Children and young people’s experiences and perceptions of self-management of type 1 diabetes: A qualitative meta-synthesis

The aim of this review was to conduct a meta-synthesis of the experiences and perceptions of self-management of type 1 diabetes of children and young people living with type 1 diabetes (CYPDs). Six databases were systematically searched for studies with qualitative findings relevant to CYPDs’ (aged 8–18 years) experiences of self-management. A thematic synthesis approach was used to combine articles and identify analytical themes. Forty articles met the inclusion criteria. Two analytical themes important to CYPDs’ experiences and perceptions of self-management were identified: (1) negotiating independence and (2) feeling in control. The synthesis contributes to knowledge on contextual factors underpinning self-management and what facilitates or impedes transition towards autonomous self-management for CYPDs

Living a healthy life : an evaluation of a self-management for chronic conditions course, Arthritis New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science (Health Psychology) at Massey University

Chronic disease management is a major challenge for health care systems in the developed world. Self-management has the ability to help improve health status, health behaviours and reduce health care utilisation for people with chronic disease. In this exploratory before-after cohort study, questionnaires were distributed to people with chronic disease attending a self-management course offered by Arthritis New Zealand. Ninety-four people at baseline, and at six months, 67 people, completed eight health status, four health behaviour, one self-efficacy, and six health care utilisation measures. The 67 participants at six months also completed seven course evaluation measures in addition to course delivery, social support, course barrier and course attendance measures. The relationship at onset between self-efficacy and health status was analysed using a stepwise regression. Self-efficacy, which accounted for 27% of variance, was significantly related to health distress and to the energy levels of participants. To determine the relationship between self-efficacy and self-management behaviours at baseline, standard multiple regressions were run. Self-efficacy was unrelated to the self- management behaviours of the participants at the course onset. To analyse the mediation effect of self-efficacy on health status a stepwise regression was run, while holding self-efficacy constant. Self-efficacy at six months explained 42% of the variance in baseline self-efficacy, after controlling for baseline self-efficacy in the second model, self-efficacy at six months was significantly related to perceived illness intrusiveness and accounted for an additional 58% of the variance. Two hierarchical stepwise-regressions assessed the mediation effect of self-efficacy on self-management behaviours. Self-efficacy at six months accounted for no additional variance in the participants' self-management skills. Paired t-tests and Wilcoxon matched-pairs signed ranks measured changes in health status, self-efficacy, health behaviours and health care utilisation. No significant improvements occurred in health status. Significant improvements occurred in four health outcomes. Independent t-tests and the Mann- Whitney tests identified significant differences between gender, age and location with health status, health behaviour and health care utilisation outcomes at baseline and at six months. The process evaluation of the course showed general satisfaction. Explanations for the results are offered, limitations of the study are highlighted, and suggestions for future chronic disease self-management research are proposed

How people with diabetes integrate self-monitoring of blood glucose into their self-management strategies

Background The benefit of self-monitoring of blood glucose by patients has been questioned, and UK policy is generally not to support this, although it is identified that there may be unidentified subgroups of people who would benefit from being supported to self-monitor. The purpose of this paper is to explore the self-management approaches of people with diabetes, and how self-testing of blood glucose contributes to self-management strategies. Methods This qualitative study of patients’ experiences drew data from contributors to online discussion boards for people living with diabetes. The principles of qualitative content analysis were used on posts from a sample of four Internet discussion boards. Results Contributors described how they were using self-testing within their self-management strategies. Most saw it as a way of actively maintaining control of their condition. The amount of testing carried varied over time; more testing was done in the early days, when people were still learning how to stay in control of their diabetes. Some people had experienced a lack of support for self-testing from healthcare professionals, or had been expected to change their self-management to fit national policy changes. This was seen as unhelpful, demotivating, stressful, and harmful to the doctor–patient relationship. Conclusions The Internet is a valuable source of information about peoples’ self-management behaviours. Patients who are using, or who wish to use, self-testing as part of their self-management strategy are one of the subgroups for whom self testing is beneficial and who should be supported to do so

Review: Self-management Support Program on Dietary Behaviors in Patients with Type 2 Diabetes Mellitus

Background: Dietary behaviors are the cornerstone in diabetes management. Diabetes self-management support program in which patients play an active role to determine their health care is an important strategy to improve dietary behaviors in type 2 diabetes mellitus (T2DM) patients. Its elements which contribute to the successfulness of the program need to be identified.Purpose: To review and identify the elements of self-management support program to improve dietary behaviors in T2DM patients.Method: An integrative review was conducted. Relevant studies published in English language during last 10-year, measured dietary behaviors in T2DM patients, and retrieved from CINAHL and PubMed were included.Results: 13 experimental studies and 3 meta-analysis studies were reviewed. Goal setting and action planning combined with other strategies (brief counseling and problem solving) seemed more effective to improve dietary behaviors. Either trained lay people or clinicians could lead the program although clinician-led programs were common. Contents and materials of the education vary across the studies. The effects on dietary behaviors could be detected in short term duration of program (<6 months). Continuing follow-up was essential element which face-to-face follow-up as the most common strategy. The utilization of technology such as telephone-call and internet based follow-up might provide more benefits for patients.Conclusion: Diabetes self-management support program is effective to improve dietary behaviors in T2DM patients. Further research is needed to test the effectiveness of goal setting strategy and technology utilization for follow-up strategy such telephone call in Indonesian T2DM population

Group Education for patients with rheumatoid arthritis

Patients with rheumatoid arthritis must learn to adjust their exercise, rest and medication to the varying activity of the disease. Patient education can help patients in making the right decisions about adjustments in their treatment regimen and in attaining ¿self-management¿ behaviors. We developed a group education program based on social learning theory and the `Arthritis Self Management Course¿ developed in the USA by Lorig. Goal of the program is the strengthening of self-efficacy, outcome expectations and self-management behaviors of RA patients which may lead to better health status. The program has been evaluated in an experimental design. We established significant positive effects of the group training on functional disability, joint tenderness, practice of relaxation and physical exercises, self-management behavior, outcome expectations, self-efficacy function and knowledge. After 14 months we still found effects on practice of physical exercises, self-efficacy function and knowledge

Self-organising management of Grid environments

This paper presents basic concepts, architectural principles and algorithms for efficient resource and security management in cluster computing environments and the Grid. The work presented in this paper is funded by BTExacT and the EPSRC project SO-GRM (GR/S21939)