Denise St-Cyr Tribble

Subjective Quality-of-Life Predictors for Older Adults with Physical Disabilities.

Levasseur M, Desrosiers J, St-Cyr Tribble D: Subjective quality-of-life predictors for older adults with physical disabilities. Am J Phys Med Rehabil 2008;87: 830-841. Objectives:To study changes in quality of life (QOL) and to explore predictors of QOL of community-dwelling older adults with physical disabilities. Design:A 2-yr longitudinal study involved a convenience sample of 49 people with physical disabilities aged 60–94 yrs. QOL was estimated twice at a 2-yr interval with the Quality of Life Index, which includes four domains: health and functioning, socioeconomic, psychological/spiritual, and family. The potential predictors evaluated at baseline were health condition, activity, participation (level and satisfaction), personal factors, and environmental factors (obstacles and facilitators). Results:No change over time in QOL mean score was observed (mean: −0.41; SD: 2.5; 95% confidence interval: −1.1 to 0.30; P = 0.25). However, about half the participants had a clinically significant change (either increase or decrease). Greater satisfaction with participation in social roles and fewer obstacles in the physical environment were identified as the best predictors (R2 = 0.27; P = 0.001) of better QOL. Greater participation in daily activities, fewer obstacles in the physical environment, and greater satisfaction with participation in social roles were found to be the best predictors (R2 = 0.49; P < 0.001) of high health and functioning QOL. Finally, increased QOL score over the 2-yr period was best predicted by initial lower socioeconomic QOL and activity level perceived as unstable (R2 = 0.27; P = 0.001). Conclusions:QOL is partially explained by participation and environmental factors. These factors may be positively modified and thus may warrant special attention in health interventions. Identified predictors of QOL changes over time need to be considered in intervention studies.

Enablement in health care context: a concept analysis

RATIONALE, AIMS AND OBJECTIVES The enablement process is defined as a professional intervention aiming to recognize, support and emphasize the patients capacity to have control over her or his health and life. The purpose of this article was to study the enablement concept through a concept analysis in the health care context to identify: (1) its attributes and (2) its antecedents and consequents. METHOD A concept analysis was performed according to the method of Rodgers. The literature was reviewed from 1980 to June 2008, using search strategies adapted to the databases Cinahl, Medline, Embase, PsycInfo and Social Works Abstract, and hand searching. All articles contributing to a deeper understanding of the concept were included. The analysis was carried out according to a thematic analysis procedure, as described by Miles & Huberman. RESULTS The search identified 1305 citations. After in-depth assessment of 148 potentially eligible citations, 61 articles were included in the review. Five articles were added with hand searching. Sixty-seven per cent of these articles were related to nursing. The attributes of the enablement concept included: contribution to the therapeutic relationship; consideration of the person as a whole; facilitation of learning; valorization of the persons strengths; implication and support to decision making; and broadening of the possibilities. CONCLUSION These attributes could be used as a basis for other studies on enablement. Conceptual and empirical work is still needed to better position this concept among others such as patient-centred care, shared decision making and patients participation.

Changes in participation level after spouse's first stroke and relationship to burden and depressive symptoms.

Background: No comprehensive data are available on the impact of stroke on the spouse’s participation level. The purpose of this study was to document changes in participation level over time and explore associations between changes in participation level, burden and depressive symptoms for spouses of people who had had a first stroke. Methods: Participants were spouses recruited in the first 2 weeks after admission of individuals with a first stroke to acute care. Prestroke measures (T0) were collected at recruitment, simultaneously with the first measure (T1); further measures were collected 6 months after the stroke event (T2). Participation level was measured with the LIFE-H, perceived burden with the Caregiver Strain Index and depressive symptoms using the Beck Depression Inventory (BDI). Results: Mean age of participants (n = 54) was 69 years (SD 10.9) and the majority were female (75.9%). Changes in participation include small but significant increases at T1 for the nutrition (effect size, ES, 0.34) and responsibilities (ES 0.22) domains, and large significant persistent decreases at T2 compared to T0 were found for personal relationships (ES 0.83), employment (ES 0.63) and recreation (ES 0.93). Changes in these last three participation domains are associated with a higher Caregiver Strain Index score (p < 0.01) but not with the BDI. Conclusions: Participation domains mostly affected for spouses after stroke were personal relationships, employment and recreation which could be addressed by clinicians in their provision of support.

Family physician enabling attitudes: a qualitative study of patient perceptions

BackgroundFamily physicians frequently interact with people affected by chronic diseases, placing them in a privileged position to enable patients to gain control over and improve their health. Soliciting patients’ perceptions about how their family physician can help them in this process is an essential step to promoting enabling attitudes among these health professionals. In this study, we aimed to identify family physician enabling attitudes and behaviours from the perspective of patients with chronic diseases.MethodsWe conducted a descriptive qualitative study with 30 patients, 35 to 75 years of age presenting at least one common chronic disease, recruited in primary care clinics in two regions of Quebec, Canada. Data were collected through in-depth interviews and were analyzed using thematic analysis.ResultsFamily physician involvement in a partnership was perceived by participants as the main attribute of enablement. Promoting patient interests in the health care system was also important. Participants considered that having their situation taken into account maximized the impact of their physician’s interventions and allowed the legitimization of their feelings. They found their family physician to be in a good position to acknowledge and promote their expertise, and to help them maintain hope.ConclusionsFrom the patient’s perspective, their partnership with their family physician is the most important aspect of enablement.

Developing a model of recovery in mental health

BackgroundThe recovery process is characterized by the interaction of a set of individual, environmental and organizational conditions common to different people suffering with a mental health problem. The fact that most of the studies have been working with schizophrenic patients we cannot extend what has been learned about the process of recovery to other types of mental problem. In the meantime, the prevalence of anxiety, affective and borderline personality disorders continues to increase, imposing a significant socioeconomic burden on the Canadian healthcare system and on the patients, their family and significant other [1]. The aim of this study is to put forward a theoretical model of the recovery process for people with mental health problem schizophrenic, affective, anxiety and borderline personality disorders, family members and a significant care provider.Method and designTo operationalize the study, a qualitative, inductive design was chosen. Qualitative research open the way to learning – the inside – about different perspectives and issues people face in their process of recovery. The study proposal is involving a multisite study that will be conducted in three different cities of the Province of Québec in Canada: Montréal, Québec and Trois-Rivières. The plan is to select 108 participants, divided into four comparison groups representing four types of mental health problem. Each comparison group (n = 27) will be made up of 9 units. Each unit will comprise one person with a mental health problem (schizophrenia, affective anxiety, and borderline personality disorders. Data will be collected through semi-structured open-ended interview. The in-depth qualitative analysis inspired from the grounded theory approach will permit the illustration of the recovery process.DiscussionThe transformation of our Health Care System and the importance being put on the people well-being and autonomy development of the person who are suffering with mental problem This study protocol follows-up on earlier theory-building process that begun with the work of Noiseux [2]. The contribution of the present study is to increase the comprehension of the concept of recovery and to enhance the body of knowledge in that domain. Very few studies have examined recovery and the one that did used a descriptive approach which did not take into account the perspective of the family members and the caregivers of the recovery process.

Strategies to Elicit and Analyze Relational Family Data

Within the paradigm of qualitative methods of inquiry and data analysis are interesting avenues to address the complex task of capturing the family’s experience from a transactional viewpoint. The purposes of this article are to identify strategies for creating family-based data as well as to offer a theoretical discussion of how data analysis can attend to and enhance the knowledge base of the family experience. This discussion will be anchored within the description of an ongoing research study involving the examination of the process of parent-infant attachment. In this research, the processes of maternal and paternal attachments to their infants are regarded as co-constructed phenomena within the family environment. In this context, conceptualization of family interactional variables, strategies to elicit these variables, and paths to qualitative analysis of the data are presented.

Not feeling sick from breast cancer: A framework on health status perceptions transition process.

PURPOSE In what state of health do women with breast cancer consider themselves to be? Health professionals classify them as cancer victims but few studies have examined womens perceptions of their own health following a breast cancer diagnosis. We looked at the transition in health status perceptions between before and after receiving the diagnosis. METHODS A grounded theory design was chosen to develop a framework. RESULTS From an analysis of semi-structured individual interviews with 32 women, it emerged that 1) over a two-year period, the participants went through four iterative steps between receipt of the official diagnosis and the return of the level of energy once the treatments are done. Theses four steps are: reacting emotionally, facing the situation, constructing a new identity and reacting to social representations of cancer, 2) the participants did not feel sick from breast cancer. CONCLUSION This study shows learning to live with a sword of Damocles over the head during the transition process. The emergent steps of the health status perceptions transition process in breast cancer trajectory give direction for care.