Purpose of the Review
As described in the theory of self-care in chronic illness, there is a wide range of factors that can influence self-care behavior. The purpose of this paper is to summarize the ...recent heart failure literature on these related factors in order to provide an overview on which factors might be suitable to be considered to make self-care interventions more successful.
Recent Findings
Recent studies in heart failure patients confirm that factors described in the theory of self-care of chronic illness are relevant for heart failure patients.
Summary
Experiences and skills, motivation, habits, cultural beliefs and values, functional and cognitive abilities, confidence, and support and access to care are all important to consider when developing or improving interventions for patients with heart failure and their families. Additional personal and contextual factors that might influence self-care need to be explored and included in future studies and theory development efforts.
Objective. The purpose of this study is to determine whether patient activation is a changing or changeable characteristic and to assess whether changes in activation also are accompanied by changes ...in health behavior.
Study Methods. To obtain variability in activation and self‐management behavior, a controlled trial with chronic disease patients randomized into either intervention or control conditions was employed. In addition, changes in activation that occurred in the total sample were also examined for the study period. Using Mplus growth models, activation latent growth classes were identified and used in the analysis to predict changes in health behaviors and health outcomes.
Data Sources. Survey data from the 479 participants were collected at baseline, 6 weeks, and 6 months.
Principal Findings. Positive change in activation is related to positive change in a variety of self‐management behaviors. This is true even when the behavior in question is not being performed at baseline. When the behavior is already being performed at baseline, an increase in activation is related to maintaining a relatively high level of the behavior over time. The impact of the intervention, however, was less clear, as the increase in activation in the intervention group was matched by nearly equal increases in the control group.
Conclusions. Results suggest that if activation is increased, a variety of improved behaviors will follow. The question still remains, however, as to what interventions will improve activation.
Aim
To evaluate the effectiveness of education using avatars for improving patients’ heart failure knowledge and self‐care.
Background
A lack of knowledge and self‐care contributes to poor outcomes ...and rehospitalization for people with heart failure.
Design
A multi‐centred, non‐blinded pragmatic randomized controlled trial.
Methods
Heart failure patients were randomly assigned to intervention (avatar education application) or usual care groups. Participants were followed up at baseline, 30 and 90 days. ANCOVA was used to compare the scores of heart failure knowledge and self‐care, between the two groups. Fisher's exact test was used to compare the two groups’ heart failure‐cause readmission. Bivariate exact binary logistic regression was used to identify the predictors associated with baseline levels of knowledge.
Results
A total of 36 participants were recruited (between October 2018 ‐ March 2019). The mean age of participants was 67.5 (SD 11.3) years. At enrolment, approximately half (47.2%) have been living with Heart Failure for over 5 years. Two groups were comparable at baseline in their demographic and clinical characteristics. At 90 days, the intervention group participants had a higher increase in knowledge score on the Dutch Heart Failure Knowledge Scales compared with the control group (22.2% versus 3.7% P = .002, partial η2 = 0.262, 95% CI −2.755 to −0.686). There was no between‐group difference observed at 30‐ or 90‐day follow‐up, on self‐care behaviour (Self‐care of heart failure index) or healthcare use. Overall satisfaction with the avatar app was 91.3%.
Conclusion
The addition of a co‐designed avatar app to usual care improved knowledge in our group of Heart Failure participants at 30 days and continued to increase up to 90 days. The results suggest that our avatar app was perceived as an enjoyable and engaging means of delivering critical knowledge and self‐care information.
Impact
Heart failure is associated with poor clinical outcomes (i.e., readmission rates and mortality rate) and substantial economic burden. The effectiveness of Heart Failure patient education using avatar have not been investigated previously. In this study, the avatar app improved knowledge and self‐care behaviours. This innovation could be used at the bedside, at home by nurses, patients and families.
Trial Registration: Australian New Zealand Trial Registry ACTRN12617001403325.
目的
探讨avatars教育对提高心衰患者心衰知识和自我保健能力的有效性。
背景
缺乏知识和自我护理能力可导致心力衰竭患者病情恶化和再次入院。
设计
多中心、非盲态且实用的随机对照试验。
方法
心力衰竭患者被随机分配到干预组(avatar教育应用程序)或普通护理组。应分别在基线水平,治疗后30天和90天对参与者进行随访。利用协方差分析法对此两组患者的心衰知识和自我保健得分进行评估。利用费希尔精确检验方法对两组心力衰竭患者的再入院率进行比较。此外,采用二元精确及二元逻辑回归分析法确定与基线知识水平相关的预测因子。
结果
目前,共招募36名参与者(2018年10月至2019年3月)。参与者的平均年龄为67.5岁(标准偏差为11.3岁)。近半数(47.2%)的患者有至少5年的心力衰竭患病史。上述两组在人口统计学和临床特征方面具有可比性。治疗后90天,干预组内参与者在荷兰心力衰竭知识量表上的知识得分较对照组的增长更高(22.2%比3.7%P =.002,部分η2 = 0.262,95%CI−2.755−0.686)。根据治疗后30天或90天的随访结果,上述两组患者在自理行为(心衰自理指数)或医疗保健方面无组间差异。患者对avatar应用程序的总体满意度为91.3%。
结论
在日常护理过程中,使用经共同设计的avatar应用程序,以实现在30天内提高此组心力衰竭患者的知识水平,并在90天内持续增加。结果表明,此avatar应用程序可满足患者需求,极具吸引力,且可用于传递关键知识和自我保健信息。
影响
心力衰竭与不良临床结果(即再入院率和死亡率)和沉重经济负担相关。此前,并无有关Avatar应用对心力衰竭患者教育的有效性研究。这一创新可由护士、患者及其家人在床边或家中应用。临床试验注册:澳大利亚‐新西兰试验注册处,注册号:ACTRN12617001403325。
Consumers are living longer, creating more pressure on the health system and increasing their requirement for self-care of chronic conditions. Despite rapidly-increasing numbers of mobile health ...applications ('apps') for consumers' self-care, there is a paucity of research into consumer engagement with electronic self-monitoring. This paper presents a qualitative exploration of how health consumers use apps for health monitoring, their perceived benefits from use of health apps, and suggestions for improvement of health apps.
'Health app' was defined as any commercially-available health or fitness app with capacity for self-monitoring. English-speaking consumers aged 18 years and older using any health app for self-monitoring were recruited for interview from the metropolitan area of Perth, Australia. The semi-structured interview guide comprised questions based on the Technology Acceptance Model, Health Information Technology Acceptance Model, and the Mobile Application Rating Scale, and is the only study to do so. These models also facilitated deductive thematic analysis of interview transcripts. Implicit and explicit responses not aligned to these models were analyzed inductively.
Twenty-two consumers (15 female, seven male) participated, 13 of whom were aged 26-35 years. Eighteen participants reported on apps used on iPhones. Apps were used to monitor diabetes, asthma, depression, celiac disease, blood pressure, chronic migraine, pain management, menstrual cycle irregularity, and fitness. Most were used approximately weekly for several minutes per session, and prior to meeting initial milestones, with significantly decreased usage thereafter. Deductive and inductive thematic analysis reduced the data to four dominant themes: engagement in use of the app; technical functionality of the app; ease of use and design features; and management of consumers' data.
The semi-structured interviews provided insight into usage, benefits and challenges of health monitoring using apps. Understanding the range of consumer experiences and expectations can inform design of health apps to encourage persistence in self-monitoring.
Conventional HIV testing services have been less comprehensive in reaching men than in reaching women globally, but HIV self-testing (HIVST) appears to be an acceptable alternative. Measurement of ...linkage to post-test services following HIVST remains the biggest challenge, yet is the biggest driver of cost-effectiveness. We investigated the impact of HIVST alone or with additional interventions on the uptake of testing and linkage to care or prevention among male partners of antenatal care clinic attendees in a novel adaptive trial.
An adaptive multi-arm, 2-stage cluster randomised trial was conducted between 8 August 2016 and 30 June 2017, with antenatal care clinic (ANC) days (i.e., clusters of women attending on a single day) as the unit of randomisation. Recruitment was from Ndirande, Bangwe, and Zingwangwa primary health clinics in urban Blantyre, Malawi. Women attending an ANC for the first time for their current pregnancy (regardless of trimester), 18 years and older, with a primary male partner not known to be on ART were enrolled in the trial after giving consent. Randomisation was to either the standard of care (SOC; with a clinic invitation letter to the male partner) or 1 of 5 intervention arms: the first arm provided women with 2 HIVST kits for their partners; the second and third arms provided 2 HIVST kits along with a conditional fixed financial incentive of $3 or $10; the fourth arm provided 2 HIVST kits and a 10% chance of receiving $30 in a lottery; and the fifth arm provided 2 HIVST kits and a phone call reminder for the women's partners. The primary outcome was the proportion of male partners who were reported to have tested for HIV and linked into care or prevention within 28 days, with referral for antiretroviral therapy (ART) or circumcision accordingly. Women were interviewed at 28 days about partner testing and adverse events. Cluster-level summaries compared each intervention versus SOC using eligible women as the denominator (intention-to-treat). Risk ratios were adjusted for male partner testing history and recruitment clinic. A total of 2,349/3,137 (74.9%) women participated (71 ANC days), with a mean age of 24.8 years (SD: 5.4). The majority (2,201/2,233; 98.6%) of women were married, 254/2,107 (12.3%) were unable to read and write, and 1,505/2,247 (67.0%) were not employed. The mean age for male partners was 29.6 years (SD: 7.5), only 88/2,200 (4.0%) were unemployed, and 966/2,210 (43.7%) had never tested for HIV before. Women in the SOC arm reported that 17.4% (71/408) of their partners tested for HIV, whereas a much higher proportion of partners were reported to have tested for HIV in all intervention arms (87.0%-95.4%, p < 0.001 in all 5 intervention arms). As compared with those who tested in the SOC arm (geometric mean 13.0%), higher proportions of partners met the primary endpoint in the HIVST + $3 (geometric mean 40.9%, adjusted risk ratio aRR 3.01 95% CI 1.63-5.57, p < 0.001), HIVST + $10 (51.7%, aRR 3.72 95% CI 1.85-7.48, p < 0.001), and phone reminder (22.3%, aRR 1.58 95% CI 1.07-2.33, p = 0.021) arms. In contrast, there was no significant increase in partners meeting the primary endpoint in the HIVST alone (geometric mean 17.5%, aRR 1.45 95% CI 0.99-2.13, p = 0.130) or lottery (18.6%, aRR 1.43 95% CI 0.96-2.13, p = 0.211) arms. The lottery arm was dropped at interim analysis. Overall, 46 male partners were confirmed to be HIV positive, 42 (91.3%) of whom initiated ART within 28 days; 222 tested HIV negative and were not already circumcised, of whom 135 (60.8%) were circumcised as part of the trial. No serious adverse events were reported. Costs per male partner who attended the clinic with a confirmed HIV test result were $23.73 and $28.08 for the HIVST + $3 and HIVST + $10 arms, respectively. Notable limitations of the trial included the relatively small number of clusters randomised to each arm, proxy reporting of the male partner testing outcome, and being unable to evaluate retention in care.
In this study, the odds of men's linkage to care or prevention increased substantially using conditional fixed financial incentives plus partner-delivered HIVST; combinations were potentially affordable.
ISRCTN 18421340.
Despite the increasing interest in leaders’ health‐promoting behavior, the employees’ role in the effectiveness of such behavior and the mechanisms underlying how such leadership behavior affects ...their well‐being have largely been ignored. Drawing on implicit leadership theories, we advance the health‐oriented leadership literature by examining employees’ ideals, that is, their expectations regarding such leader behavior, as a moderating factor. We propose that higher expectations increase the association between actual health‐oriented leader behavior and employee‐rated leader‐member relationships (LMX) and health‐oriented behaviors by employees, which, in turn, positively relate to their well‐being (here: exhaustion and work engagement). We tested our theoretical model in three studies, using a cross‐sectional design (Study 1, N = 307), a two‐wave time‐lagged design (Study 2, N = 144) and an experimental design (Study 3, N = 173). We found that the effect of actual health‐oriented leader behavior on LMX is contingent on employees’ ideal health‐oriented leader behavior. Yet, for employees’ self‐care behavior, the proposed moderation was only significant in Study 1. High expectations strengthened the relationship between actual health‐oriented leader behavior with LMX and self‐care behavior, which, in turn, were associated with less exhaustion and more work engagement (only LMX), supporting most of our mediation hypotheses. Our results highlight the pivotal role of employees’ expectations regarding leaders’ health support and help in building practical interventions with regard to leaders’ health promotion.
Background:
Advancements in smartphone technology coupled with the proliferation of data connectivity has resulted in increased interest and unprecedented growth in mobile applications for diabetes ...self-management. The objective of this article is to determine, in a systematic review, whether diabetes applications have been helping patients with type 1 or type 2 diabetes self-manage their condition and to identify issues necessary for large-scale adoption of such interventions.
Methods:
The review covers commercial applications available on the Apple App Store (as a representative of commercially available applications) and articles published in relevant databases covering a period from January 1995 to August 2012. The review included all applications supporting any diabetes self-management task where the patient is the primary actor.
Results:
Available applications support self-management tasks such as physical exercise, insulin dosage or medication, blood glucose testing, and diet. Other support tasks considered include decision support, notification/alert, tagging of input data, and integration with social media. The review points to the potential for mobile applications to have a positive impact on diabetes self-management. Analysis indicates that application usage is associated with improved attitudes favorable to diabetes self-management. Limitations of the applications include lack of personalized feedback; usability issues, particularly the ease of data entry; and integration with patients and electronic health records.
Conclusions:
Research into the adoption and use of user-centered and sociotechnical design principles is needed to improve usability, perceived usefulness, and, ultimately, adoption of the technology. Proliferation and efficacy of interventions involving mobile applications will benefit from a holistic approach that takes into account patients' expectations and providers' needs.
Self-management of chronic pediatric conditions is a formidable challenge for patients, families, and clinicians, with research demonstrating a high prevalence of poor self-management and ...nonadherence across pediatric conditions. Nevertheless, effective self-management is necessary to maximize treatment efficacy and clinical outcomes and to reduce unnecessary health care utilization and costs. However, this complex behavior is poorly understood as a result of insufficient definitions, reliance on condition-specific and/or adult models of self-management, failure to consider the multitude of factors that influence patient self-management behavior, and lack of synthesis of research, clinical practice, and policy implications. To address this need, we present a comprehensive conceptual model of pediatric self-management that articulates the individual, family, community, and health care system level influences that impact self-management behavior through cognitive, emotional, and social processes. This model further describes the relationship among self-management, adherence, and outcomes at both the patient and system level. Implications for research, clinical practice, and health care policy concerning pediatric chronic care are emphasized with a particular focus on modifiable influences, evidence-based targets for intervention, and the role of clinicians in the provision of self-management support. We anticipate that this unified conceptual approach will equip stakeholders in pediatric health care to (1) develop evidence-based interventions to improve self-management, (2) design programs aimed at preventing the development of poor self-management behaviors, and (3) inform health care policy that will ultimately improve the health and psychosocial outcomes of children with chronic conditions.
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