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The impact of a social network based intervention on self-management behaviours among patients with type 2 diabetes living in socioeconomically deprived neighbourhoods: a mixed methods approach.
Vissenberg, C, Nierkens, V, van Valkengoed, I, Nijpels, G, Uitewaal, P, Middelkoop, B, Stronks, K
Scandinavian journal of public health. 2017;(6):569-583
Abstract
AIMS: This paper aims to explore the effect of the social network based intervention Powerful Together with Diabetes on diabetes self-management among socioeconomically deprived patients. This 10-month group intervention targeting patients and significant others aimed to improve self-management by stimulating social support and diminishing social influences that hinder self-management. METHODS This intervention was evaluated in a quasi-experimental study using a mixed methods approach. Of 131 socioeconomically deprived patients with suboptimal glycaemic control, 69 were assigned to the intervention group and 62 to the control group (standard diabetes education). 27 qualitative in-depth interviews with the participants and 24 with their group leaders were held to study the subjective impact of the intervention. Further, self-management behaviours (medication adherence, diet and physical activity) were assessed at baseline, 10 and 16 months. Data were analysed using framework analyses and a linear mixture model. RESULTS Qualitative data showed that the intervention group had a better understanding of the way self-management influences diabetes. The intervention group showed more complex self-management behaviours, such as planning ahead, seeking adequate food and physical activity alternatives, and consistently taking their diabetes into consideration when making choices. In participants with complete follow-up data, we found a significant increase in physical activity in the intervention group (3.78 vs. 4.83 days) and no changes in medication adherence and diet. CONCLUSIONS This study indicates that an intensive support group and simultaneously involving significant others might improve diabetes self-management behaviours among socioeconomically deprived patients. More studies are needed to justify further implementation of the intervention. This study is registered in the Dutch Trial Register NTR1886. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1886.
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A HEALth Promotion and STRESS Management Program (HEAL-STRESS study) for prehypertensive and hypertensive patients: a quasi-experimental study in Greece.
Darviri, C, Artemiadis, AK, Protogerou, A, Soldatos, P, Kranioutou, C, Vasdekis, S, Varvogli, L, Nasothimiou, E, Vasilopoulou, E, Karantzi, E, et al
Journal of human hypertension. 2016;(6):397-403
Abstract
Current hypertension guidelines advocate strategies encouraging healthy lifestyle behaviours. So far, there is a paucity of studies for the efficacy of such multifaceted programmes. The aim of this study is to investigate the efficacy of an 8-week health-promotion programme for lowering blood pressure (BP) in prehypertensive and hypertensive patients in the community. This was a quasi-experimental study using wait-list controls of 548 patients. The intervention group was administered with an 8-week health-promotion intervention. Measurements included home BP, smoking, body mass index (BMI), perceived stress, depression, anxiety and Health Locus of Control. After adjusting for confounders, the intervention group had a significant reduction in both systolic BP (SBP; mean -2.62 mm Hg, 95% confidence interval (CI): -1.29 to -3.96) and diastolic BP (DBP; mean -1.0, 95% CI: -0.93 to -1.9) compared with controls. In all, 14.9% of patients in the intervention group had >10 mm Hg reduction in SBP vs 4.4% in the control group (P<0.001, numbers needed to treat (NNT)=10). With regards to DBP, 21.7% of patients in the intervention group had >5 mm Hg reduction vs 12.5% in the control group (P=0.01, NNT=11). In terms of effect size, moderate-to-large improvements of BMI, perceived stress, anxiety, depression, external and chance Health Locus of Control were recorded. Changes in SBP and DBP were attributed to BMI and depressive symptom reductions, respectively. Comprehensive non-pharmaceutical programmes for BP management are strongly encouraged. Their long-term benefits on cardiovascular morbidity and mortality remain to be established by future research.
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[Better health for body and soul].
Balzer, K, Hesse, K, Eisold, U, Kopke, S
Pflege Zeitschrift. 2013;(11):652-5
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Dietary intervention with cooking instructions and self-monitoring of the diet in free-living hypertensive men.
Kitaoka, K, Nagaoka, J, Matsuoka, T, Shigemura, C, Harada, K, Aoi, W, Wada, S, Asano, H, Sakane, N, Higashi, A
Clinical and experimental hypertension (New York, N.Y. : 1993). 2013;(2):120-7
Abstract
The control of blood pressure (BP) is important in the prevention of cardiovascular diseases. This study was conducted to evaluate the effect of a dietary educational program for free-living, high-normal, and stage 1 or 2 hypertensive men. The participants were volunteers aged 40-75 years who agreed to the intervention. They were divided into two groups: 39 men for the intervention group and 32 men for the control group. BP, urinary sodium and potassium excretion, dietary and lifestyle data, and nonfasting venous blood sample were collected at baseline and after the intervention period. The intervention was designed to decrease sodium level with an emphasis on a decrease in the consumption of salted foods and to increase potassium level with an emphasis on an increase in the consumption of fruit and vegetables through cooking instructions and self-monitoring of the diet. At the baseline, there were no significant differences observed between the groups, except the diastolic BP. In the intervention group, a greater decrease in the urinary sodium-to-potassium excretion ratio was observed, compared with the control group (net difference 0.6, P = .029). The systolic and diastolic BP (mm Hg) decreased in the intervention group (149.0-143.0, P = .073; 93.0-87.0, P = .002), but no changes were observed in the control group (145.0-143.0, P = .231; 84.9-85.3, P = .381). In the intervention group, the urinary sodium-to-potassium excretion ratio was significantly improved by focusing on cooking instructions and self-monitoring of the diet.
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Healthy eating and active living for diabetes in primary care networks (HEALD-PCN): rationale, design, and evaluation of a pragmatic controlled trial for adults with type 2 diabetes.
Johnson, ST, Mundt, C, Soprovich, A, Wozniak, L, Plotnikoff, RC, Johnson, JA
BMC public health. 2012;:455
Abstract
BACKGROUND While strong and consistent evidence supports the role of lifestyle modification in the prevention and management of type 2 diabetes (T2DM), the best strategies for program implementation to support lifestyle modification within primary care remain to be determined. The objective of the study is to evaluate the implementation of an evidence-based self- management program for patients with T2DM within a newly established primary care network (PCN) environment. METHOD Using a non-randomized design, participants (total N = 110 per group) will be consecutively allocated in bi-monthly blocks to either a 6-month self-management program lead by an Exercise Specialist or to usual care. Our primary outcome is self-reported physical activity and pedometer steps. DISCUSSION The present study will assess whether a diabetes self-management program lead by an Exercise Specialist provided within a newly emerging model of primary care and linked to available community-based resources, can lead to positive changes in self-management behaviours for adults with T2DM. Ultimately, our work will serve as a platform upon which an emerging model of primary care can incorporate effective and efficient chronic disease management practices that are sustainable through partnerships with local community partners. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identifier: NCT00991380.
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Self-management support in "real-world" settings: an empowerment-based intervention.
Tang, TS, Funnell, MM, Brown, MB, Kurlander, JE
Patient education and counseling. 2010;(2):178-84
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Abstract
OBJECTIVE This study examined the impact of a 6-month, empowerment-based diabetes self-management support (DSMS) intervention on clinical outcomes, self-care behaviors, and quality of life (QOL) compared to a 6-month control period. METHODS This control-intervention cohort study recruited 77 African-American adults with type 2 diabetes. Baseline, 6-month, and 12-month assessments measured A1C, weight, body mass index (BMI), blood pressure, lipids, self-care behaviors, and QOL. During the control period, participants received weekly educational newsletters. During the intervention period, participants attended weekly DSMS groups as frequently as they needed. Sessions were guided by participants' self-management questions and concerns, and also emphasized experiential learning, coping, problem-solving, and goal-setting. RESULTS The control period found significant improvements for diastolic BP (p<0.05), serum cholesterol (p<0.001), following a healthy diet (p<0.01), and monitoring blood glucose (p<0.01). The intervention period found significant additional improvements for A1C (p<0.001), weight (p<0.05), BMI (p<0.05), and LDL (p<0.001). Compared to the control period, participation in the intervention led to a significant reduction in A1C (p<0.01). CONCLUSION Findings suggest that an empowerment-based, DSMS intervention is promising for improving and/or maintaining diabetes-related health, particularly A1C. PRACTICAL IMPLICATIONS Incorporating empowerment principles in DSMS interventions may be useful for supporting patients' self-management efforts in "real-world" settings.
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Self-efficacy for health-related behaviors among deaf adults.
Jones, EG, Renger, R, Kang, Y
Research in nursing & health. 2007;(2):185-92
Abstract
The purpose of this quasi-experimental, pre-post-test study was to test the effectiveness of the Deaf Heart Health Intervention (DHHI) in increasing self-efficacy for health-related behaviors among culturally deaf adults. The DHHI targets modifiable risk factors for cardiovascular disease. A sample of 84 participants completed time-1 and time-2 data collection. The sign language version of the Self-Rated Abilities Scale for Health Practices (SRAHP) was used to measure self-efficacy for nutrition, psychological well-being/stress management, physical activity/exercise, and responsible health practices. Total self-efficacy scores were significantly higher in the intervention group than in the comparison group at time-2, controlling for scores at baseline (F [1, 81] = 26.02, p < .001). Results support the development of interventions specifically tailored for culturally deaf adults to increase their self-efficacy for health behaviors.