Siobhan McMahon
University of Minnesota
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Featured researches published by Siobhan McMahon.
International Journal of Older People Nursing | 2011
Siobhan McMahon; Kristine Mc Talley; Jean F. Wyman
Despite evidence supporting fall prevention methods, fall-related injury and death rates continue to rise. Understanding older peoples views on fall risk and prevention will help nurses and other health professionals in the design of fall prevention strategies that will broaden their scope, reach and adoption. This literature review synthesised 19 qualitative and quantitative studies examining older peoples perspectives about fall risk and prevention using a social-ecological framework. Three themes emerged about fall risk; fearing vulnerability, maintaining autonomy and independence and interpreting risk. Four themes emerged about fall prevention programs: influence of participant and program characteristics, need for personal relevance and preference, maintaining autonomy and independence and increased support for and access to programs. Implications for practice include individual, interpersonal, organizational and community level considerations for improving fall prevention efforts.
Jmir mhealth and uhealth | 2016
Siobhan McMahon; Beth A. Lewis; Michael Oakes; Weihua Guan; Jean F. Wyman; Alexander J. Rothman
Background Physical activity contributes to older adults’ autonomy, mobility, and quality of life as they age, yet fewer than 1 in 5 engage in activities as recommended. Many older adults track their exercise using pencil and paper, or their memory. Commercially available physical activity monitors (PAM) have the potential to facilitate these tracking practices and, in turn, physical activity. An assessment of older adults’ long-term experiences with PAM is needed to understand this potential. Objective To assess short and long-term experiences of adults >70 years old using a PAM (Fitbit One) in terms of acceptance, ease-of-use, and usefulness: domains in the technology acceptance model. Methods This prospective study included 95 community-dwelling older adults, all of whom received a PAM as part of randomized controlled trial piloting a fall-reducing physical activity promotion intervention. Ten-item surveys were administered 10 weeks and 8 months after the study started. Survey ratings are described and analyzed over time, and compared by sex, education, and age. Results Participants were mostly women (71/95, 75%), 70 to 96 years old, and had some college education (68/95, 72%). Most participants (86/95, 91%) agreed or strongly agreed that the PAM was easy to use, useful, and acceptable both 10 weeks and 8 months after enrolling in the study. Ratings dropped between these time points in all survey domains: ease-of-use (median difference 0.66 points, P=.001); usefulness (median difference 0.16 points, P=.193); and acceptance (median difference 0.17 points, P=.032). Differences in ratings by sex or educational attainment were not statistically significant at either time point. Most participants 80+ years of age (28/37, 76%) agreed or strongly agreed with survey items at long-term follow-up, however their ratings were significantly lower than participants in younger age groups at both time points. Conclusions Study results indicate it is feasible for older adults (70-90+ years of age) to use PAMs when self-tracking their physical activity, and provide a basis for developing recommendations to integrate PAMs into promotional efforts. Trial Registration Clinicaltrials.gov NCT02433249; https://clinicaltrials.gov/ct2/show/NCT02433249 (Archived by WebCite at http://www.webcitation.org/6gED6eh0I)
Journal of Advanced Nursing | 2012
Siobhan McMahon; Julie Fleury
AIM To appraise the external validity of physical activity interventions designed to reduce falls among community-dwelling older adults, using the reach, efficacy/effectiveness, adoption, implementation, and maintenance framework. BACKGROUND Falls are a globally common, important, and a preventable problem. The efficacy of physical activity interventions to reduce falls among older adults is well established. Translation of this research into practice is slow as evidenced by persistently low proportions of older adults who engage in physical activities and the rising incidence of falls. DATA SOURCES Four electronic databases were searched for relevant studies published between 2000-2010. Studies that examined the effects of physical activity interventions designed to reduce falls among community-dwelling older adults were included in this review (n = 46). DESIGN This was a quantitative systematic review with narrative synthesis. The reach, efficacy/effectiveness, adoption, implementation, and maintenance framework guided the identification, appraisal, and synthesis of indicators representing study validity. RESULTS The majority of studies in this review described indicators representing internal validity. Details about indicators representing external validity were reported infrequently, limiting the generalizability of fall-preventive physical activity interventions in diverse cultures and social contexts over time. CONCLUSIONS To foster translational research in real world settings, additional programmatic intervention research is needed that: (i) targets diverse populations; (ii) incorporates theories of behavioural change; (iii) describes and operationalizes critical content that enables replication and translation; (iv) tests innovative measures of fall risk and physical activity; and (v) evaluates feasibility and acceptability.
Nursing Forum | 2012
Siobhan McMahon; Julie Fleury
PURPOSE The purpose of this analysis is to examine the concept of wellness within the context of older adulthood. Identifying characteristics of wellness will clarify and develop conceptual strengths and limitations, providing a step toward evaluating its relevance in older adults and increasing utility in geriatric nursing. ORGANIZING FRAMEWORK Rodgers evolutionary perspective. METHODS Computer and manual searches were conducted of articles in the English language from 1950 to 2010, addressing wellness across the life span or among older adult populations. An inductive analysis of articles produced descriptive themes. FINDINGS A historical time line traced the evolution of the wellness concept and its operationalization. Wellness has evolved from a little used concept to one commonly applied across many industries. Antecedents, attributes, and consequences of wellness are described. Concepts related to wellness are also identified. CONCLUSIONS This concept analysis adds clarity to wellness in older adults. The state of wellness development as a concept in geriatric nursing is moving from conceptualization to use and testing in nursing theory and interventions. Increased knowledge of wellness will enable geriatric nurses to discover the strengths of older adults thereby promoting their ongoing growth and development while simultaneously guiding care for their changing and diverse health.
Diabetes Research and Clinical Practice | 2017
Helen Fu; Siobhan McMahon; Cynthia R. Gross; Terrence J. Adam; Jean F. Wyman
OBJECTIVES To assess the usability and clinical effectiveness of diabetes mobile applications (diabetes apps) developed for adults with type 2 diabetes. METHOD A systematic review of the usability and effectiveness of diabetes apps was conducted. Searches were performed using MEDLINE, EMBASE, COMPENDEX, and IEEE XPLORE for articles published from January 1, 2011, to January 17, 2017. Search terms included: diabetes, mobile apps, and mobile health (mHealth). RESULTS The search yielded 723 abstracts of which seven usability studies and ten clinical effectiveness studies met the inclusion criteria from 20 publications. Usability, as measured by satisfaction ratings from experts and patients, ranged from 38% to 80%. Usability problem ratings ranged from moderate to catastrophic. Top usability problems are multi-steps task, limited functionality and interaction, and difficult system navigation. Clinical effectiveness, measured by reductions in HbA1c, ranged from 0.15% to 1.9%. CONCLUSION Despite meager satisfaction ratings and major usability problems, there is some limited evidence supporting the effectiveness of diabetes apps to improve glycemic control for adults with type 2 diabetes. Findings strongly suggest that efforts to improve user satisfaction, incorporate established principles of health behavior change, and match apps to user characteristics will increase the therapeutic impact of diabetes apps.
Journal of Advanced Nursing | 2012
Siobhan McMahon; Julie Fleury
AIM To appraise the external validity of physical activity interventions designed to reduce falls among community-dwelling older adults, using the reach, efficacy/effectiveness, adoption, implementation, and maintenance framework. BACKGROUND Falls are a globally common, important, and a preventable problem. The efficacy of physical activity interventions to reduce falls among older adults is well established. Translation of this research into practice is slow as evidenced by persistently low proportions of older adults who engage in physical activities and the rising incidence of falls. DATA SOURCES Four electronic databases were searched for relevant studies published between 2000-2010. Studies that examined the effects of physical activity interventions designed to reduce falls among community-dwelling older adults were included in this review (n = 46). DESIGN This was a quantitative systematic review with narrative synthesis. The reach, efficacy/effectiveness, adoption, implementation, and maintenance framework guided the identification, appraisal, and synthesis of indicators representing study validity. RESULTS The majority of studies in this review described indicators representing internal validity. Details about indicators representing external validity were reported infrequently, limiting the generalizability of fall-preventive physical activity interventions in diverse cultures and social contexts over time. CONCLUSIONS To foster translational research in real world settings, additional programmatic intervention research is needed that: (i) targets diverse populations; (ii) incorporates theories of behavioural change; (iii) describes and operationalizes critical content that enables replication and translation; (iv) tests innovative measures of fall risk and physical activity; and (v) evaluates feasibility and acceptability.
American Journal of Health Promotion | 2016
Siobhan McMahon; Jean F. Wyman; Michael Belyea; Nelma B. Crawford Shearer; Eric B. Hekler; Julie Fleury
Purpose. To assess the feasibility of a new intervention, Ready~Steady, in terms of demand, acceptability, implementation, and limited efficacy. Design. Randomized controlled trial; repeated measures. Setting. Two rural communities in Itasca County, Minnesota. Subjects. Thirty participants were randomized to an intervention (n = 16) or attention-control (n = 14) group. Intervention. Ready~Steady combined two components: (1) motivational (motivational support, social network support, empowering education), and (2) fall-reducing physical activities (PAs; guidance to practice leg-strengthening, balance, and flexibility activities and walking). Measures. Acceptability questionnaire and Indices of Procedural Consistency (investigator developed), Community Health Activity Model Program for Seniors Questionnaire (confirmed with accelerometry), Short Physical Performance Battery, Perceived Environmental Support Scale, Social Support for Exercise Questionnaire, Goal Attainment Scale, Index of Readiness, and Index of Self-Regulation. Analysis. Descriptive statistics and a marginal approach to repeated-measures analysis of variance, using mixed-model procedures. Results. Attrition was 7% and mean attendance was 7.2 of 8 sessions, participants evaluated Ready~Steady as acceptable, and implementation fidelity was good. The intervention group improved significantly more than the attention-control group in PA behavior, F1,27 = 11.92, p = .002; fall risk (functional balance and strength), F1,27 = 14.89, p = .001; support for exercise from friends, F1,27 = 11.44, p = .002; and self-regulation, F1,26 = 38.82, p < .005. Conclusion. The Ready~Steady intervention was feasible as evidenced by low attrition and good attendance and implementation, as well as positive effects on targeted outcomes and theoretical mechanisms of change.
Translational behavioral medicine | 2014
Siobhan McMahon; Mithra Vankipuram; Eric B. Hekler; Julie Fleury
ABSTRACTIntegrating mobile technology into health promotion strategies has the potential to support healthy behaviors. A new theory-informed app was designed to augment an intervention promoting wellness motivation in older adults with fall risk and low levels of physical activity. The app content was evaluated for clarity, homogeneity, and validity of motivational messages; both the app and device were evaluated for acceptability and usability. The initial evaluation included nine adults (mean age, 75); four of whom also assessed the app’s sensing abilities in the field. As part of an intervention feasibility study, 14 older adults (mean age, 84) also provided a follow-up evaluation of app usability. Evaluation participants assessed the app as valid, usable, acceptable, and able to sense most reported free-living activities, and provided feedback for improving the app. Design processes illustrate methodologic and interpretive efforts to operationalize motivational content in a theory-informed app promoting change in physical activity behavior.
Journals of Gerontology Series A-biological Sciences and Medical Sciences | 2018
Shalender Bhasin; Thomas M. Gill; David B. Reuben; Nancy K. Latham; Jerry H. Gurwitz; Patricia C. Dykes; Siobhan McMahon; Thomas W. Storer; Pamela W. Duncan; David A. Ganz; Shehzad Basaria; Michael E Miller; Thomas G. Travison; Erich J. Greene; James Dziura; Denise A. Esserman; Heather G. Allore; Martha B Carnie; Maureen Fagan; Catherine Hanson; Dorothy I. Baker; Susan L. Greenspan; Neil B. Alexander; Fred C. Ko; Albert L. Siu; Elena Volpi; Albert W. Wu; Jeremy N. Rich; Stephen C. Waring; Robert B. Wallace
Background Fall injuries are a major cause of morbidity and mortality among older adults. We describe the design of a pragmatic trial to compare the effectiveness of an evidence-based, patient-centered multifactorial fall injury prevention strategy to an enhanced usual care. Methods Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) is a 40-month cluster-randomized, parallel-group, superiority, pragmatic trial being conducted at 86 primary care practices in 10 health care systems across United States. The 86 practices were randomized to intervention or control group using covariate-based constrained randomization, stratified by health care system. Participants are community-living persons, ≥70 years, at increased risk for serious fall injuries. The intervention is a comanagement model in which a nurse Falls Care Manager performs multifactorial risk assessments, develops individualized care plans, which include surveillance, follow-up evaluation, and intervention strategies. Control group receives enhanced usual care, with clinicians and patients receiving evidence-based information on falls prevention. Primary outcome is serious fall injuries, operationalized as those leading to medical attention (nonvertebral fractures, joint dislocation, head injury, lacerations, and other major sequelae). Secondary outcomes include all fall injuries, all falls, and well-being (concern for falling; anxiety and depressive symptoms; physical function and disability). Target sample size was 5,322 participants to provide 90% power to detect 20% reduction in primary outcome rate relative to control. Results Trial enrolled 5,451 subjects in 20 months. Intervention and follow-up are ongoing. Conclusions The findings of the STRIDE study will have important clinical and policy implications for the prevention of fall injuries in older adults.
Journal of the American Geriatrics Society | 2017
David B. Reuben; Priscilla K. Gazarian; Neil B. Alexander; Katy L. B. Araujo; Dorothy I. Baker; Jonathan F. Bean; Chad Boult; Peter Charpentier; Pamela W. Duncan; Nancy K. Latham; Rosanne M. Leipzig; Lisa M. Quintiliani; Thomas W. Storer; Siobhan McMahon
In response to the epidemic of falls and serious falls‐related injuries in older persons, in 2014, the Patient Centered Outcomes Research Institute (PCORI) and the National Institute on Aging funded a pragmatic trial, Strategies to Reduce Injuries and Develop confidence in Elders (STRIDE) to compare the effects of a multifactorial intervention with those of an enhanced usual care intervention. The STRIDE multifactorial intervention consists of five major components that registered nurses deliver in the role of falls care managers, co‐managing fall risk in partnership with patients and their primary care providers (PCPs). The components include a standardized assessment of eight modifiable risk factors (medications; postural hypotension; feet and footwear; vision; vitamin D; osteoporosis; home safety; strength, gait, and balance impairment) and the use of protocols and algorithms to generate recommended management of risk factors; explanation of assessment results to the patient (and caregiver when appropriate) using basic motivational interviewing techniques to elicit patient priorities, preferences, and readiness to participate in treatments; co‐creation of individualized falls care plans that patients’ PCPs review, modify, and approve; implementation of the falls care plan; and ongoing monitoring of response, regularly scheduled re‐assessments of fall risk, and revisions of the falls care plan. Custom‐designed falls care management software facilitates risk factor assessment, the identification of recommended interventions, clinic note generation, and longitudinal care management. The trial testing the effectiveness of the STRIDE intervention is in progress, with results expected in late 2019.