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Self-Management and Health Promotion in Chronic Disease

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (1 December 2020) | Viewed by 30414

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Special Issue Editors

Dr. AnneLoes van Staa

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Guest Editor

Rotterdam University of Applied Sciences, Research Centre Innovations in Care & Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
Interests: self-management support; advanced nursing; chronic illness; adolescent health; transitional care; patient empowerment; nursing

Dr. Jane Sattoe

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Guest Editor

Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands
Interests: self-management of (young) people with chronic conditions; transitional care; patient empowerment; patient reported outcomes; quality of life; intervention evaluation

Dr. Erwin Ista

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Guest Editor

Department of Internal Medicine - Section Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
Interests: self-management support; implementation science; knowledge translation; nursing care; (pediatric) intensive care; delirium

Special Issue Information

Dear Colleagues,

Living with a chronic condition requires ongoing adjustment to physical, psychological, and social demands. To date, patients are expected to be flexible and to take an active role in their disease management in the form of self-management. In the definition of Barlow et al. (2002): “Self-management refers to the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and life style changes inherent in living with a chronic condition. Efficacious self-management encompasses ability to monitor one’s condition and to effect the cognitive, behavioural, and emotional responses necessary to maintain a satisfactory quality of life. Thus, a dynamic and continuous process of self-regulation is established.” To be able to do so, patients need certain problem-solving skills, have to make decisions, find and utilize resources, form partnership with their healthcare professionals, and take action. Given these requirements, most patients will need self-management support from healthcare professionals and relatives.

This Special Issue invites papers exploring the full range of (multidisciplinary) self-management support. We particularly welcome original research into components that contribute to the success or failure of self-management interventions and about how self-management support can be implemented and optimized to the patient’s perspective.

Dr. AnneLoes van Staa
Dr. Jane Sattoe
Dr. Erwin Ista
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Self-management support
Family-based self-management support
Self-management interventions
Evaluation of self-management (support) interventions
Measurement of self-management (components)
Self-regulation
Problem-solving
Patient empowerment

Published Papers (7 papers)

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Research

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17 pages, 4738 KiB

Open AccessArticle

Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial

by Jan Douglass, Fikre Hailekiros, Sarah Martindale, Hayley Mableson, Fikre Seife, Tesfahun Bishaw, Mekdes Nigussie, Kadu Meribo, Mossie Tamiru, Getnet Agidew, Susan Kim, Hannah Betts, Mark Taylor and Louise Kelly-Hope

J. Clin. Med. 2020, 9(12), 4077; https://doi.org/10.3390/jcm9124077 - 17 Dec 2020

Cited by 8 | Viewed by 3838

Abstract

Lymphedema causes disability and exacerbates poverty in many countries. The management of lymphatic filariasis (LF) and podoconiosis-related lymphedema involves daily hygiene to reduce secondary infections, but self-massage and deep-breathing, which have proven beneficial in cancer-related lymphedema, are not included. A cluster randomized trial in northern Ethiopia investigated the effects of lymphatic stimulation for people affected by moderate to severe lymphedema. Participants were allocated to either standard (control n = 59) or enhanced (intervention n = 67) self-care groups. Primary outcomes were lymphedema stage, mid-calf circumference, and tissue compressibility. Secondary outcomes were the frequency and duration of acute attacks. After 24 weeks, fewer patients were assessed as severe (control −37.8%, intervention −42.4%, p = 0.15) and there were clinically relevant changes in mid-calf tissue compressibility but not circumference. There was a significant between-group difference in patients who reported any acute attacks over the study period (control n = 22 (38%), intervention n = 7 (12%), p = 0.014). Daily lymphedema self-care resulted in meaningful benefits for all participants with a greater reduction in acute episodes among people performing lymphatic stimulation. Observations of a change in lymphedema status support earlier findings in Bangladesh and extend the demonstrated benefits of enhanced self-care to people affected by podoconiosis. Full article

(This article belongs to the Special Issue Self-Management and Health Promotion in Chronic Disease)

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14 pages, 1002 KiB

Open AccessArticle

The Active with OsteoArthritis (AktivA) Physiotherapy Implementation Model: A Patient Education, Supervised Exercise and Self-Management Program for Patients with Mild to Moderate Osteoarthritis of the Knee or Hip Joint. A National Register Study with a Two-Year Follow-Up

by Inger Holm, Are Hugo Pripp and May Arna Risberg

J. Clin. Med. 2020, 9(10), 3112; https://doi.org/10.3390/jcm9103112 - 26 Sep 2020

Cited by 20 | Viewed by 4334

Abstract

Background: Recent systematic reviews and international guidelines recommend patient education, exercises, and weight control (if overweight) as first-line treatment for patients with hip or knee osteoarthritis (OA). The Active with osteoArthritis (AktivA) program is a physiotherapy model for the implementation of these guidelines into clinical primary care practice. The purpose of the present study was to evaluate the long-term effects of and adherence to the AktivA program for patients with mild to moderate knee or hip OA. Methods: The AktivA program includes three modules: a physiotherapy certification course, a patient education and exercise program and an electronic quality register. An electronic questionnaire including questions about, pain, quality of life, physical activity, self-efficacy and satisfaction with the AktivA program are sent to the participants at inclusion and after 3, 12 and 24 months. A linear mixed model for repeated measurements was used to assess the difference between the follow-up times. Results: Until January 2020, 6245 patients were included in the register. The response rates were 98%, 86% and 63% at 3, 12 and 24 months, respectively. After participating in the AktivA program, the patients reported decreased pain and increased health-related and disease-specific quality of life at three months and the positive effect was maintained up to two years after inclusion. The proportion of patients reporting to be inactive or having a low physical activity level was reduced from 43% to 22%. After two years, more than 80% of the participants reported to use what they have learned from the AktivA program at least once a week. Conclusions: Two years after inclusion in the AktivA physiotherapy program, the patients still report reduced pain, increased quality of life and higher activity levels. Full article

(This article belongs to the Special Issue Self-Management and Health Promotion in Chronic Disease)

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16 pages, 2702 KiB

Open AccessArticle

Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People Affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial

by Janet Douglass, Hayley Mableson, Sarah Martindale, Sanya Tahmina Jhara, Mohammad Jahirul Karim, Muhammad Mujibur Rahman, Abdullah Al Kawsar, Abul Khair, ASM Sultan Mahmood, AKM Fazlur Rahman, Salim Mahmud Chowdhury, Susan Kim, Hannah Betts, Mark Taylor and Louise Kelly-Hope

J. Clin. Med. 2020, 9(8), 2444; https://doi.org/10.3390/jcm9082444 - 30 Jul 2020

Cited by 9 | Viewed by 3447

Abstract

Background: Lymphatic filariasis (LF) is a major cause of lymphedema, affecting over 16 million people globally. A daily, hygiene-centered self-care protocol is recommended and effective in reducing acute attacks caused by secondary infections. It may also reverse lymphedema status in early stages, but less so as lymphedema advances. Lymphatic stimulating activities such as self-massage and deep-breathing have proven beneficial for cancer-related lymphedema, but have not been tested in LF-settings. Therefore, an enhanced self-care protocol was trialed among people affected by moderate to severe LF-related lymphedema in northern Bangladesh. Methods: Cluster randomization was used to allocate participants to either standard- or enhanced-self-care groups. Lymphedema status was determined by lymphedema stage, mid-calf circumference, and mid-calf tissue compressibility. Results: There were 71 patients in each group and at 24 weeks, both groups had experienced significant improvement in lymphedema status and reduction in acute attacks. There was a significant and clinically relevant between-group difference in mid-calf tissue compressibility with the biggest change observed on legs affected by severe lymphedema in the enhanced self-care group (∆ 21.5%, −0.68 (−0.91, −0.45), p < 0.001). Conclusion: This study offers the first evidence for including lymphatic stimulating activities in recommended self-care for people affected by moderate and severe LF-related lymphedema. Full article

(This article belongs to the Special Issue Self-Management and Health Promotion in Chronic Disease)

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15 pages, 1222 KiB

Open AccessArticle

A Multidisciplinary Approach for Improving Quality of Life and Self-Management in Diabetic Kidney Disease: A Crossover Study

by Nancy Helou, Dominique Talhouedec, Maya Zumstein-Shaha and Anne Zanchi

J. Clin. Med. 2020, 9(7), 2160; https://doi.org/10.3390/jcm9072160 - 08 Jul 2020

Cited by 6 | Viewed by 2965

Abstract

Individuals with diabetic kidney disease are at high risk of complications and challenged to self-manage. Previous research suggested that multidisciplinary approaches would improve health outcomes. This study investigated the effect of a multidisciplinary self-management approach of diabetic kidney disease on quality of life, and self-management, glycemic control, and renal function. A uniform balanced crossover design was used because it attains a high level of statistical power with a lower sample size. A total of 32 participants (aged 67.8 ± 10.8) were randomized into four study arms. In differing sequences, each participant was treated twice with three months of usual care alternated with three months of multidisciplinary management. The intervention improved the present dimension of quality of life demonstrating higher mean rank as compared to usual care (52.49 vs. 41.01; p = 0.026, 95% CI) and three self-care activities, general diet habits, diabetes diet habits, and blood sugar testing (respectively: 55.43 vs. 38.31; p = 0.002, 56.84 vs. 37.02; p = 0.000, 53.84 vs. 39.77; p = 0.008; 95% CI). Antihypertensive medication engagement was high across the study period (Mean = 95.38%, Min = 69%, Max = 100%). Glycemic control and renal function indicators were similar for the intervention and the usual care. Studies are needed to determine how the new recommended therapies for diabetic kidney disease such as SGLT2 inhibitors and GLP-1 receptor agonists impact on self-management and quality of life. Full article

(This article belongs to the Special Issue Self-Management and Health Promotion in Chronic Disease)

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14 pages, 298 KiB

Open AccessArticle

Implementing Supported Self-Management in Community-Based Stroke Care: A Secondary Analysis of Nurses’ Perspectives

by Lisa Kidd, Joanne Booth, Maggie Lawrence and Anne Rowat

J. Clin. Med. 2020, 9(4), 985; https://doi.org/10.3390/jcm9040985 - 01 Apr 2020

Cited by 13 | Viewed by 4218

Abstract

The provision of supported self-management (SSM) is recommended in contemporary guidelines to address the longer-term needs and outcomes of stroke survivors and their families, yet its implementation across stroke pathways has been inconsistent. This paper presents a secondary analysis of qualitative data, which aims to identify and offer insight into the challenges of implementing SSM from the perspectives of community stroke nurses (n = 14). The findings revealed that the implementation of SSM in stroke is influenced by factors operating at multiple levels of the healthcare system. Contextual challenges arise because of different understandings and interpretations of what SSM is, what it comprises and professionals’ perceptions of their roles in its implementation in practice. A professionally controlled, one-size-fits-all model of SSM continues to be reinforced within organizations, offering few opportunities for nurses to deliver contextually tailored and person-centred SSM. In conclusion, there are many professional concerns and organizational tensions that need to be addressed across multiple layers of the healthcare system to achieve the consistent implementation of contextually tailored and person-centred SSM following a stroke. Attempts to address these challenges will help to narrow the gap between policy and practice of implementing SSM, ensuring that stroke survivors and families benefit from SSM in the longer-term. Full article

(This article belongs to the Special Issue Self-Management and Health Promotion in Chronic Disease)

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15 pages, 380 KiB

Open AccessArticle

Effects of Self-Care for Older PErsons (SCOPE) on Functional and Physiological Measures: A Cluster Randomized Controlled Trial

by Ted Kheng Siang Ng, David Bruce Matchar, Rehena Sultana and Angelique Chan

J. Clin. Med. 2020, 9(3), 885; https://doi.org/10.3390/jcm9030885 - 24 Mar 2020

Cited by 1 | Viewed by 2759

Abstract

Background: Population aging poses unprecedented demands on the healthcare system. There is also a scarcity of evidence on self-care intervention to improve objective measures of morbidity and aging-associated functional and physiological measures in a low-income multi-ethnic population setting. Methods: We conducted a cluster randomized controlled trial (ClinicalTrials.gov Identifier: NCT01672177) to examine the effects of the Self-Care for Older PErsons (SCOPE) program. We randomized 14 Senior Activity Centers and randomly selected older adults within these centers. Functional and physiological measurements were performed at baseline, 10-month, and 18-month periods. The primary outcome was a composite of three morbidity-specific measures, which include hemoglobin A1c (HbA1C), peak expiratory flow, and systolic blood pressure. Aging-associated functional and physiological measures were examined as secondary outcomes. Repeated-measure mixed models were employed to examine the effects of SCOPE on these measures. Results: 378 community-dwelling older adults participated in either the treatment (n= 164) or the control arm (n = 214). The primary outcome was not significantly improved. For the secondary outcomes, SCOPE participants demonstrated slower oxygen desaturation at an 18-month period (p = 0.001), improved time to complete the chair-stand test (p < 0.001) at a 10-month period with the effect persisting at the 18-month period (p < 0.001). SCOPE participants also had significantly improved vitamin B₁₂ levels at the 18-month period (p < 0.001), increased hemoglobin concentration (p < 0.001), decreased mean corpuscular volume (p = 0.001), and decreased creatinine (p = 0.002) at the 10-month period. Conclusions: SCOPE did not improve morbidity-specific measures. However, it improved several aging-associated measures implicated in geriatric syndromes. This study highlights the potential of a self-care program in the prevention of geriatric syndromes in community-dwelling older adults, while emphasizing self-management to manage existing morbidities. Full article

(This article belongs to the Special Issue Self-Management and Health Promotion in Chronic Disease)

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Review

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17 pages, 697 KiB

Open AccessReview

Do Chronic Obstructive Pulmonary Diseases (COPD) Self-Management Interventions Consider Health Literacy and Patient Activation? A Systematic Review

by Uday Narayan Yadav, Jane Lloyd, Hassan Hosseinzadeh, Kedar Prasad Baral and Mark Fort Harris

J. Clin. Med. 2020, 9(3), 646; https://doi.org/10.3390/jcm9030646 - 28 Feb 2020

Cited by 29 | Viewed by 7531

Abstract

Self-management (SM) includes activities that patients initiate and perform in the interest of controlling their disease and maintaining good health and well-being. This review examines the health literacy and patient activation elements of self-management interventions for Chronic Obstructive Pulmonary Diseases (COPD) patients. We investigated the effects of the intervention on health-related quality of life, self-efficacy, depression, and anxiety among people with COPD. We conducted a systematic review of studies evaluating the efficacy of self-management interventions among COPD patients that also included health literacy or patient activation as keywords. Four electronic databases Medline, EMBASE, PsycINFO, and Google Scholar, were searched to identify eligible studies. These studies were screened against predetermined inclusion criteria. Data were extracted according to the review questions. Twenty-seven studies met the criteria for inclusion. All of the included studies incorporated health literacy components and focused on COPD and self-management skills. Three studies measured health literacy; two showed improvements in disease knowledge, and one reported a significant change in health-related behaviors. Seventeen studies aimed to build and measured self-efficacy, but none measured patient activation. Eleven studies with multicomponent interventions showed an improvement in quality of life. Six studies that focused on specific behavioral changes with frequent counseling and monitoring demonstrated improvement in self-efficacy. Two interventions that used psychosocial counseling and patient empowerment methods showed improvement in anxiety and depression. Most self-management interventions did not measure health literacy or patient activation as an outcome. Successful interventions were multicomponent and comprehensive in addressing self-management. There is a need to evaluate the impact of comprehensive self-management interventions that address and measure both health literacy and patient activation on health outcomes for COPD patients. Full article

(This article belongs to the Special Issue Self-Management and Health Promotion in Chronic Disease)

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