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How are virtues constituted psychologically? The virtues of caring or substantive virtues are dispositional concerns for the good in its various aspects: the well-being of people and other animals, the avoidance or relief of their suffering, the reconciliation of enemies, knowledge and truth, justice, proper formation of sensual desire and pleasure, and one’s duties. Generosity, compassion, forgivingness, justice, and the sense of duty are examples of virtues constituted by such caring. Because the caring is virtuous only if directed to real goods, the concerns need to be shaped by correct thought (understanding). The virtues of caring divide into direct (for example, generosity) and indirect (for example, justice). Another class of virtues – the enkratic – are powers, abilities, or skills of self-management. These, too, require understanding – of self and how to manage it in the various situations and influences of life. Examples are self-control, courage, patience, and perseverance.
The present study was conducted to determine self-management and influencing factors in dialysis patients who experienced the earthquake.
Methods
The study was conducted descriptively with 125 patients receiving dialysis in a city affected by the earthquake in Türkiye. Data were collected with the “Personal Information Form” and the “Chronic Illness Self-Management Scale” (CISMS). Kolmogorov-Smirnov, Mann Whitney U, Kruskall Wallis, Spearman Correlation tests, Wilcoxon, and Linear Regression were used in the statistical analysis.
Results
The study found that 9.6% of the patients were trapped under the rubble in the earthquake, 71.2% lost a relative, 43.8% changed dialysis centers, 36.8% missed dialysis sessions, and 51.2% could not comply with the diet after the earthquake. Women (p < 0.001), those with secondary school or lower educational levels (p < 0.05), those with another chronic disease, and those who lost a relative in the earthquake had lower health care maintenance efficacy (p < 0.05). The treatment adherence of those who adhered to the diet was higher than those who did not (p < 0.05).
Conclusion
It was determined that the level of self-stigma of the patients after the earthquake was low, their treatment adherence was high, and there were many variables affecting their self-management.
This chapter provides an explorative analysis of self-illness ambiguity in personality disorders. Self-illness ambiguity refers to the difficulty in distinguishing one’s self from a mental disorder or diagnosis. Personality disorder diagnoses may invoke a specific type of self-illness ambiguity, for the characteristics of personality disorders (i.e., maladaptive personality traits) seem more closely related to “who one is” than to a disorder. Our analysis focuses on the concept of trait maladaptivity. We use three characteristics of trait maladaptiveness (temporality, severity, and attitude) to compare such maladaptivity in personality disorders with other cases of trait maladaptivity. Aside from some similarities, we argue that managing one’s traits in the context of personality disorders is distinct in that it may involve a distancing or disidentification with the maladaptive trait, which sometimes leads to the development of a subsidiary (or “as if”) self. In a further step, people with a personality disorder may start to experience what we call “self–self-ambiguity,” where they struggle to determine whether a particular action is part of their default or subsidiary self. Finally, we discuss how people with a personality disorder implicitly relate to their maladaptive personality traits using the concept of self-relating.
COVID-19 saw many career health officials retire early and seasoned health practitioners simply quit due to burnout. This chapter explores various qualities that leaders can utilize to provide and receive support when faced with stressors and challenges in both their work and personal lives. Personal assessments like Myers–Briggs, DISC, the Gallup Strengths Finder, and the Enneagram offer practical tools for members of leadership to identify their strengths and areas for growth. Identifying stressors and engaging in self-regulation ensure public health leaders can mitigate burnout. Leadership qualities are outlined and described. By cultivating leadership qualities, crisis leaders can stay focused and grounded during health emergencies. Transformation leadership theory is described. A student case study uses the Crisis and Emergency Risk Communication framework to analyze former Prime Minister of New Zealand Jacinda Ardern’s communication during the COVID-19 outbreak. End-of-chapter reflection questions and activities are included.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Person-centred care (PCC) is a healthcare approach that emphasises the importance of individual patient preferences, needs, and values. It involves a shift in the power dynamic of medical consultations, allowing for shared control between the professional and the patient. The UK’s National Health Service has prioritised six processes to enable PCC, which include shared decision making and personalised care planning. Person-centred care aims to enhance patients’ skills and confidence for self-management by focusing on what matters to them rather than solely on their health conditions. The Health Foundation’s model of PCC highlights the need for care to be personalised, coordinated, and respectful of the patient’s dignity. Lifestyle Medicine, which largely focuses on supporting people to change behaviour, greatly depends on PCC as it empowers individuals to manage their health. Care planning and shared decision making are collaborative processes that balance the expertise of both the clinician and the patient. Understanding a patient’s ‘activation level’ can be useful for tailoring support to their ability to make lifestyle changes. Ultimately, PCC enhances the outcomes of Lifestyle Medicine by fostering patient self-management and improving the quality of treatment decisions.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Behaviour change science is a central concept in Lifestyle Medicine. It focuses on modifying lifestyle risk factors through evidence-based interventions. The COM-B model provides a framework that considers Capability, Opportunity, and Motivation as key components influencing health behaviours. In clinical settings, understanding and modifying patient behaviours are crucial for better health outcomes. Identifying internal and external factors that influence behaviour is essential for effective intervention. Various approaches, such as education, persuasion, and enablement, are used to target different aspects of behaviour change. Behaviour Change Techniques (BCTs) play a vital role in creating specific strategies for behaviour modification. Contextual understanding recognises the importance of considering the patient’s environment and circumstances. Additionally, addressing health inequalities acknowledges the role of wider determinants of health and emphasises the need for interventions that do not exacerbate disparities. Using behaviour change science in the practice of Lifestyle Medicine enhances patient-centred care and health outcomes.
The aim of this descriptive study was to assess diabetes self-management and health care demand procrastination behaviors among earthquake victims with type 2 diabetes.
Methods
The population of the study consisted of earthquake victims with Type 2 diabetes in Hatay, Türkiye. The sample included 202 people with type 2 diabetes who lived in 7 distinct container cities. Data were collected using the Introductory Information Form, Diabetes Self-Management Scale, and Healthcare Demand Procrastination Scale via face-to-face interviews.
Results
Participants’ average score on the diabetes self-management scale was 58.34 ± 9.11. Being under the age of 60, employed, visiting a medical center on their own, having received diabetes education, and owning a glucometer were associated with better diabetes self-management, whereas being illiterate and having difficulty covering diabetes-related expenses were associated with poor diabetes management (P < 0.05). Participants’ average score on the Healthcare Demand Procrastination Scale was 2.35 ± 0.72. Respondents who didn’t have a nearby health care institution, whose diabetes diagnosis duration was between 1-5 years, and who didn’t have a glucometer had significantly higher scores on the Healthcare Demand Procrastination Scale (P < 0.05).
Conclusions
Diabetes self-management among earthquake victims with Type 2 diabetes was low. It was also determined that participants’ health care demand procrastination behaviors were at a moderate level.
This study aimed to explore health professionals’ use, barriers, confidence, and preferences for technology and smartphone apps to assist clients with self-managing low back pain (LBP).
Methods:
Prospective observational cross-sectional survey of registered Australian health professionals that managed clients with LBP.
Results:
In total, 52 survey responses were included (mean age 43 ±13.8 years). Most did not personally use healthy lifestyle apps (60%) and did not recommend apps due to a lack of knowledge of app effectiveness (93%). The largest barrier to recommending apps was the potential for apps to be misused as a substitute to health professional diagnosis. Fifteen recommended smartphone apps (mean age 36 ±10.6 years) and were at least moderately confident in choosing/recommending apps (94%) and assessing app quality (80%). Those more likely to recommend apps personally used apps for healthy lifestyle behaviours (odds ratio (OR) 5.1 (p = 0.009)) were physiotherapists (OR 0.13 (p = 0.035) c/f chiropractors in their profession for <10 years (OR 8.6 (p = 0.015)) c/f >30 years. Increasing age decreased the odds (OR 0.94 (p = 0.013)) of recommending apps.
Conclusions:
Health professionals do not recommend LBP self-management apps due to a lack of knowledge of their effectiveness. Those that do recommend apps are confident with app choice, recommendation, and app quality assessment. Physiotherapists with <10 years’ experience were most likely to recommend apps.
Coping-Together is a self-directed, self-management intervention initially developed for patients in early-stages of cancer and their caregivers. This study evaluated its acceptability among patients with advanced cancer and their caregivers.
Methods
Twenty-six participants (patients with advanced cancer n = 15 and their caregivers n = 11) were given the Coping-Together materials (6 booklets and a workbook) for 7 weeks. Participants were interviewed twice during this time to solicit feedback on the intervention’s content, design, and recommended changes. Audio-recorded interviews were transcribed verbatim, and thematic analysis was conducted.
Results
Participants found Coping-Together was mostly relevant. All (n = 26, 100%) participants expressed interest and a desire to improve their self-management skills. Perceived benefits included learning to develop SMARTTER (specific, measurable, attainable, relevant, timely, and done together) self-management plans, normalizing challenges, and enhancing communication within the dyad and with their healthcare team. Most (n = 25, 96%) identified strategies from the booklets that benefited them. Top strategies learned were skills to manage physical health (n = 20, 77%) (e.g., monitoring symptoms), emotional well-being (n = 21, 81%) (e.g., reducing stress by reframing thoughts), as well as social well-being (n = 24, 92%) (e.g., communicating with their healthcare team). Barriers included illness severity and time constraints. The unique advanced cancer needs that are to be integrated include support related to fear of death, uncertainty, palliative care and advanced care planning. Suggested modifications involved enhancing accessibility and including more advanced cancer information (e.g., end-of-life planning, comfort care, resources).
Significance of results
Participants reported several benefits from using Coping-Together, with minimal adaptations needed. Creating SMARTTER self-management plans helped them implement self-management strategies. Specific areas for improvement addressed the need for improved accessibility and more content related to advanced cancer. Findings demonstrate how Coping-Together is acceptable for those living with advanced cancer and their caregivers, offering much of the support needed to enhance day-to-day quality of life.
Sickle cell disease (SCD) is hallmarked by recurrent episodes of severe acute pain and the risk for chronic pain. Remote peer support programs have been shown to effectively improve health outcomes for many chronic conditions. The objective of this study was to examine the feasibility and acceptability of an online peer mentoring program (iPeer2Peer program) for adolescents with SCD.
Method:
A waitlist pilot randomized controlled trial was conducted. Adolescents randomized to the intervention group were matched with trained peer mentors (19–25 years; successfully managing their SCD), consisting of up to 10 sessions of approximately 30-min video calls over a 15-week period. The control group received standard care. The primary outcomes were rates of accrual, withdrawal, and adherence to iP2P program/protocol, with secondary outcomes identifying topics of mentorship–mentee conversations through qualitative analysis.
Results:
Twenty-eight participants (14 intervention; 14 control) were randomized to the study (mean age: 14.8 ± 1.7 years; 57% female). Accrual rate was 80% (28/35) and withdrawal rate was 18% (5/28), with 28% (4/14) adhering to the iP2P program; however, 71% (10/14) of adolescents in the intervention completed at least one call. Based on content analysis of 75 mentor–mentee calls, three distinct content categories emerged: impact of SCD, self-management, transitioning to adulthood with SCD, and general topics.
Conclusion:
The results from this pilot study suggest that the current iteration of the iP2P SCD program lacks feasibility. Future research with the iP2P program can focus improved engagement via personalized mentoring, variable communication avenues, and an emphasis on gender.
Self-management practices can contribute to the lives of patients with multiple sclerosis. The aim of this study is to improve patients’ self-management abilities through a multidisciplinary developed module.
Methods:
This prospective, randomized controlled trial was conducted between January 2020 and November 2021 at a university hospital in Ankara, Turkiye. The self-management module was implemented by a clinical pharmacist with the aim of enhancing self-management capabilities through an educational approach, with a focus on medication adherence, management of drug-related problems, follow-ups and self-directed activities. The intervention group completed the self-management module, while the control group received usual outpatient care. To evaluate the impact of the module, the Multiple Sclerosis Self-Management Revised scale was administered to the patients. Interviews were conducted at 4-month intervals.
Results:
Study (n = 102) and control group (n = 98) patients were followed up for 8 months, and the median duration of intervention was 11 minutes. The mean (± SD) self-management scores of the study group increased from 68.9 (± 9.3) to 79.0 (± 9.4) at the end of the interviews, and this increase was found to be significant compared to the control group (p < 0.001). The self-management module has been shown to improve self-management, medication adherence, perception of care and patient engagement in treatment (p < 0.001).
Conclusions:
This single-center randomized controlled trial suggests that a pharmacist-implemented self-management module increased patient engagement and medication adherence. The self-management interventions could be tailored to groups that tend to have lower self-management abilities, such as older individuals, and those who have lower educational attainment, health engagement or medication adherence.
West Virginia is a rural state with high rates of type 2 diabetes (T2DM) and prediabetes. The Diabetes Prevention and Management (DPM) program was a health coach (HC)-led, 12-month community-based lifestyle intervention.
Objective:
The study examined the impact of the DPM program on changes in glycosylated hemoglobin (A1C) and weight over twelve months among rural adults with diabetes and prediabetes. Program feasibility and acceptability were also explored.
Methods:
An explanatory sequential quantitative and qualitative one-group study design was used to gain insight into the pre- and 12-month changes to health behavior and clinical outcomes. Trained HCs delivered the educational sessions and provided weekly health coaching feedback. Assessments included demographics, clinical, anthropometric, and qualitative focus groups. Participants included 94 obese adults with diabetes (63%) and prediabetes (37%). Twenty-two participated in three focus groups.
Results:
Average attendance was 13.7 ± 6.1 out of 22 sessions. Mean weight loss was 4.4 ± 11.5 lbs at twelve months and clinical improvement in A1C (0.4%) was noted among T2DM adults. Program retention (82%) was higher among older participants and those with poor glycemic control. While all participants connected to a trained HC, only 72% had regular weekly health coaching. Participants reported overall acceptability and satisfaction with the program and limited barriers to program engagement.
Conclusion:
Our findings suggest that it is feasible to implement an HC-led DPM program in rural communities and improve A1C in T2DM adults. Trained HCs have the potential to be integrated with healthcare teams in rural regions of the United States.
This position paper by the international IMMERSE consortium reviews the evidence of a digital mental health solution based on Experience Sampling Methodology (ESM) for advancing person-centered mental health care and outlines a research agenda for implementing innovative digital mental health tools into routine clinical practice. ESM is a structured diary technique recording real-time self-report data about the current mental state using a mobile application. We will review how ESM may contribute to (1) service user engagement and empowerment, (2) self-management and recovery, (3) goal direction in clinical assessment and management of care, and (4) shared decision-making. However, despite the evidence demonstrating the value of ESM-based approaches in enhancing person-centered mental health care, it is hardly integrated into clinical practice. Therefore, we propose a global research agenda for implementing ESM in routine mental health care addressing six key challenges: (1) the motivation and ability of service users to adhere to the ESM monitoring, reporting and feedback, (2) the motivation and competence of clinicians in routine healthcare delivery settings to integrate ESM in the workflow, (3) the technical requirements and (4) governance requirements for integrating these data in the clinical workflow, (5) the financial and competence related resources related to IT-infrastructure and clinician time, and (6) implementation studies that build the evidence-base. While focused on ESM, the research agenda holds broader implications for implementing digital innovations in mental health. This paper calls for a shift in focus from developing new digital interventions to overcoming implementation barriers, essential for achieving a true transformation toward person-centered care in mental health.
This article sought to explore how older people maintained their health and managed chronic conditions during the 2019-2020 Black Summer bushfires, floods, and COVID-19 pandemic in Australia. This knowledge is important in the context of intersecting public health and environmental hazards.
Methods
Qualitative, semi-structured interviews were undertaken with 19 community-dwelling older people living in South Eastern New South Wales, a region significantly impacted by the successive disasters.
Results
Three themes summarized participants’ experiences. Participants described disruption to daily activities and social networks, delayed treatment and disruption to health services, and the exacerbation of health issues and emergence of new health challenges as challenges to managing health and self-care. Strategies for staying healthy were described as drawing on connections and relationships and maintaining a sense of normalcy. Finally, the compounding nature of disasters highlighted the impact of successive events.
Conclusions
Understanding older people’s experiences of self-care during disasters is critical for developing interventions that are better targeted to their needs. This study highlights the importance of social connectedness, habit, and routine in health and well-being. Results should inform policymaking and guide interventions in health care for older people.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
This chapter covers psychosocial and physical health approaches to the management of bipolar disorder. These include psychosocial and physical health approaches to the condition that should be offered by every psychiatrist, as well as specialist psychological treatments delivered by psychological therapists. The approach outlined is supported by the National Institute for Care Excellence (NICE) in its 2014 clinical guideline for bipolar disorder as well as other clinical guidelines for bipolar disorder more recently published from Canada, Australia and New Zealand. Overall, the current best standard of practice for bipolar disorder is to adopt a collaborative proactive holistic approach attending to both mental health and physical health stability without the use of unnecessarily high doses of medication, particularly when they may impact on physical health. The approach should be consistent with the life goals and wishes of the person with bipolar disorder, convey a message of hope, and consider lifestyle and cognitive factors alongside symptoms and function. Bipolar disorder is a long-term condition where there is a potential for normal function and a high quality of life for many. A psychologically informed approach to management enables people with bipolar disorder to be proactive in their care, practice self-management and do their best.
Children who develop coronary artery aneurysms after Kawasaki disease are at risk for cardiovascular morbidity, requiring health care transition and lifelong follow-up with an adult specialist. Follow-up losses after health care transition have been reported but without outcome and patient experience evaluation.
Objective:
The Theoretical Domains Framework underpinned our aim to explore the required self-care behaviours and experiences of young adults’ post-health care transition.
Methods:
A qualitative description approach was used for virtual, 1:1 interviews with 11 participants, recruited after health care transition from a regional cardiac centre in Ontario. Directed content analysis was employed.
Results:
Health, psychosocial, and lifestyle challenges were compounded by a sense of loss. Six themes emerged within the Theoretical Domains Framework categories. Participants offered novel health care transition programme recommendations.
Conclusions:
The realities of health care transition involve multiple, overlapping stressors for young adults with Kawasaki disease and coronary artery aneurysms. Our findings will inform a renewed health care transition programme and will include outcome evaluation.
The large-scale implementation of remote work appears as a fundamental shift into the traditional understanding of the relationship between time and work. Drawing on sociomateriality literature and more especially on the concept of temporal structuring, this chapter suggests that remote workers ‘work the time’ by different practices, to (re)create adequate temporalities to work. The analysis results from an exploratory qualitative study conducted between May 2020 and April 2021 in Montreal with 17 remote workers who were already working remotely before the Covid-19 pandemic. It gives an overview of the temporal practices of remote workers, who are mainly blocking time (i), navigating between temporalities (ii) ritualizing them (iii) or an interwoven of all of them to try to create time to work (and thus, for non-work as well). It appears that remote workers work the time to be flexible. However, they still do it in the clock time of organizational life. They also experiment with temporal tensions, which leads them to exercise a fourth practice that is indispensable to the other three, that of labeling times.
This chapter provides an overview of the methodological challenges in researching social inclusion amongst people with mental health conditions and gives examples of interventions that have been shown to be effective in addressing social exclusion including pre-school parenting programmes, early intervention, peer support, recovery colleges, self-care, self-management, and self-directed care. As with all clinical practice, the starting point is the establishment of a therapeutic relationship that encompasses empathy, understanding, hope, and a willingness to help, along with a recovery orientation encompassing collaborative and strengths-based approaches. Much of this does not require a major reorganisation of services, but rather a refocusing and reprioritisation of existing tools and clinical skills, alongside commitment by mental health organisations to ensure their structures facilitate service-user involvement in the planning and delivery of services
Psychological distress is common after stroke, and affects recovery. However, there are few evidence-based psychological treatments. This study evaluates a bibliotherapy-based approach to its amelioration.
Aims:
To investigate a stroke-specific self-management book, based on acceptance and commitment therapy (ACT), as a therapist-supported intervention for psychological distress after stroke.
Method:
The design was a single case, randomised non-concurrent multiple-baseline design (MBD). Sixteen stroke survivors, eight males and eight females (mean age 60.6 years), participated in an MBD with three phases: A (randomised-duration baseline); B (intervention); and follow-up (at 3 weeks). During the baseline, participants received therapist contact only. In the bibliotherapy intervention, participants received bi-weekly therapist support. The primary measures of psychological distress (General Health Questionaire-12; GHQ-12) and quality of life (Satisfaction with Life Scale; SWLS) were completed weekly. Secondary measures of mood, wellbeing and illness impact were completed pre- and post-intervention.
Results:
Omnibus whole-group TAU-U analysis was statistically significant for each primary measure with a moderate effect size on both (0.6 and 0.3 for GHQ-12 and SWLS, respectively). Individual TAU-U analyses demonstrated that the majority of individuals exhibited positive change. All the secondary measures showed significant pre–post improvements. Eighty-one per cent of participants reported the book was helpful and 81% also found the ACT-based sections helpful. Relative risk calculations showed finding the book helpful was associated with improvement in GHQ-12 and SWLS scores.
Conclusions:
ACT-based bibliotherapy, with therapist support, is a promising intervention for psychological difficulties after stroke.
E-Mental Health in older age Ulrich Hegerl, Caroline Oehler Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe Universität Frankfurt/M, Germany European Alliance against Depression e.V. (www.EAAD.net) The implementation and uptake of digital tools for self management or psychotherapy for people suffering from depression or other mental disorders has gained momentum during the Covid-19 pandemia. While studies using waiting list or treatment as usual control groups are of limited value, meta-analyses of RCTs with face-to-face psychotherapy as control condition have found a comparable antidepressant effect, especially when the interventions were provided together with professional guidance. The iFightDepression-tool offered by the European Alliance against Depression (EAAD) is available in 10 different languages and is broadly used in several European countries. Data will be presented concerning the attitude of older people concerning iCBT and also concerning effects of age, guidance, and gender on both adherence to the iFightDepression-tool and antidepressant effects.