Self-Efficacy and Self-Care: Missing Ingredients in Health and Healthcare among Adults with Serious Mental Illnesses

To help inform the design of a self-management intervention for improving the physical health of adults with serious mental illnesses, we conducted focus groups about their perceived medical care and physical health needs. Adults with serious mental illnesses participated in four semi-structured focus groups conducted at a transitional living facility, a social club, and a Hispanic outpatient mental health clinic. Questions included their recent experiences of seeking medical care, the effect of having a mental illnesses diagnosis, strategies for active self-care, and perceived barriers to better physical health. In addition to various systemic barriers to better medical care, participants articulated limited knowledge and self-efficacy regarding active self-management of their physical health. Despite their interest in learning more about health promotion, most participants expressed a sense of personal futility and powerlessness in improving their health. These data suggest that any effort to improve the wellbeing of these adults will need to address self-efficacy in the hope of improving self-care for their physical health needs.

医院社区联动自我管理教育模式对糖尿病患者治疗效果的影响研究

目的评价医院社区联动自我管理教育模式对常规治疗效果不佳的2型糖尿病患者的代谢控制、自我管理水平和生活质量的影响。方法将134例常规治疗后糖化血红蛋白水平超过6.5%的2型糖尿病患者随机分为医院社区联动自我管理教育组(自我管理组,74例)和常规糖尿病健康教育管理组(对照组,60例)两组。自我管理组首先在综合医院糖尿病中心接受连续五天的全日制糖尿病自我管理教育,随后建立社区健康管理档案定期接受电话和门诊随访。对照组仅接受常规糖尿病健康教育和社区常规跟踪随访。评价干预前和实施健康教育管理1年后的血糖、血压、血脂、糖尿病知识、自我管理水平和生活质量的变化。结果干预后,两组患者的空腹血糖、餐后血糖和糖化血红蛋白水平均较干预前显著下降,差异有统计学意义(P<0.05);同时,自我管理组患者的空腹血糖、餐后血糖和糖化血红蛋白水平显著低于对照组,差异均有统计学意义(P<0.05)。干预后,自我管理组糖尿病知识、自我管理效能和技能得分均显著高于对照组,差异有统计学意义(P<0.05)。干预后,自我管理组患者的满意维度得分和生活质量总分显著提高,并且满意维度评分优于对照组,差异均有统计学意义(P<0.05)。结论医院社区联动自我...     

上海市群防群控高血压病工作模式探索

2007年,上海市爱卫会办公室在全市推行"社区倡导、居委实施、专业机构指导"的高血压自我管理小组活动,探索群防群控高血压病的工作模式,取得了一定的成效。2008年底,全市已在219个街道(镇)建立2398个小组,吸引了41539名社区居民参加。     

互联网技术护理对血液透析患者血管通路自我管理能力的影响

目的　探讨互联网技术护理在血液透析患者血管通路管理中的应用价值。方法　选取2021年1月至2022年3月南方科技大学医院收治的80例血液透析患者,按照时间顺序,将2021年1月至7月行常规护理的40例血液透析患者［男23例,女17例;年龄28～60（39.12±5.56）岁;透析时间8～35（27.29±3.18）个月;文化水平：小学8例,初中11例,高中13例,专科及以上8例］设为对照组,将2021年8月至2022年3月行互联网技术护理的40例血液透析患者［男21例,女19例;年龄27～61（39.58±5.62）岁;透析时间8～34（27.14±3.25）个月;文化水平：小学6例,初中13例,高中15例,专科及以上6例］设为观察组;两组均护理3个月。对比两组自我管理能力、生活质量、血管通路并发症发生情况。采用t检验和χ²检验。结果　护理后,观察组血液透析患者自我管理行为量表（SMSH）中问题解决、情绪处理、执行自我护理、伙伴关系评分及总分均高于对照组［（16.13±1.62）分比（14.76±1.57）分、（13.15±1.40）分比（11.84±1.70）分、（23.63±2.01）分比（21.24±1.97）分、（13.04±1.35）分比（11.79±1.46）分、（65.95±5.11）分比（59.63±4.02）分］,差异均有统计学意义（均P<0.05）;护理后,观察组生活质量综合评定问卷（GQOLI-74）中心理功能、躯体功能、社会功能、物质生活评分高于对照组［（74.38±6.44）分比（69.12±5.03）分、（76.19±5.84）分比（70.58±4.76）分、（79.04±5.73）分比（71.81±5.20）分、（75.21±5.80）分比（68.42±5.36）分］,血管通路并发症发生率低于对照组［5.00%（2/40）比20.00%（8/40）］,差异均有统计学意义（均P<0.05）。结论　互联网技术护理用于血液透析患者能够提高其自我管理能力,维护血管通路安全,减少并发症的发生,改善生活质量,临床应用价值高。     

Self-management program for chronic low back pain: A systematic review and meta-analysis

ObjectiveTo determine the effectiveness of self-management programs (SMPs) on chronic low back pain (CLBP).MethodsA search of randomized controlled trials (RCTs) was performed in Pubmed, Cochrane Library, Web of Science, Elsevier, and CINAHL through June, 2015. Two reviewers selected trials, conducted critical appraisal, and extracted data. Meta analyses were performed.ResultsThirteen moderate-quality RCTs were included. There were 9 RCTs for immediate post intervention on pain intensity and disability, 5 RCTs for short term, 3 RCTs for intermediate and 4 RCTs for long term. Specifically, the effect sizes (ESs) of SMP on pain intensity were −0.29, −0.20, −0.23, and −0.25 at immediate post-intervention, short-term, intermediate-term, and long-term follow-ups, respectively. The ESs on disability were −0.28, −0.23, −0.19, and −0.19 at immediate post-intervention, short-term, intermediate-term, and long-term follow-ups, respectively.ConclusionFor CLBP patients, there is moderate-quality evidence that SMP has a moderate effect on pain intensity, and small to moderate effect on disability.Practice implicationsSMP can be regarded as an effective approach for CLBP management. In addition to face-to-face mode, internet-based strategy can also be considered as a useful option to deliver SMP. Theoretically driven programs are preferred.     

华法林自我管理的Meta分析

目的系统评价使用华法林的患者华法林自我管理是否优于常规管理。方法计算机检索Cochrane Database、Med-line、Embase数据库中关于使用华法林的的患者自我管理和常规管理的随机对照实验(RCT),检索时间从2001年1月—2012年1月。对纳入资料的质量进行严格评价和资料提取,对符合质量标准的RCT进行Meta分析。统计学软件采用RevMan5.0.25软件。结果共纳入5个RCT。对5个RCT进行Meta分析,累计华法林自我管理组1 917人,常规使用华法林组1 848人,华法林国际标准化比率(INR)值在治疗范围内的时间比例自我管理组与常规组的均差为3.66(95%CI为2.59～4.73,P0.01),两组差异有统计学意义,即华法林自我管理优于常规管理。去除样本量最大的研究,对剩余的4个RCT进行Meta分析,累计华法林自我管理组454人,常规使用华法林组396人,华法林INR值在治疗范围内的时间比例自我管理组与常规组的均差为2.71(95%CI为-0.26～5.69,P0.05),两组差异无统计学意义,即华法林自我管理效果不优于常规管理。结论华法林自我管理效果优于或等效与常规管理效果,不差于常规管理。     

Treating asthma with a self-management model of illness behaviour in an Australian community pharmacy setting

Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings.     

Re-thinking the relationship between long-term condition self-management education and the utilisation of health services

Encouraging self-management has been viewed as one means of reducing health service utilisation and contributing to improved demand management. However, the processes and imputed relationship between self-management education skills and health service contact are poorly understood. This paper reports on data from an embedded qualitative study which ran alongside a randomised controlled trial in England designed to test the clinical and cost effectiveness of a self-care support policy which found no statistically significant reductions in health service utilisation. Drawing on concepts from the sociology of chronic illness, analyses suggest that the biographical and social context relevant to individuals' experience of living with a long-term condition, history of health service utilisation, and relationships with health professionals are relevant to understanding the impact of self-management education and related policies aimed at bringing about changes in service use. Our study suggests that future health policy assumptions about utilisation in the context of chronic disease management and self-care support polices may benefit by acknowledging the complex, contextual and recursive nature of health service utilisation operating in the life worlds of patients' experience of living with a long-term condition.     

What adolescents living with long-term conditions say about being involved in decision-making about their healthcare: A systematic review and narrative synthesis of preferences and experiences

Objective

To understand the preferences and experiences of adolescents (age 10–19) with long-term conditions (LTCs) towards involvement in discussions and decisions regarding management of their condition.