| 1. |
- Amsberg, Susanne, et al.
(författare)
-
Acceptance and commitment therapy (ACT) for adult type 1 diabetes management : study protocol for a randomised controlled trial
- 2018
-
Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:11
-
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.
|
|
| 2. |
|
|
| 3. |
- Ljungholm, Linda
(författare)
-
Patients’ experiences of continuity of care : What is needed and how can it be measured?
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim for this thesis was to explore continuity of care through patients’, family carers’, and health care personnel’s perceptions, and to develop and evaluate a patient-reported experience measure of continuity of care.Method: This thesis consists of four studies; I have a qualitative explorative design and II have a qualitative descriptive design, whereas III and IV are methodological studies. In studies I and II, data were collected from four geographically disparate areas in Sweden; in studies III and IV, data were collected in one of these areas. Data were collected using individual (I, II, III), focus groups, pair interviews (II), and questionnaires (III, IV). Data were analyzed using constructivist grounded theory (I), conventional content analysis (II), and according to classical test theory (III), and Rasch measurement theory (IV).Results: For patients to experience continuity of care, all aspects were interconnected, as access to tailored information was essential for gaining mutual understanding regardless of who was performing a care task. This required clarity in responsibilities and roles, interprofessional collaboration, and a trusting relationship over time and space between each link in the patient’s care trajectory (I). Further, Study II showed that to achieve continuity of care, professional and cross disciplinary cooperation at micro, meso and macro levels were needed. Continuity of care is dependent on long-term and person-centered relationships, dynamic stability in the organizational structure, and shared responsibility for cohesive care enabling uniform solutions for knowledge and information exchange (II). Studies III and IV resulted in the Patient-Experienced Continuity of care Questionnaire (PECQ). The instrument contains 20 items measuring four dimensions of continuity of care: Information (four items), Relation (six item), Management (five item), and Knowledge (five item). Overall, the PECQ showed satisfactory measurement properties according to classical test theory and Rasch measurement theory (III, IV) regarding factor structure, unidimensional, local independence, response category function, differential item functioning for age and sex, and internal consistency reliability.Conclusion: Continuity of care is perceived as multidimensional, containing several important aspects working in synergy and varying over time. To achieve continuity of care, information and knowledge sharing need to cross disciplinary and organizational boundaries. Collaborative responsibility is needed, vertically through all levels of the system, instead of focusing on personal responsibility horizontally. The PECQ can provide information on different dimensions of continuity, useful for driving quality improvements in the primary care context.
|
|
| 4. |
|
|
| 5. |
- Wijk, Ingrid
(författare)
-
Experiences of living with type 1 diabetes and improving psychological flexibility through an Acceptance and Commitment Therapy (ACT) intervention
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Impaired psychological health in type 1 diabetes is prevalent and associated with elevated glycaemic outcomes. International evidence-based guidelines have defined glycaemic treatment targets to prevent acute and long-term complications. In addition, the guidelines encourage screening for the elevated distress that living with type 1 diabetes may imply. There is a need to gain further understanding of what it means to live with type 1 diabetes as an adult with elevated HbA1c and to develop interventions to promote psychological and physiological health.Aim: The overall aim of the thesis was to describe experiences of living with type 1 diabetes as an adult with elevated HbA1c and furthermore to evaluate the impact of an Acceptance and Commitment Therapy programme for people living with type 1 diabetes. The thesis also aimed to examine the Swedish version of Acceptance and Action Diabetes Questionnaire (AADQ), which is a questionnaire for psychological flexibility related to diabetes.Method and result: In Study I we included 81 adults with type 1 diabetes and HbA1c > 60 mmol/mol in a randomised controlled trial. A seven-session programme based on Acceptance and Commitment Therapy was conducted and the impact on HbA1c, self-management and psychosocial factors was evaluated. No effect was demonstrated in the linear mixed model analysis on HbA1c or the secondary outcomes. Nevertheless, a significant statistical improvement in psychological flexibility was noted one and two years after the intervention. A large drop-out rate was observed in the study. In Study II, the psychometric properties of a translated version of the AADQ were examined through Rasch analysis. A total of 120 adults with type 1 diabetes were included. The Swedish version of the ADDQ showed acceptable psychometric properties such as fit to the Rasch model and person separation index. However, we also found indications on a malfunctioning categorisation of the response categories. A collapsed three category rating was examined. In Study III, two categories of experiences were described in the qualitative interviews: constraining and manageable. Through content analysis, an overarching theme was created "a life-long follower". The theme describes the unrelenting existence of type 1 diabetes that impact life in various degrees.Conclusion: No impact on HbA1c or secondary outcomes could be demonstrated through the Acceptance and Commitment Therapy based programme. At the same time, a key component in psychological health, psychological flexibility, was improved. The Swedish version of the AADQ showed acceptable psychometric quality. However, uncertainties regarding the categorisation should be further examined. The experiences of living with type 1 diabetes as an adult and elevated HbA1c is widely diverse. A person-centred care approach is therefore crucial to support the needs of each unique person with type 1 diabetes.
|
|
| 6. |
- Wijk, Ingrid, et al.
(författare)
-
Impact of an acceptance and commitment therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels : a randomised controlled trial
- 2023
-
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:12, s. e072061-
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the impact of an Acceptance and Commitment Therapy (ACT) programme, tailored for people living with type 1 diabetes, on glycated haemoglobin (HbA1c), self-management and psychosocial factors among individuals with HbA1c>60 mmol/mol compared with treatment as usual (TAU). Setting: An endocrinologic clinic in Sweden. Participants: In this randomised controlled trial, 81 individuals with type 1 diabetes, aged 18–70 years with HbA1c>60 mmol/mol, were randomly assigned to either an ACT group intervention or TAU. Exclusion criteria were: unable to speak Swedish, untreated or severe psychiatric disease, cortisone treatment, untreated thyroid disease and newly started insulin pump therapy. At the 2-year follow-up, HbA1c was measured in 26 individuals. Intervention: The ACT programme comprised seven 2-hour sessions held over 14 weeks and focused on acceptance of stressful thoughts and emotions, and to promote value-based committed action. Outcomes: The primary outcome was HbA1c, and the secondary outcomes were measures of depression, anxiety, general stress, fear of hypoglycaemia, diabetes distress, self-care activities, psychological flexibility (general and related to diabetes) and quality of life. The primary endpoint was HbA1c 2 years after the intervention programme. Linear mixed models were used to test for an interaction effect between measurement time and group. Results: Likelihood ratio test of nested models demonstrated no statistically significant interaction effect (χ2=0.49, p=0.485) between measurement time and group regarding HbA1c. However, a statistically significant interaction effect (likelihood ratio test χ2=12.63, p<0.001) was observed with improved scores on The Acceptance and Action Questionnaire in the intervention group after 1 and 2 years. Conclusions: No statistically significant difference was found between the groups regarding the primary outcome measure, HbA1c. However, the ACT programme showed a persistent beneficial impact on psychological flexibility in the intervention group. The dropout rate was higher than expected, which may indicate a challenge in this type of study. Trial registration number NCT02914496.
|
|
| 7. |
- Wijk, Ingrid, et al.
(författare)
-
Living with Type 1 Diabetes as Experienced by Adults with Prolonged Elevated HbA1c : A Qualitative Study
- 2023
-
Ingår i: Diabetes Therapy. - : Springer Nature. - 1869-6953 .- 1869-6961. ; 14, s. 1673-1684
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: High HbA1c levels in type 1 diabetes (T1D) are associated with increased risk of micro- and macrovascular complications and severe diabetes distress. A more comprehensive understanding of the adult perspective of living with T1D can improve the quality of care. We aimed to describe experiences of living with T1D as an adult with prolonged elevated HbA1c.Methods: Thirteen adults with T1D and HbA1c > 60 mmol/mol (7.6%) for at least 1 year were individually interviewed via a digital platform. The interviews were transcribed verbatim and analyzed using qualitative content analysis.Results: The analysis identified an overarching theme, “a lifelong follower”, and generated two main categories describing study participants’ experience: constraining and manageable. Constraining experiences were explained in obligated control, loss of control, environmental impact, and consequences of diabetes. Manageable experiences were described in everyday life, approach to diabetes, and support in life. Diabetes knowledge in health care and in the general public, and individualized care were important factors in feeling understood, safe, and supported.Conclusions: The findings revealed the diverse experiences of adults with prolonged elevated HbA1c. Living with T1D, a lifelong non-chosen follower, could be perceived as constraining but manageable in different degrees. A person-centered care approach addressing both dimensions may be beneficial. Experiences of living with and managing diabetes are multifaceted and intertwined with life context and medical prerequisites.
|
|
| 8. |
- Wijk, Ingrid, et al.
(författare)
-
Psychometric Evaluation of the Swedish Acceptance and Action Diabetes Questionnaire : A Rasch Analysis
- 2024
-
Ingår i: Journal of Nursing Measurement. - 1061-3749 .- 1945-7049. ; 32:2
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: The Acceptance and Action Diabetes Questionnaire (AADQ) is a tool for assessing the acceptance of thoughts and emotions related to diabetes in people living with the disease. This study aimed to examine the psychometric properties of the Swedish version of AADQ (Swe-AADQ) in a sample of adults with type 1 diabetes. Methods: To examine the psychometric properties of the Swe-AADQ, the Rasch model was used. Data for 120 individuals were included. Results: The Swe-AADQ showed an acceptable fit to the Rasch model. A sufficiently high value of the separation index indicated a capacity to distinguish between different levels of acceptance in the sample. The seven-point Likert scale was reduced to three categories suggesting an improvement in the ordering of the item thresholds. Conclusions: The Swe-AADQ possesses reasonable quality in terms of reliability and validity. However, there are some deficiencies regarding the categorization of the response rating that should be addressed.
|
|
| 9. |
- Wijk, Ingrid, et al.
(författare)
-
Psychometric evaluation of the Swedish Acceptance and Action Diabetes Questionnaire : A Rasch analysis
- 2023
-
Ingår i: Journal of Nursing Measurement. - 1061-3749 .- 1945-7049.
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: The Acceptance and Action Diabetes Questionnaire (AADQ) is a tool for assessing the acceptance of thoughts and emotions related to diabetes in people living with the disease. This study aimed to examine the psychometric properties of the Swedish version of AADQ (Swe-AADQ) in a sample of adults with type 1 diabetes.Methods: To examine the psychometric properties of the Swe-AADQ, the Rasch model was used. Data for 120 individuals were included.Results: The Swe-AADQ showed an acceptable fit to the Rasch model. A sufficiently high value of the separation index indicated a capacity to distinguish between different levels of acceptance in the sample. The seven-point Likert scale was reduced to three categories suggesting an improvement in the ordering of the item thresholds.Conclusions: The Swe-AADQ possesses reasonable quality in terms of reliability and validity. However, there are some deficiencies regarding the categorization of the response rating that should be addressed.
|
|
