We tested the social-cognitive model of career self-management (Lent & Brown, 2013) using a longitudinal design. Participants were 420 college students who completed measures of career exploration ...and decision-making self-efficacy, outcome expectations, social support, goals, and actions, along with trait conscientiousness, at 2 time points roughly 4 months apart, near the beginning and middle of an academic year. They also reported their level of career decidedness and decisional anxiety at both of these time points as well as near the end of the academic year (about 3 months after the 2nd assessment). The model provided good overall fit to the data and accounted for substantial portions of the variance in engagement in exploratory actions and in the 2 decisional outcomes (decidedness and decisional anxiety) over time. The findings also supported the hypothesized bidirectional paths of the decisional outcomes to self-efficacy and outcome expectations. We consider implications of the findings for the social-cognitive model as well as for future research and practice.
Public Significance Statement
We tested a theoretical model of career decision-making in college students. The findings suggest that particular elements of the model, such as confidence in career decision-making skills, predict favorable change in students' decisional status and anxiety over time.
Self-management improves health outcomes in chronic illness not only by improving adherence to the treatment plan but also by building the individual's capacity to navigate challenges and solve ...problems. Support for self-management is a critical need among children and adolescents with (medically and/or socially) complex chronic conditions. Self-management support refers to services that health systems and community agencies provide to persons with chronic illness and their families to facilitate self-management; it is a collaboration between the patient, family, and care providers. Evidence has guided the development of self-management support approaches and tools for adults and has led to an increased adoption of best practices in adult chronic illness care. However, adult models fail to account for some key differences between children and adults, namely, the integral role of parents and/or caregivers and youth development over time. There is a need for self-management support models that take into account the developmental trajectory across the pediatric age range. Effective approaches must also recognize that in pediatrics, self-management is really shared management between the youth and the parent(s) and/or caregiver(s). Health systems should design care to address self-management for pediatric patients. Although clinicians recognize the importance of self-management in youth with complex chronic conditions, they need standardized approaches and tools to do the following: assess the self-management skills of youth and families, assess modifiable environmental influences on chronic conditions, collaboratively set self-management goals, promote competence and eventual autonomy in youth, share the responsibility for self-management support among nonphysician members of the health care team, and leverage community resources for self-management support.
Aims
Facilitated self‐management support programmes have become central to the treatment of chronic diseases including diabetes. For many children and young people with diabetes (CYPD), the impact on ...glycated haemoglobin (HbA1c) and a range of self‐management behaviours promised by these programmes remain unrealised. This warrants an appraisal of current thinking and the existing evidence to guide the development of programmes better targeted at this age group.
Methods
Create a narrative review of systematic reviews produced in the last 3 years that have explored the impact on CYPD of the four key elements of self‐management support programmes: education, instruction and advice including peer support; psychological counselling via a range of therapies; self‐monitoring, including diaries and telemetric devices; and telecare, the technology‐enabled follow‐up and support by healthcare providers.
Results
Games and gamification appear to offer a promising means of engaging and educating CYPD. Psychological interventions when delivered by trained practitioners, appear to improve HbA1c and quality of life although effect sizes were small. Technology‐enabled interactive diaries can increase the frequency of self‐monitoring and reduce levels of HbA1c. Telecare provided synchronously via telephone produced significant improvements in HbA1c.
Conclusions
The cost‐effective flexibility of increasing the reliance on technology is an attractive proposition; however, there are resource implications for digital connectivity in underserved populations. The need remains to improve the understanding of which elements of each component are most effective in a particular context, and how to optimise the influence and input of families, caregivers and peers.
Objective
Self‐management has been proposed as a strategy to help cancer patients optimize their health and well‐being during survivorship. Previous reviews have shown variable effects of ...self‐management on outcomes. The theoretical basis and psychoeducational components of these interventions have not been evaluated in detail. We aimed to evaluate the evidence for self‐management and provide a description of the components of these interventions.
Methods
We conducted a systematic review of self‐management interventions for adults who had completed primary cancer treatment by searching MEDLINE, EMBASE, PsychINFO, CINAHL, Scopus, Cochrane Database of Systematic Reviews, National Institutes of Health Clinical Trials Registry, and Cochrane CENTRAL Registry of Controlled Trials. We included experimental and quasiexperimental designs. Data synthesis included narrative and tabular summary of results; heterogeneity of interventions and outcomes precluded meta‐analysis. Study quality was evaluated using the Cochrane risk of bias tool or the risk of bias of nonrandomized studies tool.
Results
Forty‐one studies published between 1994 and 29 March 2018 were included. Studies were predominantly randomized controlled trials and targeted to breast cancer survivors. A variety of intervention designs, psychoeducational components, and outcomes were identified. Less than 50% of the studies included a theoretical framework. There was variability of effects across most outcomes. Risk of bias could not be fully assessed.
Conclusions
There are limitations in the design and research on self‐management interventions for cancer survivors that hinder their translation into clinical practice. Further research is needed to understand if these interventions are an important type of support for cancer survivors.
A majority of the US adult population has one or more chronic conditions that require medical intervention and long-term self-management. Such conditions are among the 10 leading causes of mortality; ...an estimated 86% of the nation's $2.7 trillion in annual health care expenditures goes toward their treatment and management. Patient self-management of chronic diseases is increasingly essential to improve health behaviors, health outcomes, and quality of life and, in some cases, has demonstrated effectiveness for reducing health care utilization and the societal cost burden of chronic conditions. This review synthesizes the current state of the science of chronic disease self-management interventions and the evidence for their effectiveness, especially when applied with a systematic application of theories or models that account for a wide range of influences on behavior. Our analysis of selected outcomes from randomized controlled trials of chronic disease self-management interventions contained in 10 Cochrane systematic reviews provides additional evidence to demonstrate that self-management can improve quality of life and reduce utilization across several conditions.
Background:
Since the introduction of mobile phones, technology has been increasingly used to enable diabetes self-management education and support. This timely systematic review summarizes how ...currently available technology impacts outcomes for people living with diabetes.
Methods:
A systematic review of high quality review articles and meta analyses focused on utilizing technology in diabetes self-management education and support services was conducted. Articles were included if published between January 2013 and January 2017.
Results:
Twenty-five studies were included for analysis. The majority evaluated the use of mobile phones and secure messaging. Most studies described healthy eating, being active and metabolic monitoring as the predominant self-care behaviors evaluated. Eighteen of 25 reviews reported significant reduction in A1c as an outcome measure. Four key elements emerged as essential for improved A1c: (1) communication, (2) patient-generated health data, (3) education, and (4) feedback.
Conclusion:
Technology-enabled diabetes self-management solutions significantly improve A1c. The most effective interventions incorporated all the components of a technology-enabled self-management feedback loop that connected people with diabetes and their health care team using 2-way communication, analyzed patient-generated health data, tailored education, and individualized feedback. The evidence from this systematic review indicates that organizations, policy makers and payers should consider integrating these solutions in the design of diabetes self-management education and support services for population health and value-based care models. With the widespread adoption of mobile phones, digital health solutions that incorporate evidence-based, behaviorally designed interventions can improve the reach and access to diabetes self-management education and ongoing support.
The Career Indecision Profile (CIP; Brown et al., 2012) is an empirically derived measure tapping common sources of career indecision: interpersonal conflict, neuroticism/negative affect, lack of ...readiness, and choice/commitment anxiety. We adapted the social cognitive model of career self-management (Lent & Brown, 2013) to provide a theoretical structure for these sources of indecision, focusing on how they interrelate and jointly predict career decision progress. Supplementing the CIP's focus on negative decisional influences, the social cognitive model included positive sources of career decidedness, in particular, self-efficacy, mastery experiences, and positive emotions related to decision-making. Three hundred sixty-five college students completed the short form of the CIP (Xu & Tracey, 2017), along with measures of career decision self-efficacy, prior experiences with career decision-making, social barriers, trait conscientiousness and neuroticism, and career decidedness. Factor analytic findings indicated that the CIP's interpersonal conflict, negative affect, and lack of readiness items loaded together with conceptually similar social cognitive, barrier, and personality scales, with lack of readiness items divided between self-efficacy and conscientiousness factors. A path analysis, couching the CIP factors in terms of the career self-management model, provided good fit to the data and accounted for substantial portions of the variance in decisional discomfort (choice/commitment anxiety) and levels of career decidedness. We consider implications of the findings for the study of career decision-making and for practical ways to promote it.
Public Significance Statement
We tested a theoretical framework for the Career Indecision Profile, finding that its scales parallel common constructs in the social cognitive model of career self-management. The findings suggest the ways in which several negative and positive factors may operate together in the career decision-making process.
Aims
Self‐management programmes for type 1 diabetes, such as the UK’s Dose Adjustment for Normal Eating (DAFNE), improve short‐term clinical outcomes but difficulties maintaining behavioural changes ...attenuate long‐term impact. This study used the Behaviour Change Wheel (BCW) framework to revise the DAFNE intervention to support sustained behaviour change.
Methods
A four‐step method was based on the BCW intervention development approach: (1) Identifying self‐management behaviours and barriers/enablers to maintain them via stakeholder consultation and evidence synthesis, and mapping barriers/enablers to the Capability, Opportunity, Motivation‐Behaviour (COM‐B) model. (2) Specifying behaviour change techniques (BCTs) in the existing DAFNE intervention using the Behaviour Change Techniques Taxonomy (BCTTv1). (3) Identifying additional BCTs to target the barriers/enablers using the BCW and BCTTv1. (4) Parallel stakeholder consultation to generate recommendations for intervention revision. Revised materials were co‐designed by stakeholders (diabetologists, psychologists, specialist nurses and dieticians).
Results
In all, 34 barriers and 5 enablers to sustaining self‐management post‐DAFNE were identified. The existing DAFNE intervention contained 24 BCTs, which partially addressed the enablers. In all, 27 BCTs were added, including ‘Habit formation’, ‘Credible source’ and ‘Conserving mental resources’. In total, 15 stakeholder‐agreed recommendations for content and delivery were incorporated into the final DAFNEplus intervention, comprising three co‐designed components: (1) face‐to‐face group learning course, (2) individual structured follow‐up sessions and (3) technological support, including blood glucose data management.
Conclusions
This method provided a systematic approach to specifying and revising a behaviour change intervention incorporating stakeholder input. The revised DAFNEplus intervention aims to support the maintenance of behavioural changes by targeting barriers and enablers to sustaining self‐management behaviours.
Type 2 diabetes (T2D) is a complex chronic condition that requires ongoing self‐management. Diabetes health coaching interventions provide personalized healthcare programming to address physical and ...psychosocial aspects of diabetes self‐management.
Aims
This scoping review aims to explore the contexts and settings of diabetes health coaching interventions for adults with T2D, using the RE‐AIM framework.
Methods
A search was completed in MEDLINE, PsycINFO, Emcare, Embase and Cochrane. Included citations described adults with exclusively T2D who had received a health coaching intervention. Citations were excluded if they focused on any other types of diabetes or diabetes prevention.
Results
A total of 3418 records were identified through database and manual searches, with 29 citations selected for data extraction. Most health coaching interventions were delivered by health professionals, many employed lay health workers and a few included peer coaches. While many health coaching interventions were delivered remotely, in‐person intervention settings were distributed among primary care, community health settings and non‐healthcare sites.
Conclusion
The findings of this review suggest that diabetes health coaching may be implemented by a variety of providers in different settings. Further research is required to standardize training and implementation of health coaching and evaluate its long‐term effectiveness.
This scoping review has identified that health coaches for diabetes management come from diverse backgrounds and support those living with diabetes in diverse settings. There is an important need for standardized training programs for diabetes health coaches, and for future research to explore the long‐term effectiveness of these interventions.
Chronic illness effects one in ten adolescents worldwide. Adolescence involves a desire for autonomy from parental control and the necessity to transition care from parent to child. This review ...investigates the transition to adolescent self-management of chronic illness treatment behaviors in the context of parent-adolescent relationships.
A systematic search of PubMed, CINAHL, and Web of Science was conducted from earliest database records to early June 2017. Articles were included if they focused on adolescents, addressed illness self-management, discussed the parent-adolescent relationship, and were published in English. Articles were excluded if the chronic illness was a mental health condition, included children younger than 10 years of age, or lacked peer review.
Nine studies met inclusion criteria. Outcomes included challenges to adolescent self-management, nature of the parent-adolescent relationship, illness representation, perceptions of adolescent self-efficacy in compliance, medical decision making, laboratory measures, and adolescent self-management competence. Across diagnoses, parents who were available to monitor, be a resource, collaborate with their adolescent, and engage in ongoing dialogue were key in the successful transition to autonomous illness management.
There is a paucity of research addressing the experiences of adolescents in becoming experts in their own care.
•Early to late adolescence is an intense period of development.•Anecdotal evidence suggests that teens may avoid or ignore treatment regimens.•Teens must master and prioritize daily complex symptom management.•Parents need to communicate, monitor adherence, and be a resource.
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