| 1. |
- Husdal, Rebecka, et al.
(författare)
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Diabetes care provided by national standards can improve patients' self‐management skills : A qualitative study of how people with type 2 diabetes perceive primary diabetes care
- 2021
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Ingår i: Health Expectations. - : John Wiley & Sons. - 1369-6513 .- 1369-7625. ; 24:3, s. 1000-1008
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Tidskriftsartikel (refereegranskat)abstract
- Background The increasing incidence of type 2 diabetes mellitus [T2DM] has resulted in extensive research into the characteristics of successful primary diabetes care. Even if self-management support and continuity are increasingly recognized as important, there is still a need for deeper understanding of how patients' experiences of continuity of care coincide with their needs for self-management and/or self-management support.Objective To gain a deeper understanding of how people with T2DM perceive Swedish primary diabetes care and self-management support.Methods This qualitative study used focus groups as the means for data collection. Participants were identified through a purposive sampling method differing in age, sex, diabetes duration and latest registered glycated haemoglobin level. Twenty-eight participants formed five focus groups. Qualitative content analysis was applied to interview transcripts.Results The main theme emerging from the focus group data was that diabetes care provided by national standards improved self-management skills. Two themes that emerged from the analysis were (a) the importance of a clarification of structures and procedures in primary diabetes care and (b) health-care staff 'being there' and providing support enables trust and co-operation to enhance self-management.Conclusions Individual patients' self-management resources are strengthened if the importance of providing relational continuity, management continuity and informational continuity is considered. Patients also need assistance on 'how' self-management activities should be performed.Patient contribution Prior to the study, one pilot focus group was conducted with patients to obtain their perspectives on the content of the planned focus groups; thus, patients were involved in both planning and conduct of the study.
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| 2. |
- Isaksson, Sofia Sterner, et al.
(författare)
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Effects of nutrition education using a food-based approach, carbohydrate counting or routine care in type 1 diabetes: 12 months prospective randomized trial
- 2021
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Ingår i: Bmj Open Diabetes Research & Care. - : BMJ. - 2052-4897. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Evidence on the effects of structured nutrition education is weak in adults with type 1 diabetes mellitus (T1D) with moderately impaired glycemic control. Objective was to compare the effects of different types of nutrition education programs on glycemic control, cardiovascular risk factors, quality of life, diet quality and food choices in T1D. Research design and methods A 12 months randomized controlled study conducted at nine diabetes specialist centers with three parallel arms: (i) a food-based approach (FBA) including foods with low glycemic index or (ii) carbohydrate counting (CC) according to today's standard practice or (iii) individual sessions according to routine care (RC). The primary end point was difference in glycated hemoglobin A1c (HbA1c) between groups at 12 months. Results 159 patients were randomized (FBA: 51; CC: 52; RC: 55). Mean (SD) age 48.6 (12.0) years, 57.9% females and mean (SD) HbA1c level 63.9 (7.9) mmol/mol, 8% (0.7%). After 3 months, HbA1c improved in both FBA and CC compared with RC. However, there were no significant differences at 12 months in HbA1c; FBA versus RC (-0.4 mmol/mol (1.3), 0.04% (0.1%)), CC versus RC (-0.8 mmol/mol (1.2), 0.1% (0.1%)), FBA versus CC (0.4 mmol/mol (0.3), 0.04% (0.01%)). At 12 months, intake of legumes, nuts and vegetables was improved in FBA versus CC and RC. FBA also reported higher intake of monounsaturated and polyunsaturated fats compared with RC, and dietary fiber, monounsaturated and polyunsaturated fats compared with CC (all p values <0.05). There were no differences in blood pressure levels, lipids, body weight or quality of life. Conclusions Nutrition education using an FBA, CC or RC is equivalent in terms of HbA1c and cardiovascular risk factors in persons with T1D with moderately impaired glycemic control. An FBA had benefits regarding food choices compared with CC and RC.
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| 3. |
- Lostelius, Petra, et al.
(författare)
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An electronic patient-reported outcome created based on my needs is worth using : an explorative qualitative study investigating young people's opinions for a health assessment tool
- 2022
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Ingår i: Journal of Patient-Reported Outcomes. - : Springer Nature. - 2509-8020. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundYoung people in different healthcare settings are positive about using electronic patient-reported outcomes (ePROs), which are meant to increase the effectiveness and safety of interventions from the patient's perspective. Sweden offers free healthcare to young people aged 12-25 years at 275 youth health clinics (YHCs), whose goals are to strengthen young people and promote sexual, physical, and mental health. YHCs need effective ways to identify the overall picture of young people's health and health-related problems. To our knowledge, there is no ePRO for YHCs that provides an overview of young people's health from several health perspectives. The aim of this study was to explore young people's view on content and design of an ePRO to provide an overview of their health and health related problems when visiting a YHC, and their opinion on what healthcare needs to consider when using the ePRO. This was an explorative qualitative study. The participants were included from five YHCs, in different socioeconomic areas in central Sweden. Fifteen participants were included: 10 girls, three boys, and two non-binary participants with an age range of 16-22 years. Data were collected using a semi-structured interview guide and individual interviews, and inductive content analysis was performed.ResultsOne main theme, "ePRO created based on my needs is worth using" and two sub-themes, "Appealing content and design" and "Trusting healthcare", emerged. The participants wanted that an ePRO should include overall questions about mental-, physical-, and sexual health and social support. Participants also believed the ePRO must disclose the risks of self-harm or suicide. The participants noted the importance of emotional and digital security when using the ePRO and having a confidential conversation with a healthcare provider. To share health information means to trust to gain health.ConclusionsThe study participants' views on content and design can form the basis for designing an ePRO for young people. Their thoughts on safety and treatment in healthcare can be considered in the development process. This study is the starting point for developing an ePRO for young people at YHCs.
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| 4. |
- Lostelius, Petra, et al.
(författare)
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Identification of health-related problems in youth : a mixed methods feasibility study evaluating the Youth Health Report System
- 2024
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Ingår i: BMC Medical Informatics and Decision Making. - : BioMed Central Ltd. - 1472-6947. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Because poor health in youth risk affecting their entry in adulthood, improved methods for their early identification are needed. Health and welfare technology is widely accepted by youth populations, presenting a potential method for identifying their health problems. However, healthcare technology must be evidence-based. Specifically, feasibility studies contribute valuable information prior to more complex effects-based research. The current study assessed the process, resource, management, and scientific feasibility of the Youth Health Report System prototype, developed within a youth health clinic context in advance of an intervention study. Methods: This mixed-methods feasibility study was conducted in a clinical setting. The process, resource, management, and scientific feasibility of the Youth Health Report System were investigated, as recommended in the literature. Participants were youth aged 16–23 years old, attending a youth health clinic, and healthcare professionals from three clinics. The youth participants used their smart phones to respond to Youth Health Report System health questions and healthcare professionals used their computer to access the results and for registration system entries. Qualitative data were collected from interviews with healthcare professionals, which were described with thematic analysis. Youth participants’ quantitative Youth Health Report System data were analyzed for descriptive statistics. Results: Feasibility analysis of qualitative data from interviews with 11 healthcare professionals resulted in three themes: We expected it could be hard; Information and routines helped but time was an issue; and The electronic case report form was valuable in the health assessment. Qualitative data were collected from the Youth Health Report System. A total of 54 youth participants completed the evaluation questionnaire, and healthcare professionals retrieved information from, and made post-appointment system entries. Quantitative results revealed few missing items and acceptable data variability. An assessment template of merged qualitative and quantitative data guided a consensus discussion among the researchers, resulting in acceptable feasibility. Conclusions: The process-, resource-, management-, and scientific feasibility aspects were acceptable, with some modifications, strengthening the potential for a successful Youth Health Report System intervention study.
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| 5. |
- Lostelius, Vikman Lostelius, et al.
(författare)
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Development and usability evaluation of an electronic health report form to assess health in young people : a mixed-methods approach
- 2023
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Ingår i: BMC Medical Informatics and Decision Making. - : BioMed Central Ltd. - 1472-6947. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Electronic Patient-Reported Outcomes (ePROs) have potential to improve health outcomes and healthcare. The development of health-technology applications, such as ePROs, should include the potential users and be theoretically grounded. Swedish Youth Health Clinics (YHCs) offer primarily sexual and psychological healthcare for young people aged 12 to 25 years old. Young people in healthcare settings are considered a vulnerable group. The development of a collection of Patient-Reported Outcomes (PROs) in an Electronic Health Report Form (eHRF) for identifying health and health-related problems in young people, was preceded by a qualitative interview study, exploring young people’s views on using an eHRF at YHCs and which questions about health an eHRF should contain. The aim of the current study was to develop and evaluate the usability of an eHRF prototype for identifying health and health-related problems in young people visiting YHCs. Methods: This study used a participatory design. During the development, an expert panel consisting of eight researchers and one Information Technology worker, participated. A wide literature search was performed to find PROs to construct an eHRF prototype to cover health areas. A mixed methods usability evaluation included 14 participants (young people, healthcare professionals, and an expert panel). Results: The development resulted in an eHRF prototype, containing ten reliable and valid health questionnaires addressing mental-, physical-, and sexual health and social support, a self-efficacy question, and background questions, in total 74 items. The interviews in the usability evaluation resulted in three categories describing the usability of the eHRF: ‘Captures the overall health of young people but needs clarification’, ‘Fun, easy, and optional and will keep young people’s interest’, and ‘Potential contribution to improve the health consultation’. The quantitative results support the usability of the eHRF for YHCs. Conclusions: The participatory approach contributed to development of the eHRF prototype to cover health areas adapted for the target population. The usability evaluation showed that the eHRF was usable and had the potential for self-reflection and contributions to cooperation between young people and healthcare professionals during the health consultation.
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| 6. |
- Söderström, Lisa, 1982-, et al.
(författare)
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Dietary advice and oral nutritional supplements do not increase survival in older malnourished adults : a multicentre randomised controlled trial
- 2020
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 125:3, s. 240-249
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Forskningsöversikt (refereegranskat)abstract
- Objectives: The study aimed to investigate the effect on survival after 6 months of treatment involving individual dietary advice and oral nutritional supplements in older malnourished adults after discharge from hospital. Methods: This multicentre randomised controlled trial included 671 patients aged 65 years who were malnourished or at risk of malnutrition when admitted to hospital between 2010 and 2014, and followed up after 8.2 years (median 4.1 years). Patients were randomised to receive dietary advice or oral nutritional supplements, separate or in combination, or routine care. The intervention started at discharge from the hospital and continued for 6 months, with survival being the main outcome measure. Results: During the follow-up period 398 (59.3%) participants died. At follow-up, the survival rates were 36.9% for dietary advice, 42.4% for oral nutritional supplements, 40.2% for dietary advice combined with oral nutritional supplements, and 43.3% for the control group (log-rank test p = 0.762). After stratifying the participants according to nutritional status, survival still did not differ significantly between the treatment arms (log-rank test p = 0.480 and p = 0.298 for the 506 participants at risk of malnutrition and the 165 malnourished participants, respectively). Conclusions: Oral nutritional supplements with or without dietary advice, or dietary advice alone, do not improve the survival of malnourished older adults. These results do not support the routine use of supplements in older malnourished adults, provided that survival is the aim of the treatment.
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| 7. |
- Vikman Lostelius, Petra, 1972-
(författare)
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Development of a digital Health Report System : From exploration of need to identification of health-related problems in young people
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction While foremost mental health and psychosomatic symptoms are increasing in young people, little is known about the health in young people visiting Youth Health Clinics (YHC). Also, there is no unified health survey used to collect overall health data from young people nationally at YHCs.Aims To develop a health- and welfare technology tool to identify and increase knowledge about health-related problems in young people visiting YHCs.Methods The structured development of a health and welfare technology tool, the Health Report System (studies I to III) had a consultative level participatory approach. Study I was qualitative and contained interviews with young people on content and design for a digital questionnaire. Studies II and III had mixed methods design and included young people, healthcare professionals, and a researcher expert panel. Qualitative data came from interviews and quantitative data from questionnaires. The studies evaluated usability and feasibility. Study IV was quantitative and used data from the evaluation questionnaire, exploring the mediated association of variables on mental well-being, using a set of regression analyses.Results Study I: Young people (n=15) were positive to use a health and welfare technology tool if it was in accordance with their needs. It should give an overview of mental-, physical-, and sexual health and social support. The results should be discussed with healthcare professionals during a health assessment. Study II: The researchers used guidelines to develop the Health Report System and included ten validated and reliable health questionnaires. The usability of the Health Report System was evaluated by young people (n=4), YHC healthcare professionals (n=3), and an expert panel (n=7). The converged qualitative and quantitative data showed that the Health Report System was very usable for YHCs. Study III: The qualitative results from healthcare professionals’ interviews (n=11) and quantitative questionnaire results from young people (n=54) were merged. Using a matrix for assessment of feasibility, the researcher's consensus decision, was that progression and use of the Health Report System in an intervention study was feasible. Study IV: Results from young people’s (n=223) health data showed statistical significance for the mediating effect of social functioning between the sense of mastery and mental well-being. Conclusion This thesis presents that the Health Report System has the potential to identify health-related problems in young people, strengthen the health communication between young people and healthcare professionals, and influence the YHC organization.
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| 8. |
- Zakrisson, Ann-Britt, 1955-, et al.
(författare)
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Improved quality of care by using the PRISMS form to support self-management in patients with COPD : A Randomized Controlled Trial
- 2020
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Ingår i: Journal of Clinical Nursing. - : Blackwell Science Ltd.. - 0962-1067 .- 1365-2702. ; 29:13-14, s. 2410-2419
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVE: To investigate the effects on the quality of care of the Patient Report Informing Self-Management Support (PRISMS) form compared with usual care among patients with Chronic Obstructive Pulmonary Disease (COPD) consulting a COPD nurse in primary health care.BACKGROUND: Patients with COPD experience symptoms affecting their everyday lives and there is a need for interventions in self-management support. The delivery of chronic care in an organized, structured, and planned manner can lead to more productive relationships between professionals and patients.DESIGN: A multicentre randomised controlled trial with a post-test design, according to the CONSORT checklist, in one intervention group (n=94) and one control group (n=108).METHODS: In addition to usual care, the intervention group (n=94) completed the PRISMS form to indicate areas where they wanted self-management support before the consultation with the COPD nurse. This form comprises 17 items that patients with COPD commonly experience as problems. The control group received usual care (n=108). The primary outcome was patients' satisfaction with quality of care, assessed using the Quality from the Patient's Perspective (QPP) questionnaire. Means and (SD) are presented where applicable. Differences between the intervention and control group were analysed with Student's t-test for independent groups for interval data, and the Mann-Whitney U-test for ordinal data.RESULTS: Participants in the intervention group were more satisfied with the QPP domains "personal attention", regarding both "Perceived reality" (p=0.021) and "Subjective Importance" (p=0.012). The PRISMS form revealed "Shortness of breath" as the most commonly experienced problem and the issue most desired to discuss.CONCLUSION: The PRISMS form improved patient satisfaction with quality of care regarding personal attention, which is an important factor in patient participation and improving relationships and communication.RELEVANCE TO CLINICAL PRACTICE: The PRISMS form can be a useful tool in improving person-centred care when delivering self-management support.
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