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Decentralization as an organizing principle has drawn growing interest from scholars and practitioners because of its perceived suitability for contemporary market conditions and alignment with employees' evolving work expectations. However, efforts to decentralize authority face significant obstacles and often end in failure. I propose that existing research on decentralization has struggled to generate insight into how such barriers can be overcome because it has treated decentralization as a static outcome imposed by organizational designers. In contrast, this article treats decentralization as a dynamic and situated achievement that must be continually enacted, and it leverages ethnographic data from a decentralization effort in order to build theory on the organizational practices that support enactments of decentralized authority. I find that successful enactments of decentralized authority were supported by practices that established clear boundaries of authority and focused collective attention on these boundaries, as well as by practices that depersonalized collective attributions of the source of authority. At the same time, the practices were difficult to sustain because they were cognitively, emotionally, and temporally demanding. Through this study, I show that decentralization is not merely a one-time structural change but an ongoing collective process that requires navigating and neutralizing the structural and psychological forces pulling organizations back toward hierarchy. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is a complex, chronic condition that can cause multiple complications due to poor glycemic control. Self-management plays a crucial role in the management of T2DM. Lifestyle modifications, including physical activity (PA), are fundamental for self-management. This study explored the knowledge, perception, practice, enablers, and barriers of PA among individuals with T2DM. Methods: A mixed-method study was conducted among individuals with T2DM in Udupi taluk, India. A cross-sectional survey (n = 467) followed by an in-depth interview (n = 35) was performed. The data were analyzed using descriptive statistics and thematic analysis, respectively. Results: About half (48.8%) of the participants engaged in PA of which 28.3% had an adequate score in the practice of PA. Walking was the most preferred mode. Self-realization, Comprehension, perception, and source of information, PA training, Current PA practices, enablers and barriers for PA were 6 themes derived under knowledge, perception, and practice of PA. Conclusion: Despite knowing the importance of PA, compliance with PA was poor. The personal/internal, societal, and external factors constituted the trinity of barriers and enablers in compliance with PA. Behavioral changes, societal changes, policy initiatives, and PA training in health care settings may enhance PA practice among individuals with T2DM. [ABSTRACT FROM AUTHOR]

PurposeMany survivors of rectal cancer experience persistent bowel dysfunction. There are few evidence-based symptom management interventions to improve bowel control. The purpose of this study is to describe recruitment and pre-randomization baseline sociodemographic, health status, and clinical characteristics for SWOG S1820, a trial of the Altering Intake, Managing Symptoms in Rectal Cancer (AIMS-RC) intervention.MethodsSWOG S1820 aimed to determine the preliminary efficacy, feasibility, and acceptability of AIMS-RC, a symptom management intervention for bowel health, comparing intervention to attention control. Survivors with a history of cancers of the rectosigmoid colon or rectum, within 6-24 months of primary treatment completion, with a post-surgical permanent ostomy or anastomosis, and over 18 years of age were enrolled. Outcomes included total bowel function, low anterior resection syndrome, quality of life, motivation for managing bowel health, self-efficacy for managing symptoms, positive and negative affect, and study feasibility and acceptability.ResultsThe trial completed accrual over a 29-month period and enrolled 117 participants from 34 institutions across 17 states and one US Pacific territory. At baseline, most enrolled participants reported self-imposed diet adjustments after surgery, persistent dietary intolerances, and bowel discomfort post-treatment, with high levels of constipation and diarrhea (grades 1-4).ConclusionsSWOG S1820 was able to recruit, in a timely manner, a study cohort that is demographically representative of US survivors of rectal cancer. Baseline characteristics illustrate the connection between diet/eating and bowel symptoms post-treatment, with many participants reporting diet adjustments and persistent inability to be comfortable with dietary intake.ClinicaltrialsGov registration date12/19/2019.ClinicaltrialsGov identifierNCT#04205955.

Introduction: The purpose of this study was to characterize how family influences diabetes self-management in Mexican American adults. Methods: Data were analyzed from previously collected data that included 34 semi-structured interviews with Hispanic adults with diabetes and six focus groups with 37 adults with diabetes and family members. Themes related to family and diabetes management were identified and analyzed using a modified template approach. Results: Family-related facilitators to T2DM self-management were (1) provides support, (2) provides motivation, and (3) desire to protect family from diabetes. Family-related challenges were (1) lack of support, (2) family responsibilities, and (3) stress related to family. Diabetes education was shared with family members. Family member perspectives on T2DM included (1) not knowing how to help, (2) effect on emotional wellbeing, (3) diabetes affects the whole family, and (4) family provides support. Conclusion: Most participants with T2DM felt supported by family, but many desired more social support and support surrounding dietary changes from family. Many felt family did not understand what living with diabetes meant for them. Most family members wished to learn more about how to help. Future interventions should include family members and teach them supportive strategies to support beneficial diabetes self-management behaviors.

BACKGROUND: The existing literature has limited detail on theory-driven interventions, particularly in pain studies. We adapted Banduras self-efficacy framework toward a theory-driven, non-pharmacological intervention using auricular point acupressure (APA) and evaluated participants perceptions of this intervention on their pain self-management. APA is a non-invasive modality based on auricular acupuncture principles. METHODS: We mapped our study intervention components according to Banduras key sources of self-efficacy (performance accomplishments, vicarious experience, verbal persuasion, and emotional arousal) to facilitate the self-management of pain. Through a qualitative study design, we conducted virtual interviews at one and three months after a 4-week APA intervention among 23 participants using purposive sampling to describe their experiences in managing their pain based on our theory-driven APA intervention. RESULTS: Using thematic analyses, we found four themes: the enhanced self-management of pain, improved pain outcomes, the feasibility of technology, and the sustainability of APA. CONCLUSIONS: Describing how interventions are mapped according to the elements of theoretical frameworks can help to guide intervention development, advance science and knowledge development, and promote the implementation of interventions. As such, using Banduras self-efficacy theory as a foundation for the APA intervention, APA was found to be feasible and sustainable, improving self-management, pain intensity, and pain-related outcomes. Participants provided recommendations for the further improvement of this theory-driven intervention.

BACKGROUND: Health disparities in osteoarthritis (OA) outcomes exist both in the occurrence and treatment of functional limitation and disability for Mexican Americans. Although the effect of self-management of chronic illness is well established, studies demonstrate little attention to self-management of function or disability, despite the strong potential effect on both and, consequently, on patients' lives. OBJECTIVE: The purpose of this study pilot was to develop and test key variable relationships for a measure of disability self-management among Mexican Americans. METHODS: In this sequential, two-phased, mixed-methods, biobehavioral pilot study of Mexican American women and men with OA, a culturally tailored measure of disability self-management was created, and initial relationships among key variables were explored. RESULTS: First, a qualitative study of 19 adults of Mexican American descent born in Texas (United States) or Mexico was conducted. The Mexican American Disability Self-Management Scale was created using a descriptive content analysis of interview data. The scale was tested and refined, resulting in 18 items and a descriptive frequency of therapeutic management efforts. Second, correlations between study variables were estimated: Disability and function were negatively correlated. Disability correlated positively with social support and activity effort. Disability correlated negatively with disability self-management, pain, and C-reactive protein. Function was positively correlated with age, pain, and depression. Liver enzymes (alanine transaminase) correlated positively with pain and anxiety. DISCUSSION: This mixed-methods study indicates directions for further testing and interventions for disability outcomes among Mexican Americans.

BACKGROUND: Musculoskeletal pain is a prevalent concern among diverse populations, from the average individual to the elite athlete. Handheld percussive massage therapy devices like massage guns have gained much popularity in both medical and athletic settings. Its application has been prominently recognized in injury prevention and rehabilitation. The expansion of the market to provide handheld percussive therapy devices with varying features and price points has encouraged professional and novice use. While percussive therapy holds similarities to more studied therapeutic modalities, like vibration therapy and soft tissue mobilization, there is limited evidence-based information on the indications and contraindications. OBJECTIVE: This study aims to use a qualitative analysis of consumer perceptions to understand the perceived therapeutic potential of percussive massage therapy as a home-based intervention for musculoskeletal concerns of everyday users and elite athletes. Additionally, we aim to gain insight on valuable characteristics supporting its therapeutic potential as well as pertinent limitations. METHODS: The TOLOCO massage gun (TOLOCO) was identified as the best-selling percussive massage therapy device on Amazon. We performed an inductive thematic qualitative analysis on the top 100 positive comments and the top 100 critical comments of the device between June 2020 and April 2023 to determine 4 relevant themes. RESULTS: The 4 themes identified upon qualitative analysis were pain management, versatility, accessibility, and safety and user education. Consumer reviews indicated use for this percussive therapy device in adolescents, adults, and older people across a spectrum of activity levels. Consumers reported the therapeutic potential of percussive massage therapy in managing wide-ranging musculoskeletal concerns like acute pain, chronic pain, nonsurgical injury rehabilitation, postsurgical injury rehabilitation, and injury prevention. Consumers highlighted the versatility of the device to address person-specific needs as a key feature in supporting its perceived therapeutic benefits. Additionally, consumers frequently commented on the affordability and availability of this device to increase accessibility to home-based care. Some critical reviews emphasized a concern for the quality of the device itself. However, this concern did not translate to the overall modality of percussive massage therapy. Of note, despite strong approval for its therapeutic potential, consumer reviews lacked evidence-based insights on appropriate usage. CONCLUSIONS: Home-based percussive massage therapy holds value with its perceived efficacy in pain management for acute and chronic conditions, as well as in injury prevention and rehabilitation. As a low-cost and readily available device for everyday users and high-performing athletes, percussive massage therapy works toward establishing increased health care accessibility and optimizing health care usage. This home-based intervention can serve to reduce the significant personal and economic burden of prevalent musculoskeletal concerns. However, the limited scientific research on percussive massage therapy raises concerns about the lack of evidence-based care and indicates the need for future studies.

Background: Digital self-management tools including mobile apps and wearables can enhance personalized care in Parkinson's disease, and incorporating patient and clinician feedback into their evaluation can empower users and nurture patient-clinician relationships, necessitating a review to assess the state of the art and refine their use. Objective: This review aimed to summarize the state of the art of self-management systems used in Parkinson's disease management, detailing the application of self-management techniques and the integration of clinicians. It also aimed to provide a concise synthesis on the acceptance and usability of these systems from the clinicians' standpoint, reflecting both patient engagement and clinician experience. Methods: The review was organized following the PRISMA extension for Scoping Reviews and PICOS frameworks. Studies were retrieved from PubMed, CINAHL, Scopus, ACM Digital Library, and IEEE Xplore. Data was collected using a predefined form and then analyzed descriptively. Results: Of the 15,231 studies retrieved, 33 were included. Five technology types were identified, with systems combining technologies being the most evaluated. Common self-management strategies included educational material and symptom journals. Only 11 studies gathered data from clinicians or reported evidence of clinician integration; out of those, six studies point out the importance of raw data availability, data visualization, and integrated data summaries. Conclusions: While self-management systems for Parkinson's disease are well-received by patients, the studies underscore the urgency for more research into their usability for clinicians and integration into daily medical workflows to enhance overall care quality. Plain Language Summary: Digital tools, such as smartphone applications and wearable devices, could help people with Parkinson's disease manage their symptoms by using data and technology to provide support that is personalized to them and by supporting communication between patients and healthcare providers. This review studies current literature on these digital self-management systems for people with Parkinson's disease. Of the 33 studies included in our review, we found that many of these systems combine different types of digital technologies (for example, a mobile app and a wearable sensor). The most common strategies to help support patients with self-management included in these digital tools were providing educational health content and symptom diaries. Only a few studies have considered healthcare providers' perspectives on these systems. Those that did highlighted a need for better access to patient data, improved data presentation, and summaries of key health insights. While patients find digital self-management tools favorable, further research is needed to ensure they meet healthcare providers' professional needs and can fit easily into daily clinical routines, ultimately improving care for individuals with Parkinson's disease. [ABSTRACT FROM AUTHOR]

Purpose: Endometriosis is a chronic inflammatory disease that can cause various pain symptoms. Current therapy options do not always provide sufficient pain relief and often cause unpleasant side effects. Recent studies have shown that the endocannabinoid system is involved in the endometriosis pathophysiology, and using Cannabinoids may be a potential therapeutic option. We aimed to determine for the first time, the Cannabis use prevalence, self-rated effectiveness, and the possible reduction in medication in German-speaking countries. Methods: A cross-sectional online survey was distributed through endometriosis support and advocacy groups on social media. German-speaking endometriosis patients aged ≤ 18, residing in Germany, Austria, and Switzerland were eligible to participate. Results: Out of 912 participants who provided valid answers, 114 reported using cannabis for self-management. Cannabis was rated as the most effective self-management strategy to reduce symptom intensity (self-rated efficacy 7.6 out of 10). Additionally, ~ 90% of the participants were able to decrease their pain medication intake. The greatest improvement was observed in sleep (91%), menstrual pain (90%), and non-cyclic pain (80%). Apart from increased fatigue (17%), side effects were infrequent (≤ 5%). Conclusion: At the time of the study, Cannabis consumption was still illegal in Germany, Austria, and Switzerland, with medical cannabis being rarely prescribed due to complex requirements. Results suggest that Cannabis has become a popular self-management method for treating endometriosis-related symptoms, leading to substantial symptom improvement. Further studies are needed to investigate the best administration methods, dosage, THC/CBD ratio, potential side effects, and long-term effects to provide official recommendations to patients and healthcare providers. [ABSTRACT FROM AUTHOR]

Aim: To determine patients', nurses' and researchers' opinions on the appropriateness and completeness of the proposed conceptualization of nurses' support of hospitalised patients' self‐management. Design: A modified Delphi study. Methods: We conducted a two‐round Delphi survey. The panel group consisted of patients, nurses and researchers. The conceptualization of nurses' support of hospitalised patients' self‐management presented in the first Delphi round was based on previous research, including a scoping review of the literature. Data was analysed between both rounds and after the second round. Results are reported in accordance with the guidance on Conducting and Reporting Delphi Studies (CREDES). Results: In the first round all activities of the proposed conceptualization were considered appropriate to support the patients' self‐management. Panel members' comments led to the textual adjustment of 19 activities, the development of 15 new activities, and three general questions related to self‐management support during hospitalisation. In the second round the modified and the newly added activities were also deemed appropriate. The clarification statements raised in the first Delphi round were accepted, although questions remained about the wording of the activities and about what is and what is not self‐management support. Conclusion: After textual adjustments and the addition of some activities, the proposed conceptualization of nurses' support in patients' self‐management while hospitalised have been considered appropriate and complete. Nevertheless, questions about the scope of this concept still remains. The results provide a starting point for further discussion and the development of self‐management programs aimed at the hospitalised patient. Implication for the profession and/or patient care: The results can be considered as a starting point for practice to discuss the concept of nurses' support for hospitalised patients' self‐management and develop, implement and research self‐management programs specific for their patient population. Reporting Method: Results are reported in accordance with the guidance on Conducting and Reporting Delphi Studies (CREDES). Patient or Public Contribution: Patients were involved as expert panellist in this Delphi study. Impact statementWhat problem did the study address?Self‐management support during hospitalisation is understudied, which undermines the development of evidence‐based interventions.What were the main findings?A panel, consisting of patients, nurses and researchers, agreed on the appropriateness of a conceptualization of nurses' support of inpatients' self‐management, and identified some points for discussion, mainly related to the boundaries of the concept self‐management.Where and on whom will the research have an impact?This study is crucial for generating conceptual understanding of how nurses support patients' self‐management during hospitalisation. This is necessary for policy, clinical practice, education, and research on this topic. [ABSTRACT FROM AUTHOR]

Introduction: Self-management is pivotal in helping people with their independence and in managing their health conditions more effectively. The PRIDE-app is a novel online intervention, providing support and information for people living with dementia and their families, aimed at increasing self-management and improving quality of life. Knowledge generated will help inform future developments to the app, with the aim of improving its uptake and implementation in services. Methods: A mixed-methods approach incorporating the RE-AIM framework. Recruited 25 people living with dementia, of which 17completed the PRIDE-app intervention over 8 weeks with support from a dementia adviser facilitator. Measures exploring mood, physical well-being, and quality of life were collected at baseline, 3 and 6 months and analysed through modelled analysis. Post-intervention interviews were conducted with participants and facilitators and analysed through thematic analysis. Results: Quantitative results did not show significant improvements in participants' scores. Qualitative data showed that the PRIDE-app motivated people to reconnect socially and set individual goals for activities. Participants and facilitators identified areas for improvements to the app interface and delivery format. Conclusions: This study evaluated the PRIDE-app's reach, effectiveness and adoptability in the independence and quality of life of people living with dementia, as well as how it could be implemented and maintained within services. Pre- and post-intervention scores were inconclusive. Interviews provided positive feedback of the app's influence on peoples' activities and mood. [ABSTRACT FROM AUTHOR]

To develop and support teachers' skills in classroom management, resource-efficient teacher training approaches are needed. This study evaluated the effects of an online tiered training intervention on teachers' use of class-wide positive behavior supports, either behavior-specific praise (BSP) or opportunities to respond (OTRs), using a randomized controlled trial conducted in an online graduate course in classroom management. Fifty-nine participants (52 teachers, 6 paraprofessionals, and 1 after-school instructor) completed the study. We randomly assigned 29 teachers to receive tiered training for BSP and 30 teachers to receive tiered training for OTRs. We found tiered training increased participants' use of the target practice, BSP or OTR, with medium to large effect sizes, and most teachers required support beyond universal training. Teachers rated the training they received as highly acceptable, feasible, and useful. [ABSTRACT FROM AUTHOR]

Background: While preventive swallowing exercises reduce the risk of radiation‐associated dysphagia in patients with head and neck cancer, strategies are needed to improve patient adherence. Methods: Before radiation, all participants were taught preventive swallowing exercises and randomized to either an adherence intervention or enhanced usual care. During radiation, all participants met twice with a speech pathologist for swallowing assessment and reinforcement of exercises. Intervention participants met weekly with a counselor in‐person or by phone. At 6‐week post‐radiation follow‐up, all participants completed a follow‐up assessment of self‐reported adherence, which was then corroborated with medical record documentation. Results: Newly diagnosed pharyngeal and laryngeal cancer patients without distant metastases were randomized (n = 265; 135 to intervention, and 130 to usual care). Intervention participants were more likely to adhere to exercises during radiation compared to the control group (p < 0.0001). Conclusion: The weekly in‐person adherence intervention program significantly increased patient's adherence to preventive swallowing exercises during radiation. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Methods Results Conclusions Reporting Method Patient or Public Contribution This study aims to describe disease‐specific self‐care behaviours in patients with heart failure (HF), diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) in various combinations; to compare these self‐care behaviours within patient groups; and to evaluate differences across these groups.Cross‐sectional study.A total sample of 1079 older patients was recruited from outpatient clinics and home settings. Eligible patients were aged ≥ 65 years and had a diagnosis of HF and/or DM, and/or COPD, along with at least one additional chronic condition. Data were collected using validated tools: the Self‐Care of Heart Failure Index, Self‐Care of Diabetes Inventory and Self‐Care of Chronic Obstructive Pulmonary Disease Inventory. Descriptive statistics were used to analyse disease‐specific self‐care behaviours. Group comparisons were performed using Student's t‐test and univariate, followed by multivariate analyses of variance.The analysis focused on a subset of 223 patients who had a combination of at least two chronic conditions between HF, DM and/or COPD. The mean age of participants was 77.3 (SD 7.5) years, with a majority being female (53.4%). Self‐care maintenance, monitoring and management for HF and COPD were found to be inadequate across all patient groups. Adequate self‐care was only observed in DM management among those with HF and DM and in DM maintenance for those with DM and COPD treated with insulin. Significant differences in all self‐care dimensions were observed across groups, particularly in patients managing all three conditions (HF, DM and COPD).The findings provide valuable insights into the complexities of self‐care in patients with multiple chronic conditions, underscoring the need for tailored, integrated and patient‐centred interventions. Healthcare strategies should focus on enhancing patient education and developing personalised approaches to improve health outcomes and quality of life in this population.All the authors have adhered to the EQUATOR guidelines STROBE Statement.A convenience sample of patients was recruited in outpatient clinics and their homes. Data were collected between March 2017 and August 2022, by face‐to‐face during routine outpatient visits or directly at the patient's home. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus occurs in approximately 15–17% of pregnant women worldwide and causes high mortality and morbidity for mothers and infants. Pregnant women who are newly diagnosed with gestational diabetes mellitus experience higher levels of stress and anxiety than pregnant women without this condition. Thus, it is important to identify effective interventions to help pregnant women cope with the additional stress and anxiety associated with pregnancy-related complications. Aim: This integrative review aimed to synthesise evidence on the effects of educational interventions for pregnant women with gestational diabetes mellitus regarding knowledge, self-efficacy, self-care behaviour, anxiety, depression, and birth outcomes. Methods: An integrative review of articles published between 2009 and 2024, written in English and Arabic. The review followed the Whittemore and Knafl's 5-stage process framework. Results: From the 922 abstracts identified using search terms, 16 articles were eligible for this review. Psychoeducational interventions were provided for (1) informational support: information about gestational diabetes mellitus, diabetes mellitus, blood glucose monitoring, exercise management, diet management, and stress; (2) motivational support: setting individual goals, enhancing health behaviours, and motivational messages; (3) emotional support: expression of feelings, enforcement of self-management, and sharing of experiences; and (4) relaxation techniques: breathing exercises, meditation, and mindfulness. In this review, only two studies entirely focused on reducing stress and anxiety through cognitive-behavioural stress management training and mindfulness training. The effects of the interventions on self-efficacy, knowledge, depression, anxiety, and birthing outcomes were inconsistent due to variations in intervention designs and duration. However, consistent positive outcomes were found in self-care behaviours. Conclusion: This integrative review found informational and motivational support were frequently used by pregnant women. In contrast, emotional support and relaxation techniques were rarely used. Psychoeducational interventions may enhance self-care behaviours, improve self-efficacy, and reduce stress and depression for women with gestational diabetes mellitus. Nurses and midwives play an essential role in providing holistic care through comprehensive psychoeducational interventions for pregnant women. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims and Objectives Background Design Methods Results Conclusion Clinical Relevance The purpose of this study was to explore the relationship between symptom clusters and self‐management among maintenance haemodialysis (MHD) patients.MHD patients experience disease progression and multiple symptom burdens that severely impact quality of life, and self‐management of symptoms may significantly improve patient‐reported outcomes.A cross‐sectional study.This cross‐sectional descriptive study included 194 patients undergoing MHD. The patients were assessed using the Dialysis Symptom Index (DSI) and the Haemodialysis Self‐Management Instrument (HD‐SMI). We used descriptive analysis, exploratory factor analysis, Pearson's correlation analysis and linear regression analysis to examine (1) the level of individual self‐management, (2) the presence of symptom clusters by symptom severity and (3) the correlation between symptom clusters and self‐management behaviours. This study was conducted in accordance with the STROBE checklist.The top five most severe symptoms among the patients were itching, feeling tired or lack of energy, difficulty sleeping, dry mouth and dry skin. We identified five groups of symptoms: (1) poor sleep, (2) neuromuscular, (3) gastrointestinal, (4) skin irritation and (5) psychological. In the present study, MHD patients reported low to moderate levels of self‐management behaviours (50.84 ± 10.56), and low self‐management ability was correlated with greater severity of the five symptom clusters (p < 0.01). Linear regression analysis revealed that all five symptom clusters were included in the regression equation, explaining 30% of the total variance in self‐management skills among MHD patients.Enhanced awareness of symptom clusters and comprehensive symptom management are necessary to improve patients' quality of life.Nursing practices should incorporate comprehensive symptom assessments to help patients develop effective self‐management strategies to improve quality of life. [ABSTRACT FROM AUTHOR]

Background: Latinx children in the United States experience disparities in asthma control and asthma-related functional outcomes compared to non-Latinx White children, including more school absences, emergency department visits, and hospitalizations for asthma. Stress appears to play a role in asthma control, but interventions designed to address the role of stress in asthma control for Latinx children are limited. Method: The current randomized controlled trial tests the effects of Adapt 2 Asthma (A2A), a family-based coping skills and asthma management intervention tailored to the stressors, strengths, and cultural beliefs of Latinx families, compared to an asthma self-management control arm (the Asthma Plan for Kids; APK). Latinx families of children ages 8 to 14 years old with asthma (target N = 280) are identified and enrolled from primary care clinics and randomly assigned to either A2A or APK. The intervention is delivered by lay health workers trained and receiving ongoing consultation from the study team. The primary outcome is child- and parent-reported asthma control, while secondary outcomes are child's quality of life, lung function, school absences, and emergency department visits, and child and parent coping and family asthma management behaviors. Participants will be assessed at baseline, post-intervention, and at 6- and 12-month follow-up timepoints. Discussion: This study has the potential to provide new evidence regarding the effects of culturally relevant coping and asthma management intervention strategies for Latinx children with asthma. Trial Registration: Clinicaltrials.gov NCT05118282. Registered on 11 November 2021. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The diabetes annual review is an important part of clinical care. Non‐attendance is increasingly common and associated with poor health outcomes. At‐home self‐collection of blood tests, urine samples and anthropometric data through a postal box may facilitate engagement. We aimed to explore the views of people living with diabetes on the use of a postal box as an alternative to usual care for self‐collecting blood samples, urine samples and anthropometric data and to understand whether the availability of a postal box would facilitate the uptake of the diabetes annual review.We conducted semi‐structured interviews and focus groups with adults who have type 1 or type 2 diabetes. Purposive sampling was used to obtain a high representation of infrequent attendees of annual review appointments within the study population. Transcripts were collated and analysed thematically.Twenty participants took part including eight infrequent attendees. All infrequent attendees and most regular attendees responded positively to a postal box, with convenience being the most prominent value described. Concerns raised related to capability of self‐collection and the accuracy of results. Participants were asked for suggestions to improve the postal box. The most common themes related to communication; needing clearer information about each test in the postal box; feedback of results; and utilising the box to communicate priorities for discussion at future consultations.Postal boxes for annual reviews were well‐received by those living with diabetes. Designed well, they have the potential to overcome more than just the physical barriers to annual review attendance. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aim Methods Results Conclusions Hypertension is a chronic disease that consumes considerable medical resources.The aim of this study is to evaluate a model able to develop and assess the effectiveness of a mobile application disease self‐management programme regarding mental health and self‐management for patients with hypertension.A randomised controlled trial and single‐blind random assignment was employed to group the participants. A total of 100 patients were collected from the cardiology clinic of a teaching hospital in Taiwan. There were 50 participants in each group: the mobile application group (experimental group) and the routine care (control group). The primary outcome measures were mental health and self‐management.This study discovered that the intervention improved the mental health and self‐management of the experimental group. The results for the experimental group revealed significantly improved effects and outcomes superior to those of the control group.The study results verified that a mobile application disease self‐management programme could improve the mental health and disease self‐management of patients with hypertension. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated the impact of self-management interventions based on the COM-B model on peri-implant conditions in older adults with periodontitis. Materials and methods: The patients were randomly divided into two groups: Group 1 (control group) received only an oral health education (OHE) pamphlet. Group 2 (test group) performed a self-management intervention based on the COM-B model. Each patient was examined for the most inflammatory implant. The measurement parameters included self-efficacy, self-management ability, and clinical indicators such as probing depth (PD), bleeding on probing (BOP), modified gingival index (mGI), modified plaque index (mPI), and peri-implant mucositis severity score (PMSS). The data was collected at baseline, 4, 8, and 12 weeks. Results: 42 patients underwent testing for 3 months. After 12 weeks, the improvement of self-efficacy, self-management ability, and the reduction of BOP, mPI, and PMSS in the test group was significantly higher than in the control group. Conclusion: The study suggests that self-management interventions based on the COM-B model can enhance the self-management ability of older adults with periodontitis and reduce peri-implant inflammation. This method is more effective than distributing OHE pamphlets. Trial registration: The randomized controlled clinical trial was registered on Chinese Clinical Trial Registry (No. ChiCTR2400082660, Date: 03/04/2024). [ABSTRACT FROM AUTHOR]

Background: Falls are prevalent among people living with Multiple Sclerosis (PwMS) and Spinal Cord Injury (PwSCI) who use wheelchairs or scooters (WC/S) full time, however, there is a scarcity of evidence-based fall prevention and management programs. Objective: To describe the systematic translation of an in-person fall prevention and management program (Individualized Reduction Of FaLLs - iROLL) for PwMS to an online platform, extending its scope to include PwSCI, and to evaluate the preliminary useability, usefulness, and safety of the intervention. Methods: iROLL was systematically translated to an online platform (iROLL-O). PwMS and PwSCI who use a WC/S full time, experienced at least one fall within the past 36 months, and could transfer independently or with minimal to moderate assistance, enrolled in iROLL-O. Usability, usefulness, and safety were evaluated through 1:1 semi-structured interviews, gathering feedback on: perceived impact of the intervention on falls and functional mobility, program experiences, adverse events, and recommendations for improvement. Results: Five participants successfully completed the iROLL-O program. No safety concerns were raised by participants. Themes emerging from the semistructured interviews included: (1) barriers and facilitators to program access, (2) motivation for participation, (3) program outcomes, and (4) program content and structure. Participants reported reduced concerns about falling, enhanced functional mobility skills, and highlighted the supportive nature of synchronous group meetings for learning. Conclusion: No adverse events occurred during the implementation of iROLL-O and participants found the program to be useable and useful. Further testing is needed to examine efficacy among a large and diverse population. [ABSTRACT FROM AUTHOR]

Objective To explore the status and influencing factors of self-management in community patients with type 2 diabetes mellitus based on socio-ecological model. Methods From Auguast to December, 2023, a total of 225 patients with type 2 diabetes mellitus were recruited from several communities in Nanjing and were investigated with a basic information questionnaire, the Diabetes Knowledge Test, the Diabetes Man- agement Self-efficacy Scale and the Summary of Diabetes Self Care Activities based on socio-ecological model. Results The average score of self-management was (47.94±12.91) socre, with a indicator of 62. 26%. Educa- tion level. hospitalizations, self-provided glucometer, potation, self-efficacy, medical support, community envi- ronment.geographical position are the main influencing factors of the status of self-management, which could explain 45.0% of the total variation. Conclusion The status of self-management in community patients with type 2 diabetes mellitus is mediocre and influenced by factors at multiple levels of socio-ecological model. To improve the awareness and ability of self-management in community patients with type 2 diabetes mellitus. health departments should comprehensively take various influencing factors into consideration, and carry out pertinent and individualized health education and interventions for them. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is typically managed using both medical and patient self-management interventions. Individuals with HF often have frequent readmissions to hospital for medical management. Effective self-management can help to reduce the exacerbation of HF symptoms and the frequency of readmissions. Methods: A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines was conducted to identify literature on the interventions used by allied health professionals to promote HF self-management. A search strategy was implemented, and articles were reviewed by two independent reviewers. Results: Twenty articles met the inclusion criteria. Articles included interventions from physical therapy, nutrition, social work, and occupational therapy, as well as other health professions in team-based programs. The most common interventions were verbal education, textual information, monitoring resources, and skills practice. Interventions addressed diet/fluid control, exercise and activity, symptom monitoring, medication management, cardiovascular disease knowledge, and mental health. Many interventions were theory informed. Conclusion: There is nascent evidence that interventions promoting HF self-management positively impact health and quality of life outcomes. HF self-management is multi-faceted and requires interprofessional collaboration. Further work is warranted exploring the impact of theory-informed interventions, and the effectiveness of interventions on self-management competence and desired health outcomes. IMPLICATIONS FOR REHABILITATION: Verbal education, printed information, monitoring documents/systems, and skills practice were the most common intervention modalities to promote heart failure self-management. Self-management interventions address diet/fluid control, exercise and activity, symptom monitoring, medication management, cardiovascular disease knowledge, and mental health aspects of heart failure. There is indicative evidence that interventions promoting heart failure self-management lead to increased health and quality of life outcomes. An interprofessional collaborative practice approach is important given that heart failure self-management is multi-faceted. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Aim Method Results Implications for Practice Conclusion Somatic comorbidity is the main cause of reduced life expectancy in patients with substance use disorders (SUDs).This study aims to investigate somatic health challenges in patients with SUDs using the USS. Patient self‐management of somatic health and quality of life were also assessed.In our study, a stratified random sample of 136 clients who received treatment at a specialist addiction facility was drawn to investigate their physical health and lifestyle behaviours using the Utrecht Somatic Screening 2.0 (USS 2.0). The sample included three subgroups, that is, patients receiving outpatient treatment through Flexible Assertive Community Treatment (FACT), Heroin‐Assisted Treatment (HAT) and Opioid Replacement Therapy (ORT). Pain, self‐management and quality of life were also measured. Descriptive statistics were used to analyse the data.The findings indicate that many patients experience a large number of somatic health problems, including pain and exhaustion. The most prevalent conditions in this study are cardiovascular disease (25%) and COPD (20%), underweight and poor oral health. Tobacco smoking is prevalent among 88% of patients. Fifty percent of the patients expressed a need for support in managing their physical health.Somatic health care and lifestyle promotion should be tailored to the specific characteristics of patients.Patients with SUDs suffer from poor physical health and show unhealthy lifestyle behaviours, which demand the promotion of tailored somatic health. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Methods Results Conclusion Relevance to Clinical Practice The study investigated the influence of quality of discharge teaching (QDT) on readiness for hospital discharge (RHD) and pathways involved in patients with first‐episode stroke, aiming to provide a theoretical framework for enhancing RHD levels and reducing readmission rates.Cross‐sectional study.A total of 372 inpatients completed the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale, Chronic Disease Self‐efficacy Scale and Southampton Stroke Self‐Management Questionnaire. Structural equation modelling and Pearson's correlation analysis were utilised to elucidate relationships and action pathways among these variables.The correlation analysis demonstrated significant positive pairwise correlations between QDT, RHD, self‐efficacy and self‐management (r = 0.376–0.678, p < 0.01). The final model exhibited a good fit with the following indices: χ2/df = 3.286, RMSEA = 0.078, SRMR = 0.0303, GFI = 0.984, AGFI = 0.926, CFI = 0.991 and TLI = 0.970. The impact of QDT on RHD in patients with first‐episode stroke was observed through one direct and three indirect pathways: (1) QDT exerted a direct influence on RHD (p < 0.001); (2) QDT indirectly influenced RHD via self‐efficacy (p < 0.001); (3) QDT indirectly affected RHD through self‐management (p < 0.001); and (4) QDT had an indirect effect on RHD via both self‐efficacy and self‐management (p < 0.05).QDT was found to directly influence RHD in patients with first‐episode stroke and also exerted indirect effects through self‐efficacy and self‐management, either independently or in combination. Early screening of RHD levels in patients before discharge is recommended, along with the enhancement of QDT through the development of tailored guidance plans according to different disease stages, ultimately improving RHD levels and facilitating a safer transition from hospital to home or community.Healthcare professionals should assess both QDT and RHD levels to provide targeted interventions. The establishment of transitional care teams and implementation of long‐term poststroke management are essential for reducing stroke recurrence and mortality rates. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions We developed MARVIN, an artificial intelligence (AI)‐based chatbot that provides 24/7 expert‐validated information on self‐management‐related topics for people with HIV. This study assessed (1) the feasibility of using MARVIN, (2) its usability and acceptability, and (3) four usability subconstructs (perceived ease of use, perceived usefulness, attitude towards use, and behavioural intention to use).In a mixed‐methods study conducted at the McGill University Health Centre, enrolled participants were asked to have 20 conversations within 3 weeks with MARVIN on predetermined topics and to complete a usability questionnaire. Feasibility, usability, acceptability, and usability subconstructs were examined against predetermined success thresholds. Qualitatively, randomly selected participants were invited to semi‐structured focus groups/interviews to discuss their experiences with MARVIN. Barriers and facilitators were identified according to the four usability subconstructs.From March 2021 to April 2022, 28 participants were surveyed after a 3‐week testing period, and nine were interviewed. Study retention was 70% (28/40). Mean usability exceeded the threshold (69.9/68), whereas mean acceptability was very close to target (23.8/24). Ratings of attitude towards MARVIN's use were positive (+14%), with the remaining subconstructs exceeding the target (5/7). Facilitators included MARVIN's reliable and useful real‐time information support, its easy accessibility, provision of convivial conversations, confidentiality, and perception as being emotionally safe. However, MARVIN's limited comprehension and the use of Facebook as an implementation platform were identified as barriers, along with the need for more conversation topics and new features (e.g., memorization).The study demonstrated MARVIN's global usability. Our findings show its potential for HIV self‐management and provide direction for further development. [ABSTRACT FROM AUTHOR]

Background: Foot care self-management is underutilized in older adults and diabetic foot ulcers are more common in older adults. It is important to identify predictors of foot care self-management in older adults with diabetes in order to identify and support vulnerable groups. This study aimed to identify predictors of foot care self-management in older adults with diabetes using a machine learning approach. Method: This cross-sectional study was conducted between November 2023 and February 2024. The data were collected in the endocrinology and metabolic diseases departments of three hospitals in Turkey. Patient identification form and the Foot Care Scale for Older Diabetics (FCS-OD) were used for data collection. Gradient boosting algorithms were used to predict the variable importance. Three machine learning algorithms were used in the study: XGBoost, LightGBM and Random Forest. The algorithms were used to predict patients with a score below or above the mean FCS-OD score. Results: XGBoost had the best performance (AUC: 0.7469). The common predictors of the models were age (0.0534), gender (0.0038), perceived health status (0.0218), and treatment regimen (0.0027). The XGBoost model, which had the highest AUC value, also identified income level (0.0055) and A1c (0.0020) as predictors of the FCS-OD score. Conclusion: The study identified age, gender, perceived health status, treatment regimen, income level and A1c as predictors of foot care self-management in older adults with diabetes. Attention should be given to improving foot care self-management among this vulnerable group. [ABSTRACT FROM AUTHOR]

Background: There has been a sharp increase in the prevalence of hypertension in young and middle-aged people at high risk of the disease. Despite the fact that good self-management can be effective in controlling blood pressure, patients do not perform well in this area, resulting in poor blood pressure control. It is therefore particularly important to gain a thorough understanding of patients' attitudes to self-management and the factors that influence them. The aim of this study was to synthesise the qualitative research on attitudes, motivations and challenges of self-management in young and middle-aged hypertensive patients, to analyse the synthesised results using the COM-B model and to propose appropriate improvement actions. Methods: From the time of construction until May 2023, the system searched PubMed, Web of Science, ProQuest, Embase, MEDLINE, CINAHL, PsyCINFO and CNKI databases. The analyses were carried out using a thematic synthesis approach to summarise the key findings. The findings were then mapped and analysed using the COM-B model. Results: A total of 11 studies were included, involving 250 patients between the ages of 18 and 64. Four themes with ten sub-themes were identified: Poor disease recognition (low disease perception, fuzzy disease knowledge); Barriers to doctor-patient interactions (short communication time, unmet knowledge needs, incomplete guidance for disease management); Living in a hostile environment (heavy workload, lack of companionship, ignorance of families); Expectations for a healthy body (responsibility of family roles, witness the cruelty of illness). Analysis of the composite results based on the COM-B model showed that low disease perceptions, barriers to doctor-patient interactions and life circumstances with enemies on all sides were the main challenges faced by young and middle-aged hypertensive patients, whereas the expectation of a healthy body was a motivation to promote self-management of blood pressure in patients. Conclusions: This study shows that family responsibilities are a particular motivator for self-management in young and middle-aged hypertensive patients. In response to the problems they face, we believe that meeting patients' knowledge needs, improving healthcare professionals' communication skills and valuing the role of community hospitals are effective ways to promote patient self-management. In the future, telemedicine, mobile healthcare and intelligent monitoring devices will provide a solution to reduce the burden on medical resources. Systematic review registration: PROSPERO CRD42018100810. [ABSTRACT FROM AUTHOR]

Purpose: Polypharmacy presents many challenges to patient medication selfmanagement. This study aims to explore the self-management processes of medication in polypharmacy from the perspectives of both patients and healthcare providers, which can help identify barriers and facilitators to effective management. Methods: A systematic review of qualitative studies was performed by searching seven databases: PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE, from their establishment until August 2024. The Critical Appraisal Skills Programme (CASP) tool was employed to evaluate the quality of the studies included. The extracted data were then analysed thematically and integrated into The Taxonomy of Everyday Self-management Strategies (TEDSS) framework. Results: A total of 16 studies were included, involving 403 patients and 119 healthcare providers. Patient management measures were mapped into TEDSS framework, including categories such as medical management, support-oriented domains, and emotional and role management. Conclusion: Enhancing patients' proactive health awareness, improving medication literacy, balancing lifestyle adjustments with medication therapy, dynamically reviewing and optimizing medications, strengthening patients' social support networks, and helping patients integrate medication management into their daily life are the key elements that can effectively assist patients in self-managing their medications. Future interventions to improve patient medication self-management ability should be designed for these issues. [ABSTRACT FROM AUTHOR]

Background: Self-management programs can help patients with rheumatoid arthritis develop strategies to address their disease-related problems. However, accessibility to traditional self-management programs is often limited. Purpose: This study was developed to assess the effectiveness, feasibility, and acceptability of a smartphone-delivered self-management program application (app) for adults with rheumatoid arthritis. Methods: A two-arm (intervention vs. control) randomized controlled trial was used. Adult patients with rheumatoid arthritis were recruited from the rheumatology departments of a medical center. Study enrollment capabilities were limited by current pandemic restrictions. The patients who met the inclusion criteria and agreed to participate (N = 46) were enrolled as participants and randomly assigned either to the intervention group (n = 25), which received instructions on the use of a smartphone app designed to facilitate the self-management of rheumatoid arthritis, or to the control group (n = 21), which received instructions on related self-management only. The outcome variables were assessed at baseline and at 8 and 12 weeks. Differences in between-group outcomes over time were analyzed using generalized estimating equations. Feasibility and acceptability were also evaluated. Data were collected between August 1, 2020, and July 31, 2022. Results: At baseline, no differences were detected between the two groups in terms of the demographic and disease characteristics of concern. Outcome measures for the intervention group improved significantly more than the control group for self-efficacy of pain at 8 weeks (B = 6.39, p < .05) and for both of self-efficacy of pain and self-management behavior at 12 weeks (B = 9.16, p < .05, and B = 4.25, p < .001, respectively). Factors related to app ease of use included limiting pop-ups and windows and having no time restrictions. Most of the participants reported the app as acceptable and easy to use, although challenges relating to using technology limited the usability of the app for some. Conclusions/Implications for Practice: The smartphone app was shown to improve self-efficacy of pain and self-management behaviors. However, an accurate assessment of the effectiveness of the app and generalizability of the findings is limited by the smaller-than-desired sample size due to the COVID-19 pandemic and technological challenges. A greater understanding of how to overcome technological challenges is needed to optimize the delivery of self-management programs via smartphone-based apps. Studies reevaluating this app on a larger sample size should be conducted. [ABSTRACT FROM AUTHOR]

The UK has a growing ageing population with increased prevalence of long-term conditions. It has the potential to overwhelm the country's healthcare system. The COVID-19 pandemic and its risk of transmission provided an opportunity for people with long-term conditions to focus on self-care and for district nurses to promote self-management. Self-management strategies, such as digital technology, motivational interviewing, social prescribing and shared decision-making can assist them in planning a whole-population approach towards managing physical and mental wellbeing. For this to become a reality, investment is needed to educate the patients, their carers, district nurses, multidisciplinary teams and to ensure the sustainability of self-care methods for future practice. [ABSTRACT FROM AUTHOR]

Background: Increasing numbers of underserved people with chronic diseases and decreasing providers in rural areas have contributed to the care shortage in the United States. Nurse-led telehealth/mobile care models have potential benefits for this population. However, there is a substantial gap in the literature regarding this topic. Purpose: To examine the available literature on nurse-led telehealth/mobile health care models with a particular focus on care model settings, nursing roles, care components, achieved outcomes, and the identification of both facilitative factors and encountered challenges. The ultimate goal is to offer recommendations based on these findings, thereby aiding the development or refinement of evidence-based care models that meet to the unique needs of low-income populations. Methodology: Literature published from 2010 to 2023 was searched in six electronic databases (Cumulative Index to Nursing and Allied Health Literature, Communication and Mass Media Complete, Medline, APA PsycINFO, Social Sciences Index, and Web of Science databases). Results: Commonalities identified among included studies with significant improvements were the provision of home monitors and education to participants, multiple engagements, and extensive community and/or family involvement. Conclusions: Nurse-led telehealth/mobile health care models for chronic diseases are an emerging approach. Nurse educators must ensure that future nurses are adept in diverse telehealth modes, collaborating across disciplines. Leveraging advanced practice registered nurses and interdisciplinary teams provides holistic care. Implications: Our review outlined recent research findings that suggest enhanced patient outcomes through technology, communication, and community support. In addition, we offered suggestions for future research and practice, emphasizing the importance of exploring the requirements of diverse and underserved communities. [ABSTRACT FROM AUTHOR]

Aims: Health education is integral to cardiometabolic disease (CMD) management. This study aimed to assess whether and how education preferences have changed over time, and whether trends differ by sociodemographic characteristics (education status, age, ethnicity, and sex). Methods: A cross‐sectional questionnaire was deployed across five counties in the East Midlands, UK between 2017 and 2022 to adults with CMD (type 2 diabetes, cardiovascular disease or cerebrovascular disease). Respondent demographic data were collected alongside health education preferences. Statistical analyses ascertained whether demographic characteristics influenced preferences. The distribution of preferences over time was charted to identify trends. Results: A total of 4301 eligible responses were collected. Face‐to‐face one‐to‐one education was preferred (first choice for 75.1% of participants) but popularity waned over the five‐year period. Trends were similar amongst demographic groups. Online education showed a U‐shaped trend: In 2017, 44% of respondents ranked it as acceptable, peaking at 53% in 2019, but declining again, to below base line, 43%, by 2022. This modality was more popular with participants aged younger than 65 years, but popularity in people older than 65 years increased over the study period. The popularity of printed information also declined over time across all demographic groups except those of South Asian ethnicity, for whom it remained static. Conclusions: The overwhelming preference for face‐to‐face one‐to‐one health education from a doctor or nurse highlights the importance of preserving access to this modality, even in the face of current NHS pressures and trends towards digitalisation. Trends are changing, and should continue to be monitored, including between different sociodemographic groups. [ABSTRACT FROM AUTHOR]

Background: Patient Assessment of Care in Chronic Conditions (PACIC+), included in some Australian guidelines, has been shown reliable for measuring patient engagement and perception of their care in primary care settings. Various studies have focussed on PACIC+ use in specific conditions. This study aims to expand PACIC+ to measure patient empowerment to self-manage their chronic condition and validate it in the broader Australian primary care population. This study aims to evaluate internal consistency and reliability of PACIC+ and six new supplementary items proposed to assess patient wellbeing and empowerment to self-manage their chronic condition. Methods: A repeated-measures correlation design study assessed the expanded PACIC+ over three time-points. Particpants were patients with at least one chronic disease, referred by consultant physician, or recruited by advertisement posters in hospital clinic areas. Results: PACIC+ (26-item) had acceptable internal consitency (Cronbach's alpha 0.96). Test–retest reliability (Time-1 and 2, P < 0.01) was acceptable: Total score r (48) = 0.43; and New supplementary items: Confidence r (48) = 0.54; Understanding r (48) = 0.62; Support r (48) = 0.43; Overall Health r (48) = 0.42; Overall Health Change r (48) = −0.31, P = 0.03; and Acute Episodes of Care in 1-month r (48) = 0.42, P < 0.01. Four factors from the original PACIC+ accounted for 66.5% of the variance. Conclusions: The expanded PACIC+ is an improved psychometric tool providing for the patient's voice in a shared health journey. It is a valid, reliable tool to monitor and measure self-management of chronic conditions in Australian population clinic and primary healthcare settings. Six new supplementary patient empowerment and health status measures proved reliable and, in combination with the PACIC+ psychometric tool, could offer a method to monitor and measure the self-management of chronic conditions in the Australian clinic setting and for future research. [ABSTRACT FROM AUTHOR]

Background: Most people with a stoma worry about leakage, and a quarter experience leakage of stomal effluent outside the baseplate on a monthly basis. Leakage has additional physical and psychosocial consequences, for instance, peristomal skin complications, feeling unable to cope, and self-isolation. Method: An interventional, single-arm, multi-centre study was undertaken in the United Kingdom to evaluate a novel digital leakage notification system for ostomy care, including a support service (=test product) for 12 weeks in patients with a recent stoma formation (≤9 months). Patients completed questionnaires at baseline and after 4, 6, 8, 10, and 12 weeks, evaluating leakage episodes, Ostomy Leak Impact (tool containing three domains), and patient self-management (by PAM-13). Additionally, mental well-being (by WHO-5) and health-related quality of life (QoL) (by EQ-5D-5L) were assessed. Outcomes between baseline and final evaluation were compared by generalised linear and linear mixed models. Results: 92 patients (ITT population) with a mean age of 49.4 years (range 18–81 years) were recruited. Of these, 80% had an ileostomy, and 53% were female. After 12 weeks of using the test product, a significant decrease in mean episodes of leakage outside the baseplate (1.57 versus 0.93, p < 0.046) was observed. Ostomy Leak Impact scores improved across all three domains (p < 0.001), indicating less embarrassment, increased engagement in social activities, and increased control. Patient self-management also improved significantly (PAM-13 score: ∆6.6, p < 0.001), as did the WHO-5 well-being index (∆8.0, p < 0.001). Lastly, EQ-5D-5L profile scores tended to improve (p = 0.075). Conclusions: A new digital leakage notification system demonstrated strong improvements to patients' stoma self-care, mental well-being, and QoL. Registration number on ClinicalTrials.gov: NCT05135754. [ABSTRACT FROM AUTHOR]

Aims: To explore the psychosocial experiences during dietary management among Chinese adults with inflammatory bowel disease. Design: Qualitative phenomenological design. Methods: Eighteen adults diagnosed with inflammatory bowel disease for more than 6 months were recruited using purposive sampling from June to December 2023. Two trained researchers used van Manen's approach to analyse the data. Results: The three themes with multiple subthemes emerged: facing the unknown: at a loss and aggrieved, trying to cope: uncertain and distressed, and growing in adaptation: relieved and transcendent. The first theme included unknown relapses, overlooking diet management and the absence of dietary rules. The second theme showed different coping situations, like complex dietary information and ever‐closing worlds. The third theme explores how participants adapted to disease and their eating patterns. Conclusion: The psychosocial experiences during dietary management are complex. The accumulation of diet‐related experience, acceptance of illness and social support facilitate patients in overcoming negative emotions and adhering to dietary management. Implications for the Profession and Patient Care: Nurses should provide tailored dietary guidance and appropriate psychological interventions to promote healthy eating in patients. Impact: This study may enhance healthcare professionals' understanding, particularly those in China, of the diet‐related experiences among patients. Reporting Method: The Consolidated Criteria for Reporting Qualitative Research checklist. Patient or Public Contribution: Participants contributed by sharing their first hand experiences. [ABSTRACT FROM AUTHOR]

Aim: To explore the cognitive representations and emotional responses to living with chronic heart failure of people receiving limited community disease management. Background: Individuals living with heart failure face self‐care and emotional challenges due to the overwhelming nature of adapting to lifestyle changes, particularly in subtropical areas. Design: Qualitative descriptive. We applied Leventhal's Common Sense Model of Self‐Regulation as the framework for interviews and analyses. Methods: Twenty patients with chronic heart failure were interviewed during a hospital admission for exacerbation of their condition in a tertiary hospital in Thailand. Results: Analysis of the components of Leventhal's model of cognitive representations of illness revealed two themes relating to Illness Identity: (1) lack of knowledge of the diagnosis and how to recognise symptoms of the disease, and (2) recognition of symptoms of an exacerbation of CHF was based on past experience rather than education. These resulted in delays responding to cardiac instability and confusion about the intent of treatment. Participants recognised the chronicity of their disease but experienced it as an unrelenting cycle of relative stability and hospitalisations. Perceived Controllability was low. Two themes were: (1) Low perceived trust in the efficacy of medical treatment and lifestyle changes, and (2) Low perceived trust in their ability to comply with recommended lifestyle changes. The Consequences were significant emotional distress and high burden of disease. The two themes of emotional responses were (1) Frustration and hopelessness with the uncertainty and unpredictability of the disease, and (2) Sense of loss of independence, functional capacity and participation in life's activities. Conclusion: Chronically ill patients need support to understand their illness and make better treatment and lifestyle decisions. Improving patients' self‐efficacy to manage treatment and symptom fluctuations has the potential to improve their mental well‐being and minimise the impact of their condition on suffering and participation in employment and community. Implications for the Profession and/or Patient Care: Leventhal's Common Sense Model of Self‐Regulation can be used to examine cognitive and emotional elements of illness perceptions, which link to individuals' ability to make informed decisions about disease management and influence health behaviours. Understanding illness perceptions underpins strategies for enhancing and sustaining self‐management behaviours. Impact: The study findings accentuate the need to establish long‐term condition support programs in low‐middle income countries where the burden of heart failure is increasing exponentially. Reporting Method: The Consolidated Criteria for Reporting Qualitative Research (COREQ) guideline was used to explicitly and comprehensively report our qualitative research. Patient or Public Contribution: Patients contributed to the conduct of the study by participating in the data collection via face‐to‐face interviews. [ABSTRACT FROM AUTHOR]

Background: With increased emphasis on self-management in healthcare, clinicians need outstanding skills in offering advice and empowering patients to attain an optimal outcome. Objectives: This study explores how undergraduate physiotherapists acquire knowledge, skills, and confidence to offer advice to patients in clinical practice. Methods: Convenience sampling was used to recruit 50 BSc and MSc pre-registration physiotherapy students across all years of study in one university in southern England, UK. Semi-structured interviews were conducted for first year BSc students (n = 13). Six focus groups of mixed BSc and MSc students were conducted, three groups (n = 15 students) were mid-training, and three groups (n = 22 students) were in their final year. Results: Thematic analysis identified 6 themes: advice content; a patient-centered approach; delivery; acquisitions; perceptions; and uptake of advice. Students placed high value on advice-giving, drawing upon multiple learning opportunities, however they felt under-prepared to deliver this skill in practice. Furthermore, perceptions of their student status, and pressures to perform on graded placements were reported to influence the advice they offered to patients. Conclusions: Developing high-level skills in promoting self-management is essential in physiotherapy, this study highlights the challenges for students to develop these skills. Academic and practice educators must explicitly enable and support students to develop the knowledge and skills to confidently offer high-quality advice to patients. [ABSTRACT FROM AUTHOR]

Aim: This qualitative systematic review aimed to consolidate existing evidence on the self‐management experience of older patients with multimorbidity worldwide. Methods: Nine databases were searched, for papers published from database inception to April 2023. The systematic review was conducted according to the systematic review method of qualitative evidence by the Joanna Briggs Institute (JBI). Results: Seven studies were included. Finally, four themes and 12 subthemes were formed: (1) physical level: reduced physical function and lack of coordinated care; (2) psychological level: mental state of anxiety and positive attitude towards life; (3) social level: technical support, support from family, support from healthcare workers and support from others; and (4) practical level: economic burden, lifestyle changes, self‐care in daily life and compliance was much lower than expected. Conclusions: To improve self‐management in older people with multimorbidity, nurses should provide more guidance to patients to improve their self‐management skills, and clinicians should recommend effective self‐management behaviours. Summary statement: What is already known about this topic?: Globally, approximately 50% of older people aged over 65 years demonstrate multimorbidity, with sharp increases in the prevalence in this population.In recent years, the phenomenon of older people with multimorbidity has received increasing attention, and there has been an increase in the number of related qualitative studies. While these studies provide an in‐depth account of experiences among samples, synthesizing these findings can help identify similarities and differences, as well as gaps in current knowledge. Therefore, there is a need for systematic evaluation and meta‐integration of the results of multiple qualitative studies to obtain deeper, more comprehensive findings. What the paper adds to existing knowledge?: The practice of self‐management in older patients with multimorbidity should include the physical, psychological, social and practical levels of the patient.As the primary providers of health services, nurses should sensitize older patients with multimorbidity to the susceptibility and severity of their disease and help them to improve their self‐management skills.Clinicians need to recommend effective self‐management behaviours to implement into the daily lives of older patients with multimorbidity in their clinical practice. What are the implications for practice?: These findings remind us that clinical healthcare professionals should be patient‐centred and focus on the personal experience of self‐management in older adults with multimorbidity.Findings emphasize the need for healthcare professionals to focus on diversifying management strategies and the need to provide targeted self‐management guidance to older patients with multimorbidity to help them improve their self‐management skills. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to investigate the status of self‐management behaviour and illness perceptions and to examine illness perceptions in relation to self‐management behaviour in elderly patients with chronic obstructive pulmonary disease (COPD). Methods: A cross‐sectional study was conducted, and 152 elderly COPD patients were recruited via the convenience sampling method. The COPD Self‐Management Scale and the Revised Illness Perception Questionnaire for COPD patients were used to examine self‐management behaviour and illness perceptions. Pearson correlation analysis, univariate analysis and hierarchical linear regression analysis were used to explore illness perceptions in relation to self‐management behaviour. Results: The mean overall score for self‐management behaviour was 2.90 ± 0.39. Among the subscales of self‐management behaviour, information management had the lowest score of 2.20 ± 0.76. Patients' demographic and clinical characteristics, including educational level, smoking status, type of primary caregiver, home oxygen therapy and COPD duration, were found to be significant determinants of self‐management behaviour. After controlling for these variables, several illness perception subscales, including treatment control, personal control, coherence, timeline cyclical and identity, were significantly correlated with self‐management behaviour. Conclusions: This study confirmed that elderly COPD patients' self‐management behaviour was unsatisfactory and that illness perceptions were significant determinants of self‐management behaviour. The findings may contribute to the development of self‐management interventions for elderly COPD patients. Summary statement: What is already known about this topic? Self‐management behaviour plays an essential role in managing COPD.Illness perceptions are predictors of self‐management behaviours in COPD patients, but little is known about how illness perceptions influence self‐management behaviour in elderly patients with COPD. What this paper adds? Several illness perception subscales, including treatment control, personal control, coherence, timeline cyclical and identity, were significantly correlated with self‐management behaviour.Patients' demographic and clinical characteristics, including educational level, smoking status, type of primary caregiver, home oxygen therapy and COPD duration, were found to be determinant of self‐management behaviour. The implications of this paper: The findings may contribute to developing tailored interventions that help patients establish beneficial illness perceptions to improve their self‐management behaviour. [ABSTRACT FROM AUTHOR]

Self-management of chronic diseases, which increase with age, is vital. This article discusses the benefits of chronic disease self-management and how nurses and other healthcare professionals can provide supportive care. It also presents an evidence-based intervention project that promoted chronic disease self-management among community-dwelling older adults. [ABSTRACT FROM AUTHOR]

This study aimed to describe the use of recommendations as a guide for healthcare providers to support patients experiencing medication self‐management problems and to evaluate their feasibility, user‐friendliness and usefulness. Between March and August 2023, 58 hospitalized patients completed a self‐assessment on medication self‐management problems. The problems addressed in this self‐assessment were based on a list of frequently encountered medication self‐management problems from previous research. Consequently, 18 nurses responded to the reported problems using the recommendations. Nurses evaluated the feasibility, user‐friendliness and usefulness of these recommendations through a survey. A total of 217 medication self‐management problems were reported by 58 patients. Nurses intervened in 52% of the problems using the recommendations. According to nurses, the recommendations were user‐friendly and feasible but required a substantial time investment. Considering these pilot‐based results, the recommendations have the potential to be a valuable resource for nurses in practice, though this potential requires further exploration. [ABSTRACT FROM AUTHOR]

Background: A review of previous studies shows that, among the variables that affect the underlying mechanisms of panic and depression disorders, are body awareness, difficulty in emotional regulation, and patient's self-management. Considering the lack of research background on the comparison of the above three components in patients with panic and depression disorders, the present study seeks to answer the question whether these three components are different in patients with panic, depression and nonaffected persons? Aims: The purpose of this research was to compare body awareness, difficulty in emotion regulation and self-management among people with panic disorders, depression and nonaffected persons. Methods: The current research design was descriptive and causal-comparative. The statistical population of the research included all people suffering from panic disorders, depression and non-suffering people in the city of Babol in the autumn of 2022. The sampling method was available and the sample size was 30 people for each group. The data collection tools in this study included three body awareness questionnaires of Shields (1989), the difficulty in emotion regulation questionnaire of Gratz & Roemer (2004) and the self-management questionnaire of Houthun and Neck (2000). The collected data were analyzed by multivariate analysis of variance and Benferoni post hoc test using SPSS22 software. Results: The obtained results showed that there is no significant difference in body awareness between people suffering from panic disorders, depression and non-suffering people. There was no significant difference in other variables, including difficulty in emotion regulation and self-management, between the two panic and depressed groups, but both groups had a significant difference compared to the group of non-diseased people. It was also found that three groups of people suffering from panic, depression and non-suffering people have a significant difference in the three strategies of self-management, including behavioral strategies, natural reward and constructive thought pattern and difficulty in emotional regulation (P< 0.05). Conclusion: According to the obtained results, it can be concluded that people with panic disorders and depression have problems in emotion regulation and self-management compared to non-afflicted people. Therefore, it is suggested that psychiatrists and psychotherapists pay attention to the three variables of the present study in the therapeutic interventions of patients suffering from panic and depression in order to prevent the progression and exacerbation of disease symptoms. [ABSTRACT FROM AUTHOR]

To determine if self-management programs, supported by a health professional, in rehabilitation are cost effective. Six databases were searched until December 2023. Randomized controlled trials with adults completing a supported self-management program while participating in rehabilitation or receiving health professional input in the hospital or community settings were included. Self-management programs were completed outside the structured, supervised therapy and health professional sessions. Included trials had a cost measure and an effectiveness outcome reported, such as health-related quality of life or function. Grading of Recommendations, Assessment, Development, and Evaluations was used to determine the certainty of evidence across trials included in each meta-analysis. Incremental cost-effectiveness ratios were calculated based on the mean difference from the meta-analyses of contributing health care costs and quality of life. After application of the search strategy, two independent reviewers determined eligibility of identified literature, initially by reviewing the title and/or abstract before full-text review. Using a customized form, data were extracted by one reviewer and checked by a second reviewer. Forty-three trials were included, and 27 had data included in meta-analyses. Where self-management was a primary intervention, there was moderate certainty of a meaningful positive difference in quality-of-life utility index of 0.03 units (95% confidence interval, 0.01-0.06). The cost difference between self-management as the primary intervention and usual care (comprising usual intervention/therapy, minimal intervention [including education only], or no intervention) potentially favored the comparison group (mean difference=Australian dollar [AUD]90; 95% confidence interval, −AUD130 to AUD310). The cost per quality-adjusted life year (QALY) gained for self-management programs as a stand-alone intervention was AUD3000, which was below the acceptable willingness-to-pay threshold in Australia per QALY gained (AUD50,000/QALY gained). Self-management as an intervention is low cost and could improve health-related quality of life. [ABSTRACT FROM AUTHOR]

This study examined the efficacy of a health education technology program on self-management adherence behavior and quality of life among people with type 2 diabetes (T2D). A randomized experimental study design was employed. A total of 110 subjects was recruited. The experimental group received a novel technology education program plus routine shared care. The control group received routine shared care alone. Quality of life and adherence to self-management behavior questionnaires were used to measure outcomes. A linear mixed-effects model was used to analyze changes in quality of life after controlling for pre-test effects. The odds ratio was calculated for differences in adherence behavior between the two groups. The between-group mean difference in quality of life scores and adherence to physical activity comparing pre-test at 3 months follow-up showed significant progress at 3 months post-test compared with the control group. However, the increase in mean quality of life scores and adherence behavior at 6 months did not demonstrate a sustained between-group difference. The results showed adherence to physical activity and improved quality of life in patients with T2D at 3 months post intervention. Therefore, the program can be used as an intensive model for diabetes shared care. • At 3 months technology based self-management education improved quality of life. • Independence with physical activity compliance persisted at 3 months. • Technology education on diabetes shared care yields clinically promising outcomes. [ABSTRACT FROM AUTHOR]

The high rate of perinatal abnormality among pregnant nurses and midwives attributable to their working environment is a serious international occupational health concern. Self-management behaviours can prevent abnormalities, but nurses and midwives have difficulty carrying out these behaviours during pregnancy. This cross-sectional study aimed to examine self-management behaviours and associated factors during pregnancy among nurses and midwives. The participants were 232 pregnant or postpartum registered nurses and midwives from four Japanese general hospitals. Participant recruitment and questionnaire distribution were undertaken through hospital management. Data were collected from July to November 2022. Instruments included the Personal Demographic and Obstetric Conditions Questionnaire, the Self-Management Behaviours Questionnaire, the Working Conditions during Pregnancy Questionnaire, the Social and Workplace Support Scale, the Sense of Coherence Scale, and Self-Management Difficulties Scale. Data analysis used univariate and multiple classification analysis. Results indicated that participants demonstrated good compliance with contraindications among self-management behaviours but scored lower in knowledge and self-monitoring, abnormalities prevention, and avoiding burden movements. Multiple classification analyses revealed that parity, profession, overtime, acquisition of maternity protection provisions, managers support, family support, and prioritising the foetus were significantly associated with self-management behaviors. Nursing administrators must provide adequate information and adjust the work of pregnant staff. Policymakers need to propose measures to reinforce maternity protection provisions for pregnant nurses and midwives. Pregnant nurses and midwives need to be proactively educated on occupational health and safety. Learning the importance of acquiring maternity protection provisions, receiving support and prioritising the foetus will contribute to effective self-management practices in them. Further research is needed to promote self-management behaviours among pregnant nurses and midwives. [ABSTRACT FROM AUTHOR]

Diabetes management applications effectively help patients monitor blood glucose levels and adjust diet and exercise plans. However, most diabetes management apps, including the SugarShift application developed in 2023, use generalized designs that often fail to consider the unique cognitive and physiological characteristics of elderly users, thereby impacting their acceptance and usage. This paper proposes an enhancement for the SugarShift application by introducing a mode specifically designed for elderly users. This proposed enhancement aims to directly involve elderly patients so as to meet their needs better through a participatory design approach. A heuristic evaluation conducted with six experts identified 126 usability issues and 179 heuristic violations in the current version, which has led to the recommendation to develop optimization strategies tailored for elderly users. Subsequent usability testing with 28 elderly patients and six experts emphasized the importance of interface simplicity, logical operation, and interaction quality in enhancing user experience. These factors improve usability, facilitate information processing, and reduce cognitive load. Despite the overall usability of SUS scores, significant challenges still need to be addressed in information display, system feedback, and user interaction. Recommendations for future enhancements include simplifying data entry and presentation, improving readability, and providing timely feedback to enhance usability and user satisfaction, ultimately increasing user retention. [ABSTRACT FROM AUTHOR]