês | MEDLINE | ID: mdl-31509950

RESUMO

Purpose: Increasing attention is being paid to the role of the intelligent self-management of hypertension under the context of increasing prevalence but limited medical resources. However, heterogeneity in interventions and outcome measures has hindered the interpretation of research evaluating mobile health technologies for hypertension control, and little study of such technology has been performed in China. Objective: This was a feasibility study aimed to understand patient and medical practitioners' acceptance and experience of a mobile-phone based platform for the management of hypertensive patients. Methods: The model used behavioral incentives for daily blood pressure measurement and physician-facing prioritization of patients based on level of blood-pressure control. Patients were enrolled by purposive sampling. The platform was used for two-week blood pressure monitoring through WeChat, which simulated our future app. Qualitative interviews with patients and providers were conducted in time. Results: Twenty hypertensive patients and two providers were enrolled and used the platform throughout the two weeks. Patients reported daily home blood pressure monitoring to be simple, feasible and increased their health awareness. Specifically, patients self-reported that reminders, the daily frequency and time of monitoring, and positive reinforcement were important for maintaining adherence. Providers reported that they could manage patients more quickly and accurately, but reasonable feedback information was needed to avoid excessive increases in workload. Conclusion: The adoption of mobile-based technology to monitor patient's blood pressure may provide a practical solution for managing patients in Chongqing, China. Patient health education and enhanced app functionality could improve patient compliance and satisfaction while reducing provider workload.


Assuntos
Pressão Sanguínea , Telemedicina , Adulto , Idoso , Telefone Celular , China , Estudos de Viabilidade , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Médicos , Autorrelato , Autogestão
16.
BMC Public Health ; 19(1): 1228, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488086

RESUMO

BACKGROUND: The few previous studies investigating acculturation and self-management have suggested that increased participation in (or adaptation to) the host culture is associated with better health and disease management. However, research on the relationship between acculturation strategies (attachment to the Dutch and Turkish cultures) and broader self-management abilities among older Turkish immigrants in the Netherlands is lacking. This study aimed to investigate this relationship in this population. METHODS: Turkish immigrants aged > 65 years and residing in Rotterdam, the Netherlands (n = 2350), were identified using the municipal register. In total, 680 respondents completed the questionnaire (32% response rate). RESULTS: The average age of the respondents was 72.90 (standard deviation, 5.02; range, 66-95) years and 47.6% of respondents were women. The majority (80.3%) of respondents reported having low educational levels. Women, single individuals, less-educated respondents, and those with multimorbidity experienced lower levels of attachment to the Dutch culture and reported poorer self-management abilities. Slightly stronger relationships were found between self-management and attachment to the Dutch culture than attachment to the Turkish culture. Multimorbidity negatively affected the self-management abilities of older Turkish people living in the Netherlands. CONCLUSIONS: The study findings indicate that especially attachment to the Dutch culture matters for the self-management abilities of older Turkish immigrants in the Netherlands. Given the high prevalence of multimorbidity in this population, investment in their self-management abilities is expected to be beneficial. Special attention is needed for women, single individuals, less-educated people, and those with multimorbidity. Interventions aiming to better integrate these groups into Dutch society are also expected to be beneficial for their self-management abilities.


Assuntos
Aculturação , Emigrantes e Imigrantes/psicologia , Autogestão , Idoso , Idoso de 80 Anos ou mais , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Masculino , Países Baixos , Inquéritos e Questionários , Turquia/etnologia
17.
Stud Health Technol Inform ; 267: 282-288, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483283

RESUMO

BACKGROUND: Mobile health applications (mHealth apps) have the potential to help patients with chronic conditions such as hypertension by supporting self-management activities in daily life. However, the uptake of mHealth apps remains poor among patients. To improve the utilization of mHealth apps for hypertension, the analysis of the behavioral intention to use such applications must consider personality traits and illness-related perceptions. METHOD: Adults with hypertension in Germany and Austria filled out a self-administered questionnaire in a cross-sectional study based on the UTAUT-model in order to identify potential predictors for the behavioral intention to use mHealth applications as an indicator for their early acceptance. Beyond the four core determinants of acceptance of the UTAUT (performance expectancy, effort expectancy, social influence and facilitating conditions), self-efficacy, openness to experience and perceived health threat were analyzed as predictors. RESULTS: 145 participants (mean age 52.51 years, SD 14.33; 60% female) completed the survey. Acceptance was moderate on average (M = 3.26, SD = 1.07, min 1 to max 5). In a multiple hierarchical regression, performance expectancy and effort expectancy were confirmed as significant predictors of acceptance (step 1, R2 = .57, p < .001), while self-efficacy could not be confirmed (step 2, p = .87). In addition, perceived health threat (ß = .12, p < .05) and openness to experience (ß = .22, p < .001) had a significant influence on acceptance of mHealth apps for hypertension (step 3, overall model with R2 = .62). Age showed a negative association with the intention to use (ß = .22, p = .005) while no influence of gender could be found (p = .06). CONCLUSION: Above expectations regarding effectiveness and usability, openness to experience and perceived health threat make a significant contribution in predicting the acceptance of mHealth solutions in the field of chronic diseases.


Assuntos
Hipertensão , Autogestão , Telemedicina , Adulto , Idoso , Áustria , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade
18.
BMC Health Serv Res ; 19(1): 641, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492176

RESUMO

BACKGROUND: The use of mobile health apps is now common in diabetes self-management and acceptability of such tools could help predict further use. There is limited research on the acceptability of such apps: use over time, the factors and features that influence self-management, how to overcome barriers, and how to use an app in relation to health-care personnel. In this study, we aimed to obtain an in-depth understanding of users' acceptability of a mobile app for diabetes self-management, and to explore their communication with health-care personnel concerning the app. METHODS: The study had a qualitative descriptive design. Two researchers conducted 24 semi-structured in-depth interviews with adults with type 2 diabetes who had used a digital diabetes diary app for 1 year, during participation in the Norwegian Study in the EU project RENEWING HeALTH. We recruited the participants in a primary health-care setting. The transcripts of the interviews were analyzed using qualitative content analysis on developing themes, which we interpreted according to a theory of acceptability. We used NVivo 11 Pro during the process. RESULTS: The users' acceptability of the app diverged. Overall, the responses indicated that the use of a digital diabetes diary requires hard work, but could also ease the effort involved in following a healthy lifestyle and better-controlled levels of blood glucose. Crucial to the acceptability was that a routine use could give an overview of diabetes registration and give new insights into self-management. In addition, support from health-care personnel with diabetes knowledge was described as necessary, either to confirm the decisions made based on use of the app, or to get additional self-management support. There were gradual transitions between practical and social acceptability, where utility of the app seems to be necessary for both practical and social acceptability. Lack of acceptability could cause both digital and clinical distress. CONCLUSIONS: Both practical and social acceptability were important at different levels. If the users found the utility of the app to be acceptable, they could tolerate some lack of usability. We need to be aware of both digital and clinical distress when diabetes apps form a part of relevant health-care. TRIAL REGISTRATIONS: Self-management in Type 2 Diabetes Patients Using the Few Touch Application, NCT01315756, https://clinicaltrials.gov/show/NCT01315756 March 15, 2011.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Aplicativos Móveis , Autocuidado/métodos , Adulto , Idoso , Atitude do Pessoal de Saúde , Glicemia/metabolismo , Comunicação , Diabetes Mellitus Tipo 2/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Comportamentos Relacionados com a Saúde , Estilo de Vida Saudável , Humanos , Hipoglicemiantes/uso terapêutico , Insulinas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Atenção Primária à Saúde , Pesquisa Qualitativa , Autogestão/métodos , Distância Social
19.
Stud Health Technol Inform ; 266: 183-188, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31397321

RESUMO

Using a Design Thinking and co-design methodology, hospital staff and consumers developed a novel mobile health app for heart failure self-management. Various stakeholders engaged in three development stages: interviews, design workshops and prototype iterations. Eleven of 18 co-design team members reflected on the co-design process and design outcomes. A total of 144 data points were collected: 96 about the co-design process and 48 about the design outcomes. Successes and failures reflect the strengths and weaknesses of operationalising co- design in practice. Overall, participants were surprised the design outcomes were achieved. The app was considered a supportive tool for meaningful self-monitoring and patients believed the app would be applicable to their situations. Our findings suggest that local co-design can be achieved through meaningful partnerships, and managing stakeholders was key to the projectâAZs success.


Assuntos
Insuficiência Cardíaca , Aplicativos Móveis , Autogestão , Telemedicina , Humanos
20.
J Clin Nurs ; 28(23-24): 4478-4487, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410916

RESUMO

AIMS AND OBJECTIVES: To examine the effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes and to determine whether resilience mediates the effects of family functioning on self-management and glycaemic control. BACKGROUND: Poor self-management and glycaemic control are common in youth with type 1 diabetes. Family functioning and resilience are known to be important psychosocial factors that contribute to individual health and development. However, no studies have explored the effects of family functioning and resilience on self-management and glycaemic control among youths with type 1 diabetes in mainland China. DESIGN: This study was conducted using a survey with a convenience sample following the STROBE guidelines. METHODS: A total of 204 Chinese youth who had been diagnosed with type 1 diabetes for at least 6 months were recruited. Family functioning, resilience, self-management and diabetes distress were measured using self-reports and standard measurement tools. Glycaemic control was assessed by glycated haemoglobin (HbA1C ) levels. A structural equation model was used to test the hypothesised model. RESULTS: The final model accounted for 52.1% and 19.5% of the total variance of self-management and HbA1C level, respectively. Resilience had a direct effect on self-management and an indirect effect on control of HbA1C . Family functioning had an indirect effect on both self-management and control of HbA1C through resilience. The model remained invariant across the mild-distress and severe-distress groups. CONCLUSION: In Chinese youth with type 1 diabetes, resilience positively affected self-management and ultimately optimised glycaemic control, even in the presence of diabetes distress. Family functioning positively affected self-management and glycaemic control by promoting resilience. RELEVANCE TO CLINICAL PRACTICE: This study found that family functioning and resilience had positive effects on self-management and glycaemic control in youth. This study confirms the importance of incorporating resilience assessments and family-based resilience interventions into clinical nursing practice with youth with type 1 diabetes.


Assuntos
Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 1/psicologia , Família/psicologia , Resiliência Psicológica , Autogestão/psicologia , Adolescente , Diabetes Mellitus Tipo 1/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Autorrelato , Inquéritos e Questionários , Adulto Jovem
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