Re-thinking technology and its growing role in enabling patient empowerment

© The Author(s) 2018. The presence and increase of challenges to eHealth in today’s society have begun to generate doubts about the capability of technology in patient empowerment, especially within the frameworks supporting empowerment. Through the review of existing frameworks and articulation of patient demands, weaknesses in the current application of technology to support empowerment are explored, and key constituents of a technology-driven framework for patient empowerment are determined. This article argues that existing usage of technology in the design, development and implementation of patient empowerment in the healthcare system, although well intentioned, is insufficiently constituted, primarily as a result of fragmentation. Systems theory concepts such as holism and iteration are considered vital in improving the role of technology in enabling patient empowerment

Disseminating Research Information through Facebook and Twitter (DRIFT): presenting an evidence based framework

Background: The social media platform Facebook boasts over 1,284 million daily active users globally. It is also known that a large proportion of adults use the internet to seek health related information.Aim: to critically analyse the use of social media to engage parents of children with ADHD with clinical research findings.Methods: Observation and qualitative content analysis combined with Facebook insights was used to evaluate the levels of engagement and interaction with different types of research information.Results: Over 1100 people from 41 nations have engaged with the group. Sharing information through a range of Facebook functions was found to successfully achieve engagement and reach nationally and internationally for this demographic.Conclusion: Lay research users are eager to engage and understand clinical research and social media is an appropriate way to disseminate this. This article has proposed some methods and explanatory reasons for this phenomena.Implications for practice: It is known that social media can be used for effective communication. This article presents a much-needed evidence based framework that may be used by nursing and health researchers to successfully achieve this

Nutrition in an ethnically diverse society : what are some of the key challenges?

The role of nutrition is especially important in certain ‘lifestyle’ diseases that impact disproportionately on ethnic minority populations. The aim of this paper is to review the evidence of risk, health outcomes and interventions for certain diseases that affect the UK’s largest ethnic minority group (South Asians) in order to help professionals better address the needs of this diverse population. Research evidence is presented on factors influencing access to services by ethnic minority populations and the changing UK policy background for public health and preventive care. The available research base on obesity, diabetes and CVD is discussed. Conditions such as type 2 diabetes, which are more prevalent among the South Asian population, are associated with poorer health outcomes and appear to exhibit links to diet and nutrition that start in childhood or even before birth; all making preventive care important. Obesity is a major risk factor and it appears that BMI thresholds may need to be lower for South Asians. Targeted interventions to improve diet and outcomes in the South Asian population also appear promising. Recent moves to promote access to evidence of ethnicity and health and to improve the cultural competence of organisations are discussed. Health professionals will increasingly need to promote lifestyle changes in a manner that meets the needs of a diverse population in order to address future public health challenges. Nutritionists and other professionals will need to ensure that interventions are culturally appropriate and involve engagement with extended family members and communities

Examining professionals' and parents' views of using transanal irrigation with children: Understanding their experiences to develop a shared health resource for education and practise

Irrigation as a bowel management approach has been reportedly used with children for more than 20 years. Parents managing their child's chronic bowel problem have previously been shown to have increased emotional stress. The aim of this study was to explore professionals' (n = 24) understanding and parents' (n = 18) experiences of using transanal irrigation with children at home as a mid to longer term bowel management approach. This study was underpinned by action research methodology and used mixed methods determined by an action research group of parents, professionals, researchers, a voluntary sector worker, commercial representative and independent observer. Data informed the study outcome which was the development and evaluation of a shared health resource to support professionals in their holistic approach when prescribing transanal irrigation and guide parents in the areas of education, management, problem solving, support and goal setting. The resource includes constructed case studies from parents of their experiences to inform choice and decision-making between parents and professionals. The shared health resource provides an approach to initiating and evaluating transanal irrigation and is available in a paper format from key Internet sites across hospital, community and voluntary services

Two sides of the coin:Patient and provider perceptions of health care delivery to patients from culturally and linguistically diverse backgrounds

BACKGROUND: Australia is a culturally diverse nation with one in seven Australians born in a non-English speaking country. Culturally and Linguistically Diverse (CALD) populations are at a high risk of developing preventable chronic diseases such as cardiovascular disease, type 2 diabetes mellitus, renal disease, and chronic respiratory disease, especially communities from the Pacific Islands, the Middle East, North Africa, the Indian subcontinent and China. Previous studies have shown that access to services may be a contributing factor. This study explores the experiences, attitudes and opinions of immigrants from different cultural and linguistic backgrounds and their health care providers with regard to chronic disease care. METHODS: Five focus groups were conducted comprising participants from an Arabic speaking background, or born in Sudan, China, Vietnam or Tonga. A total of 50 members participated. All focus groups were conducted in the participants’ language and facilitated by a trained multicultural health worker. In addition, 14 health care providers were interviewed by telephone. Interviews were digitally recorded and transcribed. All qualitative data were analysed with the assistance of QSR NVivo 8 software. RESULTS: Participants were generally positive about the quality and accessibility of health services, but the costs of health care and waiting times to receive treatment presented significant barriers. They expressed a need for greater access to interpreters and culturally appropriate communication and education. They mentioned experiencing racism and discriminatory practices. Health professionals recommended recruiting health workers from CALD communities to assist them to adequately elicit and address the needs of patients from CALD backgrounds. CONCLUSIONS: CALD patients, carers and community members as well as health professionals all highlighted the need for establishing culturally tailored programs for chronic disease prevention and management in CALD populations. Better health care can be achieved by ensuring that further investment in culturally specific programs and workforce development is in line with the number of CALD communities and their needs

Evaluating Motivational Interviewing in the Physician Assistant Curriculum

Purpose Motivational interviewing (MI) is an evidence-based technique that enables clinicians to help patients modify health behaviors. Although MI is an essential tool for physician assistants (PAs), the extent to which it is addressed in PA curricula in the United States is unknown. This study is a comprehensive description of MI education in PA programs in the United States. Methods Data are from the 2014 Physician Assistant Education Association Annual Program Survey. Descriptive statistics were conducted on de-identified data from all 186 PA programs in the United States. Results Of the 186 PA programs surveyed, 72.58% (n = 135) reported at least one course providing MI training. Availability of courses providing training in skills essential to the MI process varied. Having a course with verbal communication training was most frequently endorsed, and having a course with training in developing discrepancy was least frequently endorsed. The most popular teaching modality was lecture (84.95%, n = 158), whereas only 41.40% (n = 77) and 58.60% (n = 109) reported role play with evaluation and standardized patient exercises with evaluation, respectively. Conclusions More than 70% of programs included at least one course in their curriculum that provided training in MI, suggesting that PA programs recognize the importance of MI. Instruction in change talk was not provided in nearly half of the programs. Role-play and standardized patient exercises with evaluation were underused methods despite their proven efficacy in MI education. As the first comprehensive benchmark of MI education for PAs, this study shows that although most programs address MI, opportunities exist to improve MI training in PA programs in the United States

Nursing Students’ Learning about an Empowering Discourse In Patient Education

The main purpose of this study was to describe and evaluate nursing students' learning about an empowering discourse in patient education. In Phase 1, the purpose was to describe an empowering discourse between a nurse and a patient. In Phase 2, the purpose was first to create a computer simulation program of an empowering discourse based on the description, and second, the purpose was to evaluate nursing students’ learning of how to conduct an empowering discourse using a computer simulation program. The ultimate goal was to strengthen the knowledge basis on empowering discourse and to develop nursing students’ knowledge about how to conduct an empowering discourse for the development of patient education. In Phase I, empowering discourse was described using a systematic literature review with a metasummary technique (n=15). Data were collected covering a period from January 1995 to October 2005. In Phase 2, the computer simulation program of empowering discourse was created based the description in 2006–2007. A descriptive comparative design was used to evaluate students’ (n=69) process of learning empowering discourse using the computer simulation program and a pretest–post-test design without a control group was used to evaluate students’ (n=43) outcomes of learning. Data were collected in 2007. Empowering discourse was a structured process and it was possible to simulate and learned with the computer simulation program. According to students’ knowledge, empowering discourse was an unstructured process. Process of learning empowering discourse using the computer simulation program was controlled by the students and it changed students’ knowledge. The outcomes of learning empowering discourse appeared as changes of students’ knowledge to more holistic and better-organized or only to more holistic or better-organized. The study strengthened knowledge base of empowering discourse and developed students to more knowledgeable in empowering discourse.Siirretty Doriast

Patients' self-empowerment : patients and informal caregivers taking the lead

Background: It is rather common for patients and informal caregivers affected by chronic conditions to experience aspects of disempowerment being in a paternalistic structure. Patient empowerment is often understood as a power to achieve control over the determinants of a person’s quality of life, as well as being authorized by healthcare professionals and steered from a healthcare perspective on self-management and care. Patient self-empowerment, on the other hand, describes patients’ and informal caregivers’ power to perform activities that are not mandated by health care and to take control over their own lives and self-management with increased self-efficacy and confidence. Self-empowered patients and informal caregivers are described in the literature by many different concepts and can be the key to future development of health care and diffusion of innovation solutions for themselves and their peers. Knowledge about self-empowering behaviors and motivation of patients and informal caregivers is scarce. Further, the perspective of healthcare professionals and their attitudes, experiences, and workplace support when working with self-empowered patients and informal caregivers has not been researched extensively. Aim: To further understand how patients and informal caregivers can take the lead in their own care and self-management, the overall aim of this thesis is to study the driving forces and self-empowering behaviors of patients and informal caregivers affected by chronic conditions, and how healthcare professionals and the healthcare systems meet these behaviors. Methods: This is a mixed methods thesis with four studies deriving from two projects. Qualitative data collection was done through semi-structured interviews (study I-III) and focus groups (study III), and quantitative data was collected through surveys (study II & IV). Patients and informal caregivers affected by chronic conditions and with self-empowering behaviors participated in study I (n=15) and study III (n=48), and persons with Parkinson Disease performing self-tracking participated in study II (n=187). Healthcare professionals were respondents in study IV (n=279). The data were analyzed using five different approaches: Framework analysis (study I), Conventional content analysis (study II), Thematic analysis (study III), Direct content analysis (study III), and Descriptive analysis (study II & IV). Inductive, deductive, and abductive reasonings were used to process the data to draw conclusions. Results: As self-empowered patients and informal caregivers, the second generation of e-patients generated health data and learned how to handle their situation from it. Further, they invented self-management solutions for themselves and their peers, as well as innovations to co-operate with healthcare professionals. This was done in line with support for their psychological needs; relatedness, competence, and autonomy. Still, to generate own data through self-tacking always came with the risk of being obsessed of their own condition. Other behaviors were experienced as forced upon the patients and informal caregivers and not completely voluntary, whereas some behaviors were wished to be expanded. This might lead to difficult situations with healthcare professionals, not having the time or understanding of these self-empowering behaviors. Still, there were overall positive attitudes from healthcare professionals, even though they lacked experiences of working together with self-empowered patients and especially informal caregivers. There were no existing workplace support or guidelines for meeting patients and informal caregivers with self-empowering behaviors. Conclusion: This thesis makes a unique contribution by analyzing patient self-empowerment as well as healthcare professionals’ attitudes towards self-empowering behaviors. With a rather limited understanding of self-management tasks, healthcare professionals are here provided with a better understanding of self-empowering behaviors and needs among patients and informal caregivers. Self-empowerment will continue to influence the development of participatory healthcare. Hence, to understand the behaviors of the users of health care are essential to further develop towards experienced-based participatory design, person-centered health care, and support for healthcare professionals to partner with patients and informal caregivers in a joint empowerment

Exploring resilience for people with type 2 diabetes who have a wound

Comorbidities related to diabetes such as chronic wounds can increase the need for surgical procedures, with at least 10% of all patients undergoing surgery having diabetes. Being diagnosed with diabetes can be seen as a risk factor for developing wound healing problems. Discussion: This short report highlights the potential positive influences gained from providing resilience education and self- management education to people with type 2 diabetes, potentially enhancing self-managing abilities and reducing poor wound healing. Summary: Modern wound care practice is centred on symptom reduction and working with pathology; however, working with people to enhance their personal resilience and promoting positive psychological adaptation can impact positively on their mental health

Do people with intellectual disabilities understand their prescription medication? A scoping review

© 2019 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd.Background: People with intellectual disabilities are more likely to experience poor health than the general population and are frequently prescribed multiple medications. Therefore, it is important that people with intellectual disabilities understand their medication and potential adverse effects. Method: A scoping review explored people with intellectual disabilities' knowledge of prescription medications, their risks and how medication understanding can be improved. Results: Ten journal articles were included. People with intellectual disabilities often lacked understanding of their medication, including its name, purpose and when and how to take it. Participants were often confused or unaware of adverse effects associated with their medication. Information was sometimes explained to carers rather than people with intellectual disabilities. Some interventions and accessible information helped to improve knowledge in people with intellectual disabilities. Conclusion: There is a need for accessible and tailored information about medication to be discussed with people with intellectual disabilities in order to meet legal and best practice standards.Peer reviewe