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  • 1.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Being creative and resourceful: Individuals’ abilities and possibilities for self-management of chronic illness2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Individuals’ self-management styles are crucial for how they manage to live with illness. Commonly investigated factors include social support, self-efficacy, health beliefs, and demographics. There is a gap in the literature with regard to in-depth studies of how those factors actually influence an individual’s self-management.

     

    The aim of this thesis was to investigate the underlying mechanisms of self-management from the perspective of individuals living with chronic illness.

     

    Interviews were conducted with 47 individuals with various chronic illnesses, some of them repeatedly over two and a half years (a total of 107 interviews). The material was analysed with; constructive grounded theory, content analysis, phenomenography, and interpretive description.

     

    The Self-management Support Model identified aspects that influenced participants’ self-management: economic and social situation, social support, views and perspectives on illness, attribution of responsibility, and ability to integrate self-management into an overall life situation. For example, individuals with a life-oriented or disease-oriented perspective on illness prioritized different aspects of self-management. People who attributed internal responsibility performed a more complex self-management regimen than individuals who attributed external responsibility. In conclusion, individuals who were creative and resourceful had a better chance of tailoring a self-management regimen that suited them well. People in more disadvantaged positions (e.g., financial strain, limited support, or severe intrusive illness) experienced difficulty in finding a method of self-management that fit their life situation.

     

    These findings can inspire healthcare providers to initiate a reflective dialogue about self-management with their patients.

  • 2.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Hur utvecklas egenvård?: En longitudinell kvalitativ studie om mönster i egenvårdsutveckling2013In: Best Practice Diabetes, Vol. 3, no 8, p. 19-21Article in journal (Other academic)
  • 3.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The over time development of chronic illness self-management patterns: a longitudinal qualitative study2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. Art. no. 452-Article in journal (Refereed)
    Abstract [en]

    Background: There currently exists a vast amount of literature concerning chronic illness self-management, however the developmental patterns and sustainability of self-management over time remain largely unknown. This paper aims to describe the patterns by which different chronic illness self-management behaviors develop and are maintained over time.

    Method: Twenty-one individuals newly diagnosed with chronic illnesses (e.g., diabetes, rheumatism, ischemic heart disease, multiple sclerosis, chronic renal disease, inflammatory bowel disease) were repeatedly interviewed over two-and-a-half years. The interviews were conducted in Sweden from 2006 to 2008. A total of 81 narrative interviews were analyzed with an interpretive description approach.

    Results: The participants’ self-management behaviors could be described in four different developmental patterns: consistent, episodic, on demand, and transitional. The developmental patterns were related to specific self-management behaviors. Most participants took long-term medications in a consistent pattern, whereas exercise was often performed according to an episodic pattern. Participants managed health crises (e.g., angina, pain episodes) according to an on demand pattern and everyday changes due to illness (e.g., adaptation of work and household activities) according to a transitional pattern. All of the participants used more than one self-management pattern.

    Conclusion: The findings show that self-management does not develop as one uniform pattern. Instead different self-management behaviors are enacted in different patterns. Therefore, it is likely that self-management activities require support strategies tailored to each behavior’s developmental pattern.

  • 4.
    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
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Being free of symptoms or experiencing mental wellbeing – different ways of understanding wellness among people living with chronic illness2009Conference paper (Refereed)
  • 5.
    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
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The impact of illness - Various ways of perceiving illness influences on self-management among people living with chronic disease2010In: The impact of illness - Various ways of perceiving illness influences on self-management among people living with chronic disease, 2010Conference paper (Refereed)
  • 6.
    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
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The influence of illness perspectives on self-management of chronic disease2011In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 3, no 2, p. 109-118Article in journal (Refereed)
  • 7.
    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
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The integration of chronic illness self-management2012In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 22, no 3, p. 332-345Article in journal (Refereed)
    Abstract [en]

    Self-management is crucial for people living with chronic diseases, but the actual process of integrating self-management has not been explored in depth. In this article, we investigate the integration of self-management into the lives of people with chronic illness. In this longitudinal study, we used an interpretive description approach. Twenty-one individuals were interviewed regularly during the first 3 years after they were diagnosed with a chronic condition. We found self-management integration to be an ongoing process that included four phases: seeking effective self-management strategies, considering costs and benefits, creating routines and plans of action, and negotiating self-management that fits one's life. The participants managed the phases according to their context, e.g., illness experience, life situation, personal beliefs, and social support. Health care providers should therefore facilitate self-management integration by providing support that is adjusted to the person's phase of self-management integration and life context.

  • 8.
    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.

  • 9.
    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.

  • 10.
    Audulv, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kneck, Åsa
    Ersta Sköndal Högskola.
    How do we understand time and change? Five approaches to longitudinal qualitative research in nursing2016In: Abstracts, Oral Presentations for Qualitative Methods Conference, May 2016: Symposium: Longitudinal QualitativeAnalysis—How Can It Be Done?, 2016, Vol. 15, article id 1Conference paper (Refereed)
  • 11.
    Audulv, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kneck, Åsa
    Ersta Sköndal Högskola.
    How to analyze time and change in qualitative longitudinal materials?: Insights from a literature review of longitudinal qualitative studies in nursing.2017In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 16, p. 10-10Article in journal (Refereed)
    Abstract [en]

    Background Longitudinal qualitative research can give new insights in social processes and experiences over time. In recent years, there has been a growing interest in conducting longitudinal qualitative research within nursing. However, the definition of what constitutes longitudinal qualitative research is unclear, the methodological literature scarce, and the variation of procedures great. This review of longitudinal qualitative articles within the nursing field aims to identify and describe various types of qualitative longitudinal approaches. Materials and Method Searches in pubmed identified over a hundred qualitative nursing articles with data collection over time. These articles were analyzed regarding 1) described analysis procedure, 2) how the results related to aspects of time and change, and 3) if results were person oriented vs category oriented. Results Five different types of longitudinal qualitative approaches were identified. In total, a large part of the papers described as having a longitudinal design performed a data collection over time, but did not integrate ideas of time or change in their analysis or results. Four fruitful approaches to analyzing longitudinal qualitative data were identified; time-line, pool, phase and pattern-oriented approaches. Articles classified as using any of these approaches have a clear perspective of time or change in the results. However, depending on type of approach different aspects of time, change, and process are in focus. Further, using different approaches yielded different kinds of results. Conclusion All approaches have pros and cons and researchers need to make informed decisions when choosing which approach they will take when analyzing qualitative longitudinal material.

  • 12.
    Audulv, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kneck, Åsa
    Ersta Sköndal Högskola.
    Longitudinal qualitative analysis: A practical guide to a pattern oriented analysis approach2016In: Abstracts, Oral Presentations forQualitative Methods Conference, May 2016: Longitudinal qualitative analysis – How can it be done?, 2016, Vol. 15Conference paper (Refereed)
  • 13.
    Audulv, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Norbergh, Karl-Gustaf
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hörnsten, Åsa
    An ongoing inner negotiation process. A Grounded Theory study concerning self-management among people living with chronic illness.2009Conference paper (Refereed)
  • 14.
    Audulv, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Norbergh, Karl-Gustaf
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hörnsten, Åsa
    An ongoing process of inner negotiation – a Grounded Theory study of self-management among people living with chronic illness2009In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 1, no 4, p. 283-293Article in journal (Refereed)
    Abstract [en]

    Aim.  The aim of this study was to better understand the main concern of self-management processes among people with chronic illness.

    Background.  One aspect of living with chronic illness is self-management that can reduce the illness impact on daily life and promote future health. Although factors that influence self-management have been identified in previous research, little attention has been brought to the process of making self-management decisions. In clinical settings, use of a theory could facilitate patient-empowering approaches.

    Method.  The data collection for this Grounded Theory was mostly conducted in 2006. Data were collected by interviews with 26 adults with a variety of chronic illnesses, including rheumatoid arthritis, diabetes mellitus, inflammatory bowel syndrome, multiple sclerosis, ischaemic heart disease and chronic kidney failure.

    Results.  Individuals are conflicted by competing preferences when taking decisions about self-management. Consequently, the decision-making process can be understood as an ongoing inner negotiation between different incompatible perspectives, e.g. social needs vs. medical needs. The process of negotiating self-management starts with the individual’s considering beliefs about health and illness, which make the individual face illness threats and the need for self-management. Several aspects influence negotiating self-management namely, assessing effects of self-management; evaluating own capacity; perceiving normality or stigmatisation; and experiencing support and external resources. The process has been demonstrated in a model.

    Conclusions.  The process of negotiating self-management is an ongoing inner debate rather than a one-time decision. This opens up new ways of understanding, and communicating with, patients. The described model also links behavioural theories and research findings in a comprehensive understanding.

    Relevance to clinical practice.  This model could be applicable as a communication tool for health-care providers in identifying barriers to, and resources in, self-management behaviour among individuals with chronic illness.

  • 15.
    Audulv, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Packer, T.
    School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada.
    Hutchinson, S.
    School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada.
    Roger, K. S.
    Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
    Kephart, G.
    Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
    Coping, adapting or self-managing – what is the difference?: A concept review based on the neurological literature2016In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 11, p. 2629-2643Article, review/survey (Refereed)
    Abstract [en]

    Aim: The aim of this study was to report: (1) an analysis of the concepts of coping, adaptation and self-management in the context of managing a neurological condition; and (2) the overlap between the concepts. Background: The three concepts are often confused or used interchangeably. Understanding similarities and differences between concepts will avoid misunderstandings in care. The varied and often unpredictable symptoms and degenerative nature of neurological conditions make this an ideal population in which to examine the concepts. Design: Concept analysis. Data sources: Articles were extracted from a large literature review about living with a neurological condition. The original searches were conducted using SCOPUS, EMBASE, CINAHL and Psych INFO. Seventy-seven articles met the inclusion criteria of: (1) original article concerning coping, adaptation or self-management of a neurological condition; (2) written in English; and (3) published between 1999–2011. Methods: The concepts were examined according to Morse's concept analysis method; structural elements were then compared. Results: Coping and adaptation to a neurological condition showed statistically significant overlap with a common focus on internal management. In contrast, self-management appears to focus on disease-controlling and health-related management strategies. Coping appears to be the most mature concept, whereas self-management is least coherent in definition and application. Conclusion: All three concepts are relevant for people with neurological conditions. Healthcare teams need to be cautious when using these terms to avoid miscommunication and to ensure clients have access to all needed interventions. Viewing the three concepts as a complex whole may be more aligned with client experience.

  • 16.
    Audulv, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Packer, Tanya
    Dalhousie University.
    Identifying gaps in knowledge: How can literature reviews give us a bird perspective of a research field2016Conference paper (Refereed)
  • 17.
    Audulv, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. School of Occupational Therapy, Dalhousie University, Halifax, Canada.
    Packer, Tanya
    School of Occupational Therapy, Dalhousie University, Halifax, Canada.
    Versnel, Joan
    School of Occupational Therapy, Dalhousie University, Halifax, Canada.
    Identifying gaps in knowledge: A map of the qualitative literature concerning life with a neurological condition2014In: Chronic Illness, ISSN 1742-3953, E-ISSN 1745-9206, Vol. 10, no 3, p. 192-243Article, review/survey (Refereed)
    Abstract [en]

    Objectives: To describe patterns in the qualitative literature regarding the everyday experience of living with a neurological condition; to identify areas of depth as well as gaps in the existing knowledge base.

    Methods: An extensive search of the literature yielded 474 articles meeting the inclusion criteria. Data extraction, based on scrutiny of both abstract and full text article included country of origin, diagnosis, stated aim, methodological framework/design, participants, and data collection method(s). Studies were categorized into 27 topics within four broad foci.

    Results: Four broad foci describe the field: impact and management, daily activities and occupations, impact on family, and the healthcare experience. Overall the research is unevenly distributed by diagnosis; some are well represented while others are the subject of little research. Even diagnoses well represented in quantity can be limited in breadth.

    Discussion:Possible explanations for the patterns of emphasis include: a focus on issues and problems, highlighted points of contact between patients and healthcare providers, and ability of participants to voice their views. The literature is also characterized by limited across diagnoses research or that comparing the experience of people with different diagnoses. There is a need for more research in particular diagnoses; more varied data collection methods and acknowledgement of ethnicity, gender, discrimination, and social inequalities.

  • 18.
    Hörnsten, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad, Umeå, Sweden.
    Jutterström, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad, Umeå, Sweden.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad, Umeå, Sweden.
    A model of integration of illness and self-management in type 2 diabetes.2011In: Journal of Nursing and Healthcare of Chronic illness, ISSN 1752-9824, Vol. 3, no 1, p. 41-51Article in journal (Refereed)
    Abstract [en]

    Aim.  To describe the process of illness integration and self-management among people with type 2 diabetes.

    Background.  Integration of illness is a developmental process referring to the emotional and existential aspects of being ill. It is an overarching concept that describes the process that a person undergoes in living with a chronic disease, from prediagnosis to adaptation to illness as a natural part of life. Despite the common use of terms such as illness integration and self-management, there exists little research that investigates how these concepts relate to one another.

    Methods.  A narrative interview study applying qualitative content analysis was conducted with people diagnosed with type 2 diabetes. The study focused on their personal understandings of illness, and particularly, the relationship of the participants’ illness integration to self-management of the disease. Data were collected in 2002.

    Results.  In the trajectory from prediagnosis to adaptation, there is a turning point when people seem to integrate the illness emotionally and existentially, and in relation to their self-management practice. The trajectory includes the phases of suspecting illness/being diagnosed, understanding and explaining the illness, and negotiating illness and taking stands about self-management. These phases in turn are influenced by perceptions of the seriousness and threat of the disease; the intensity and nature of the ill person’s emotional response to the disease and its management; goals and expectations for living with the disease and for living in general; and lastly, perceptions of the outcomes and impacts of self-management.

    Conclusion.  Illness integration and self-management processes develop simultaneously. In some cases, a turning point occurs that causes the person to view self-management as both necessary and feasible.

    Relevance to clinical practice.  Nurses may influence the illness integration trajectory and assist people with type 2 diabetes to integrate the disease and its management more readily.

  • 19.
    Kephart, George
    et al.
    Dalhousie University, Halifax, Canada.
    Packer, Tanya
    Dalhousie University, Halifax, Canada.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Warner, Grace
    Dalhousie University, Halifax, Canada.
    The structural and convergent validity of three commonly used measures of self-management in persons with neurological conditions2019In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 28, no 2, p. 545-556Article in journal (Refereed)
    Abstract [en]

    Purpose

    Self-management ability is commonly assessed in chronic disease research and clinical practice. The purpose of this study was to assess the structural and convergent validity of three commonly used self-management outcome measures in a sample of persons with neurological conditions.

    Methods

    We used data from a Canadian survey of persons with neurological conditions, which included three commonly used self-management measures: the Partners in Health Scale (PIH), the Patient Activation Measure (PAM), and the Self-Efficacy for Managing a Chronic Disease Scale (SEMCD). Confirmatory factor analysis was used to assess the structural and convergent validity of the three measures.

    Results

    When treated as single-factor constructs, none of the measurement models provided a good fit to the data. A four-domain version of the PIH was the best fitting model. Confirmatory factor analysis suggests that the three tools measure different, but correlated constructs.

    Conclusions

    While the PAM, PIH and SEMCD scales are all used as measures of patient self-management, our study indicates that they measure different, but correlated latent variables. None, when treated as single, uni-dimensional construct, provides an acceptable fit to our data. This is probably because self-management is multi-dimensional, as is consistently shown by qualitative evidence. While these measures may provide reliable summative measures, multi-dimensional scales are needed for clinical use and more detailed research on self-management.

  • 20.
    Kneck, Åsa
    et al.
    Ersta Sköndal Högskola.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    A pattern-oriented approach: Practical advice about longitudinal qualitative analysis procedures2016Conference paper (Refereed)
  • 21.
    Kneck, Åsa
    et al.
    Ersta Sköndal Bräcke University College, Stockholm.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Analyzing variations in changes over time: development of the Pattern-Oriented Longitudinal Analysis approach2019In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 26, no 3, article id e12288Article in journal (Refereed)
    Abstract [en]

    Longitudinal qualitative research in nursing is rare but becoming more common. Data collection and analysis over time provide some intriguing possibilities to better understand processes, development, and change in illness experience, healthcare organizations, and self-management. This paper aims to present a process for analyzing qualitative longitudinal data material, namely the Pattern-Oriented Longitudinal Analysis approach (POLA). We developed this approach after synthesizing experiences from two longitudinal qualitative projects and comparing our procedures and reflections with the relevant literature. Using the POLA approach, researchers can describe complexity and variation in changes over time. During the analysis process, emphasis is put on visualizing and identifying change at both an individual and a group level. Ontological and epistemological assumptions for the approach are also described. The benefit of this approach is the possibility to describe complexity and diversity in processes over time, which is important for the development of nursing knowledge. The analysis approach can be further used and developed by researchers seeking to understand variance or contextual features in processes and changes over time.

  • 22.
    Olsson, Helen
    et al.
    Dalarna University.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Strand, Susanne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences. Sundsvall Forensic Psychiatric Hospital.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Reducing or Increasing Violence in Forensic Care: A Qualitative Study of Inpatient Experiences2015In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 29, no 6, p. 393-400Article in journal (Refereed)
    Abstract [en]

    Semi-structured interviews with 13 forensic psychiatric inpatients that had decreased their assessed risk of violence were analyzed using interpretive description. The main contribution from this study is a detailed description of patients' own strategies to avoid violence. Participants described having an ongoing inner dialog in which they encouraged themselves, thereby increasing their self-esteem and trying to accept their current situation. An unsafe and overcrowded ward with uninterested and nonchalant staff increased the risk of aggressive behavior. In the process of decreasing violence, the patients and the forensic psychiatric nursing staff interacted to create and maintain a safe environment.

  • 23.
    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.

  • 24.
    Packer, Tanya
    et al.
    Dalhousie Univ, Sch Occupat Therapy, Halifax, NS B3H 4R2, Canada.
    Kephart, George
    DalhousiDalhousie Univ, Community Hlth & Epidemiol, Halifax, NS B3H 4R2, Canada.
    Ghahari, Setareh
    Queens Univ, Sch Rehabil Therapy, Kingston, ON, Canada.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Dalhousie Univ, Sch Occupat Therapy, Halifax, NS B3H 4R2, Canada.
    Versnel, Joan
    Dalhousie Univ, Sch Occupat Therapy, Halifax, NS B3H 4R2, Canada.
    Warner, Grace
    Dalhousie Univ, Sch Occupat Therapy, Halifax, NS B3H 4R2, Canada.
    The Patient Activation Measure: a validation study in a neurological population2015In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 24, no 7, p. 1587-1596Article in journal (Refereed)
    Abstract [en]

    Purpose To assess the validity of the Patient Activation Measure (PAM13) of patient activation in persons with neurological conditions. Methods ‘‘The Everyday Experience of Living with and Managing a Neurological Condition’’ (The LINC study) surveyed 948 adults with neurological conditions residing in Canada in 2011 and 2012. Using data for 722 respondents who met coding requirements for the PAM-13, we examined the properties of the measure using principle components analysis, inter-item correlations and Cronbach’s alpha to assess unidimensionality and internal consistency. Rasch modeling was used to assess item performance and scaling. Construct validity was assessed by calculating associations between the PAM and known correlates. Results PAM-13 provides a suitably reliable and valid instrument for research in patients with neurological conditions, but scaling problems may yield measurement error and biases for those with low levels of activation. This is of particular importance when used in clinical settings or for individual client care. Our study also suggests that measurement of activation may benefit from tailoring items and scaling to specific diagnostic groups such as people with neurological conditions, thus allowing the PAM-13 to recognize unique attributes and management challenges in those conditions. Conclusions The PAM-13 is an internally reliable and valid tool for research purposes. The use of categorical activation ‘‘level’’ in clinical settings should be done with caution.

  • 25.
    Rising Holmström, Malin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Häggström, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Junehag, Lena
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Coyne, Imelda
    Trinity College Dublin.
    Söderberg, Siv
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    To integrate and manage diabetes in school: Youth's expereinces of living with Type 1 diabetes in relation to school- a qualitative study2017In: International Diabetes Nursing, ISSN 2057-3316, E-ISSN 2057-3324, Vol. 14, no 2-3Article in journal (Refereed)
    Abstract [en]

    In Sweden, each year approximately 700 children develop Type 1 diabetes. Living with the illness is a challenge for youth and requires adjustments to lifestyle, and to manage school. The aim was to describe youths’ experiences of living with Type 1 diabetes in relation to school. A qualitative research design was used and interviews were performed with eight girls and five boys with Type 1 diabetes. The interviews were subjected to qualitative content analysis. Three themes were identified: to be friends with the diabetes, striving for normality and receiving support from others. Results showed a need to increase the understanding of T1D and diabetic competence within the Swedish school system and knowledge of youths’ own experiences is vital in this work. Living with T1D was a struggle for normality, independency and the youth needed to be friends with diabetes to handle everyday self-management. Although there are demanding life and school circumstances, it eventually becomes possible for the youth to handle the illness and to integrate and manage diabetes in school.

  • 26.
    Rönngren, Ylva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Björk, Annette
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Enmarker, Ingela
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Högskolan i Gävle; Center for Care Research, Steinkjer, Norway.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Haage, David
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Educational nurse-led lifestyle intervention for persons with mental illness.2018In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, no 3, p. 1022-1031Article in journal (Refereed)
    Abstract [en]

    Although persons with severe mental illness face an increased risk of mortality and of developing negative health outcomes, research has shown that lifestyle interventions can sufficiently support their health. In response, this study examined a nurse-led lifestyle intervention developed in cooperation with members of municipal and county councils to gauge its impact on the quality of life, cognitive performance, walking capacity, and body composition of persons with severe mental illness. Lasting 26 weeks and involving 38 persons with severe mental illness, the intervention prioritised two components: the interpersonal relationships of persons with severe mental illness, staff, and group leaders and group education about physical and mental health. Pre-post intervention measurements of quality of life collected with the Manchester Short Assessment of Quality of Life, cognitive performance with the Frontal Systems Behaviour Scale, walking capacity with a 6-min walk test, and body composition in terms of waist circumference and body mass index were analysed using a nonparametric test Wilcoxon signed-rank test. Results suggest that the intervention afforded significant improvements in the health-related variables of quality of life, cognitive performance, walking capacity, and waist circumference for persons with severe mental illness. However, long-term studies with control groups and that examine parameters related to cardiovascular risk factors are essential to ensure the sustained impact of the intervention.

  • 27.
    Rönngren, Ylva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Björk, Annette
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Haage, David
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Perspectives of a tailored lifestyle program for people with severe mental illness receiving housing support2018In: Perspectives in psychiatric care, ISSN 0031-5990, E-ISSN 1744-6163, Vol. 54, no 2, p. 309-316Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of the present study was to describe the acceptability of the lifestyle program PHYS/CAT and to get information about the tools used for assessment of functional exercise capacity, cognitive performance, and self-health-related quality of life.

    Design and Methods

    The findings are based on focus groups and the researchers’ experiences of conducting the program as well as using the assessment tools.

    Findings

    The acceptability of the program and the assessment tools was mainly satisfactory.

    Practice Implications

    The program with relational, educational, and supportive dimensions may be a promising tool to be integrated into daily nursing care.

  • 28.
    Rönngren, Ylva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Björk, Annette
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kristiansen, Lisbeth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Haage, David
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Enmarker, Ingela
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Univ Gävle; Mid Norway, Steinkjer, Norway.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Meeting the needs? Perceived support of a nurse-led lifestyle programme for young adults with mental illness in a primary health-care setting2018In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, no 1, p. 390-399Article in journal (Refereed)
    Abstract [en]

    Being a young adult with mental illness challenges all aspects of health, including an increased risk for developing lifestyle-related diseases. There is a lack of lifestyle programmes in primary health care that target physical, mental, and social needs for young adults with mental illness. The aim of the present study was to describe the experiences of young adults with mental illness receiving support from a nurse-led lifestyle programme, and how this support was related to their life context, including challenges and coping strategies. Two focus groups and six individual interviews were performed with 13 young adults (16–25 years), and analysed using a qualitative content analysis. The findings showed that the young adults experienced challenges in their daily lives, including psychiatric symptoms, lack of social understanding, and loneliness. The study indicated that the programme could support lifestyle habits with its components of supportive interpersonal relationships, awareness of coping strategies, understanding of health and illness, and cognitive support (e.g. schedules and reminders). However, the programme could not meet everyone's needs for new social relationships or more comprehensive support. Even so, this nurse-led programme provides health information-management strategies that could easily be integrated in a primary health-care setting.

  • 29.
    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 1873-5134Article 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. 

  • 30.
    Warner, Grace
    et al.
    Dalhousie Univ, Sch Occupat Therapy, POB 15000, Halifax, NS B3H 4R2, Canada.
    Packer, Tanya
    Dalhousie Univ, Sch Occupat Therapy, POB 15000, Halifax, NS B3H 4R2, Canada.
    Villeneuve, Michelle
    Univ Sydney, Fac Hlth Sci, Sydney, NSW 2006, Australia.
    Audulv, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Dalhousie Univ, Sch Occupat Therapy, POB 15000, Halifax, NS B3H 4R2, Canada.
    Versnel, Joan
    Dalhousie Univ, Sch Occupat Therapy, POB 15000, Halifax, NS B3H 4R2, Canada.
    A systematic review of the effectiveness of stroke self-management programs for improving function and participation outcomes: self-management programs for stroke survivors2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 23, p. 2141-2163Article in journal (Refereed)
    Abstract [en]

    Purpose: A systematic review of stroke self-management programs was conducted to: (i) identify how many and what self-management support strategies were included in stroke selfmanagement interventions and (ii) describe whether self-management programs effectively improved outcomes, focusing specifically on function and participation outcomes. Methods: Twelve databases were searched for the years 1986–2012 to identify self-management programs for stroke survivors. Pre-post, quasi-experimental and randomized controlled trial study designs were included. Descriptive information about the intervention was scrutinized to identify what self-management support strategies were present in the intervention and comparisons were made between programs using a group versus a one-to-one format. All outcomes were included and categorized. Results: The most prominent strategies identified in our review were goal setting and follow-up, and an individualized approach using structured information and professional support. There are indications that self-management programs can significantly increase participation and functional ability. However, the high level of clinical heterogeneity in program delivery, outcomes and level of stroke severity made it impossible to conduct a meta-analysis. Further examination of individual self-management support strategies, such as linking rehabilitation goal setting to post-acute self-management programs, the inclusion of family members and the contribution of peer-support is warranted.

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