Individual differences in processes of lifestyle changes among people with obesity: an acceptance and commitment therapy (ACT) intervention in a primary health care setting.

AIM: To explore what thoughts, feelings, and learning processes were involved in obese participants' lifestyle change during an acceptance and commitment therapy (ACT) lifestyle intervention delivered in primary health care. BACKGROUND: Previous studies have revealed that lifestyle interventions are effective at promoting initial weight loss, but reduced weight is often difficult to sustain because of the failure to maintain healthy lifestyle changes. Achieving and maintaining lifestyle changes requires to learn self-regulation skills. ACT-based lifestyle interventions combine many self-regulatory skill factors, and the results from previous studies are promising. Research on the individual learning processes of lifestyle change is still needed. METHODS: This study investigated a subset of data from a larger web-based lifestyle intervention. This subset consisted of online logbooks written by 17 obese participants (n = 17, body mass index mean 41.26 kg/m2) during the six-week online module. The logbooks were analyzed via data-driven content analysis. FINDINGS: Four groups were identified based on the participants being at different phases in their lifestyle changes: stuck with barriers, slowly forward, reflective and hardworking, and convincingly forward with the help of concrete goals. Differences between the groups were manifested in personal barriers, goal setting, training of mindfulness and acceptance, and achieving healthy actions. The ACT-based lifestyle intervention offered participants an opportunity to reflect on how their thoughts and feelings may hinder healthy lifestyle changes and provided tools for learning psychological flexibility.

Implementation and Outcomes of Lay Health Worker-Led Self-Management Interventions for Long-Term Conditions and Prevention: A Systematic Review.

The aim of this study was to systematically review lay health worker (LHW)-led self-management interventions for adults with long-term conditions to see how the interventions have been implemented and to compose a synthesis of research findings, taking into consideration the intervention components that have been applied. We conducted systematic searches for articles published between January 2010 and December 2015 in five databases: Cochrane, MEDLINE, CINAHL, PsycINFO, and Web of Science. Forty original studies were found that met the inclusion criteria: self-management with diabetes (n = 29), cardiovascular diseases (n = 8), and those at risk of cardiovascular diseases (n = 3). These consisted of 22 randomized controlled trials and 18 other trials, with durations of 1 day to 24 months. The findings showed that the training of LHWs and the implementation of interventions varied widely. A synthesis of the implementation methods covers the background of the LHWs and the interventions as well as the components applied in each. Eight interventions had effects on physical activity and eight on nutrition behavior. The review also includes preliminary findings on intervention components effective in improving physical activity and nutrition behavior, including self-monitoring as a behavior change technique and group meetings as an intervention format. The same components and behavior change techniques were applied in effective and noneffective interventions. The review found that LHW-led interventions have potential in promoting self-management in long-term condition. In the future, a qualified and evidence-based structure for LHW-led interventions is suggested in order to improve the systematization of interventions and their effects.

A patient as a self-manager of their personal data on health and disease with new technology--challenges for nursing education.

Background: Digital technologies have transformed nearly every aspect of our lives. However, for many of us, they have not yet improved the way we receive or participate in our health services and disease care. Hostetter et al. (2014) explore in a new multimedia essay the changes occurring with the arrival of new digital tools, from mobile apps and data-driven software solutions to wearable sensors that transmit information to a patient's team of health care providers. Digitisation will revolutionise health technology to a new extent, as the self-measurement, cloud services, teleconsultation and robotics technologies are being used to get health expenditure under control. In the future, robots will dispense drugs, and treatment routines will utilise cloud services (Biesdorf and Niedermann, 2014; Grain and Sharper, 2013). According to the rationale of the Horizon 2020 (European Commission, 2013b) work programme, personalising health and care has been stated to empower citizens and patients to manage their own health and disease, which can result in more cost-effective healthcare systems by enabling the management of chronic diseases outside institutions, improving health outcomes, and by encouraging healthy citizens to remain so. Solutions should be developed and tested with the use of open innovation platforms, such as large-scale demonstrators for health and service innovation. It is a fact that ICT/new health technology and personal health applications are transforming patients' self-management in many ways. A huge amount of personal health application solutions are being offered in the marketplace, which engage in activities that promote health, monitoring the symptoms and signs of illness, and managing the impact of illness (European Commission eHealth Action Plan 2012-2020, 2012). The WHO (2011) has conducted a comprehensive study and published a report on Member States' use of mHealth (mobile Health) as well as the readiness and barriers to its use. The percentage of countries reporting that they had formally evaluated mHealth initiatives was 12%. Seven per cent of developing countries reported conducting a mHealth evaluation. Mobile technologies have already changed, and they will continue to change the lives of millions around the world. In the WHO's report, it was estimated that mHealth can revolutionise health and well-being outcomes if implemented strategically and systematically, thereby providing virtually anyone with a mobile phone with health and well-being expertise and knowledge in real-time. In the research reports (European Commission eHealth Action Plan 2012-2020, 2012; Blake, 2013), it was reported that mobile phones as a tool are cost-effective and wide reaching, while they easily target large samples and hard-to-reach groups. Studies show that eHealth as a way to self-monitor and self-manage as well as supportive interventions for clients offers a good possibility to bridge the gap between inpatient and outpatient care. The mobile phone is especially effective in enhancing the therapist-patient bond so that this does not collapse when the client leaves the therapist's consulting room. Furthermore, eHealth applications can assist the client to cope with everyday situations in an autonomous way while improving the transfer of the abilities acquired by the client in the health care setting to everyday life. The findings of various projects (European Commission eHealth Action Plan 2012-2020, 2012; European Commission, 2012; European Commission, 2013b; Hämäläinen, 2013) provide an opportunity for an open discussion regarding the digital health revolution, which will change health care processes and citizens' applications for health promotion and self-care.