The experience of facilitators and participants of long term condition self-management group programmes: a qualitative synthesis

Objective: Our aim was to systematically review the qualitative literature about the experiences of both facilitators and participants in a range of group-based programmes to support the self-management of long-term conditions. Methods: We searched 7 databases using the terms ‘self-management’, ‘group’ and ‘qualitative’. Full text articles meeting the inclusion criteria were retrieved for review. A thematic synthesis approach was used to analyse the studies. Results: 2126 articles were identified and 24 were included for review. Group participants valued being with similar others and perceived peer support benefits. Facilitators (HCP and lay) had limited group specific training, were uncertain of purpose and prioritised education and medical conformity over supportive group processes and the promotion of self-management agency and engagement. Overall, studies prioritised positive descriptions. Conclusion: Group programmes’ medical self-management focus may reduce their ability to contribute to patient-valued outcomes. Further research is needed to explore this disconnect. Practice implications: This review supports broadening the scope of group-based programmes to foreground shared learning, social support and development of agency. It is of relevance to developers and facilitators of group self-management programmes and their ability to address the burden of long-term conditions

How do facilitators of group programmes for long-term conditions conceptualise self-management support?

Objectives: Increasing self-management skills in people with long-term conditions is widely advocated in policies and guidelines. Group programmes are a common format; yet, how self-management support objectives are enacted in their delivery is poorly understood. Our aim is to explore the perspectives of group programme facilitators. Methods: We undertook thematic analysis of transcribed data from in-depth semi-structured interviews with health professional facilitators (n = 13) from six diverse self-management support group programmes (of obesity, diabetes and chronic obstructive pulmonary disease). Results: Facilitators viewed group programmes as responses to health system pressures, e.g. high patient demand. They focussed on providing in-depth education and instruction on physical health, risks and lifestyle behaviour change and emphasised self-responsibility for behaviour change whilst minimising goal setting and support amongst group participants. There were tensions between facilitators’ professional identity and group leader role

Educating for Complexity In Nursing Practice: A Baccalaureate Curriculum Innovation

This expository article describes an overview of salient changes made to a baccalaureate curriculum to meet the ever changing demands of health care, professional nursing practice, and post-secondary education. The innovations were embedded in the tenets of complexity science, mandates of our professional practice, the contextual relevance of the curriculum and the scholarship of integrative learning. The curriculum is present and future oriented, evidence-based and relevant. The curricular structure shifts content and pedagogy from the traditional stance. The planned and integrative semester course design is greater than the sum of its parts; course content is carefully chosen to illustrate the integrative nature of health and illness, and taken together, these strategies prevent notions of simple to complex learning. The shift from a traditional curricular approach necessitated the examination of how we optimized the use of scarce fiscal and physical educational resources and how we collaborated with all of our stakeholders. Résumé Cet article vise à donner un aperçu des principales modifications apportées à un programme de baccalauréat en vue de répondre aux demandes en constante évolution aux niveaux des soins de santé, de la pratique professionnelle de l’infirmière et de la formation postsecondaire. Les innovations dont il y est question s’inspirent des principes de la science de la complexité, des mandats de notre pratique professionnelle, de la pertinence contextuelle du programme d’études ainsi que de l’avancement des connaissances relatives à l’apprentissage intégré. Le programme, axé sur le présent et l’avenir, est à la fois pertinent et fondé sur des connaissances scientifiques. Dans cette nouvelle structure de programme, le contenu et la pédagogie s’éloignent de l’orientation traditionnelle. La planification intégrée des cours d’un semestre permet d’obtenir un résultat supérieur à la somme des parties. Le contenu des cours est choisi minutieusement afin d’illustrer la nature intégrative de la santé et de la maladie, et ensemble, les stratégies adoptées permettent de dépasser les notions d’apprentissage du plus simple au plus complexe. Pour s’éloigner d’une approche traditionnelle de programme, il a été nécessaire d’examiner les façons dont nous pouvons optimiser l’utilisation de nos ressources limitées sur les plans budgétaire, physique et des ressources éducatives, ainsi que nos façons de collaborer avec tous nos partenaires

Goal setting in group programmes for long-term condition self-management support: experiences of patients and healthcare professionals

Objective: To examine group facilitators’ and participants’ experiences of and engagement with goal setting in long-term condition (LTC) self-management group programmes. Design: We conducted a qualitative mixed method study including 13 interviews with group facilitators, 20 interviews with group participants and content analysis of programme workbooks. Participant interviews explored their goals for managing their condition. Facilitator interviews explored their goals for participants. Data from the three sources were analysed inductively and thematically. Results: The three themes showed: 1. Participants have personal and meaningful biomedical, social and emotional goals and, facilitators believe these goals to be important and perceive them as integral to increasing motivation and self-responsibility; 2. Facilitators shape participants’ goals into pre-determined health behaviour change activities, disregarding social and emotional aspects; and 3. Participant disengagement from the goal setting process and questioning of the value of goal setting was evident. Conclusions: Patient engagement with goal setting may be less attainable when what matters to people is sidelined to focus on behaviour change goals and self-responsibility. Yet, supporting people to identify and pursue meaningful goals for living with LTCs is more likely to increase engagement and motivation. Stakeholders in group programme development and delivery should review their goal setting activities

Toward an Understanding of (Em)Power(Ment) for HIV/AIDS Prevention with Adolescent Women

Adolescent females, particularly urban and low-income youth of color, are at particular risk for HIV infection. This article uses an empowerment perspective to consider the degree to which intrapersonal and interpersonal power dynamics in heterosexual relations have an impact on condom use among high-risk youth. Participants in this study were 333 African American and European American urban youth, ages 14–19 years, who were heterosexually active. Measures focused on interpersonal and intrapersonal factors thought to be associated with condom use. This model was most useful in predicting condom use among women and least useful in predicting condom use among male participants. Implications for empowerment theory and future research are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45621/1/11199_2004_Article_224330.pd

Digging deeper: quality of patient-provider communication across Hispanic subgroups

<p>Abstract</p> <p>Background</p> <p>Recent research suggests that ethnic subgroup designation plays an important role in health-related disparities among Hispanics. Our objective was to examine the influence of Hispanics' self-reported ethnic subgroup designation on perceptions of their health care providers' communication behaviors.</p> <p>Methods</p> <p>Cross-sectional analysis of the 2005 Medical Expenditure Panel Survey (MEPS). Participants included non-institutionalized Hispanics (n = 5197; US population estimate = 27,070,906), aged ≥18 years, reporting visiting a health care provider within the past 12 months. Six (n = 6) items were used to capture respondents' perceptions of their health care providers' communication behaviors.</p> <p>Results</p> <p>After controlling for socio-demographic covariates, compared to Other Hispanics (reference group), very few differences in perceptions of health care providers communication emerged across ethnic subgroups. Puerto Ricans were more likely to report that their health care provider "always" showed respect for what they had to say (OR = 2.16, 95% CI 1.16-4.03). Both Puerto Ricans (OR = 2.28, 95% CI 1.06-4.92) and Mexicans (OR = 1.88, 95% CI 1.02-3.46) were more likely to indicate that their health care provider "always" spent enough time with them as compared to Other Hispanics.</p> <p>Conclusions</p> <p>We observed very few differences among Hispanics respondents in their perceived quality of interactions with health care providers as a function of their ethnic subgroup designation. While our findings somewhat contradict previous research, they do suggest that other underlying factors may influence the quality of perceived interactions with health care providers.</p

Can a reflective rubric be applied consistently with raters globally? A study across three countries

Introduction Reflection is a powerful tool for assisting students to develop the skills to make better informed decisions. As a pharmacy competency standard, reliable and fair assessment strategies are required to measure reflective skills and support students in developing their reflective capacity. The aim of this research was to explore whether we can extend the applicability of a previously tested rubric to a range of educational settings, to account for diversity of pharmacy educators and curricula internationally. Methods Four raters from three countries applied a reflective rubric to assess a sample (n = 43) of reflective accounts, representing 41% of a cohort of 105 second-year undergraduate pharmacy students. The interrater reliability (IRR) was measured utilizing the intra-class correlation coefficient (ICC), using a two-way random effects model with absolute agreement, to determine the level of agreement between the raters' absolute scores. Generalizability Theory analysis was used to estimate generalizability of raters and stages. Results Results indicated agreement of raters for (i) each of the seven stages of reflection and (ii) overall score for the reflective account, with moderate to substantial agreement (ICC = 0.55–0.69, p < 0.001); and high agreement for all raters for the overall score (ICC = 0.96, p < 0.001), respectively. The G-Study estimated a relative error coefficient of 0.78. Conclusion This additional analysis further confirms the reliability and applicability of the rubric to a range of rater academic backgrounds

Aflatoxin Contamination of Commercial Maize Products during an Outbreak of Acute Aflatoxicosis in Eastern and Central Kenya

In April 2004, one of the largest aflatoxicosis outbreaks occurred in rural Kenya, resulting in 317 cases and 125 deaths. Aflatoxin-contaminated homegrown maize was the source of the outbreak, but the extent of regional contamination and status of maize in commercial markets (market maize) were unknown. We conducted a cross-sectional survey to assess the extent of market maize contamination and evaluate the relationship between market maize aflatoxin and the aflatoxicosis outbreak. We surveyed 65 markets and 243 maize vendors and collected 350 maize products in the most affected districts. Fifty-five percent of maize products had aflatoxin levels greater than the Kenyan regulatory limit of 20 ppb, 35% had levels > 100 ppb, and 7% had levels > 1,000 ppb. Makueni, the district with the most aflatoxicosis case-patients, had significantly higher market maize aflatoxin than did Thika, the study district with fewest case-patients (geometric mean aflatoxin = 52.91 ppb vs. 7.52 ppb, p = 0.0004). Maize obtained from local farms in the affected area was significantly more likely to have aflatoxin levels > 20 ppb compared with maize bought from other regions of Kenya or other countries (odds ratio = 2.71; 95% confidence interval, 1.12–6.59). Contaminated homegrown maize bought from local farms in the affected area entered the distribution system, resulting in widespread aflatoxin contamination of market maize. Contaminated market maize, purchased by farmers after their homegrown supplies are exhausted, may represent a source of continued exposure to aflatoxin. Efforts to successfully interrupt exposure to aflatoxin during an outbreak must consider the potential role of the market system in sustaining exposure

A consideration of the challenges involved in supervising international masters students

This paper explores the challenges facing supervisors of international postgraduate students at the dissertation stage of the masters programme. The central problems of time pressure, language difficulties, a lack of critical analysis and a prevalence of personal problems among international students are discussed. This paper makes recommendations for the improvement of language and critical thinking skills, and questions the future policy of language requirements at HE for international Masters students