Exploring the mechanisms of change in the chronic disease self-management programme: secondary analysis of data from a randomised controlled trial

Objective

The Chronic Disease Self-Management Programme (CDSMP) has been shown to be clinically and cost effective; however the specific mechanisms by which benefits are achieved are not well understood. We investigate what aspects of the course are associated with different outcomes.

Methods

Post-hoc analysis of data from participants in a randomised controlled trial of the CDSMP using evaluations after 6 months for all patients and longer term outcomes at 12 months for a sub-set of patients. Data were analysed using univariate and multivariate regressions.

Results

All course quality variables apart from the venue predicted satisfaction with CDSMP. The best predictors were ratings of the group process and course content. Group process was also significantly associated with self-care behaviour and long-term group outcomes (such as maintaining contact). Few associations between course ratings and patient health outcomes were found.

Conclusion

The most consistent predictor of CDSMP outcomes was the rating of the group process, highlighting the importance of group dynamics, however the complexity of mechanisms by which the CDSMP works cautions against giving primacy to any single factor.

Practice implications

Taking measures to ensure group processes are of high quality and effective within CDSMP are important in maximising patient satisfaction and self-care behaviour change.     

口服抗凝治疗两种监测方法的Meta分析

目的 评价口服抗凝治疗自我监测的方法 是否优于传统方法 .方法 通过多种途径检索截至2008年10月关于两种监测方法 比较的前瞻性随机对照试验,然后进行meta分析.结果 纳入的17项研究分析结果 显示自我监测方法 较之传统方法 治疗达标率高,并且能将伞因死亡率降低近三分之一;栓塞事件发生率减少54%;大出血事件发生率减少.亚组分析显示,自我调整药量组较之依靠专业人员调整药量组全因死亡率及栓寒事件发生率明显降低,但大出血事件发生率未降低.结论 口服抗凝治疗自我监测的方法 较传统方法 优越,但实施之前必须对病人进行教育与严格培训.     

乳腺癌术后患者自我照顾能力的分析与研究

目的：了解和分析乳腺癌术后患者自我照顾及其影响因素,为护理乳腺癌术后患者提供依据。方法：采用自我照顾能力的个人随访,对我院148例接受乳腺癌根治术、170例乳腺癌扩大根治术的患者进行定期随访,并对影响她们自我照顾能力的因素进行分析。结果：通过多方面指导后,有效提高了患者自我照顾能力,增强了生活信心和自我价值,提高了生活质量。结论：乳腺癌术后患者的自我照顾能力是不同的,并受各种因素影响,医护人员根据患者的自我照顾能力提供适当的帮助。     

The use of medicinal plants in self-care in the Agonlin region of Benin

Aim of the study: To investigate the extent and type of medicinal plants used in self-care by the inhabitants of the Agonlin community in the Republic of Benin. Materials and Methods: A semi-structured questionnaire was used to interview a total of one thousand mothers Results: The prevalence rate of the use of herbal medicines in self-care was found to be 51.04%. One hundred and fourteen (114) plant species belonging to 69 families were reported, each with their local names, medicinal use, and parts used. Of all the indications of the identified plants, fever, headache, abdominal pain, and vomiting were the most frequently reported, with malaria treatment recording the highest usage of plant remedies (22%). The plant part most frequently used was the leaves. Conclusions: This study showed that self-care using medicinal plants is a major part of health care in the Agonlin area.     

基于Orem自理理论康复护理联合情志干预对脑梗死偏瘫患者神经功能、自护能力及生活质量的影响

目的:探究基于Orem自理理论康复护理联合情志干预对脑梗死偏瘫患者神经功能、自护能力及生活质量的影响。方法:选取2018年6月至2019年2月在雅安市中医医院进行脑梗死治疗的100例患者,根据患者入院时间将其分为常规组及研究组,对常规组患者行常规护理,对研究组患者行基于Orem自理理论康复护理联合情志干预,比较两组患者干预前后神经功能、自护能力及生活质量。结果:干预前,两组患者NIHSS评分、Barthel指数评分及SF36量表评分比较差异均无统计学意义(均P>0.05),干预后,研究组患者NIHSS评分及Barthel指数评分分别为(3.08±1.12)分及(79.28±6.41)分,均显著优于常规组及干预前,差异有统计学意义(均P<0.05),且研究组患者各项活质量评分均显著优于常规组及干预前(P<0.05)。结论:对脑梗死偏瘫患者实施脑梗死偏瘫患者,能够有效改善其神经功能,且对提高患者自护能力及生活质量具有重要意义。     

The prediction of self-care behaviors in end-stage renal disease patients using Leventhal's Self-Regulatory Model

OBJECTIVE: To assess the utility of Leventhal's Self-Regulatory Model (SRM) to predict self-care behavior with regard to dietary, medication, and fluid regimes in end-stage renal disease (ESRD) patients. METHODS: In a prospective study, ESRD patients treated via hospital-based haemodialysis (N=73) were screened for cognitive deficits and completed questionnaires that enquired about illness perceptions, coping strategies, knowledge of kidney disease, and psychological distress at Time 1. Physiological proxy measures of self-care behaviors regarding diet (serum potassium levels), fluid intake (mean and standard deviation of interdialytic weight gain), and medication (serum phosphate levels) regimes were collected 3 weeks later at Time 2. RESULTS: Illness representations (emotional and timeline perceptions) predicted self-care behaviors with regard to diet and medication. Emotion-focused coping strategies predicted higher levels of variation in adherence to fluid restrictions. Younger males were less likely to adhere to the fluid restrictions. CONCLUSIONS: The SRM has predictive utility. Psychological interventions should focus on alleviating disease-specific distress and challenging erroneous timeline perceptions in order to increase adherence to dietary and medication regimes in ESRD patients. A more specific measure of coping for ESRD is required to clarify the role of coping strategies in this population. Younger, male patients should be targeted for extra support with fluid restrictions.     

上海市某社区中老年妇女自我保健现状及分析

目的 了解社区中老年妇女自我保健意识和行为状况及相关影响因素。方法 自行设计问卷，随机选择老西门社区4个里委共400名35岁以上妇女作现场问卷调查。结果 (1)400名中老年妇女自我保健意识和保健行为不尽如人意。(2)学历高低与经济收入多少对妇女保健知识的认知和行为实施有影响。(3)74．25％的妇女从电视、广播获取保健知识，从社区健康宣教中获得占10．00％。(4)92．25％的妇女对社区开展妇女保健宣教有需求。结论 社区卫生服务应把普及妇女保健知识，促进中老年妇女主动保健意识和行为作为重要服务内容，强化社区健康宣教的作用。     

A case of senile self-neglect in a married couple: ‘Diogenes à deux’?

A case is presented of senile self-neglect in a cohabiting pair. Many features of what has been called Diogenes syndrome are illustrated. Aetiological factors are discussed and parallels with models for folie À deux are drawn.     

Familia,economía y servicios sanitarios: claves de los cuidados en pacientes con diabetes y amputación de miembros inferiores. Estudio cualitativo en Andalucía

Aim

To examine the experience of diabetic care in patients undergoing lower limb amputation.

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.