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  • 1. Amsberg, Susanne
    et al.
    Anderbro, Therese
    Wredling, Regina
    Lisspers, Jan
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Lins, Per-Eric
    Adamson, U
    Johansson, Unn-Britt
    A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients--a randomized controlled trial.2009In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 77, no 1, p. 72-80Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine the impact of a Cognitive Behavior Therapy (CBT)-based intervention on HbA(1c), self-care behaviors and psychosocial factors among poorly controlled adult type 1 diabetes patients. METHODS: Ninety-four type 1 diabetes patients were randomly assigned to either an intervention group or a control group. The intervention was based on CBT and was mainly delivered in group format, but individual sessions were also included. All subjects were provided with a continuous glucose monitoring system (CGMS) during two 3-day periods. HbA(1c), self-care behaviors and psychosocial factors were measured up to 48 weeks. RESULTS: Significant differences were observed with respect to HbA(1c) (P<0.05), well-being (P<0.05), diabetes-related distress (P<0.01), frequency of blood glucose testing (P<0.05), avoidance of hypoglycemia (P<0.01), perceived stress (P<0.05), anxiety (P<0.05) and depression (P<0.05), all of which showed greater improvement in the intervention group compared with the control group. A significant difference (P<0.05) was registered with respect to non-severe hypoglycemia, which yielded a higher score in the intervention group. CONCLUSION: This CBT-based intervention appears to be a promising approach to diabetes self-management. PRACTICE IMPLICATIONS: Diabetes care may benefit from applying tools commonly used in CBT. For further scientific evaluation in clinical practice, there is a need for specially educated diabetes care teams, trained in the current approach, as well as cooperation between diabetes care teams and psychologists trained in CBT.

  • 2.
    Audulv, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Norbergh, Karl-Gustaf
    Department of Public Health and Research, Sundsvall Hospital, Sweden.
    Who's in charge? The role of responsibility attribution in self-management among people with chronic illness2010In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 81, no 1, p. 94-100Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore how responsibility attribution influences self-management regimens among people with chronic illness. METHODS: This qualitative content analysis included 26 interviews with people living with chronic illness. RESULTS: The participants attributed responsibility to internal, external or a combination of these factors, meaning that they either assumed responsibility for self-management or considered other people or factors responsible. Internal responsibility was associated with a multifaceted self-management regimen, whereas external responsibility was related to "conventional" self-management such as taking medication, managing symptoms and lifestyle changes. CONCLUSION: How responsibility is attributed is vital for the way in which individuals perform self-management. In this study, those who attributed responsibility to external factors mainly performed recommended behaviours to control their illness. In contrast, to take charge of their illness and be an active participant in the care, individuals must take responsibility for themselves, i.e. internal responsibility. PRACTICE IMPLICATIONS: Health-care providers should acknowledge and support individuals' wishes about various levels of responsibility as well as different kinds of patient-provider relationships.

  • 3.
    Audulv, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Ghahari, Setareh
    Queen’s University.
    Kephart, George
    Dalhousie University.
    Warner, Grace
    Dalhousie University.
    Packer, Tanya
    Dalhousie University; Radboud University Medical Center, Nijmegen, The Netherlands.
    The Taxonomy of Everyday Self-management Strategies (TEDSS): A framework derived from the literature and refined using empirical data2019In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 102, no 2, p. 367-375Article in journal (Refereed)
    Abstract [en]

    Objective: To extend our understanding of self-management by using original data and a recent concept analysis to propose a unifying framework for self-management strategies.

    Methods: Longitudinal interview data with 117 people with neurological conditions were used to test a preliminary framework derived from the literature. Statements from the interviews were sorted according to the predefined categories of the preliminary framework to investigate the fit between the framework and the qualitative data. Data on frequencies of strategies complemented the qualitative analysis.

    Results: The Taxonomy of Every Day Self-management Strategies (TEDSS) Framework includes five Goal-oriented Domains (Internal, Social Interaction, Activities, Health Behaviour and Disease Controlling), and two additional Support-oriented Domains (Process and Resource). The Support-oriented Domain strategies (such as information seeking and health navigation) are not, in and of themselves, goal focused. Instead, they underlie and support the Goal-oriented Domain strategies. Together, the seven domains create a comprehensive and unified framework for understanding how people with neurological conditions self-manage all aspects of everyday life.

    Conclusions: The resulting TEDSS Framework provides a taxonomy that has potential to resolve conceptual confusion within the field of self-management science.

    Practice Implications: The TEDSS Framework may help to guide health service delivery and research.

  • 4.
    Grankvist, Olov
    et al.
    Department of Obstetrics and Gynecology, Sunderby Hospital, Norrbotten County Council, Luleå , Sweden.
    Olofsson, Anders D.
    Umeå universitet, Pedagogiska institutionen.
    Isaksson, Rose-Marie
    Department of Research, Norrbotten County Council, Luleå , Sweden & Division of Nursing, Department of Medical and Health Sciences, Linko¨ping University, Sweden.
    Can physicians be replaced with gynecological teaching women to train medical students in their first pelvic examination? A pilot study from Northern Sweden.2014In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 96, no 1, p. 50-54Article in journal (Refereed)
    Abstract [en]

    Objective The main objective was to gain a deeper understanding of how medical students perceive and experience learning from gynecological teaching women (GTW) instead of physicians in their first pelvic examination. A second aim was to describe how the women experience their roles as GTW.

    Methods Data were collected from individual interviews with 24 medical students from a medical school in Sweden and with 5 GTW. Discourse analysis was performed to acquire a deeper understanding of the informants’ experiences and to understand social interactions.

    Results Five themes revealed in the medical students’ experiences: “Hoping that anxiety will be replaced with security,” “Meeting as equals creates a sense of calm,” “Succeeding creates a sense of security for the future,” “Wanting but not having the opportunity to learn more,” and “Feeling relieved and grateful.” One theme revealed in the GTW experiences: “Hoping to relate in a trustworthy way.”

    Conclusion To replace physicians with GTW may facilitate the learning process and may also help medical students improve their communicative skills. Using GTW will hopefully further improve students’ basic medical examination techniques and physician–patient relationships.

    Practice implications Since GTW seems to increase self-confidence and skills of medical students performing their first pelvic examination we recommend that the use of GTW is considered in the training of medical students.

  • 5.
    Jong, Miek C
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    van de Vijver, Lucy
    Department Healthcare and Nutrition, Louis Bolk Institute, Driebergen, Netherlands.
    Busch, Martine
    Van Praag Institute, Utrecht, Netherlands.
    Fritsma, Jolanda
    Zorgbelang Groningen, Groningen, Netherlands.
    Seldenrijk, Ruth
    Patiënten Platform Complementaire Gezondheidszorg, Netherlands.
    Integration of complementary and alternative medicine in primary care: What do patients want?2012In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 89, no 3, p. 417-422Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore patients' perspectives towards integration of Complementary and Alternative Medicine (CAM) in primary care.

    METHODS: A mixed-methods approach was used. This included a survey on use, attitudes and disclosure of CAM, an e-panel consultation and focus group among patients with joint diseases.

    RESULTS: A total of 416 patients responded to the survey who suffered from osteoarthritis (51%), rheumatoid arthritis (29%) or fibromyalgia (24%). Prevalence of CAM use was 86%, of which 71% visited a CAM practitioner. Manual therapies, acupuncture and homeopathy were most frequently used. A minority (30%) actively communicated CAM use with their General Practitioner (GP). The majority (92%) preferred a GP who informed about CAM, 70% a GP who referred to CAM, and 42% wanted GPs to collaborate with CAM practitioners. Similar attitudes were found in the focus group and upon e-panel consultation.

    CONCLUSIONS: Most patients in primary care want a GP who listens, inquires about CAM and if necessary refers to or collaborates with CAM practitioners.

    PRACTICE IMPLICATIONS: To meet needs of patients, primary care disease management would benefit from an active involvement of GPs concerning CAM communication/referral. This study presents a model addressing the role of patients and GPs within such an integrative approach.

  • 6.
    Packer, Tanya
    et al.
    Dalhousie University, Canada.
    Fracini, America
    Dalhousie University, Canada.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Alizadeh, Neda
    Dalhousie University, Canada.
    van Gaal, Betsie G I
    Radboud University, The Netherlands.
    Warner, Grace
    Dalhousie University, Canada.
    Kephart, George
    Dalhousie University, Canada.
    What we know about the purpose, theoretical foundation, scope and dimensionality of existing self-management measurement tools: A scoping review2018In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 101, no 4, p. 579-595Article in journal (Refereed)
    Abstract [en]

    Objectives:

    To identify self-report, self-management measures for adults with chronic conditions, and describe their purpose, theoretical foundation, dimensionality (multi versus uni), and scope (generic versus condition specific). Methods: A search of four databases (8479 articles) resulted in a scoping review of 28 self-management measures. Results: Although authors identified tools as measures of self-management, wide variation in constructs measured, purpose, and theoretical foundations existed. Subscales on 13 multidimensional tools collectively measure domains of self-management relevant to clients, however no one tool’s subscales cover all domains. Conclusions: Viewing self-management as a complex, multidimensional whole, demonstrated that existing measures assess different, related aspects of self-management. Activities and social roles, though important to patients, are rarely measured. Measures with capacity to quantify and distinguish aspects of self-management may promote tailored patient care. Practice implications: In selecting tools for research or assessment, the reason for development, definitions, and theories underpinning the measure should be scrutinized. Our ability to measure self-management must be rigorously mapped to provide comprehensive and system-wide care for clients with chronic conditions. Viewing self-management as a complex whole will help practitioners to understand the patient perspective and their contribution in supporting each individual patient.

  • 7.
    Sjöling, Mats
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Nordahl, Gunnar
    Olofsson, Niclas
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management.2003In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 51, no 2, p. 169-176Article in journal (Refereed)
    Abstract [en]

    The primary objective of this study was to test whether specific information given prior to surgery can help patients obtain better pain relief after total knee arthroplasty (TKA). Secondary objectives were to study the impact of preoperative information on state and trait anxiety, satisfaction with pain management and satisfaction with nursing care. The study was an intervention study with two groups of equal size (n ¼ 30). The intervention group was given specific information while the control group received routine information. Pain assessments were made preoperatively and every 3 h for the first three postoperative days, using the visual analogue scale (VAS). The results of this study suggest that information does influence the experience of pain after surgery and related psychological factors. The postoperative pain declined more rapidly for patients in the treatment group, the degree of preoperative state anxiety was lower and they were more satisfied with the postoperative pain management.

  • 8.
    Warner, Grace
    et al.
    Dalhousie University, Halifax, Nova Scotia, Canada.
    Packer, Tanya L.
    Dalhousie University, Halifax, Nova Scotia, Canada; Radboud University Medical Center and HAN University of Applied Sciences, Nijmegen, the Netherlands.
    Kervin, Emily
    Mount Saint Vincent University, Halifax, Nova Scotia, Canada.
    Sibbald, Kaitlin
    Dalhousie University, Halifax, Nova Scotia, Canada.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    A systematic review examining whether community-based self-management programs for older adults with chronic conditions actively engage participants and teach them patient-oriented self-management strategies2019In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 102, no 12, p. 2162-2182Article in journal (Refereed)
    Abstract [en]

    Objective: To identify whether community-based Self-Management Programs (SMPs) actively engaged, or taught, individuals patient-oriented strategies; and whether having these attributes led to significant differences in outcomes. Methods: This systematic review included randomized controlled trials (RCTs)and cluster RCTs reporting on community-based SMPs with a group component for older adults with chronic conditions. The ways SMPS actively engaged participants and whether they taught patient-oriented strategies were analyzed. All study outcomes were reported. Results: The 31 included studies demonstrated community-based SMP programs actively engaged participants and provided strategies to improve health behaviour or care of their condition. Few included strategies to help manage the impact of conditions on their everyday lives. Seventy-nine percent of studies reported significant differences; variations in sample sizes and outcomes made it difficult to conclude whether having these attributes led to significant differences. Conclusion: SMPs are not supporting older adults to use strategies to address the impact of conditions on their everyday lives, addressing the needs of older adults with multiple conditions, nor assessing outcomes that align with the strategies taught. Practice implications: Health-care providers delivering SMPs to older adults need to tailor programs to the needs of older adults and assess whether participants are using strategies being proposed. 

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