The effect of an educational programme consisting of group and individual arthritis education for patients with polyarthritis--a randomised controlled trial

Objective

The aim of this study was to investigate the effect of an educational programme for patients with polyarthritis compared to usual care.

Methods

Patients with rheumatoid arthritis, psoriatic arthritis and unspecified polyarthritis were randomised to the intervention (n = 71) or usual care (n = 70). The intervention consisted of three group educational sessions followed by one individual educational session. The primary outcomes were a patient's global well-being and arthritis self-efficacy. Secondary outcomes were patient activation, physical and psychological health status, educational needs and disease activity.

Results

After four months the intervention group had significantly better global well-being, 95% CI (2.3–14.1), p = 0.01, and self-efficacy, 95% CI (0.2–8.1), p = 0.04, than the control group. There were also trends for improved disease activity, and a statistically significant improvement in patient activation and pain in the intervention group.

Conclusion

This patient educational programme consisting of group sessions and nurse-delivered individual education has statistically significant benefits for global well-being and maintaining a level of self-efficacy in managing other symptoms in patients with polyarthritis.

Practice implications

This educational programme allows patients to learn from each other in addition to addressing individual educational needs.     

Examining why smokers do not want behavioral support with stopping smoking

Objective

This article delineates theory-based determinants of the low use of behavioral stop-smoking support with a view to inform interventions to address the low use.

Methods

Study 1 comprised interviews with 27 smokers recruited from a primary care centre in England. Study 2 used a nationwide sample of 212 smokers who completed a questionnaire informed by Study 1. Multiple regression and mediation analyses were used in Study 2 to discern the determinants of smokers’ motivation to use behavioral stop-smoking support.

Results

The best predictors of low motivation to use (a) group support, and (b) one-to-one support were expectations that stop-smoking support is ineffective at increasing chances of stopping smoking. In turn, expectations of ineffectiveness were predicted by expectations that both services provide insufficient support, as well as smokers’ low self-efficacy to use them. A negative image of those attending groups was another predictor of group support.

Conclusion

A substantial proportion of smokers hold expectations about stop-smoking support that are unlikely to facilitate motivation to use such support.

Practice implications

Intervention studies are now needed targeting such expectations.     

Feeling that life is not worth living (death thoughts) among middle-aged,Australian women providing unpaid care

Objective

To identify the proportion of female carers who experience death thoughts and the factors associated with these thoughts, using data from the Australian Longitudinal Study on Women's Health (ALSWH).

Methods

A cross-sectional analysis of the fifth ALSWH survey was conducted. 10,528 middle-aged women provided data on caring and death thoughts, 3077 were carers and 2005 of those were included in the multivariate analysis.

Results

7.1% of female carers had felt life was not worth living in the previous week and were classified as having experienced death thoughts, compared with 5.7% of non-carers (p = .01). Carers with death thoughts had poorer physical and mental health, higher levels of anxiety, lower levels of optimism, and reported less social support (p < .01). In a multivariate model social support, mental health, carer satisfaction, and depressive symptoms significantly predicted death thoughts. Carers with clinically significant depressive symptoms were four times more likely to experience death thoughts than those without. Carers who were satisfied with their role were 50% less likely to have experienced death thoughts than those who were dissatisfied.

Conclusions

A small but significant proportion of female carers experience death thoughts and may be at risk for suicide. These findings add to the growing body of evidence on suicide-related thoughts and behaviours in carers and have implications for health professionals and service providers.     

A qualitative evaluation of a pre-consultation guide intended to promote the participation of young people in asthma review consultations

Objective

Young people's (age range 14–19 years) participation in consultations with health professionals can be limited. There has been little research into pre-consultation support for young people. This study evaluated a pre-consultation guide developed to promote young people's participation in asthma review consultations.

Methods

A pre-consultation guide was evaluated in qualitative exit interviews with 24 young people and 9 primary care nurses in the United Kingdom.

Results

Young people found the guide to be reassuring and supportive; peer written content, particularly example questions, helped to develop confidence and an intention to participate. Nurses suggested the guide could be a useful tool to aid young people's communication of asthma-related experiences.

Conclusion

Quotations from young people were highlighted as of particular value. Self-efficacy can be increased through observing how peers perform. Confidence and intention to change behavior are linked with actual behavior change. Future research should explore the impact of the pre-consultation guide on increased self-efficacy, developing an intention to change behavior and whether this is acted upon.

Practice implications

Used as a tool in a consultation may support change in practice nurses’ consulting style and enable young people's participation.     

Implementing decision and communication aids to facilitate patient-centered care in breast cancer: A case study

Objective

Decision Services (DS) provide support for breast cancer patients at the University of California, San Francisco to help ensure patient-centered care.

Methods

We examined a case study to explore whether our program practices matched our program theory, and what the patient in the case thought was effective and ineffective about our decision support interventions.

Results

The patient relied on a decision aid to educate her husband about her condition; felt that her question list contributed to a productive and efficient consultation with her oncologist; credited an audio-recording with helping her remember to follow-up with a genetic counselor; and reviewed the consultation summary 30 days into treatment in order to reflect on her decision. The patient rated the interventions highly on surveys, and experienced desirable reductions in decisional conflict, and improvements in knowledge. However, the question-prompting intervention was associated with a small decrease in self-efficacy, and the patient criticized the decision aid for omitting mention of a prognostic test.

Conclusion

This case illustrates how decision support interventions can be deployed to promote patient-centered care.

Practice implications

Breast care centers should consider distributing decision aids and assisting patients in listing questions, recording consultations, and obtaining written consultation summaries.     

Women's journey to safety – The Transtheoretical model in clinical practice when working with women experiencing Intimate Partner Violence: A scientific review and clinical guidance

Objective

Review the applicability of the Transtheoretical model and provide updated guidance for clinicians working with women experiencing intimate partner violence.

Methods

Critical review of related primary research conducted from 1990 to March 2013.

Results

Women's experiences of creating change within abusive relationships can be located within a stages of change continuum by identifying dominant behavioral clusters. The processes of change and constructs of decisional-balance and turning-points are evident in women's decision-making when they engage in change.

Conclusion

Clinicians can use the stages of change to provide a means of assessing women's movement toward their nominated outcomes, and the processes of change, decisional-balance and turning-points, to enhance understanding of, and promote women's movement across stages in their journey to safety.

Practice implications

Clinicians should assess women individually for immediate and ongoing safety and well-being, and identify their overarching stage of change. Clinicians can support women in identifying and implementing their personal objectives to enhance self-efficacy and create positive change movement across stages.The three primary objectives identified for clinician support are: 1. Minimizing harm and promoting well-being within an abusive relationship, 2. Achieving safety and well-being within the relationship; halting the abuse, or 3. Achieving safety by ending/leaving intimate relationships.     

Depression self-management support: A systematic review

Objective

To systematically review empirical evidence regarding the efficacy of depression self-management support (SMS) interventions for improving depression symptomatology and preventing relapse.

Methods

Pubmed and PsycINFO databases were searched for relevant articles on depression SMS interventions. Scanning of references in the articles and relevant reviews and communications with field experts yielded additional articles. Two independent reviewers analyzed the articles for inclusion and data was extracted from the selected articles.

Results

13 papers met the inclusion criteria and reported the results of six separate studies, including three pilot studies. The results were mostly positive. A majority of the trials assessing depression severity changes found SMS to be superior to care as usual. SMS interventions were found to improve self-management behaviors and self-efficacy. Mixed results were found concerning relapse rates. Promising results were found on assessments of functional status. Based on the findings, cost-effectiveness remains unclear.

Conclusion

SMS has been mostly examined through pilot studies with insufficient power. The results are promising, but larger randomized controlled trials are needed.

Practice implications

SMS interventions can be administered by non-physician professionals and are well accepted by patients, but more research is needed before we can recommend implementing specific depression SMS approaches in primary care.     

Parental anxiety and depression associated with caring for a child newly diagnosed with type 1 diabetes: opportunities for education and counseling

Objective

To examine demographic and clinical characteristics, such as pediatric parenting stress and self-efficacy for diabetes care, of parents of children newly diagnosed with type 1 diabetes that are associated with parental anxiety and depression.

Methods

102 parents reported on their levels of depression (CESD), state anxiety (STAI), pediatric parenting stress (PIP), and self-efficacy for diabetes care (SED) within 4 weeks of their child's diagnosis with type 1 diabetes. Data were analyzed using hierarchical multiple regression.

Results

Parents’ scores in the clinical range for depression and anxiety were associated with increased frequency and difficulty of pediatric parenting stress, and there was a trend for depression to be related to lower self-efficacy for diabetes care. The association of female gender with anxiety and depression was partially mediated by more frequent pediatric parenting stress.

Conclusion

Parents of children newly diagnosed with type 1 diabetes are at risk for experiencing anxiety and depression, related, in part, to their experiences of pediatric parenting stress.

Practice implications

Providers and educators should be aware of the risk for depression and anxiety in parents and should work to decrease pediatric parenting stress, increase self-efficacy, and refer parents who are experiencing significant anxiety or depression following their child's diagnosis to a mental health specialist.     

Toward a theory of patient and consumer activation

Objective

The purpose of this study is to begin the process of developing a theory of activation, to inform educational efforts and the design of interventions. Because the experience of positive emotions in daily life, tends to widen the individual's array of behavioral responses and increase their openness to new information, we examine how emotions relate to activation levels.

Methods

A web survey was carried out in 2008 with a National sample of respondents between the ages of 25–75. The study achieved a 63% response rate with a final sample size of 843.

Results

The findings indicate that activation is linked with the experience of positive and negative emotion in daily life. Those low in activation are weighted down by negative affect and negative self-perception.

Conclusions

Bringing about change in activation, likely means breaking this cycle of negative self-perception and emotions.

Practice implications

Experiencing success can start a positive upward cycle, just like failure produces the opposite. By encouraging small steps toward improving health, ones that are realistic, given the individuals level of activation, it is possible to start that positive cycle. Effective educational efforts should focus on improving self-efficacy and the individual's self-concept as a self-manager.     

Lessons learned from an HIV adherence pilot study in the Deep South

Objective

Adherence to treatment for chronic illnesses, including HIV disease, is a complex process, and needs practical interventions in poorly resourced clinic settings.

Methods

This study tested the feasibility of an adherence intervention in 73 HIV-infected individuals in a Deep South public clinic based on Fisher & Fisher's Information-Motivation-Behavioral Skills Model.

Results

There was high baseline adherence and unexpectedly high clinic attrition, and 27% of the intervention group received less than one-quarter of the planned intervention contacts. Refill rate was the adherence measure that correlated best with HIV viral load and CD4 count, and there was poor use of electronic adherence monitoring (MEMS). Interviewed individuals expressed positive feelings about audio-supported computer-assisted survey instruments (ACASI) and the intervention support.

Conclusions

This process evaluation showed feasible study components in this population and setting. Lessons learned included: (1) clinic retention is an important part of adherence; (2) telephone interventions may need to add additional technology and flexibility to maximize dose; (3) ongoing fidelity monitoring is important with motivational interviewing; (4) refill rate was the most accurate adherence assessment; (5) MEMS was not well-accepted; (6) ACASI was easily used in this population; and (7) individuals appreciated adherence support from a consistent caring individual.     

A systematic review of patient education in cardiac patients: Do they increase knowledge and promote health behavior change?

Objective

(1) To investigate the impact of education on patients’ knowledge; (2) to determine if educational interventions are related to health behavior change in cardiac patients; and (3) to describe the nature of educational interventions.

Methods

A literature search of several electronic databases was conducted for published articles from database inception to August 2012. Eligible articles included cardiac patients, and described delivery of educational interventions by a healthcare provider. Outcomes were knowledge, smoking, physical activity, dietary habits, response to symptoms, medication adherence, and psychosocial well-being. Articles were reviewed by 2 authors independently.

Results

Overall, 42 articles were included, of which 23 (55%) were randomized controlled trials, and 16 (38%) were considered “good” quality. Eleven studies (26%) assessed knowledge, and 10 showed a significant increase with education. With regard to outcomes, educational interventions were significantly and positively related to physical activity, dietary habits, and smoking cessation. The nature of interventions was poorly described and most frequently delivered post-discharge, by a nurse, and in groups.

Conclusions

Findings support the benefits of educational interventions in CHD, though increase in patients’ knowledge and behavior change.

Practice implications

Future reporting of education interventions should be more explicitly characterized, in order to be reproducible and assessed.     

Effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions

Objective

To develop and pilot test the effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report symptoms of acute deteriorating conditions.

Method

Using cluster randomization, acute care general wards were randomized to the experimental and control groups. 34 patients in the experimental group received a 30-minute patient education intervention on Alert Worsening conditions And Report Early (AWARE) while 33 patients in the control group received the routine care only. Levels of self-efficacy to recognize and report symptoms were measured before and after the intervention.

Results

The level of self-efficacy reported by the experimental group was significantly higher than the control group (p < 0.0001).

Conclusion

The AWARE intervention was effective in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions.

Practical implications

Patient engagement through patient education could be included in the rapid response system which aims to reduce hospital mortality and cardiac arrest rates in the general wards.     

Self-efficacy for temptations is a better predictor of weight loss than motivation and global self-efficacy: Evidence from two prospective studies among overweight/obese women at high risk of breast cancer

Objectives

Identifying predictors of weight loss could help to triage people who will benefit most from programs and identify those who require additional support. The present research was designed to address statistical, conceptual and operational difficulties associated with the role of self-efficacy in predicting weight loss.

Methods

In Study 1, 115 dieting overweight/obese women at high risk of breast cancer were weighed and completed questionnaires assessing motivation, global self-efficacy and self-efficacy for temptations. The main outcome measure was weight, measured 3-months post-baseline. Study 2 was identical (n = 107), except changes in psychological variables were computed, and used to predict weight 6-months post-baseline.

Results

In Study 1, self-efficacy for temptations was a significant predictor of weight loss at 3-month follow-up. In Study 2, improved self-efficacy for temptations between baseline and four-weeks was predictive of lower weight at 6 months.

Conclusion

The key finding was that self-efficacy for temptations, as opposed to motivation and global self-efficacy, was predictive of subsequent weight loss.

Practice implications

The implication is that augmenting dieters’ capability for dealing with temptations might boost the impact of weight loss programs.     

The Coping with Caregiving Group Program for Chinese caregivers of patients with Alzheimer's disease in Hong Kong

Objective

This pilot study evaluated the effectiveness of Coping with Caregiving (CWC) psychoeducational program for Chinese family caregivers of patients with Alzheimer's disease in Hong Kong.

Method

Twenty-seven female primary caregivers were randomized to join the treatment group or wait-list control group. The caregivers in the treatment group participated in 13 weekly training sessions which taught specific cognitive–behavioral strategies to handle caregiving stress.

Results

As compared to the wait-list control group, caregivers completing the CWC program demonstrated a significant increase in their self-efficacy for controlling their upsetting thoughts and handling disruptive behaviors of the care recipients. They also reported a significant increase in the use of both problem-focused and emotion-focused coping strategies.

Conclusion

These findings suggested that cognitive–behavioral programs can be effective in improving the resourcefulness of Chinese caregivers of persons with dementia in Hong Kong.

Practice implications

Future CWC programs will have to enhance participants’ ability to differentiate among various coping skills and to use situation-appropriate strategies.     

Complex interventions to improve the health of people with limited literacy: A systematic review

Objective

To evaluate the published literature on the effects of complex (multi-faceted) interventions intended to improve the health-related outcomes of individuals with limited literacy or numeracy.

Methods

We undertook a systematic review of randomized and quasi-randomized controlled trials with a narrative synthesis. The search strategy included searching eight databases from start date to 2007, reference checking and contacting expert informants. After the initial screen, two reviewers independently assessed eligibility, extracted data and evaluated study quality.

Results

The searches yielded 2734 non-duplicate items, which were reduced to 15 trials. Two interventions were directed at health professionals, one intervention was literacy education, and 12 were health education/management interventions. The quality of the trials was mixed, 13/15 trials were conducted in North America, and all focused on literacy rather than numeracy. 13/15 trials reported at least one significant difference in primary outcome, all favoring the intervention group. Only 8/15 trials measured direct clinical outcomes. Knowledge and self-efficacy were the class of outcome most likely to improve.

Conclusion

A wide variety of complex interventions for adults with limited literacy are able to improve some health-related outcomes.

Practice implications

This review supports the wider introduction of interventions for people with limited literacy, particularly within an evaluation context.     

The effects of scenario-based communication training on nurses’ communication competence and self-efficacy and myocardial infarction knowledge

Objective

The aim of the study was to determine the effects of a simulated communication training course on nurses’ communication competence, self-efficacy, communication performance, myocardial infarction knowledge, and general satisfaction with their learning experience.

Methods

A randomized controlled trial was conducted with a pre-test and two post-tests. The experimental group underwent simulated communication training course and the control group received a case-based communication training course.

Results

The experimental group made more significant improvement in competence and self-efficacy in communication from pre-test to the second post-test than the control group. Although both groups’ satisfaction with their learning experience significantly increased from the first post-test to the second post-test, the experimental group was found to be more satisfied with their learning experience than the control group. No significant differences in communication performance and myocardial infarction knowledge between the two groups were identified.

Conclusion

Scenario-based communication training can be more fully incorporated into in-service education for nurses to boost their competence and self-efficacy in communication and enhance their communication performance in myocardial infarction patient care.

Practice implications

Introduction of real-life communication scenarios through multimedia in communication education could make learners more motivated to practice communication, hence leading to improved communication capacity.     

The Complementary Medicine Education and Outcomes (CAMEO) program: A foundation for patient and health professional education and decision support programs

Objective

This paper describes the background, design and evaluation of a theory-informed education and decision support program for cancer patients considering complementary medicine (CM).

Methods

The program was informed by the Shared Decision Making theory, the Ottawa Decision Support Framework and the Supportive Care Framework. Previous empirical evidence and baseline research were used to identify patients’ and health professionals’ (HPs) information and decision support needs related to CM.

Results

To address the continuum of CM needs, a variety of education and decision support interventions were developed, including basic CM information and resources for patients and HPs, a group education program and one-on-one decision support coaching for patients, and an on-line education module for HPs. Evaluation of the program and individual interventions is underway.

Conclusions

This education and decision support program addresses a significant gap in care and offers an evidence-informed framework in which to translate CM evidence to conventional care settings and promote communication about CM.

Practice implications

Evidence-informed CM education and decision support interventions are needed to shift the culture around CM within conventional care settings and promote open communication that will lead to CM therapies being safely integrated into care.     

Sexual experiences during the climacteric years: What do women think about it?

Purpose

To describe women's sexual experiences during the climacteric years.

Methods

The analysis was conducted using a theoretical–methodological perspective based on phenomenology. Data were obtained through a group interview method: the focus group. Participants were women attending a health education programme during the climacteric period. This programme was developed by the sexual and reproductive health services for the area of Barcelona (Spain).

Results

Reading and analysis of participants’ discourse revealed four categories: the climacteric stage, a time for self-reassertion; the relative burden of biology; the journey through sexual life; and the importance of social/family factors as regards sexual experiences.

Conclusions

In this study, social, family and structural factors had the greatest impact on sexual experience during this stage of life. The lack of independence with respect to parents, who have often moved into the family's residence, turns many of these women into informal carers. Tiredness, lack of intimacy and a reduced living space that is often shared with parents or grownup children are strong determinants as regards the free expression of sexuality.     

Web-based self-management support training for health professionals: A pilot study

Objective

To evaluate a web-based self-management training for health professionals. Patients spend 99% of their time outside the healthcare system. Thus self-management support from health professionals is central to optimal care. Our objective was to teach health professionals the skills to provide this support.

Methods

Primary care residents and practicing providers enrolled in six groups. Each group received four web-based interactive training sessions derived from self-efficacy theory. Retrospective-pre/post assessed changes in self-management beliefs and confidence. Wilcoxon signed-rank tests with Bonferroni correction compared responses. Focus groups solicited qualitative feedback.

Results

Fifty-seven residents and providers across the United States enrolled. Residents demonstrated positive changes on all belief questions (P 0.001–0.012). Practicing providers had a non-significant positive change on one and significant changes on the remainder (P 0.001–0.018). Both types of participants demonstrated significant increases on confidence questions regarding their ability to support self-management (P < 0.01 for all). Participants described learned techniques as being useful, reducing burnout, and increasing acceptance of patient involvement in care planning.

Conclusion

The web-based self-management support training for health professionals was feasible and changed beliefs and confidence.

Practice implications

The program may maximize patient self-management by increasing provider self-efficacy and skill for self-management support.     

The Effectiveness of an Internet Support Forum for Carers of People With Dementia: A Pre-Post Cohort Study

Background

The well-being of informal carers of people with dementia is an important public health issue. Caring for an elderly relative with dementia may be burdensome and stressful, and can negatively affect the carer’s social, family, and professional life. The combination of loss, the physical demands of caregiving, prolonged distress, and biological vulnerabilities of older carers may compromise their physical health, increase social isolation, and increase the risk of anxiety and depressive disorders. Caregiver stress is also linked to negative outcomes for the recipient of care and costs to society, including increased nursing home and hospital admissions. Consequently, carer support interventions are an important component of dementia care. Computer-mediated carer support offers a range of potential advantages compared to traditional face-to-face support groups, including accessibility and the possibility of tailoring to meet individual needs, but there has been little research on its effectiveness so far.

Objective

This mixed-methods study examined the impact of a well-respected UK-based online support forum for carers of people with dementia.

Methods

A total of 61 new forum users completed measures of anxiety (7-item Generalized Anxiety Disorder scale, GAD-7), depression (9-item Patient Health Questionnaire, PHQ-9), and quality of relationship with the person with dementia (Scale for the Quality of the Current Relationship in Caregiving, SQCRC), at baseline and again after 12 weeks of forum usage, within a pre-post design. In addition, 8 participants were interviewed about their experiences with using the forum.

Results

There was an improvement in the quality of the relationship with the person with dementia (SQCRC: P=.003). There was no change in users’ depression (PHQ-9) or anxiety (GAD-7) over the 12-week study period. Interview participants reported a range of positive experiences and benefits from using the forum. Limited negative experiences were also reported.

Conclusions

Many of the reported experiences and benefits are unique to online peer support. Further research into online peer support for carers of people with dementia is needed to clarify who benefits under what conditions.