Factors associated with food insecurity among the chronically ill population during the COVID-19 pandemic in the United States.

Introduction: Little is known about food insecurity among Americans with chronic diseases, one of the vulnerable groups in health care. Factors influencing food insecurity among this population group are especially poorly understood. Methods: Using data from the COVID Impact Survey, this cross-sectional study sought to examine food insecurity among adults with chronic diseases in the United States and to identify factors associated with their risks for food insecurity during the COVID-19 pandemic. Results: Nearly 28% of the national and 32% of the regional samples from the COVID Impact Survey were at risk for food insecurity. The logistic regressions show that chronically ill US adults with one of the following characteristics have higher odds of being at risk for food insecurity: younger than 60 years, having financial stress, unemployed, having received food from a food pantry, without health insurance, having a household income lower than $100,000, and without a college degree. Discussion: Targeted policies and programs are warranted to address underlying determinants of food insecurity that adults with chronic illnesses experience.

Assessing the Cardiovascular Health Status and Knowledge Level of College Students.

Background. Statistics show that the cardiovascular health (CVH) of young Michigan residents is problematic, yet little is known about the CVH of Michigan's college students. This study sought to (1) estimate the prevalence of ideal levels of CVH metrics among college students, (2) assess their CVH knowledge, and (3) examine the association between students' CVH knowledge level and sociodemographics on their CVH behaviors. Methods. A cross-sectional survey was administered online from August 2017 to April 2018. The survey included questions related to students' demographic characteristics, CVH behaviors, presence of CVH factors, and knowledge of ideal levels for CVH metrics. The study included 341 Oakland University students aged 20 to 40 years. Descriptive statistics estimated students' CVH status and knowledge of CVH measures. Generalized ordinal logistic regression analyses examined the association between students' CVH knowledge level and sociodemographic characteristics on their CVH behaviors. All analyses were performed using STATA MP14. Results. More than 87% of the participants did not have an ideal body mass index level. Students' CVH knowledge score significantly decreased (odds ratio = 0.80, 95% confidence interval = 0.67-0.96) with each increase in the number of non-ideal CVH behaviors performed. Conclusions. Michigan college students may benefit from lifestyle interventions that improve their knowledge of CVH and promote ideal CVH behaviors.

Underlying Factors of Health Insurance Use Among Blacks and Hispanics With Ambulatory Care-Sensitive Conditions.

This study examined satisfaction with and confidence in understanding health insurance use among Blacks and Hispanic Americans with ambulatory care-sensitive conditions. Using the 2013-2016 Health Reform Monitoring Survey data sets, descriptive statistics and ordinary least-square regressions estimated the association between satisfaction and confidence scores and racial or ethnic groups with ambulatory care-sensitive conditions. Compared with their White counterparts, Black (ß = -.13; 95% confidence interval [CI], -0.19 to -0.06) and Hispanic (ß = -0.41; 95% CI, -0.48 to -0.33) participants' standardized confidence scores were significantly lower. Research is needed to identify factors that may enhance this population's confidence level.

Health Insurance Literacy and Medical Debt in Middle-Age Americans.

BACKGROUND: Health insurance literacy (HIL) may influence medical financial burden among people who are sick and the most vulnerable. OBJECTIVE: This study examined the relationships between HIL, health insurance factors, and medical debt among middle-age Americans, a population with an increasing prevalence of illnesses. METHODS: Linear and generalized linear regression analyses were conducted on data drawn from the 2015-2016 waves of the Health Reform Monitoring Survey, a national, internet-based sample of Americans age 18 to 64 years. The analytical sample included 8,042 people age 50 to 64 years. KEY RESULTS: Adjusted mean HIL scores did not differ by private versus public insurance or by out-of-pocket costs. Mean HIL scores were lower with higher deductibles; however, differences in mean scores were small. Higher HIL was associated with lower medical debt (odds ratio = 0.97; 95% confidence interval [0.96, 0.98]), but at the highest HIL score, the risk of having medical debt was still 13.8%. Public coverage, higher annual deductibles, and out-of-pocket costs were associated with higher risks of having medical debt. CONCLUSIONS: The findings suggest that HIL plays an important role in medical debt burden. However, with the shift toward high cost-sharing insurance plans, addressing health care affordability issues along with HIL are critical to eliminate medical debt problems. [HLRP: Health Literacy Research and Practice. 2021;5(4):e319-e332.] Plain Language Summary: Understanding and using health insurance (also defined as health insurance literacy) may influence the ability to pay medical bills among people who are sick and vulnerable. This study examined the relationships among health insurance literacy, health insurance factors, and difficulty paying medical bills (i.e., medical debt) in Americans age 50 to 64 years using data from the Health Reform Monitoring Survey. People with higher health insurance literacy reported lower medical debt. Type of insurance coverage did not influence medical debt. Those with annual deductibles and out-of-pocket health care costs were more likely to report having medical debt.

Social Determinants of Health Associated With Michigan Residents 50 Years and Older Health-Related Quality of Life and Cardiovascular Health.

Objective: Studies show perceived health-related quality of life (HRQL) is associated with cardiovascular health (CVH) status; however, there is a limited understanding of underlying determinants of the CVH and HRQL of adults ≥50 years. Therefore, this study's objective was to examine social determinants of health (SDOH) associated with Michigan residents ≥50 years HRQL measures and CVH status. Methods: Michigan-level data was extracted from the 2017 Behavioral Risk Factor Surveillance System to complete the study's objective. The data were weighted to obtain state-level estimates. Multinomial and binary logistic regression analyses identified SDOH significantly associated with Michiganders ≥50 years CVH status and HRQL measures. Results: The sample consisted of 10,889 participants. Compared to residents with a moderate CVH and mental health status, residents who reported unable to visit a doctor due to costs were two times more likely than those who were able to visit a provider to have a non-ideal CVH and mental health status (OR = 2.65; 95% CI: 1.39-5.07). Discussion: SDOH were significantly associated with non-ideal CVH and HRQL measures. Interventions that seek to address the CVH and perceive HRQL of residents ≥50 years should also address their underlying SDOH. Research should be performed to determine the generalizability of these findings.

Confidence in Understanding Health Insurance and Challenges Paying Medical Bills Among Men in the United States.

Although the number of men with health insurance has increased, men are less likely to utilize health services than females, and experience difficulty in paying medical bills. Understanding the details of health insurance can be challenging and the lack of understanding can have financial consequences. This study, guided by Andersen's model of health-care utilization, assessed the relationship between confidence level in understanding health insurance terms and difficulty in paying medical bills among American men. Data were drawn from the Health Reform Monitoring Survey, 2015-2016. The study included 6,643 men aged between 18 and 64. Descriptive statistics examined participants' difficulty in paying medical bills by predisposing, enabling, and need characteristics, and by confidence in understanding health insurance terms. A modified Poisson regression analysis examined the association between difficulty in paying medical bills, confidence in understanding health insurance terms score, and predisposing, enabling, and need characteristics. An increase in confidence in understanding health insurance terms score was associated with significantly lower reported difficulty in paying medical bills (PR = .98; 95% CI = [.97-.99]; p = .002). Participants with a college degree or higher were less likely to report difficulty in paying their medical bills compared to participants with less than a high school degree (PR = .72; 95% CI = [.56-.92]; p = .009). A better understanding of health insurance might prevent men from experiencing difficulties in paying medical bills. Additional research should be performed to understand the relationship between the level of confidence in understanding health insurance, knowledge level of health insurance terms, use of health insurance, and their impact on difficulty in paying medical bills.

Patient and Caregiver Experience of Hospital Discharge from an Acute Medicine Unit via the Discharge Lounge: A Qualitative Case Study.

Discharge lounges enable the swift movement of patients imminently awaiting hospital discharge, to free beds without delay. This Qualitative Yin-Style Case Study describes the patient and caregivers experience of transition from an Acute Medicine Unit (AMU) to a discharge lounge and staff perspectives, as organisers of this process. Audiorecorded, interviews and focus groups were undertaken. Data were analysed using Framework Analysis. Lack of patientcenteredness in moving patients to the discharge lounge emerged with three themes: 'moving the problem'; 'being moved' and 'feeling removed'. Patients were transferred at accelerated speed. Communications between staff, patients and carers were abruptly curtailed. Patient transfer from AMU to a discharge lounge is a transitional stage in the acute discharge process and must be adequately communicated.

Social Determinants of Cardiovascular Disease among Michigan Residents: A Call to Action for Population Health Initiatives.

OBJECTIVE: Little is known about the cardiovascular health (CVH) and social determinants of cardiovascular diseases (SDCVDs) among Michigan residents by race and ethnicity. Therefore, the objective of this cross-sectional study was to determine the CVH of Michigan residents and to examine the relationship between CVH and SDCVDs by race/ethnicity and age. METHODOLOGY: Michigan-level data consisting of 10,889 participants was extracted from the 2017 Behavioral Risk Factor Surveillance System data. Descriptive statistics examined the adjusted proportions of the CVH measures and determined the adjusted mean CVH score for the SDCVDs among racial/ethnic groups by age. Generalized ordinal logistic regression analyses assessed the relationship between residents' CVH and SDCVDs by racial/ethnic status. All analyses were performed using STATA MP14. RESULTS: Residents from each racial/ethnic group did not meet the criteria for ideal BMI. The mean CVH score was found to be low for Black (2.65; 95% CI, 2.41-2.89) and Hispanic (2.84; 95% CI, 2.29-3.40) residents ≥ 50 years old with a high school degree or less. Black residents unemployed for more than a year were less likely to have a high CVH score (OR = 0.45; 95% CI, 0.21-80.97) compared with Black residents employed for wages. CONCLUSION: Michigan residents' CVH is lacking across multiple dimensions. Multifaceted population health initiatives are warranted to address influential SDCVDs to diminish the CVH disparities identified across racial/ethnic and age groups.

Randomised feasibility study to compare the use of Therabite® with wooden spatulas to relieve and prevent trismus in patients with cancer of the head and neck.

Our aim was to compare the efficacy of the Therabite® jaw motion rehabilitation system (Atos Medical) with that of wooden spatulas to relieve and prevent trismus in patients who have had radiotherapy for stage three and four oral and oropharyngeal cancer. Secondary aims were to assess the feasibility and the impact of exercise on health-related quality of life (QoL), and the use of health services after treatment. We designed a randomised, open-label, controlled, three-centre feasibility study to compare the effectiveness and cost of the Therabite® and wooden spatulas. We studied compliance with exercises and health-related QoL, assessed cost using three health economics measures, and conducted semistructured interviews with patients. Patients were randomised into two groups: the Therabite® group (n=37) and the wooden spatula group (n=34). All patients had some sense of jaw tightening before the study started. Mean mouth opening after six months increased in both groups, but the difference between the groups was not significant (p=0.39). Completion rates for the three economic measures were good. There was no significant difference between the two groups in frequency of contact with care services or in QoL. Exercises during and after radiotherapy can ameliorate trismus in patients with stage three and four oral and oropharygeal cancers, but differences between groups in efficacy, compliance, QoL, or use of hospital or community health services, were not significant.

Rural-urban differences in human papillomavirus knowledge and awareness among US adults.

Rural residents of the United States have higher HPV-associated cancer incidence and mortality, and suboptimal HPV vaccine uptake compared to urban residents. This study aimed to assess differences in knowledge and awareness of HPV, the HPV vaccine, and HPV-associated cancers among rural and urban residents. We analyzed data from the Health Information National Trends Survey 2013-2017 on 10,147 respondents ages ≥18 years. Multivariable logistic regression analyses compared urban/rural differences in knowledge and awareness of HPV, associated cancers, and HPV vaccine. Models were adjusted for sex, age, race/ethnicity, education, household income, census region, health insurance, regular provider, internet use, and personal history of cancer. Overall, 67.2% and 65.8% of urban residents were aware of HPV and HPV vaccine, respectively, compared to only 55.8% and 58.6% of rural residents. Adjusted models illustrated that compared to urban residents, rural residents were less likely to be aware of HPV (OR = 0.68, 95% CI = 0.53-0.86) and HPV vaccine (OR = 0.78, 95% CI = 0.63-0.97). Among those who were aware of HPV, rural residents were less likely to know that HPV causes cervical cancer (OR = 0.62, 95% CI = 0.46-0.84) and that HPV can be transmitted through sexual contact (OR = 0.72, 95% CI = 0.56-0.94). No significant differences between rural and urban residents were noted for knowledge that HPV is transmitted sexually and that it causes oral, anal, and penile cancers. This study highlights significant rural health disparities in knowledge and awareness of HPV and the HPV vaccine compared to urban counterparts.

Patient, Physician, and Practice Characteristics Associated with Cardiovascular Disease Preventive Care for Women.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death for American women. Although CVD preventive care has the potential to reduce a significant number of these deaths, the degree to which healthcare providers deliver such care is unknown. The purpose of this study was to identify patient, physician, and practice characteristics that significantly influence the provision of CVD preventive care during ambulatory care visits for female patients. METHODS: The National Ambulatory Medical Care Survey datasets from 2005 to 2010 were utilized. The study sample included female patients ≥20 years of age whose healthcare provider performed CVD preventive care and who had visits for a new health problem, a routine chronic problem, management of a chronic condition, and preventive care. Binary logistic regression models estimated the association of patient, physician, and practice characteristics and CVD preventive care; cholesterol testing, body mass index (BMI) screening, and tobacco education. RESULTS: Of the 32,009 visits, 15.9% involved cholesterol testing, 50.3% involved BMI screening, and 3.20% involved tobacco education. Obstetricians/gynecologists were less likely to perform cholesterol testing (aOR: 0.39; 95% CI: 0.25-0.61) and tobacco education (aOR: 0.56; 95% CI: 0.32-0.98) than general/family physicians. CONCLUSION: The delivery of CVD preventive care varied by healthcare provider type, with obstetricians/gynecologists having lower odds of providing two of the three services. The amount of time a physician spent with a patient was a significant predictor for the provision of all three services. These findings demonstrate the need to implement multifaceted approaches to address predicting characteristics of CVD preventive care.

Assessing the significance of health information seeking in chronic condition management.

OBJECTIVE: To examine the relationship between health information seeking and confidence in performing self-management activities, and to assess the influence of predisposing, enabling, and perceive need factors on confidence to perform self-management activities among adults with chronic conditions. METHODS: The sample included 6724 adults from the 2007 Health Tracking Household Survey who were ≥18 years with a chronic condition. Binary logistic regression examined the relationship between health information seeking, predisposing, enabling, and perceive need factors and confidence in performing three self-management activities; prevent symptoms, tell doctor concerns, and know when to get medical care. RESULTS: Analyses indicated that 63.7% of adults sought health information. Rural residents who sought health information had 50% (95% CI: 0.28-0.89) lower odds of being confident to tell doctor concerns compared to urban residents who did not seek health information. CONCLUSION: The relationship between health information seeking and confidence to perform self-management varies by self-management activity. Rurality, education level, having a usual source of care, and perceived health status strongly predict confidence to perform self-management activities. PRACTICE IMPLICATIONS: Self-management strategies should incorporate health information seeking behavior that will enhance confidence to perform specific self-management activities, and should incorporate predisposing, enabling, and perceive need factors.

Parents' experiences of caring for a child with a cleft lip and/or palate: a review of the literature.

This review brings together for the first time the existing quantitative and qualitative research evidence about the experiences of parents caring for a child with a cleft. It summarizes salient themes on the emotional, social and service-related experiences of parents and critiques the literature to date, comparing it with wider, selected literature from the field of children's long-term conditions, including disability. The review suggests that there are similarities and differences between the literatures, in terms of research focus and approach. Similarities are found across children's conditions in the perspectives of parents on emotional, social and service-related aspects, although much of the cleft literature is focused on the early stages of children's lives. However, the quality of cleft research to date about parents' experiences has also been variable, with a narrow emphasis on cross-sectional, deficit-orientated psychological approaches focused mainly on mothers. Despite a substantial literature, little qualitative research has examined parents' perspectives in-depth, particularly about their child's treatment journey. This contrasts with the wider children's literature, which has traditionally drawn not only on psychological approaches but also on the broader perspectives of sociology, social policy, nursing and health services research, using both qualitative and quantitative methods, often in integrated ways. Such approaches have been able to highlight a greater range of experiences from both mothers and fathers, about caring for a child with a long-term condition and views about treatment. The review identifies a lack of comparable research in the cleft field to examine parents' experiences and needs at different stages of their children's lives. Above all, research is needed to investigate how both mothers and fathers might experience the long-term and complex treatment journey as children become older and to elicit their views about decision making for cleft treatments, particularly elective surgeries.

Exploring the needs, concerns and behaviours of people with existing respiratory conditions in relation to the H1N1 'swine influenza' pandemic: a multicentre survey and qualitative study.

BACKGROUND: People with respiratory conditions are a 'high-risk' group for H1N1 pandemic swine influenza ('swine flu'), hence they and their families may have information needs, worries and concerns regarding the condition. Health-related behaviours, including vaccination, are recommended during the pandemic; understanding uptake of these is important. OBJECTIVES: To explore and compare information needs, worries and concerns, and health-related behaviours regarding swine flu in people with respiratory conditions and their family members. METHODS: Mixed-methods study - cross-sectional survey (253 patients, 101 family members); one-to-one interviews (13 patients, seven family members) and focus groups (n = three groups, 30 participants). Data collected October 2009-January 2010 from hospital chest clinics (n = 7) and patient support groups (n = 10) in North West England. RESULTS: Most patients (P) and family members (FM) wanted more information (n = 158, 62.5% P; n = 55, 54.4% FM), but few felt completely uninformed (n = 15, 5.9% P; n = 3, 3.0% FM). Most had already received information about swine flu (n = 187, 73.9% P; n = 78, 77.2% FM), mainly via a leaflet delivered to their home (n = 125, 49.4% P; n = 55, 54.5% FM). Information received was considered helpful (n = 154, 60.9% P; n = 77, 72.6% FM), but many wanted more condition-specific information (n = 141, 55.7% P; n = 60, 59.4% FM). More patients were worried (n = 147, 58.3%) than not worried (n = 99, 39.3%) about swine flu. FM were less often concerned about personal risk (n = 47, 46.6% worried) than about risk to patients (n = 76, 77.6%). Two-thirds (n = 161, 63.6% P; 65, 65.6% FM) incorrectly believed patients had increased risk of developing swine flu, but most (n = 204, 81.0% P; 89, 89.9% FM) correctly identified patients' greater risk of developing complications. Commonly adopted preventative measures were more frequent hand-washing (107, 42.8% P; 38, 37.6% FM) and greater use of sanitising hand gel (n = 100, 40.5% P; 37, 36.6% FM). In total, 212 patients (83.8%) and 69 family members (68.3%) were very/fairly likely to take up swine flu vaccination. Qualitative data mirrored survey findings. CONCLUSIONS: Participants were generally well-informed about swine flu, but more targeted information would have been welcomed. Participants were not highly anxious about swine flu, but did recognise risks for patients. Behaviour change was modest, but in line with recommendations. Vaccination intent was high. STUDY REGISTRATION: The study has been registered as REC/IRAS (Ref 09/H1015/76) and NIHR CSP (Ref 32483).

Pharmacological and non-pharmacological interventions for cough in adults with respiratory and non-respiratory diseases: A systematic review of the literature.

The management of cough in adults with respiratory and non-respiratory illnesses is suboptimal and based mostly on clinical opinions rather than evidence. A systematic review was carried out assessing all trials in adult patients with respiratory and non-respiratory diseases (excluding cancer) that had chronic cough as primary or secondary outcome. A total of 1177 trials were retrieved and 75 met the criteria for inclusion in the review. The vast majority were in patients with asthma and chronic obstructive pulmonary disease (COPD). Cough was the primary outcome in less than one-quarter of the studies. The measurement of cough was variable, mostly using unvalidated scales or being part of an overall 'symptoms' score. Positive results were overall seen with the use of corticosteroids, leukotriene receptor antagonists, mast cell stabilizers, ipratropium bromide, neltenexine, iodinised glycerol and lidocaine. Speech pathology training and symptom monitoring through SMS messages (accompanied by treatment adjustments) have also shown promise. Evidence for established anti-tussive agents such as codeine was scarce, with positive studies from the 1960s, whilst more recent studies showed no effect in patients with COPD. Many studies had conflicting results. It is imperative that the management of cough and its evidence base be improved, using higher quality research designs and with cough being the primary outcome of trials.

Development, dimensions, reliability and validity of the novel Manchester COPD fatigue scale.

INTRODUCTION: Fatigue is a prominent symptom in chronic obstructive pulmonary disease (COPD) and it has distinctive features; however, there is a need for a robust scale to measure fatigue in COPD. METHODS: At baseline, 122 patients with COPD (forced expiratory volume in 1 s (FEV(1)) 52%, women 38%, mean age 66 years) completed a pilot fatigue scale covering a pool of 57 items and underwent a range of tests, including indicators of mood and a short general fatigue questionnaire. All patients responded to the 57-item scale and it was readministered to a subset of 30 patients. The pilot scale was first subjected to constructive validated shortening steps and then to a principal components analysis. RESULTS: The Manchester COPD fatigue scale (MCFS) consists of 27 items, loading into three dimensions: physical, cognitive and psychosocial fatigue. Internal consistency (Cronbach's alpha = 0.97) and test-retest repeatability (r = 0.97, p<0.001) were tested. It had significant convergent validity, correlating with the FACIT (Functional Assessment of Chronic Illness Therapy) fatigue scale and the fatigue in Borg scale at baseline and after a 6 minute walk distance (6MWD) test (r = -0.81, 0.53 and 0.63, respectively, p<0.001). Its scores were associated with BODE, SGRQ (St George's Respiratory Questionnaire) and MRC (Medical Research Council) dyspnoea scores (r = 0.46, 0.8 and 0.51, respectively, p<0.001). The scale demonstrated meaningful discriminating ability; patients who walked <350 m in a 6MWD test as well as depressed patients (>or=16 scores in the Center for Epidemiologic Study on Depression (CES-D) scale) had nearly twice as high fatigue scores as those who walked >or=350 m or were not depressed (p<0.001). CONCLUSION: The MCFS provides a simple, reliable and valid measurement of total and dimensional fatigue in moderate stable COPD.

Implementation and impact of the Gold Standards Framework in community palliative care: a qualitative study of three primary care trusts.

The Gold Standards Framework (GSF) has been widely adopted within UK general practices, yet there is little understanding of its impact on the provision of community palliative care services. This study presents data on the anticipation and adoption of the GSF within three Primary Care Trusts in North West England. Forty-seven interviews were conducted with generalist and specialist palliative and primary care professionals. Important aspects of the GSF identified were the patient register, communication and out-of-hours protocols. Positive benefits to professionals included improved communication between professionals and appropriate anticipatory prescribing. Negative aspects included increased nursing workload and the possibility of fewer or later visits for patients. Many respondents believed that the GSF needed local champions to be sustainable. Slow or incomplete adoption was reported. The GSF was recognised as important because it facilitated changes to previously difficult aspects of work between professionals, but few respondents reported direct benefits to patient care.

Can lay people deliver asthma self-management education as effectively as primary care based practice nurses?

OBJECTIVES: To determine whether well trained lay people could deliver asthma self-management education with comparable outcomes to that achieved by primary care based practice nurses. DESIGN: Randomised equivalence trial. SETTING: 39 general practices in West London and North West England. PARTICIPANTS: 567 patients with asthma who were on regular maintenance therapy. 15 lay educators were recruited and trained to deliver asthma self-management education. INTERVENTION: An initial consultation of up to 45 min offered either by a lay educator or a practice based primary care nurse, followed by a second shorter face to face consultation and telephone follow-up for 1 year. MAIN OUTCOME MEASURES: Unscheduled need for healthcare. SECONDARY OUTCOME MEASURES: Patient satisfaction and need for courses of oral steroids. RESULTS: 567 patients were randomised to care by a nurse (n = 287) or a lay educator (n = 280) and 146 and 171, respectively, attended the first face to face educational session. During the first two consultations, management changes were made in 35/146 patients seen by a practice nurse (24.0%) and in 56/171 patients (32.7%) seen by a lay educator. For 418/567 patients (73.7%), we have 1 year data on use of unscheduled healthcare. Under an intention to treat approach, 61/205 patients (29.8%) in the nurse led group required unscheduled care compared with 65/213 (30.5%) in the lay led group (90% CI for difference -8.1% to 6.6%; 95% CI for difference -9.5% to 8.0%). The 90% CI contained the predetermined equivalence region (-5% to +5%) giving an inconclusive result regarding the equivalence of the two approaches. Despite the fact that all patients had been prescribed regular maintenance therapy, 122/418 patients (29.2%) required courses of steroid tablets during the course of 1 year. Patient satisfaction following the initial face to face consultation was similar in both groups. CONCLUSIONS: It is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses.

Lay educators in asthma self management: reflections on their training and experiences.

OBJECTIVE: To capture the experiences and feelings of lay educators in an asthma self-management programme to aid understanding of optimal methods of recruitment, training and retention, and to enhance their value within the programme. METHODS: A multi site randomised controlled equivalence trial of asthma educators and primary care practice based nurses during which the educators were asked to keep a diary of their experience. A qualitative thematic analysis of these diaries was undertaken. RESULTS: Eight lay educators supplied diaries. From these diaries emerged personal reasons for involvement in the programme, constructive comments on the training programme, a need for preparation for the realities of clinical practice and significant ongoing support and training. CONCLUSION: Lay educators are a potential resource for giving self-management education to patients with long-term conditions such as asthma. However, there are some considerations that need to be taken into account regarding contracts, retention and continual support. PRACTICE IMPLICATIONS: Lay educators need a flexible but comprehensive training programme, contracts, on site mentoring and support. They seem most contented when welcomed by health professionals and treated as part of the team.