| 1. |
- Alvariza, Anette, et al.
(författare)
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A person-centred approach in nursing: Validity and reliability of the Carer Support Needs Assessment Tool
- 2018
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Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 35, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The Carer Support Needs Assessment Tool (CSNAT) was developed for use among family caregivers in palliative care for assessment of their support needs. The purpose of this study was to translate and evaluate the validity and reliability of the CSNAT in a sample of Swedish family caregivers and nurses in a palliative care context. Methods: Data for this validation study was collected during 2016 in the context of palliative home care in two larger Swedish cities. The study was conducted in three stages to reach conceptual, semantic, operational and measurement equivalence between the original UK version and the Swedish version. Stage I consisted of translation to Swedish. In Stage II, cognitive interviews were performed with 8 family caregivers and 10 nurses. Data were analyzed based on relevance, clarity and sensitivity. In Stage III, the CSNAT and related self-rating measures (caregiver burden, preparedness for caregiving and quality of life) were completed by 118 family caregivers. Data quality, construct validity and test-retest reliability were evaluated. Results: The CSNAT items were considered relevant and useful to identify areas of support needs. The Swedish CSNAT showed sound psychometric properties with satisfactory data quality and few problems with missing data across items (1.8%-6.1%). All items except one correlated as expected (rho>0.3) with caregiver burden, supporting construct validity. All items had satisfactory test-retest reliability (κw=0.45-0.75). Conclusions: This study further adds to the validity of the CSNAT and shows in addition that it is reliable and stable for use among family caregivers in palliative care. © 2018 Elsevier Ltd
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| 2. |
- Alvariza, Anette, et al.
(författare)
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Palliativ vård i hemmet
- 2019
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Ingår i: Hemsjukvård. - Stockholm : Liber. - 9789147112777 ; , s. 83-95
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Amsberg, Susanne, et al.
(författare)
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A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients : a randomized controlled trial
- 2009
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 77:1, s. 72-80
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To examine the impact of a Cognitive Behavior Therapy (CBT)-based intervention on HbA(1c), self-care behaviors and psychosocial factors among poorly controlled adult type 1 diabetes patients. METHODS: Ninety-four type 1 diabetes patients were randomly assigned to either an intervention group or a control group. The intervention was based on CBT and was mainly delivered in group format, but individual sessions were also included. All subjects were provided with a continuous glucose monitoring system (CGMS) during two 3-day periods. HbA(1c), self-care behaviors and psychosocial factors were measured up to 48 weeks. RESULTS: Significant differences were observed with respect to HbA(1c) (P<0.05), well-being (P<0.05), diabetes-related distress (P<0.01), frequency of blood glucose testing (P<0.05), avoidance of hypoglycemia (P<0.01), perceived stress (P<0.05), anxiety (P<0.05) and depression (P<0.05), all of which showed greater improvement in the intervention group compared with the control group. A significant difference (P<0.05) was registered with respect to non-severe hypoglycemia, which yielded a higher score in the intervention group. CONCLUSION: This CBT-based intervention appears to be a promising approach to diabetes self-management. PRACTICE IMPLICATIONS: Diabetes care may benefit from applying tools commonly used in CBT. For further scientific evaluation in clinical practice, there is a need for specially educated diabetes care teams, trained in the current approach, as well as cooperation between diabetes care teams and psychologists trained in CBT.
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| 4. |
- Amsberg, Susanne, et al.
(författare)
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Acceptance and commitment therapy (ACT) for adult type 1 diabetes management : study protocol for a randomised controlled trial
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:11
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Integrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The aim of this study is to evaluate the impact of a stress management group intervention based on acceptance and commitment therapy (ACT) among adults living with poorly controlled type 1 diabetes.METHODS AND ANALYSIS: This study will use a randomised controlled trial design evaluating treatment as usual (TAU) and ACT versus TAU. The stress management group intervention will be based on ACT and comprises a programme divided into seven 2-hour sessions conducted over 14 weeks. A total of 70 patients who meet inclusion criteria will be recruited over a 2-year period with follow-up after 1, 2 and 5 years.The primary outcome measure will be HbA1c. The secondary outcome measures will be the Depression Anxiety Stress Scales, the Swedish version of the Hypoglycemia Fear Survey, the Swedish version of the Problem Areas in Diabetes Scale, The Summary of Self-Care Activities, Acceptance Action Diabetes Questionnaire, Swedish Acceptance and Action Questionnaire and the Manchester Short Assessment of Quality of Life. The questionnaires will be administered via the internet at baseline, after sessions 4 (study week 7) and 7 (study week 14), and 6, 12 and 24 months later, then finally after 5 years. HbA1c will be measured at the same time points.Assessment of intervention effect will be performed through the analysis of covariance. An intention-to-treat approach will be used. Mixed-model repeated measures will be applied to explore effect of intervention across all time points.ETHICS AND DISSEMINATION: The study has received ethical approval (Dnr: 2016/14-31/1). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders.TRIAL REGISTRATION NUMBER: NCT02914496; Pre-results.
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| 5. |
- Amsberg, Susanne, et al.
(författare)
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Experience from a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients
- 2009
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 84:1, s. 76-83
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Tidskriftsartikel (refereegranskat)abstract
- Aim To describe experience from a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients, in terms of feasibility, predictors and associations of improved glycaemic control. Methods Data were collected on 94 poorly controlled adult type 1 diabetes patients who were randomised to a study evaluating the effects of a behavioural medicine intervention. Statistics covered descriptive and comparison analysis. Backward stepwise regression models were used for predictive and agreement analyses involving socio-demographic and medical factors, as well as measures of diabetes self-efficacy (DES), diabetes locus of control (DLOC), self-care activities (SDSCA), diabetes-related distress (Swe-PAID-20), fear of hypoglycaemia (HFS), well-being (WBQ), depression (HAD) and perceived stress (PSS). Results The participation rate in the study was 41% and attrition was 24%. Of those patients actually participating in the behavioural medicine intervention, 13% withdrew. From the regression models no predictors or associations of improvement in HbA1c were found. Conclusions The programme proved to be feasible in terms of design and methods. However, no clear pattern was found regarding predictors or associations of improved metabolic control as the response to the intervention. Further research in this area is called for.
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| 6. |
- Amsberg, Susanne
(författare)
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Health Promotion in Diabetes Care : Studies on Adult Type 1 Diabetes Patients
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: A landmark report has shown that improving glycaemic control among type 1 diabetes patients markedly reduces diabetes-related complications. In clinical practice, however, many patients have problems in adhering to the treatment, and thus remain in poor glycaemic control. Research suggests a more behaviour-oriented approach to diabetes, but there is a lack of evidence on the efficacy of interventions, especially for those adult type 1 diabetes patients who are in poor glycaemic control. Diabetes-related distress has been associated with poor adherence to treatment and poor glycaemic control. There is a need for validated measures in this area, to identify patients who experience diabetes-related distress. Additionally, injection technique is crucial for the management of diabetes, and lipohypertrophy is a common side effect which deserves further attention.Objectives: The overall aim of this thesis was to evaluate a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients, and to gain a deeper knowledge in an area of diabetes self-management.Methods: Quantitative design was used for the studies, and the clinical settings comprised two diabetes care units in Stockholm, Sweden. Study I: The Swedish version of the Problem Areas in Diabetes (Swe-PAID-20) scale was evaluated regarding its psychometric properties by type 1 diabetes patients, as well as by an expert panel of diabetes specialist nurses. Study II: A behavioural medicine intervention based on Cognitive Behaviour Therapy (CBT) was evaluated in a randomised controlled trial among poorly controlled adult type 1 diabetes patients. Study III: Using the same sample as in study II, descriptive statistics were produced, and predictive and comparative analyses performed, in order to find predictors of or associations with improvements in glycaemic control as a response to the intervention. Study IV: In a randomised crossover trial insulin absorption in lipohypertrophic injection sites was investigated in type 1 diabetes patients.Results and conclusions: Study I: A three-factor solution of the scale was found, comprising sub-dimensions of diabetes-related emotional problems, treatment-related problems and support-related problems. Cronbach’s alpha for the total score was 0.94 and varied between 0.61 and 0.94 in the three subscales. The findings also supported the convergent and content validity. The Swe-PAID-20 seems to be a reliable and valid outcome for measuring diabetes-related distress in type 1 diabetes patients. Study II: Significant differences were observed with respect to HbA1c, well-being, diabetes-related distress, frequency of blood glucose testing, fear of hypoglycaemia, perceived stress, and depression, all of which improved more in the intervention group compared with the control group. The CBT based behavioural medicine intervention appears to be a promising approach to diabetes self-management. Study III: The participation rate in the study was 41% and attrition was 24%. Of those patients who actually participated in the intervention, 13% withdrew. From the regression models no predictors or associations were found with regard to improvement in HbA1c. The programme proved to be feasible in terms of design and methods. However, no clear pattern was found regarding predictors of or associations with improved metabolic control. Study IV: Impairment of insulin absorption from lipohypertrophic injection sites was also found with analogue insulins. It is suggested that patients should be advised to refrain from injecting insulin aspart into lipohypertrophic subcutaneous tissue.
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| 7. |
- Amsberg, Susanne, et al.
(författare)
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The psychometric properties of the Swedish version of the Problem Areas in Diabetes Scale (Swe-PAID-20) : scale development
- 2008
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 45:9, s. 1319-28
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Considering the importance of psychological aspects in the management of diabetes, there is a need of validated measurements in this area. Such tools make it possible to screen patients for specific conditions as well as they serve as reliable measures when evaluating medical, psychological and educational interventions. OBJECTIVES: The current study was conducted to adapt the Problem Areas in Diabetes Scale for use among Swedish-speaking patients with type 1 diabetes and to evaluate the psychometric properties. DESIGN: Methodological research design was used in this study. SETTING AND PARTICIPANTS: A convenience sample of 325 type 1 diabetes patients was systematically selected from the local diabetes registry of a university hospital in Stockholm, Sweden. METHODS: Following the linguistic adaptation using the forward-backward translation method, the 20-item PAID was answered by the selected patients. Statistics covered exploratory factor analysis, Cronbach's alpha, convergent validity and content validity. RESULTS: In the factor analysis a three-factor solution was found to be reasonable with the sub-dimensions diabetes-related emotional problems (15 items), treatment-related problems (2 items) and support-related problems (3 items). Cronbach's alpha coefficient for the total score was 0.94 and varied between 0.61 and 0.94 in the three subscales. The findings also gave support for the convergent and content validity. CONCLUSIONS: The Swedish version of the Problem Areas in Diabetes Scale (Swe-PAID-20) seems to be a reliable and valid outcome for measuring diabetes-related emotional distress in type 1 diabetes patients.
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| 8. |
- Anderbro, Therese Carin, et al.
(författare)
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A longitudinal study of fear of hypoglycaemia in adults with type 1 diabetes
- 2018
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Ingår i: Endocrinology, Diabetes & Metabolism. - : Wiley. - 2398-9238 .- 2057-3316. ; 1:2
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To investigate fear of hypoglycaemia (FoH) longitudinally in a cross‐sectional study of adult patients with type 1 diabetes. Specifically, we investigated two subgroups of patients who over 4 years either showed a substantial increase or decrease in level of FoH to identify factors associated with changes in FoH.Methods: The Swedish version of the Hypoglycaemia Fear Survey (HFS) along with a questionnaire to assess hypoglycaemia history was sent by mail to 764 patients in 2010. The responders in 2010 (n = 469) received another set of the same two questionnaires in 2014. HbA1c, insulin regimen, weight and creatinine from 2010 and 2014 were obtained from medical records. Those with an absolute difference in HFS scores ≥ 75th percentile were included in the subgroup analyses. Statistical analyses included one‐sample t tests, chi‐square and McNemar's test.Results: The absolute difference in the HFS total score (n = 347) between 2010 and 2014 was m = ±7.6, SD ± 6. In the increased FoH group, more patients reported a high level of moderate hypoglycaemic episodes as well as impaired awareness of hypoglycaemia in 2014 compared with the decreased FoH group. There were more subjects in the increased FoH group with insulin pumps in 2014 and in 2010. In the decreased FoH group, more patients had a high frequency of daily self‐monitoring of blood glucose (SMBG) in 2010 and in 2014.Conclusions: Fear of hypoglycaemia is stable across time for most patients. Changes in fear level are associated with changes in hypoglycaemia frequency. Thus, asking patients about changes in hypoglycaemia experiences is of great importance.
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| 9. |
- Anderbro, Therese, et al.
(författare)
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Psychometric evaluation of the Swedish version of the Hypoglycaemia Fear Survey
- 2008
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 73:1, s. 127-31
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective of this study was to evaluate the psychometric properties of the Swedish version of the Hypoglycaemia Fear Survey (Swe-HFS) for use among Swedish-speaking patients with type 1 diabetes. METHODS: The HFS was translated using the forward-backward translation method and was thereafter answered by 325 type 1 patients. The psychometric properties were investigated using exploratory factor analysis, Cronbach's alpha, content and convergent validity. RESULTS: The factor analysis showed that a three-factor solution was reasonable with the subscales Behaviour/Avoidance (10 items), Worry (6 items) and Aloneness (4 items). Cronbach's alpha coefficient for the total score was 0.85. The result also supports the instrument's content validity and convergent validity. CONCLUSION: The Swedish version of the HFS appears to be a reliable and valid instrument for measuring fear of hypoglycaemia (FoH) in type 1 patients. PRACTICE IMPLICATIONS: The results from this study suggest that the Swe-HFS, an instrument that is brief and easy to administer, may be valuable in clinically assessing FoH among patients with type 1 diabetes.
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| 10. |
- Axelsson, Lena, et al.
(författare)
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End of life of patients treated with haemodialysis as narrated by their close relatives
- 2015
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 29:4, s. 776-784
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The study aimed to describe end of life for patients treated with maintenance haemodialysis as narrated by their close relatives.INTRODUCTION: Many patients undergoing haemodialysis are older, have several comorbidities and underestimated symptoms and are in their last year of life. To improve care, we need to know more about their end-of-life situation.DESIGN: Qualitative and descriptive.METHODS: Qualitative retrospective interviews were conducted with 14 close relatives of deceased haemodialysis patients (3-13 months after death). Data were analysed using qualitative content analysis. The study is ethically approved.FINDINGS: In the last months, a gradual deterioration in health with acute episodes necessitating hospital admissions was described. This involved diminishing living space and expressions of dejection, but also of joy. Three patterns emerged in the last weeks: uncertain anticipation of death as life fades away; awaiting death after haemodialysis withdrawal; and sudden but not unexpected death following intensive care. Findings show complexities of decisions on haemodialysis withdrawal.CONCLUSIONS: Different end-of-life patterns all involved increasingly complex care needs and existential issues. Findings show a need for earlier care planning. The identification of organisational factors to facilitate continuity and whole person care to meet these patients' specific care needs with their complex symptom burdens and comorbidities is needed. Findings indicate the need for integration of a palliative care approach in the treatment of patients in haemodialysis care.
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