Study protocol: The Technology-Enhanced Coaching (TEC) program to improve diabetes outcomes – A randomized controlled trial

BackgroundRacial and ethnic minority adults with diabetes living in under-resourced communities face multiple barriers to sustaining self-management behaviors necessary to improve diabetes outcomes. Peer support and decision support tools each have been associated with improved diabetes outcomes.Methods290 primarily African American adults with poor glycemic control were recruited from the Detroit Veteran's Administration Hospital and randomized to Technology-Enhanced Coaching (TEC) or Peer Coaching alone. Participants in both arms were assigned a peer coach trained in autonomy-supportive approaches. Coaches are diabetes patients with prior poor glycemic control who now have good control. Participants met face-to-face initially with their coach to review diabetes education materials and develop an action plan. Educational materials in the TEC arm are delivered via a web-based, educational tool tailored with each participant's personalized health data (iDecide). Over six months, coaches call their assigned participants once a week to provide support for weekly action steps. Data are also collected on an Observational Control group with no contact with study staff. Changes in A1c, blood pressure, other patient-centered outcomes and mediators and moderators of intervention effects will be assessed.Results290 participants were enrolled.DiscussionTailored e-Health tools with educational content may enhance the effectiveness of peer coaching programs to better prepare patients to set self-management goals, identify action plans, and discuss treatment options with their health care providers. The study will provide insights for scalable self-management support programs for diabetes and chronic illnesses that require high levels of sustained patient self-management.     

Patients’ readiness to receive psychosocial care during nurse-led routine diabetes consultations in primary care: A mixed methods study

BackgroundPatients with type 2 diabetes mellitus face several emotional and social consequences of their chronic illness in their everyday life. Symptoms of distress and depression are prevalent. For providing psychosocial self-management support, nurses in primary care were trained to identify patients with psychosocial problems during routine medically-shaped diabetes consultations. However, detection rates appeared to be strikingly low.ObjectivesOur study aimed to examine patients’ readiness to discuss psychosocial problems with nurses during diabetes consultations.DesignA mixed methods design was used in which qualitative data collection was followed up by quantitative data collection.SettingDiabetes care in a regional group of family practices in the south of the Netherlands.ParticipantsType 2 diabetes patients with psychosocial problems, determined by a self-administered questionnaire.MethodsFirst, in-depth interviews (n = 12) were conducted about patients’ experiences with routine diabetes consultations and their perspective on a biopsychosocial care approach. Based on a qualitative content analysis, a structured questionnaire was designed to further explore the findings among a larger group of patients. This questionnaire was completed by 205 patients. The questionnaire included 14 items measuring patients’ agreement with statements about diabetes care and the role of the nurse to focus on patients’ emotional and social functioning.ResultsThe interviews showed that patients view a diabetes consultation primarily as a biomedical check-up, and do not perceive discussion of psychosocial well-being as an integral part of diabetes management. More than 90% of the sample showed a positive attitude towards current diabetes consultations. Patients’ intentions and perceived needs regarding a biopsychosocial care approach of the nurse were variable. Younger patients seemed more open to discussing psychosocial problems with the nurse than patients over 65. Patients’ openness to discussing psychosocial problems was not significantly (p < 0.05) associated with the nurses being trained in the biopsychosocial self-management approach.ConclusionPatients see primary care nurses primarily as specialists regarding the biomedical management of diabetes. Although patients seemed to support the ideal of integrated care, they did not expect a discussion about psychosocial problems in diabetes consultations. The incorporation of systematic detection of patients with psychosocial problems in diabetes care requires endeavours to make patients acquainted with the new role of the nurse.     

Improving family caregiver and patient outcomes in lung cancer surgery: Study protocol for a randomized trial of the multimedia self-management (MSM) intervention

ObjectiveTo describe the study protocol of the Multimedia Self-Management (MSM) intervention to prepare patients and family caregivers (FCGs) for lung cancer surgery.DesignThe study is a five-year, single site, randomized controlled trial of 160 lung cancer surgery FCG and patient dyads (320 total participants), comparing intervention and attention control arms.SettingOne National Cancer-Institute (NCI) designated comprehensive cancer center in Southern California.ParticipantsPatients who are scheduled to undergo lung cancer surgery and their FCGs are enrolled as dyads only.InterventionBased on the Chronic Care Self-Management Model (CCM), the intervention is a nurse-led, caregiver-based, multimedia care program for lung cancer surgery. Its primary focus is to help FCGs develop self-management skills related to their caregiving role through goal setting, proactive planning, building problem-solving skills, and accessing family support services. The intervention also supports dyads to prepare for surgery and post-operative recovery at home. It includes videos, print, web-based, and post-discharge telephone support.Main outcome measuresFCG and patient psychological distress and QOL; FCG burden and preparedness for caregiving; FCG and patient healthcare resource use (in-home nursing care, urgent care/ER visits, readmissions).AnalysisRepeated measures ANCOVA statistical design will be used, removing variances prior to examining mean squares for the group by occasion interactions, and co-varying the baseline scores. In addition, structured equation modeling (SEM) will assess whether mediating and moderating factors are associated with outcomes.ClinicalTrials.gov Identifier: NCT03686007     

Practice standards for Australian cardiovascular nurses: An electronic Delphi study

BackgroundProfessional standards for nurse practice protect the public and define the scope of nursing broadly and in specialty areas. Nurses encounter patients with cardiovascular disease in a variety of clinical contexts, and specialty practice standards have the potential to articulate the scope and role expectations for nurses caring for this population. Practice standards and role expectations for nurses caring for cardiovascular patients in Australia were developed through electronic Delphi (eDelphi) technique.AimTo present the development of practice standards and role expectations for Australian cardiovascular nurses.MethodsThree-round eDelphi survey with experts from a broad range of contexts who identified as cardiovascular nurses to reach a consensus on the Practice Standards for Australian Cardiovascular Nurses. External stakeholder agreement was also sought on the final version prior to publication.FindingsThree domains were identified: Clinical Care, Cultural Safety, and Person-Centred Care, and Leadership and Teamwork, and their supporting elements. Role expectations reflected the varied context and scope of practice.DiscussionThese standards describe the scope of cardiovascular nursing practice regardless of context. Underpinning the standards is the recognition of person-centred care and cultural safety. The standards provide a framework for professional recognition, support the delivery of patient care, and may be used to aid curriculum development in cardiovascular nursing education.ConclusionThe eDelphi technique and external stakeholder agreement validated the expected capability of nurses involved in the assessment, management, and evaluation of care for the cardiovascular patient. The standards and role expectations reflect the various contexts where care for the cardiovascular patient occurs.     

Study protocol and baseline sample characteristics: From clinic to community: Using peer support as a transition model for improving long-term diabetes-related health outcomes

BackgroundThe objective of this randomized controlled trial is to examine the effects of a 12-month telephone-based peer-led diabetes self-management support (DSMS) intervention on long-term diabetes-related health outcomes.MethodsIn total, 197 participants with type 2 diabetes were recruited from specialty care settings (diabetes and endocrinology clinics). They were randomly assigned to 1) a 12-month Peer-Led, Empowerment-based Approach to Self-management Efforts in Diabetes (PLEASED) program where they received 12 weekly contacts from their peer supporter (PS) in the first 3 months, followed by 18 biweekly telephone support contacts over the last 9 months, or 2) usual care. The primary clinical and psychosocial outcomes were HbA1c and diabetes distress (DD), respectively. Secondary outcomes were cardiovascular risk factors. Assessments were conducted at baseline, 3 months, and 12 months.ResultOf 197 recruited participants, 49.7% were female. The majority of participants were married/partnered, well-educated, employed, and Caucasian, with a mean HbA1c of 8.09 ± 1.7. Forty-two percent of participants reported little or no distress. There was no significant difference between the two groups.DiscussionDespite evidence showing that individuals with poor glycemic control benefit the most from peer support interventions, the majority of such interventions have been designed for and implemented in community and primary care-based settings. The present study investigates a 12-month peer support model to help patients initiate and sustain effective self-management behaviors while transitioning from specialty care to a community setting. The study was completed in November 2018. The outcome data analyses are currently underway.Trial registrationThe study was registered on clinicaltrials.gov (NT02804620).Protocol versionThe protocol version is 3.5.     

What factors influence nurses’ behavior in supporting patient self-management? An explorative questionnaire study

BackgroundA major challenge for nurses in hospital care is supporting chronically ill patients in self-managing their chronic condition. Self-management support requires a broad range of competencies and is often regarded as difficult to implement in daily practice. So far, we have no insight in nurses’ behavior in daily practice with regard to self-management support and what factors may influence their behavior.ObjectivesThe aim of this survey was to explore (i) the self-reported behavior on self-management support of nurses in a university hospital; and (ii) the factors influencing this behavior.DesignTotal sample approach with cross-sectional design.Participants and settingNurses employed by a university hospital received an invitation for the research through e-mail containing a link to the survey. Of the 2054 nurses who had been invited to participate, 598 responded (29.11%). The entire questionnaire was completed by 379 nurses, 32 of whom indicated they did not work with patients on a daily basis. After excluding those 32, the final sample included 347 valid responses (16.9%). 90.5% of the respondents was female, mean age was 38.8 years.MethodsIn a web-based questionnaire, the self-efficacy and performance in self-management support instrument (SEPSS-36) was used, with additional questions about attitude, subjective norms, and perceived barriers for self-management support.ResultsThis study shows that nurses are self-confident of their capabilities to support self-management. They also feel that most of the time they acted accordingly. Still, a significant gap between self-efficacy and behavior of self-management support was found (p < 0.001). Nurses themselves perceive lack of time and patients’ lack of knowledge as barriers for self-management support, but this did not influence their behavior (p > 0.05). Regression analysis showed that perceived lack of own knowledge, the presumed absence of a patients’ need for self-management support, and nurses’ self-efficacy in self-management support are factors that influence the behavior of self-management support. 41.1% of the variance of behavior is explained by these three factors.ConclusionThis study shows a significant gap between self-reported self-efficacy and behavior in self-management support in nurses working in a university hospital. To enhance self-management support, managers and educators should take these influential factors into account. A third of the nurses did not report a need for additional training on self-management support. This implies that programs should also aim to improve reflective skills and raising awareness.     

Critical care nurses’ experiences of working during the first phase of the COVID-19 pandemic – Applying the Person-centred Practice Framework

AimThe aim of the study was to deductively study person-centred care, based on critical care nurses’ experiences during the first phase of the CoViD-19 pandemic.DesignThe study used a qualitative design.MethodData collection was conducted as individual interviews and was analysed with qualitative content analysis with a deductive approach.ParticipantsSix critical care nurses working in a special CoViD-19 intensive care unit during the first phase of the pandemic participated.FindingsThe findings are presented within the four domains of person-centred practice: the prerequisites, the care environment, person-centred processes and person-centred outcomes. While the ambition and knowledge about how to work in accordance with person-centred practice were high, there were several obstacles to perform it.ConclusionWe need to prepare ahead of time so that nurses have optimal organisational prerequisites to be able to work in accordance with person-centred practice, also during pandemics and other crisis, which means to be able to give nursing care in accordance with the ill person’s needs and resources.     

Peer supporters for cardiac patients with diabetes: a randomized controlled trial

WU C.-J., CHANG A.M., COURTNEY M. & KOSTNER K. (2012) Peer supporters for cardiac patients with diabetes: a randomized controlled trial. International Nursing Review59, 345-352 Aims: To determine whether incorporation of patient peer supporters in a Cardiac-Diabetes Self-Management Program (Peer-CDSMP) led to greater improvement in self-efficacy, knowledge and self-management behaviour in the intervention group compared to a control group. Background: Promoting improved self-management for those with diabetes and a cardiac condition is enhanced by raising motivation and providing a model. Peer support from former patients who are able to successfully manage similar conditions could enhance patient motivation to achieve better health outcomes and provide a model of how such management can be achieved. While studies on peer support have demonstrated the potential of peers in promoting self-management, none have examined the impact on patients with two co-morbidities. Methods: A randomized controlled trial was used to develop and evaluate the effectiveness of the Peer-CDSMP from August 2009 to December 2010. Thirty cardiac patients with type 2 diabetes were recruited. The study commenced in an acute hospital, follow-up at participants' homes in Brisbane, Australia. Results: While both the control and intervention groups had improved self-care behaviour, self-efficacy and knowledge, the improvement in knowledge was significantly greater for the intervention group. Conclusions: Significant improvement in knowledge was achieved for the intervention group. Absence of significant improvements in self-efficacy and self-care behaviour represents an inconclusive effect; further studies with larger sample sizes are recommended.     

Cost-Effectiveness of a Diabetes Self-Management Education and Support Intervention Led by Community Health Workers and Peer Leaders: Projections From the Racial and Ethnic Approaches to Community Health Detroit Trial

OBJECTIVETo simulate the long-term cost-effectiveness of a peer leader (PL)–led diabetes self-management support (DSMS) program following a structured community health worker (CHW)–led diabetes self-management education (DSME) program in reducing risks of complications in people with type 2 diabetes (T2D).RESEARCH DESIGN AND METHODSThe trial randomized 222 Latino adults with T2D to 1) enhanced usual care (EUC); 2) a CHW-led, 6-month DSME program and 6 months of CHW-delivered monthly telephone outreach (CHW only); or 3) a CHW-led, 6-month DSME program and 12 months of PL-delivered weekly group sessions with telephone outreach to those unable to attend (CHW + PL). Empirical data from the trial and the validated Michigan Model for Diabetes were used to estimate cost and health outcomes over a 20-year time horizon from a health care sector perspective, discounting both costs and benefits at 3% annually. The primary outcome measure was the incremental cost-effectiveness ratio (ICER).RESULTSOver 20 years, the CHW + PL intervention had an ICER of $28,800 and $5,900 per quality-adjusted life-year (QALY) gained compared with the EUC and CHW-only interventions, respectively. The CHW-only intervention had an ICER of $430,600 per QALY gained compared with the EUC intervention. In sensitivity analyses, the results comparing the CHW + PL with EUC and CHW-only interventions were robust to changes in intervention effects and costs.CONCLUSIONSThe CHW + PL–led DSME/DSMS intervention improved health and provided good value compared with the EUC intervention. The 6-month CHW-led DSME intervention without further postintervention CHW support was not cost effective in Latino adults with T2D.     

A training intervention to enhance self-management support competencies among nurses: A non-randomized trial with mixed-methods evaluation

AimTo evaluate the process and outcomes of INTENSS, a training intervention grounded in Self-Determination Theory to enhance nurses’ competencies for self-management support.DesignNon-randomized intervention study with mixed-methods evaluation approach (2019–2020).MethodsThe multifaceted training was implemented in six groups. Cluster-assignment to study arm 1 or arm 2. Arm 1 received a basic training module and arm 2 the basic module with additional video-interaction guidance. Focus groups were held to detect what was helpful in competency enhancement. Intervention effectiveness was determined on trainees’ attitude, motivation, self-efficacy and skills for self-management support (multiple time-points by self-reports and observations).ResultsTrainees (N = 50) indicated the video-interaction guidance, the connectivity within the training group, the constructive feedback from trainers as well as from peers, as helpful for the acquisition of self-management support skills. At 2-month post-training, participants slightly improved in their competencies for the assess (p = .03), agree (p = .02), arrange (p < .01) phase and partnership skills (p < .01). Between the study arms, video-trained participants significantly reduced their use of controlling approaches (p = .03). Observations indicated that trainees mostly used an autonomy-supportive approach, seldom we observed the use of competence supportive, controlling or chaotic approaches. The interviews gave indications that obligatory training in this field needs to be questioned.ConclusionThe outcome evaluation of the INTENNS training indicated most improvement in nurses’ skills for collaborative goal setting and partnership with patients. The mixed-methods evaluation emerges transferable principles to implement the training amongst nurses and, by extension, other healthcare professions. A training intervention involving patient experts can add value to further pave the way towards a true partnership between patients and healthcare professionals.ImpactA training intervention taking into account the complexity of supporting patients towards self-management is available. Important elements for growth are: connectivity within training group, a safe learning climate where ‘failure’ is allowed and video-interaction guidance. Obligatory training participation can be questioned.     

Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people

mccormack b., dewing j., breslin l., coyne-nevin a., kennedy k., manning m., peelo-kilroe l., tobin c. & slater p. (2010) Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people. International Journal of Older People Nursing 5 , 93–107 Aim. To present the nursing outcomes from the evaluation of developments in the care environment in residential settings for older people. Design. The evaluation data reported here is derived from a larger national programme of work that focused on the development of person-centred practice in residential services for older people using an emancipatory practice development framework. A multi-method evaluation framework was utilised. Outcome data were collected at three time points between December 2007 and September 2009. The data reported here were collected using an instrument called the ‘Person-Centred Nursing Index’. Findings. Heavy workload was the main cause of stress among nurses. Personal and professional satisfaction with the job was scored highest by the total sample of nurses. Nineteen factors were examined using the Person-Centred Nursing Index. Statistically significant changes were observed in 12 of these. In addition, there were statistically significant changes in nurses’ perceptions of caring, indicating a shift from a dominant focus on ‘technical’ aspects of care, to one where ‘intimate’ aspects of care were more highly valued. Relevance to clinical practice. The findings highlight the importance of the development of effective teamwork, workload management, time management and staff relationships in order to create a culture where there is a more democratic and inclusive approach to practice and space for the formation of person-centred relationships.     

Effects of self-management support programmes on activities of daily living of older adults: A systematic review

BackgroundThe ability of older adults to carry out activities of daily living and to adapt and to manage their own life decreases due to deterioration of their physical and cognitive condition. Nurses and other health care professionals should support the self-management ability of older adults to prevent activities of daily living dependence and increase the ability to adapt and to self-manage the consequences of living with a chronic condition.ObjectiveTo gain insight into the evidence of the effects of self-management support programmes on the activities of daily living of older adults living at home.DesignA systematic literature review of original research publications.Data sourcesSearches were performed in PubMed, CINAHL, PsychInfo, EMBASE and the Cochrane Central Register of Controlled Trials (in February 2016). No limitations were applied regarding date of publication, language or country.Review methodsPublications were eligible for this review on condition that they described a self-management support programme directed at adults of on average 65 years or older, and living in the community; used a randomized control group design; and presented information about the effects on activities of daily living. The methodological quality of the included studies was independently assessed by the authors using the quality criteria for reviews of the Cochrane Effective Practice and Organisation of Care Review Group. A best evidence synthesis was performed using guidelines provided by the Cochrane Collaboration Back Review Group.ResultsA total of 6246 potentially relevant references were found. After screening the references, 12 studies with a randomized controlled trial design were included. The methodological assessment of the 12 studies indicated variations in the risk of bias from low (n = 1) to unclear (n = 3) and high (n = 8). Although there was considerable variation in study population, intervention characteristics and measurement instruments used, most studies (n = 11) showed effects of self-management support programmes on the activities of daily living of older adults.ConclusionsThere is a moderate level of evidence that self-management support programmes with a multi-component structure, containing disease-specific information, education of knowledge and skills and, in particular, individually tailored coaching, improve the activities of daily living of older adults.Further research is required to gain insight into the most appropriate context and approach of self-management support interventions targeting activities of daily living of older adults living in the community.     

Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: a randomized controlled trial

BackgroundType 2 diabetes is a serious and growing problem in Taiwan where it is the fifth leading cause of death, and health care costs are 4.3 times higher than for people without diabetes.ObjectivesThe purpose of this study was to determine whether participation in a motivational interview for people with type 2 diabetes would improve their self-management, psychological and glycemic outcomes.DesignA randomized controlled trial to assess the effects of the motivational interviewing intervention.SettingsParticipants were drawn from the diabetes outpatient clinic of a large teaching hospital in South Taiwan.ParticipantsA sample of 250 type 2 diabetes people.MethodsType 2 diabetes people were randomly allocated into either the motivational interview group or the usual care group from baseline to 3 months follow-up. The intervention was based on motivational interviewing which encompassed a variety of interviewing techniques, and reflected each person's readiness stage to change. The control group was provided with usual care by nursing staff.ResultsA total of 250 type 2 diabetic participants were randomized. The retention rate in the intervention group was 83% (n = 104). The motivational interview did improve participants significantly in self-management, self-efficacy, quality of life, and HbA1c among diabetes people with appropriate baseline value (<121.24, <174.57, <107.18, and >7.62, respectively) but not in depression, anxiety and stress (F = 0.13, p = 0.72) compared to the control group at 3 months follow-up.ConclusionThe findings provided important evidence concerning the positive effect of motivational interventions in self-management, psychological and glycemic outcomes. This research provided evidence for future clinical practices in diabetes care.     

社区2型糖尿病患者自我管理行为现状调查

目的:了解社区2型糖尿病患者自我管理行为的现状并探讨其影响因素。方法:采取分层整群抽样方法,抽取合肥市3个区的3个社区卫生服务中心418例2型糖尿病患者,并对其进行自我管理行为现状调查。结果:自我管理行为总分为(82.30±17.79)分,平均得分指标为63.31%;不同的自我管理活动水平有所不同,其中遵医嘱用药得分最高,平均得分指标为76.47%;血糖监测得分最低,得分指标为54.85%。自我管理水平影响因素众多,其中行为变化阶段、病程、并发症、住院史、居住方式是重要影响因素。结论:患者的自我管理行为现状不够理想,护理人员应对患者进行有针对性的行为干预,延缓和控制并发症的发生,从而提高患者的生活质量。     

Predictors of diabetes self-management among type 2 diabetics in Indonesia: Application theory of the health promotion model

ObjectiveThis study aimed to identify factors predicting diabetes self-management among adults with type 2 diabetes mellitus in Malang City, East Java, Indonesia.MethodsA cross-sectional design was used in this study. Participants were selected from five primary health centers in Malang City, East Java, Indonesia using the multistage sampling method. A total of 127 adults with type 2 diabetes mellitus were recruited. Data were collected by questionnaires which were the general diabetes knowledge, the Beliefs of Treatment Effectiveness, the Diabetes Distress Scale, the Self-efficacy for Diabetes Scale, the brief Chronic Illness Resources Survey, the Situational Questionnaire and the Summary of Diabetes Self-care Activities. A self-administered questionnaire was used to collect the data. Multiple linear regression with stepwise method was used toanalyze the data.ResultsThe scores of seven questionnaires (i.e, diabetes knowledge, perceived benefit of diabetes self-management, diabetes distress, perceived self-efficacy, social support, situational influence, and diabetes self-management) were 13.75 ± 3.59, 34.9 ± 4.89, 3.03 ± 0.86, 3.60 ± 0.53, 27.79 ± 5.56, 3.27 ± 0.58,3.81 ± 1.08, respectively. The significant predictors of diabetes self-management were treatment, perceived self-efficacy, and situational influences. These variables explained 20.8% (adjusted R² = 0.208) of the variance in diabetes self-management among adults with type 2 diabetes mellitus in Malang City.ConclusionDiabetes self-management among adults with type 2 diabetes mellitus could be improved by enhancing their perceived self-efficacy to achieve their self-management behavior, such as having a healthy diet, exercising regularly, actively monitoring blood glucose level, taking medication and foot care, and providing support to promote good situational influence.     

Experiencias de los pacientes con diabetes sobre la promoción de la actividad física durante las consultas enfermeras en Cataluña

ObjectiveAlthough physical activity (PA) is a key behaviour for controlling Type 2 Diabetes, problematic adoption and/or adherence continues to impair disease management. This study aims to understand how patients with T2D live and experience nurses PA promotion during consultations in Spanish context.MethodThe present study is a qualitative research. In 2019-2020, pre-COVID-19, 22 people living with T2D from Barcelona province contributed either to focus groups (n = 5) or to semi-structured interviews (n = 4). All interviews were recorded, transcribed, and analysed using conventional content analysis approach through constant comparative method.ResultsData analysis revealed two major themes with 16 subthemes. The two major themes include: «Intra-personal conscious PA adoption processes» and «Structural unconscious PA (non)adherence processes».ConclusionPatients’ experiences reflect two concurrent and interconnected issues. First, most patients readily adopted new PA after encouragement from nurses, who were the main proponents of PA. Indeed, adoption seemed to be most nurses’ PA priority and it was effective for most patients. Second, few nurses discussed adherence, making it an almost universal problem and source of disappointment. For adherence, patients experience that nurses’ attention needs to focus on activating processes and skills that support continued involvement in already-adopted PA.     

The Mexican-American Trial of Community Health workers (MATCH): design and baseline characteristics of a randomized controlled trial testing a culturally tailored community diabetes self-management intervention

ObjectivesCommunity Health Workers (CHWs) have been recommended to reduce diabetes disparities, but few robust trials of this approach have been conducted. Limitations of prior studies include: unspecified a priori outcomes; lack of blinded outcome assessments; high participant attrition rates; and lack of attention to intervention fidelity. These limitations reflect challenges in balancing methodologic rigor with the needs of vulnerable populations. The Mexican-American Trial of Community Health workers (MATCH) was a blinded randomized controlled trial testing CHW efficacy in improving physiologic outcomes and self-management behaviors among Mexican-Americans with type 2 diabetes. This paper describes methods used to overcome limitations of prior studies.Research design and methodsThe primary aim was to determine if a CHW intervention would result in significant reductions in Hemoglobin A1c and rates of uncontrolled blood pressure. 144 Mexican-Americans with diabetes were randomized. The intervention consisted of self-management training delivered by CHWs over a 24-month period; the comparison population received identical information via bilingual newsletter. Blinded research assistants completed assessments at baseline, 12 months, and 24 months post-randomization.ResultsThe MATCH cohort was characterized by low acculturation and socioeconomic status. Study participants had low rates of medication adherence and glucose monitoring. 70% had poor glycemic control with A1c levels over 7.0, and 57.3% had blood pressures worse than ADA target levels (< 130/80).ConclusionsMATCH preserved community sensitivity and methodologic rigor. The study's attention to intervention fidelity, behavioral attention control, blinded outcomes assessment, and strategies to enhance participant retention can be replicated by researchers testing culturally-tailored CHW interventions.     

Advancing Oncology Nursing Practice Through the Adoption of Patient Monitoring Digital Tools

ObjectiveThe objective of this paper is to describe the use of oncology digital symptom monitoring and patient self-management coaching tools, how nurses and nurse practitioners (NPs) can optimize their use as an adjunct in improving oncology care and discuss issues and strategies needed for adoption within a variety of clinical settings.Data SourcesA review of the research literature regarding digital health in oncology symptom management in PubMed provided the foundation for this paper.ConclusionDigital symptom monitoring technology provides a variety of opportunities for oncology nurses and NPs to efficiently extend and improve symptom management in multiple settings including cancer patients at home between clinic visits, at clinic visits, and during inpatient stays. Digital monitoring and patient engagement make possible frequent symptom assessments, just-in-time personalized self-management reinforcement, and judiciously alert nurses and NPs about key times for follow-up with patients supported with evidenced-based guidelines. Oncology nurses at all levels have the opportunity to be leaders in the adoption and expansion of digital tools to enhance their practice.Implications for Nursing PracticeOncology nurses and NPs can lead practice changes that improve patient outcomes through understanding and shaping the use of digital tools.