The critical elements of digital health in diabetes and cardiometabolic care.

Digital innovations provide novel opportunities to individualize a person's care to best match their lifestyle needs and circumstances and to support them as they live their daily lives with diabetes. These innovations also serve to provide actionable data and insights for the care team giving them a "Webb telescope-like" view into their individual self-management journey, allowing them to see what cannot be seen during infrequent and limited office visits, thereby facilitating collaboration and communication to optimize the care plan on a timely basis. Technology advances are enabling diabetes care to transition from episodic, synchronous, primarily in-person care to include synchronous virtual care options and to continuous, on-demand, data-informed, asynchronous digital care better matching the demands of living with a relentless 24/7 chronic condition. In this paper we will discuss the critical elements and considerations in designing and implementing successful diabetes digital health tools in clinical practice.

Technology-Based Interventions to Promote Diabetes Self-Management Behaviors for Persons Newly Diagnosed with Type 2 Diabetes: A Scoping Review.

PURPOSE OF REVIEW: Type 2 diabetes (T2D) management is complex and requires daily personal involvement and self-management skills to maintain optimal glycemic levels and improve health outcomes. Engagement in self-management behaviors in the early years of diagnosis can be challenging due to prevailing psychosocial factors present during this critical transition period, coupled with a lack of information, support, and skills. Technology-based diabetes self-management interventions can improve access to needed education and support, and their effectiveness in the general T2D population is well documented. This scoping review synthesized evidence on the use of technology for promoting diabetes self-management behaviors and related outcomes among individuals newly diagnosed with T2D (within the first 12 months since diagnosis). RECENT FINDINGS: Twenty-five studies were included. Technology-based diabetes self-management interventions tailored to those newly diagnosed with T2D have grown exponentially in the past five years. Existing evidence, though limited, showed that technologies such as websites, mobile apps, and continuous glucose monitoring combined with other communication features, can facilitate patient education, patient-provider communication, and health data monitoring. However, these technologies less commonly involved social support functions. These technologies have the potential to improve diabetes knowledge and positively impact clinical, behavioral, and psychological outcomes. However, small sample sizes, use of non-experimental designs, and the absence of formative research and theoretical foundations limit the strength of existing studies. Technology-based self-management interventions for those newly diagnosed with T2D show promise in improving T2D-related outcomes. Future studies should include larger sample sizes, adopt rigorous study designs, and integrate formative work to enhance relevance, adoption, and impact.

Diabetes distress profiles and health outcomes of individuals with type 2 diabetes and overweight/obesity: A cluster analysis.

AIMS: To determine the prevalence and patterns of diabetes distress, and evaluate the differences in health outcomes between profiles. METHODS: This cross-sectional study included 330 adults with T2DM and overweight/obesity. The participants completed questionnaires on diabetes distress, sleep quality, self-efficacy, depression, anxiety and positive and negative affect. A cluster analysis was performed to identify different patterns of diabetes distress and one-way ANOVA was used to investigate the differences in physical and psychological outcomes between profiles. RESULTS: 30.6% of patients were identified as moderately to highly distressed, with the regimen-related distress found to be the most prominent. The Cluster analysis revealed four distinct clusters: (1) "comprehensively exhausted profile"; (2) "strained profile"; (3) "high internal anguish profile"; (4) "unperturbed profile". The measures of fasting blood glucose (FBG), glycated hemoglobin (HbA1c), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, sleep quality, depression, anxiety, positive and negative affect and self-efficacy differ between clusters. CONCLUSIONS: This study identified important differences that existed in patterns of diabetes distress among people with T2DM and overweight/obesity, and this variation can be utilized to tailor intervention strategies to the particular needs of different subgroups within individuals with T2DM.

Facilitators and challenges of implementing a digital patient education programme for rheumatoid arthritis into clinical practice.

BACKGROUND: The integration of telehealth interventions into clinical practice is frequently delayed, hindering the full adoption. Previously, we developed a digital patient education (PE) programme for self-management in rheumatoid arthritis (RA). While the programme design considered crucial factors to ensure the likelihood of success in clinical practice, there is a need for a systematic evaluation of implementation perspectives. The purpose of this study was to explore perspectives crucial to implementation of a digital PE programme in clinical practice. METHODS: The non-adoption, abandonment, scale-up, spread and sustainability (NASSS) framework was used to evaluate the successes and challenges of implementing the digital PE programme. We included a data set consisting of qualitative focus group discussions involving study nurses, rheumatologists, and leaders from rheumatology departments. Data analysis was guided by a deductive content analysis approach. Further we included data from earlier studies pertaining to the programme's implementation, comprising the programme development process, a randomized controlled trial evaluating the programme's effectiveness, and a qualitative study exploring patients' perspectives of the programme. RESULTS: Facilitators and challenges of importance to implementation of digital PE were identified. While a wide range of patients could benefit from using digital PE, future implementation should aim for an even broader group than those studied. Both patients and healthcare providers embraced the technology, and the fact that it did not require specific technical skills enhances its potential for success. However, offering digital PE should be based on individual assessments, and expanding its use will require organizational adjustments. An adaptable structure is needed to accommodate unforeseen care needs that may arise following the use of digital PE at home. There was indication of some reluctance among healthcare providers toward the programme shown by concerns about changing roles, which could impact the adoption of the program. CONCLUSIONS: The design and ease of use of the technology, the program's effectiveness, its availability, and the potential to release healthcare resources may encourage the implementation of digital patient education. Challenges associated with implementing this mode of care pertains to the condition and the patient population, user adoption of the technology, and the organization of patient education. TRIAL REGISTRATION: The study is registered by the Central Denmark Region Scientific Committee (no. 1-16-02-52-19).

Self-management support from health care providers in Shared Medical Appointments: Didactic techniques, peer learning, group dynamics and motivation.

Objective: We investigated the support of self-management by health care providers (HCP) in prenatal Shared Medical Appointments (SMA). Methods: on an topic list, semi-structured interviews were conducted. HCP who provided prenatal care in SMA in the last five years were recruited. Thematic analysis was used. Results: We conducted 15 interviews. Four research themes were defined: didactic techniques, peer learning, motivation and the health care providers. Self-management support in SMA is based on peer-learning and is influenced by group dynamics. HCP play a role in the creation of an effective learning climate by using practical and communication techniques. HCP motivate participants for self-management through peer learning and person centered care. HCP need certain personality traits and leadership skills. Conclusion: Self-management support in SMA is based on peer-learning and is influenced by group dynamics. HCP create an effective learning climate using practical and communication techniques and motivate participants for self-management through peer learning and person-centered care. Innovation: This is the first study that gives insight in self-management support in SMA. HCP and medical schools should be aware of the fact that HCP in SMA need insight in didactic techniques, peer learning, group dynamics and leadership skills.

Recommendations to Address Barriers to Patient Portal Use Among Persons With Diabetes Seeking Care at Community Health Centers: Interview Study With Patients and Health Care Providers.

BACKGROUND: Community health centers (CHCs) are safety-net health care facilities in the United States that provide care for a substantial number of low-income, non-English speaking adults with type 2 diabetes (T2D). Whereas patient portals have been shown to be associated with significant improvements in diabetes self-management and outcomes, they remain underused in CHCs. In addition, little is known about the specific barriers to and facilitators of patient portal use in CHCs and strategies to address the barriers. OBJECTIVE: The objectives of this qualitative study were to explore the barriers to and facilitators of the use of patient portals for managing diabetes in 2 CHCs from the perspective of adults with T2D and clinicians (community health workers, nurses, nurse practitioners, and physicians) and to make recommendations on strategies to enhance use. METHODS: A qualitative description design was used. A total of 21 participants (n=13, 62% clinicians and n=8, 38% adults with T2D) were purposively and conveniently selected from 2 CHCs. Adults with T2D were included if they were an established patient of one of the partner CHCs, aged ≥18 years, diagnosed with T2D ≥6 months, and able to read English or Spanish. Clinicians at our partner CHCs who provided care or services for adults with T2D were eligible for this study. Semistructured interviews were conducted in either Spanish or English based on participant preference. Interviews were audio-recorded and transcribed. Spanish interviews were translated into English by a bilingual research assistant. Data were collected between October 5, 2022, and March 16, 2023. Data were analyzed using a rapid content analysis method. Standards of rigor were implemented. RESULTS: Themes generated from interviews included perceived usefulness and challenges of the patient portal, strategies to improve patient portal use, and challenges in diabetes self-management. Participants were enthusiastic about the potential of the portal to improve access to health information and patient-clinician communication. However, challenges of health and technology literacy, maintaining engagement, and clinician burden were identified. Standardized implementation strategies were recommended to raise awareness of patient portal benefits, provide simplified training and technology support, change clinic workflow to triage messages, customize portal notification messages, minimize clinician burden, and enhance the ease with which blood glucose data can be uploaded into the portal. CONCLUSIONS: Adults with T2D and clinicians at CHCs continue to report pervasive challenges to patient portal use in CHCs. Providing training and technical support on patient portal use for patients with low health literacy at CHCs is a critical next step. Implementing standardized patient portal strategies to address the unique needs of patients receiving care at CHCs also has the potential to improve health equity and health outcomes associated with patient portal use.

Enhancing self-management of patients with inflammatory bowel disease: the role of autonomy support in health goal pursuit.

Background: Inflammatory bowel disease (IBD) is a chronic condition that significantly affects patients' physical, mental, and social health, as well as their overall quality of life. Effective management of the disease demands self-management skills, enabling patients to navigate the daily challenges associated with IBD, such as unpredictable flare-ups, frequent hospitalization, severe symptoms, pain, and physical changes. Objectives: This study examines the motivational aspects of self-management for patients with IBD and focuses on the role of autonomy and directive support from healthcare professionals in enhancing their self-concordance and self-efficacy. Design: From November 2022 to February 2023, a cross-sectional questionnaire study was conducted at the IBD Center of Internal Medicine Clinic in Szeged, Hungary. Methods: A total of 374 adult patients with IBD completed the paper-pencil questionnaire, of whom 241 patients (64.4%) had Crohn's disease, and 133 patients (35.6%) had ulcerative colitis. Results: Based on the findings of the path analysis (χ2 (8) = 18.914, p = 0.01, comparative fit index = 0.935, TLI = 0.837, root mean squared error of approximation = 0.06), autonomy support positively predicted self-concordance (ß = 0.48) and self-efficacy (ß = 0.02), particularly during disease relapse. In addition, self-concordance and self-efficacy predicted more positive (ßs = 0.28 and 0.35) and fewer negative emotional experiences (ßs = -0.09 and -0.20). The model's associations varied between the relapse and remission groups, indicating distinct impacts on different states of the disease. Conclusion: Overall, autonomy support from healthcare professionals has been shown to enhance self-management in patients with IBD, particularly during disease relapse. Meanwhile, self-concordance and self-efficacy act as positive internal factors, thus reducing negative emotional experiences, especially during remission. In sum, this study underscores the need for further exploration of the motivational aspects of self-management and provides insights into developing interventions that promote the health behaviors of patients with IBD.

Self-management of inflammatory bowel disease patients Autonomy support from healthcare professionals has been shown to significantly improve the effectiveness of self-management in patients with inflammatory bowel disease (IBD) (especially during disease relapse), by enhancing their self-concordance and self-efficacy. In this case, the interplay between disease activity, positive and negative emotions, and self-regulatory mechanisms underscores the importance of examining the motivational aspects for developing interventions that promote health behaviors in patients with IBD.

The Relationship Between Benefit Finding and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease: The Mediating Effects of Self-Management.

Objective: To explore the relationships among benefit finding (BF), self-management, and quality of life (QOL) among patients with COPD. Methods: A total of 205 patients with COPD were selected via a convenient sampling method. BF refers to the ability to find meaning or benefit from difficult situations. The Benefit Finding Scale (BFS), self-management scale, and 36-item Short-Form Health Survey (MOS SF-36) were used to investigate BF, self-management and QOL (including a physical component summary (PCS) and a psychological component summary (MCS)). Structural equation modeling was used to examine the relationships among BF, self-management and QOL in patients with COPD and to analyze the effects of BF and self-management on QOL. Results: The total QOL score of patients with COPD was 61.38±21.15, and the PCS and MCS scores were 57.67±23.60 and 65.09±21.24, respectively. BF and self-management had positive predictive effects on both the PCS (ßBF = 0.519, PBF = 0.012; ßself-management = 0.473, Pself-management = 0.012) and MCS (ßBF = 0.425, PBF = 0.013; ßself-management = 0.535, Pself-management = 0.016) of patients with COPD, and self-management mediated the relationships of BF with the PCS (ß = 0.144, P = 0.008) and MCS (ß = 0.162, P = 0.007). Conclusion: The QOL of patients with COPD needs to be improved, especially in terms of physical aspects. Helping COPD patients obtain better BF not only helps them improve their PCS and MCS directly but also indirectly through enhancing self-management to improve their PCS and MCS.

Qualitative study on health self-management of patients with metabolic syndrome among bereaved population after earthquake.

The study explore the influencing factors and healthy self-management of MS patients with bereaved relatives after Wenchuan and Yushu Earthquake of their real life; explore difficulties and challenges in the process of self-management; and supply information that could not be sought in quantitative studies. Purposive sampling was used to recruit 36 MS patients who are bereavement population in two earthquakes, and those patients met the inclusion criteria for semi-structured focus group interview. The Nvivo11 software was used to collate and analyze the transcribed data. The main influencing factors of health self-management behavior for MS patients are as follows: the degree of understanding of disease prevention knowledge, emotion management induced by earthquake trauma, the source of disease-related information, access and identification are very limited; ethnic traditional culture, religious beliefs, and production activities and routines before and after the earthquake is an important factor in their healthy self-management behavior. The lack of health beliefs and self-efficacy of MS patients among bereaved families after Wenchuan and Yushu earthquake are key obstacle in their self-management. The overall level of the knowledge of patients' MS prevention, self-efficacy and self-management behaviors are still low. Some positive factors that can be changed including MS prevention knowledge, self-efficacy, social support, and family function. Some negative factors which can be improved afterwards, including negative coping style, traumatic life experiences from earthquake and smoking.

Examining the Relationship Between Social Support, Self-Efficacy, Diabetes Self-Management, and Quality of Life Among Rural Individuals With Type 2 Diabetes in Eastern China: Path Analytical Approach.

BACKGROUND: Patients with type 2 diabetes (T2D) in rural China frequently exhibit inadequate diabetes self-management (DSM) and a reduced quality of life (QoL). Social support and self-efficacy are known to influence DSM and QoL. However, the pathways through which social support and self-efficacy impact DSM and QoL among patients with T2D in rural China has yet to be fully elucidated. OBJECTIVE: This study offers a foundation for developing policies in rural chronic disease management, thereby, contributing to the improvement of T2D prevention and control in China and other transitional countries. METHODS: This study used a cross-sectional design, collecting data from a survey conducted between May and July 2021 on DSM and QoL among rural patients diagnosed with T2D in 2 townships in East China. All patients with T2D were enrolled through cluster sampling from the township health center database, and a questionnaire survey was administered by investigators. Structural equation modeling and multiple regression analyses were used to explore the pathways through which social support influences DSM and QoL, as well as the mediating role of self-efficacy. RESULTS: It was found that the DSM score (mean 37.42, SD 7.70) was less than half of the maximum theoretical score. The QoL score (mean 48.92, SD 8.88) accounted for 36% of the maximum theoretical score. Social support directly and positively affected the DSM and QoL of Chinese rural patients with T2D (P<.01); an increase of 1 unit in social support was associated with a direct increment of 0.339 units in DSM and 0.397 units in QoL. Self-efficacy played a positive mediating role (P<.01), further increasing DSM and QoL by 0.147 and 0.159 units, respectively. The mediating effect of self-efficacy accounted for 30.2% and 28.6% of the total effect of social support on DSM and QoL. Furthermore, the family and friend dimension of social support, along with the symptom and disease management dimensions of self-efficacy, were significantly associated with DSM or QoL (P<.01). CONCLUSIONS: The study confirmed the direct and indirect influences of social support on DSM and QoL and elucidated the mediating effect of self-efficacy among rural patients with T2D in eastern China. Interventions should be developed to enhance both social support and self-efficacy, creating a positive cycle of mutual reinforcement to improve DSM and QoL among this group.

The effectiveness of an individual and family self-management theory-based education program given for adolescents with epilepsy and parents: Randomized controlled trial.

BACKGROUND: This study focused on an online education program based on Individual and Family Self-Management Theory. PURPOSE: The study investigated whether the education program affected adolescents' attitudes toward epilepsy, seizure self-efficacy, quality of life, and their parents' perceived nurse-support levels. METHODS: The study is a single-blind, randomized, controlled trial. The study was conducted in the pediatric neurology outpatient clinic of a medical hospital between January 2021 and April 2022 in Konya. The sample consisted of adolescents with epilepsy (n = 36) and their parents (n = 36). The intervention group attended the education program in three main sessions, two weeks apart. The control group received routine education. Data were collected using a Child Demographics Form (CDF), a Parent Demographics Form (PDF), the Child Attitude Toward Illness Scale (CATIS), the Self-Efficacy Scale for Children with Epilepsy (SSES-C), the Pediatric Quality of Life Inventory (PedsQL), and the Nurse Parents Support Tool (NPST). The data were analyzed using descriptive statistics, Pearson's chi-square test, Fisher's Exact test, independent samples t-test, Mann-Whitney U test, Mixed design ANOVA analysis, Cohen's d, and 95 % confidence interval. This study adhered to CONSORT research guidelines. RESULTS: The intervention group adolescents had a significantly higher mean of all scale scores than the control group adolescents. The intervention group parents had a significantly higher mean NPST score than the control group parents. CONCLUSION: Healthcare professionals should organize theory-based online education programs for adolescents and their parents at regular intervals for the self-management of epilepsy in special situations, such as pandemics, where face-to-face education is impossible. PRACTICE IMPLICATIONS: The study revealed that, unlike existing cues that highlight the effectiveness of face-to-face education, online interventions will strengthen epilepsy self-management of children with epilepsy and their parents. In extreme situations where face-to-face education has to be postponed for a long time and in routine education interventions, it is recommended to plan and implement online education so that children with chronic diseases can maintain their self-management. CLINICALTRIALS: The paper is registered in the Clinical Trials database (NCT04822662).

Addressing emotional distress to improve outcomes in adults with type 1 diabetes: Protocol for ACT1VATE randomized controlled trial.

BACKGROUND: Diabetes distress (DD) is a prevalent concern among people with type 1 diabetes (T1D) and is linked to poor clinical outcomes. Instead of targeting the elimination of DD, we propose a novel approach that empowers individuals with strategies to manage their diabetes effectively in the context of DD: Acceptance and Commitment Therapy (ACT). The purpose of this in-progress trial is to compare an ACT group intervention (ACT1VATE) with usual care in improving HbA1c, DD, quality of life, and cost-effectiveness in adults with T1D. METHODS: This is a two-arm, parallel group, randomized controlled superiority trial enrolling N = 250 adults with T1D, elevated HbA1c, and significant DD in a real-world community-based health system. Participants are randomized to receive ACT1VATE (a five-week ACT group telehealth intervention) or diabetes self-management education and support (usual care as the first-line recommended intervention for DD). The trial will examine comparative effectiveness in improving HbA1c, DD, quality of life, and cost-effectiveness over 12 months. DISCUSSION: We predict that ACT1VATE will be superior given its (1) specific focus on DD, without any expectation that difficult diabetes-related thoughts and emotions must (or can) be completely eliminated; and (2) purposeful linkage of diabetes self-care behaviors to an individual's deeply held values, thus eliciting intrinsic, patient-centric motivation for meaningful and lasting health behavior changes. This trial will provide a valuable test of real-world effectiveness, drive sustainability and scalability, and inform the future of chronic disease care. TRIAL REGISTRATION: NCT04933851 (https://clinicaltrials.gov/ct2/show/NCT04933851). CLINICAL TRIAL: Clinicaltrials.govNCT04933851https://clinicaltrials.gov/study/NCT04933851.

Investigating Patient Perspectives on Using eHealth Technologies for the Self-Management of Inflammatory Bowel Disease: Mixed Methods Study.

BACKGROUND: Inflammatory bowel disease (IBD) poses significant challenges for patients, requiring continuous monitoring and self-management to improve quality of life. OBJECTIVE: This study aims to investigate the viewpoints of individuals living with IBD on the use of information and communication technology (ICT) for the self-management of their condition, with a particular focus on the concept of a "smart" toilet seat as an example of ICT for IBD self-management. METHODS: We conducted an analysis of questionnaire responses obtained from 724 participants. They were encouraged to share their use cases and identify any perceived barriers associated with ICT adoption for managing their condition. To assess their responses, we used descriptive quantitative analysis, summative content analysis, and thematic qualitative analysis. We combined these results in an epistemic network analysis to look for meaningful patterns in the responses. RESULTS: Of the 724 participants, more than half (n=405, 55.9%) were already using various forms of ICT for IBD self-management. The primary factor influencing their use of ICT was their affinity for interacting with technology. Distinct differences emerged between individuals who were using ICT and those who were not, particularly regarding their perceived use cases and concerns. CONCLUSIONS: This study provides valuable insights into the perspectives of individuals with IBD on the use of ICT for self-management. To facilitate wider adoption, addressing privacy concerns, ensuring data security, and establishing reliable ICT integration will be critical.

Self-management in the post-hair transplantation recovery period among patients with androgenetic alopecia: A qualitative study.

Background: The success of hair transplantation surgeries for androgenetic alopecia is evaluated by postoperative long-term outcomes. Patients' self-management during the long recovery period affects this outcome. Objective: This study aimed to explore patients' self-management status, facilitators, and impediments in the postoperative period and to provide a reference for developing a postoperative self-management intervention program. Methods: Patients who underwent hair transplantation for androgenetic alopecia were selected using purposive sampling. They were interviewed using one-to-one semi-structured interviews at a general tertiary hospital in Hangzhou from March to April 2022. Qualitative research analysis software Nvivo 12.0 was used to analyze the collected data. Results: The self-management of postoperative patients with androgenetic alopecia during the recovery period encompasses six areas: more problems with postoperative medication (e.g., not being able to take medication on time) and wound care (e.g., not daring to shampoo, etc.), not being able to review their postoperative condition on time (due to busy schedules at work and at home), more hindrances to the establishment of good living habits (affected by overtime work, socialising, and bad habits of the people around them), and seeking positive ways of relieving bad emotions (stress, anxiety, depression, etc.), worrying about one's image during recovery and taking the initiative to obtain and use resources to promote recovery (through the Internet, books, etc.). Conclusions: Various factors impact the postoperative self-management abilities of patients, including medication, shampooing, and emotions. It is essential to design support programs to enhance these abilities and improve long-term hair transplantation outcomes.

Age-based challenges to type 1 diabetes management in the pediatric population.

Type 1 diabetes is rising in the pediatric population, affecting approximately 1.2 million children and adolescents globally. Its complex pathogenesis involves the interaction between genetic predisposition and environmental factors, leading to T cell-mediated destruction of insulin-producing pancreatic beta-cells. This destruction results in insulin insufficiency and hyperglycemia. Hence, managing type 1 diabetes requires a comprehensive approach that includes various aspects such as blood glucose monitoring, insulin therapy, carbohydrate counting, caloric intake monitoring, considering family habits and food preferences, planning daily schedules, and incorporating physical activity. Children with type 1 diabetes encounter age-specific challenges in disease management that may exacerbate the risk of metabolic complications and adverse health outcomes. These risk factors may be neurological, physiological, behavioral, psychological, or social, complicate management and necessitate tailored approaches for effective care. Regardless of the age group, primary caregivers have a high responsibility to maintain optimal glycemic control, including monitoring diet, daily activity, and administering insulin. By reviewing research on the challenges faced by pediatric patients with type 1 diabetes, we summarized key insights aimed at developing targeted interventions and support systems that enhance diabetes management and improve health outcomes in this vulnerable population.

Pressure ulcer prevention for people with long-term neurological conditions (LTNCs) who self-manage care and live at home.

AIM: To develop a Theory of Change (ToC) pathway to facilitate the development of a multi-component intervention package supporting pressure Ulcer (PU) risk identification and management, in partnership with people with Long Term Neurological Conditions (LTNC) who self-manage care and live at home, their informal carers and PAs. METHODS: A participatory approach, with extensive input from those whose lives are the focus of the research, was used throughout the 4 interlinked work packages (WP): Iterative data analysis was undertaken with emerging findings from each WP informing subsequent stages of the study. FINDINGS: Overall, 74 participants contributed across the 4 WPs, incorporating 31 Service Users (SU), 8 carers, 9 Personal Assistants (PAs) and 26 professional stakeholders. We identified 8 key themes related to PU prevention, incorporating, learning, safe routines, third sector and peer support, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and supporting roles. The findings indicate systemic and professional barriers which hamper people's ability to self-care and seek help. CONCLUSIONS: The study highlights the complexities and impact of managing PU prevention activities at home for people with LTNC and areas of learning for health professionals and systems. By understanding these complexities we developed a systems map, identified resource requirements and illustrated a Theory of Change (ToC) pathway, to underpin future work to develop and user test an interactive, multi-component intervention.

Lived experiences of diabetes self-management among persons with disabilities in rural Tamil Nadu - a case study approach.

BACKGROUND: People with disabilities have numerous challenges in diabetes self-management. Poor self-management leads to the worsening of disability and secondary complications of diabetes. This study was conducted to explore the challenges in diabetes self-management and the factors influencing diabetes self-management among people with disabilities. METHODS: We conducted 16 case studies among people with physical, neurological, visual, hearing, and multiple disabilities who were affected by diabetes. We adopted a thematic content analysis approach to analyse the data. RESULTS: People with disabilities have challenges in adopting healthy diets as they are unable to purchase and consume fruits and vegetables which are costly, unavailable, and inaccessible. They have difficulty in doing physical activity due to lack of inclusive public spaces which are inaccessible, lack of motivation, and dependence on others for their mobility. Irregular drug supply in the public health system and unaffordable cost of drugs hamper adherence to medications. Laboratories are inaccessible to people with disabilities thus preventing monitoring of blood sugars. They have poor quality of life, life with pain and mental health issues, which prevent adoption of self-management behaviors. The intersectionality of age and gender with disability worsens self-management behaviors. Inaccessible health system, poor quality of health care and insensitive health care providers further complicate self-management. CONCLUSION: This study documents the challenges faced by persons with disabilities in practicing diabetes self management. There is a need for public health policy and planning that is inclusive of persons with disabilities to make access to diabetes care universal.

Influencing factors of self-management ability among dry eye patients in west China.

AIM: To investigate the current situation and influencing factors of self-management ability in dry eye patients in west China. METHODS: A total of 265 patients clinically diagnosed with dry eye received a convenience survey questionnaire at West China Hospital of Sichuan University. All participants completed the rating scale of health self-management skill for adults (AHSMSRS), Huaxi Emotional-Distress Index (HEI), e-health literacy scale (e-HEALS) and Brief Illness Perception Questionnaire (Brief-IPQ). A generalized linear model was employed to establish a multivariate linear model with demographic data, psychological state, e-HEALS, and illness perception as independent variables and health self-management skill score as the dependent variable. RESULTS: The mean score for health self-management skill was 165.58±15.79. Multivariate analysis revealed that advanced age, better illness perception and improved psychological state were associated with better health self-management ability among dry eye patients. Furthermore, the health self-management ability of patients with a disease duration less than 1y was found to be higher compared to those with a disease duration exceeding 1y. CONCLUSION: The health self-management ability of dry eye patients in west China is relatively high. Age, duration of disease, illness perception and psychological state are the influencing factors on the health self-management ability of dry eye patients.

The association of calligraphy activities with peace of mind, stress self-management, and perceived health status in older adults.

Introduction: Calligraphy, as a form of mindful practice, encourages focus, creativity, and relaxation, which collectively contribute to a more peaceful mental state. Through regular engagement in calligraphy, older adults can develop better coping mechanisms for stress, leading to more effective self-management of daily stressors. This enhanced ability to manage stress can reduce the overall burden on their mental and physical health, promoting a more positive outlook on life. Methods: This study employed convenience sampling and snowball sampling to select 246 older adults aged 60-70 from Changsha, China, in March 2024 as valid samples. AMOS v.23 was used to construct a structural equation model to validate the hypotheses. Results: The study found a significant positive correlation between calligraphy activities and peace of mind/stress self-management. There is also a significant positive correlation between peace of mind/stress self-management and perceived health status. Additionally, peace of mind and stress self-management act as mediators between calligraphy activities and perceived health status. Discussion: This indicates that calligraphy activities not only contribute to the psychological well-being of older adults but also indirectly enhance their positive perception of their own health by improving their mental state. Consequently, such activities can be an integral part of holistic health interventions aimed at enhancing the quality of life and overall health of older adults.

Perspectives on Self-Management and Meditation: A Qualitative Study of Adolescents With Type 1 Diabetes Mellitus and Their Parents.

BACKGROUND: One in three adolescents with type 1 diabetes mellitus (T1DM) experiences diabetes distress, which predicts poor self-management and glycemic control. Mindfulness-based interventions such as meditation have been associated with reduced psychological distress and health outcomes in different populations. This study explores the psychosocial barriers and facilitators of diabetes self-management and beliefs about meditation practices. METHODS: Eight adolescents aged 15-19 who had been diagnosed with T1DM for more than a year were invited to participate in a 40-60-minute semi-structured one-on-one interview. Their parents were also invited to participate in the study. Three of the eight parents invited were able to participate in the study. Participants were asked about perceived psychosocial barriers and facilitators of diabetes self-management and their beliefs about meditation as a tool for addressing some of the psychosocial barriers to self-management. Data were analyzed using NVivo 10 (QSR International, Melbourne, Australia). Conventional content analysis was conducted based on an inductive coding approach. RESULTS: Adolescents with T1DM had similar psychosocial challenges with managing T1DM, including high levels of diabetes distress and forgetfulness due to competing demands on their time. They also noted similar facilitators to effective self-management, such as the presence of family and peer support. Acceptance of T1DM diagnosis and personal commitment to self-management were also indicated as common facilitators of self-management. Adolescents with T1DM and parents of adolescents with T1DM believe that meditation can play a positive role in T1DM self-management by reducing diabetes distress and improving mental health and overall well-being. CONCLUSION: Results suggest that adolescents with T1DM and parents of adolescents with T1DM believe peer and family support is crucial to diabetes self-management. They also noted that diabetes distress and forgetfulness are primary barriers to self-management. Participants also see a potential for meditation to help manage general stress and diabetes distress, thereby aiding self-management. Further research is needed to explore meditation-based interventions to reduce diabetes distress in adolescents diagnosed with T1DM. The findings from this study can inform the development and implementation of meditation-based interventions that integrate family and peer support to reduce diabetes distress and enhance self-management in adolescents with T1DM.