Kjersti Grønning

Efficacy of ongoing group based diabetes self-management education for patients with type 2 diabetes mellitus. A randomised controlled trial

OBJECTIVE To evaluate the efficacy of ongoing group based diabetes self-management education (DSME) for patients with type 2 diabetes. METHODS 146 patients were randomised to either group education or waiting list control. Primary outcomes were A1C and patient activation measured with patient activation measure (PAM). RESULTS There were no differences in the primary outcomes between the groups at 12 months, but the control group had an increase in A1C of 0.3% points during follow-up. Diabetes knowledge and some self-management skills improved significantly in the intervention group compared to the control group. A sub group analysis was conducted for the quartile with the highest A1C at baseline (>7.7, n=18 in both groups). There were significant improvements within the intervention group at 12 month follow-up for both A1C and PAM and a trend for better outcome in the intervention group compared to the control. CONCLUSIONS The locally developed ongoing diabetes self-management education programs prevented an increase in A1C and can have an effect on A1C in patients with higher A1C level. PRACTICE IMPLICATIONS Locally developed programs may be less effective than programs developed for studies.

The effect of an educational programme consisting of group and individual arthritis education for patients with polyarthritis—A randomised controlled trial §

OBJECTIVE The aim of this study was to investigate the effect of an educational programme for patients with polyarthritis compared to usual care. METHODS Patients with rheumatoid arthritis, psoriatic arthritis and unspecified polyarthritis were randomised to the intervention (n=71) or usual care (n=70). The intervention consisted of three group educational sessions followed by one individual educational session. The primary outcomes were a patients global well-being and arthritis self-efficacy. Secondary outcomes were patient activation, physical and psychological health status, educational needs and disease activity. RESULTS After four months the intervention group had significantly better global well-being, 95% CI (2.3-14.1), p=0.01, and self-efficacy, 95% CI (0.2-8.1), p=0.04, than the control group. There were also trends for improved disease activity, and a statistically significant improvement in patient activation and pain in the intervention group. CONCLUSION This patient educational programme consisting of group sessions and nurse-delivered individual education has statistically significant benefits for global well-being and maintaining a level of self-efficacy in managing other symptoms in patients with polyarthritis. PRACTICE IMPLICATIONS This educational programme allows patients to learn from each other in addition to addressing individual educational needs.

Coping with arthritis is experienced as a dynamic balancing process. A qualitative study

The aim of this study was to investigate the process of coping in people living with chronic inflammatory arthritis. Semi-structured individual face-to-face interviews with 26 persons having rheumatoid arthritis, psoriatic arthritis or unspecified polyarthritis were performed. The informants were asked how they experienced to live with arthritis and how they coped with challenges due to the arthritis. The main finding was that the informants experienced the process of coping with arthritis as a dynamic, iterative, balancing process. They balanced between different states, entitled “go on as usual”, “listen to the body”, “adjustments” and “attitude towards life”. The informants preferred to be in a “go on as usual” state as this was seen as normal life. However, disease fluctuations with pain, fatigue and stiffness disturbed the balance and made the informants “listen to the body”, a state where they became aware of how the disease affected them, followed by the “adjustment” state. Adjustments were composed of different efforts to ease the arthritis influence and for regaining balance. The “attitude towards life” influenced the overall process of coping. A redefined view of what the informants considered to be normal life thus happened through longer periods of imbalance. The process of coping with arthritis was found to be a dynamic, iterative, balancing process where patients redefined what they considered as normal life through the course of the disease.

Psychometric properties of The Hospital Anxiety and Depression Scale and The General Health Questionnaire-20 in COPD inpatients

AIM To compare the psychometric properties between the Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire-version 20 (GHQ-20) in detecting psychological distress in COPD patients referred to pulmonary rehabilitation, and to examine the factor structure of GHQ-20. METHODS The study comprised 161 consecutive patients with mild to very severe COPD. For comparison of mean scores between the HADS and GHQ-20, one sample t-test was used. Potential differences in the detection of possible and normal cases were analysed using Pearson Chi square test. We report Pearsons correlations within and between the questionnaires, and internal consistency was assessed through Chronbachs alpha. The factor structure of the GHQ-20 was examined through principal axis factoring (PAF) with oblique rotation and eigenvalue >1. RESULTS There were no differences in mean scores of psychological distress between HADS and GHQ-20 (12.03 vs. 24.73, p = 0.000), as well as no differences in the prevalence of possible cases of psychological distress (34.6 vs. 36.9, p = 0.000) and normal cases (65.4 vs. 63.1, p = 0.000). The observed difference between HADS and GHQ-20 regarding internal consistency was marginal, with Chronbachs alpha coefficients of 0.91 and 0.94, respectively. The PAF analysis resulted in a three-factor solution for GHQ-20, notably with only two items loading on the third factor, giving an internal consistency <0.70. A two-factor solution, comprising anxiety/depression and coping, may therefore be more appropriate. CONCLUSIONS This study demonstrates no significant differences between the HADS and GHQ-20 in their ability to detect possible cases of psychological distress in a rehabilitation setting for COPD patients. Although the HADS and GHQ-20 are measuring different concepts of psychological distress, both questionnaires can be recommended as screening tools for detection of psychological distress in COPD inpatients. The GHQ-20 appears to be two-dimensional, comprising anxiety/depression as one dimension, and coping as the other dimension.

Patients’ confidence in coping with arthritis after nurse-led education; a qualitative study

BackgroundThe aim of this study was to explore how patients with chronic inflammatory polyarthritis described coping with their disease after a nurse-led patient education program and compare these experiences to patients in a control group who did not receive any education.MethodsThis was a qualitative study nested within a randomized controlled trial (RCT) investigating the effect of nurse-led patient education for patients with chronic inflammatory polyarthritis. Twenty-six individual face-to-face interviews, 15 in the intervention group and 11 in the control group were conducted approximately two months after the educational program. The same opening question; «Can you please tell me how you have been these last four months, since last time we spoke», followed by questions about the informants’ experiences of coping with disease-related challenges, disease activity changes, coping with disease activity changes, the informants’ perceptions of good and challenging situations to be in were asked to all informants.ResultsInformants who attended the educational program expressed a strengthened confidence in coping with the consequences of having arthritis, which made them feel good. The strengthened confidence was attributed to sharing experiences with other participants in the group and learning something new. Informants in the intervention group further linked their confidence to 1) coping with disease fluctuations, 2) changed health behaviours and 3) knowledge about medications.ConclusionsPatients taking part in nurse-led patient education described a strengthened confidence in coping with their arthritis stemming from sharing experiences with other patients and learning something new.Trial registrationThe RCT was registered in ClinicalTrials.gov (NCT00623922) in February 2008.

Dietary Patterns Characterized by High Meat Consumption Are Associated with Other Unhealthy Life Styles and Depression Symptoms

Objective We aimed to identify dietary patterns (DPs) of Portuguese adults, to assess their socioeconomic, demographic, lifestyle determinants, and to identify their impact on health. Design EpiDoC 2 study included 10,153 Portuguese adults from the EpiDoC Cohort, a population-based study. In this study, trained research assistants using computer-assisted telephone interview collected socioeconomic, demographic, dietary, lifestyles, and health information from March 2013 to July 2015. Cluster analysis was performed, based on questions regarding the number of meals, weekly frequency of soup consumption, vegetables, fruit, meat, fish, dairy products, and daily water intake. Factors associated with DP were identified through logistic regression models. Results Two DPs were identified: the “meat dietary pattern” and the “fruit & vegetables dietary pattern.” After multivariable adjustment, women (OR = 0.52; p < 0.001), older adults (OR = 0.97; p < 0.001), and individuals with more years of education (OR = 0.96; p = 0.025) were less likely to adopt the “meat dietary pattern,” while individuals in a situation of job insecurity/unemployment (OR = 1.49; p = 0.013), Azores island residents (OR = 1.40; p = 0.026), current smoking (OR = 1.58; p = 0.001), daily alcohol intake (OR = 1.46; p = 0.023), and physically inactive (OR = 1.86; p < 0.001) were positively and significantly associated with “meat dietary pattern.” Moreover, individuals with depression symptoms (OR = 1.50; p = 0.018) and the ones who did lower number of medical appointments in the previous year (OR = 0.98; p = 0.025) were less likely to report this DP. Conclusion Our results suggest that unhealthy DPs (meat DP) are part of a lifestyle behavior that includes physical inactivity, smoking habits, and alcohol consumption. Moreover, depression symptoms are also associated with unhealthy DPs.

Individual user involvement at Healthy Life Centres: a qualitative study exploring the perspective of health professionals

ABSTRACT The aim of this study was to explore how professionals experience user involvement at an individual level and how they describe involving users at Healthy Life Centres. Four focus group interviews were conducted with a total of 23 professionals. Data were analysed using systematic text condensation. Four themes were identified: (1) Involving users through motivational interviewing; (2) Building a good and trustful relation; (3) Assessing and adjusting to the user’s needs and life situation; and(4) Strengthening the user’s ownership and participation in the lifestyle change process. Motivational interviewing was described by the professionals as a way to induce and ensure user involvement. However, seeing motivational interviewing and user involvement as the same concept might reduce user involvement from being a goal in itself and evolve into a means of achieving lifestyle changes. The professionals might be facing opposing discourses in their practice and a dilemma of promoting autonomy and involvement and at the same time promoting change in a predefined direction. Greater emphasis should thus be put on systematic reflection among professionals about what user involvement implies in the local Healthy Life Centre context and in each user’s situation. Abbreviations: HLC: Healthy Life Centre; MI: Motivational Interviewing; NCD: Non-communicable diseases; STC: Systematic Text Condensation. SDT: Self-determination theory

Expectations towards participation in easily accessible pain management interventions: a qualitative study

BackgroundPeople with chronic pain use a range of healthcare services, but they also report a high degree of dissatisfaction with treatments. One reason for dissatisfaction might be participants’ expectations towards treatments. The aim of this study was to explore expectations of people with chronic pain towards participation in easily accessible pain management interventions delivered in public primary care.MethodsA qualitative study using semi-structured individual face-to-face interviews with 21 informants. The informants were recruited among participants enrolled in a randomised controlled trial on the effect of an easily accessible self-management course for people with chronic pain. The data were analysed thematically using Systematic Text Condensation.ResultsHaving experienced pain for a long time, there was no specific expectation of a cure or a significant alleviation of the pain. The informants’ expectations mainly concerned a hope that participation could lead to a better everyday life. The informants said that hope was important as it motivated them to keep going and continue self-care activities. The hope acted as a driving force towards trying new interventions and maintaining motivation to do activities they experienced as beneficial. Both concrete aspects of the current intervention and an understanding of what interventions in general could offer contributed to the informants hope. The expectations centred about the interventions being something new, as they had not previously tried this service, an opportunity to gain and reinforce skills, to help them continue to grow as a person, to meet others in similar situations, and to access professional support in an easy manner. Participating in interventions provided by healthcare services was seen by some as an act of self-care, where they did something active to manage their health.ConclusionsExpectations towards the interventions were related to a hope for participation leading to a better everyday life. The role of hope for peoples’ motivation to self-care implies that service providers should be aware of and help to maintain hope for a better everyday life. The importance of social support as part of self-care should be acknowledged when developing interventions targeting chronic pain.Trial registrationClinicalTrials.gov: NCT02531282. Registered on August 21 2015.

THU0733-HPR Rehabilitation in warm climate for young adults with inflammatory rheumatic disease. a 12 months randomized controlled trial

Background Rehabilitation in warm climate has long been an established non-pharmacological treatment for patients with inflammatory rheumatic disease (IRD) in Norway. It has however not been tailored to the needs of young adults, who often have different challenges than older adults with IRD. Objectives The aim of this study was to investigate if a rehabilitation program in warm climate tailored to young adults from 20 to 35 years had effect on physical function and self-management/coping, 12 months after completed intervention. Methods This was an open randomized controlled pilot trial, with a 2-group parallel design and a 1:1 allocation ratio. Patients were recruited from three different rheumatology outpatient clinics in central Norway. The intervention group received a 17 day long rehabilitation stay in Spain. The main component of the tailored intervention was intensive exercise (2–3 times per/day), individual physiotherapy (daily) and patient education. The control group received treatment as usual. The primary outcome measure was physical function assessed by the “30 second Sit to Stand test” (30sSTS, number of sit and stand during 30 seconds, higher score is better) and self-management/coping measured by the “Effective Musculoskeletal Consumer Scale” (EC17, higher score is better). Results Forty patients (mean age 27.5, 65% female) with IRD (intervention/control: 3/2 rheumatoid arthritis, 3/9 juvenile idiopathic arthritis, 4/5 psoriatic arthritis, 8/3 ankylosing spondylitis and 2/1 polyarthritis) were randomized. 19 out of 20 patients completed the intervention. At twelve months follow up there were 3 patients lost to follow up from the intervention group, and 2 in the control group. Patients in the intervention group had a significant improvement in the 30sSTS test 3, 6 and 12 months after completed intervention, compared to the control group (Table 1). The within group analysis showed that both groups improved at 6 and 12 months. The EC17 showed no difference between the two groups at 3, 6 or 12 months.Table 1 Outcome measures Baseline values Change from baseline to 3 months 6 months 12 months Mean (SD) Mean (95% CI) p-value Mean (95% CI) p-value Mean (95% CI) p-value 30sSTS Within group  Intervention 12.75 (3.2) 8.7 (5.7–11.8) <0.001 8.5 (5.1–11.9) <0.001 10.6 (7.3–14.0) <0.001  Control 13.15 (2.7) 1.1 (-0.5–2.7) 0.169 3.7 (1.2–6.2) 0.006 3.8 (0.6–7.1) 0.024  Between groups 7.6 (4.3–10.9) <0.001 4.7 (0.7–8.8) 0.024 6.8 (2.3–11.3) 0.004 EC17 Within group  Intervention 64.5 (19.1) 0.9 (-4.0 -5.7) 0.709 2.2 (-3.4–7.8) 0.427 4.0 (-3.7–11.7) 0.291  Control 64.4 (10.3) 2.2 (-2.1–6.5) 0.295 6.8 (1.9–11.7) 0.009 4.2 (-1.2–9.5) 0.119  Between groups -1.3 (-7.6–4.9) 0.670 -4.6 (-11.8–2.6) 0.2 -0.2 (-9.0–8.7) 0.966 Conclusions The results indicate that the intervention group significantly improved their physical function one year after the intervention compared to the control group, but there was no effect on self-management/coping. These results might reflect that the focus of the intervention was mainly intensive exercise, and less on self-management /coping. This was a small study and the results should be interpreted with caution. Disclosure of Interest None declared