A substantial proportion of chronic disease patients do not respond to self-management interventions, which suggests that one size interventions do not fit all, demanding more tailored interventions. To compose more individualized strategies, we aim to increase our understanding of characteristics associated with patient activation for self-management and to evaluate whether these are disease-transcending. A cross-sectional survey study was conducted in primary and secondary care in patients with type-2 Diabetes Mellitus (DM-II), Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF) and Chronic Renal Disease (CRD). Using multiple linear regression analysis, we analyzed associations between self-management activation (13-item Patient Activation Measure; PAM-13) and a wide range of socio-demographic, clinical, and psychosocial determinants. Furthermore, we assessed whether the associations between the determinants and the PAM were disease-transcending by testing whether disease was an effect modifier. In addition, we identified determinants associated with low activation for self-management using logistic regression analysis. We included 1154 patients (53% response rate); 422 DM-II patients, 290 COPD patients, 223 HF patients and 219 CRD patients. Mean age was 69.6±10.9. Multiple linear regression analysis revealed 9 explanatory determinants of activation for selfmanagement: age, BMI, educational level, financial distress, physical health status, depression, illness perception, social support and underlying disease, explaining a variance of 16.3%. All associations, except for social support, were disease transcending. This study explored factors associated with varying levels of activation for self-management. These results are a first step in supporting clinicians and researchers to identify subpopulations of chronic disease patients less likely to be engaged in self-management. Increased scientific efforts are needed to explain the greater part of the factors that contribute to the complex nature of patient activation for self-management.
andlt;pandgt;Self-monitoring of blood glucose levels, food intake, and physical activity supports self-management of patients with type 2 diabetes mellitus (T2DM). There has been an increase in the development and availability of mobile health apps for T2DM.andlt;/pandgt;
MULTIFILE
The prevalence of type 2 diabetes (T2D) is relatively high among people with a low socioeconomic status (SES). As lifestyle is crucial in T2D management, patients are advised to live healthily, but incorporating lifestyle changes in daily life is not easy. It may be even more difficult for people with a low SES, as they often struggle with more urgent issues in daily life that supersede healthy lifestyle. How to promote a healthy lifestyle such that the needs of low SES patients are met? A boundary condition is a thorough understanding of the target group, and of the differences between individuals in this group. Too often, people with a low SES receive either general advice, or advice targeted to literacy level or ethnic background, whereas the diversity within the low SES population is much wider than that. We developed personas to identify archetypes of the target group, each reflecting a distinct pattern in goals, attitudes and behaviours, to help grasp the diversity of the target group. Ten interviews with low SES T2D-patients revealed their perceptions and experiences related to what is important in life, a healthy lifestyle, living with diabetes, and lifestyle advice. Following Goodwin’s persona development methodology (2011), three groups were qualitatively extracted from the data. In short, the personas are: 1) the worrisome caregiver: wants to live healthier, but is incapable of incorporating advices into one’s life; caring for others is first priority; 2) the conscious self-confident: willing and able to follow up advice in order to reduce medication use; 3) the selfwilled survivor: dealing with multiple (health) issues, and dedicated to solve things one’s own way. Each persona likely responds differently to health promoting strategies. Additional research is needed to enrich the set of personas, for example by verifying them with the target group’s family or health professionals.
In Europe nearly 10% of the population suffers from diabetes and almost 1% from Rheumatoid Arthritis which can lead to serious problems with mobility and active participation, especially in the ageing population. Pedorthists deliver personalised designed and manufactured orthopaedic footwear or insoles for these patients. However, despite their often laborious efforts upfront, the industry has very little means to quantify how successful the fitting and function of a shoe is. They have to rely on subjective, qualitative measures such as client satisfaction and diminishing of complaints. Although valuable, the need for objective quantitative data in this field is growing. Foot plantar pressure and shear forces are considered major indicators of potential foot problems. Devices to measure plantar pressure slowly gain terrain as providers of objective quantitative data to guide orthotic design and manufacturing. For shear forces however, measuring devices are not yet commercial available. Although shear forces are considered as a major contributor to ulcer formation in diabetic feet, their exact role still requires elucidation and quantification. This project aims to develop a prototype of an in-shoe wearable device that measures both shear forces and pressure using state-of-the-art developments in sensor technologies, smart textiles and wireless data transfer. The collaboration of pedorthists’ small and medium-sized enterprises (SME)’s with medical device engineering companies, knowledge institutes,technical universities and universities of applied sciences in this project will bring together the different fields of expertise required to create an innovative device. It is expected that the tool will be beneficial to improve the quality of pedorthists’ services and potentially reduce health insurance costs. Furthermore, it can be used in new shear forces research and open new business potential. However, the eventual aim is to improve patient care and help maintain personal mobility and participation in society.
