The results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self-management support as well as giving the primary healthcare nurses adequate resources to support patients' self-management while still maintaining the values associated with person-centred care.
BackgroundDigital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services.ObjectiveThe objective of this study was to describe perceptions of using electronic health (eHealth) services and related technologies for self-management support among people with T2D treated in Swedish primary health care.MethodsThis is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D.ResultsFindings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and security, as well as concerns such as ambivalence and uncertainty.ConclusionsDigital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required, and personalized devices must be adapted and become more person-centered to improve patients’ involvement in their own care.
Background Self-management is a substantial part of treatment for patients with type 2 diabetes (T2D). Modern digital technology, being small, available, and ubiquitous, might work well in supporting self-management. This study follows the process of developing a pilot implementation of an electronic health (eHealth) service for T2D self-management support in primary health care. The use of digital health, or eHealth, solutions for supporting self-management for patients with T2D is increasing. There are good examples of successful implementations that can serve as guides in the development of new solutions. However, when adding person-centered principles as a requirement, the examples are scarce. Objective The objective of this study was to explore challenges that could impact the design of a person-centered eHealth service for T2D self-management support. The study included data collection from multiple sources, that is, interviews, observations, focus groups, and a Mentimeter (interactive presentation with polling) survey among stakeholders, representing various perspectives of T2D. Methods A user-centered design approach was used to exploratively collect data from different sources. Data were collected from a workshop, interviews, and observations. The different data sources enabled a triangulation of data. Results Results show that user needs related to an eHealth service for person-centered T2D self-management support are multifaceted and situated in a complex context. The two main user groups, patients and diabetes specialist nurses, express needs that both diverge and converge, which indicates that critical design decisions have to be made. There is also a discrepancy between the needs expressed by the potential users and the current work practice, suggesting more attention toward changing the organization of work to fully support a new eHealth service. Conclusions A total of three overarching challenges—flexible access, reducing administrative tasks, and patient empowerment—each having a significant impact on design, are discussed. These challenges need to be considered and resolved through careful design decisions. Special attention has to be given to the patient user group that could greatly impact current work practice and power structures at the primary care unit. A need for further studies investigating patient needs in everyday life is identified to better support the implementation of technology that does not give specific attention to organizational perspectives but instead approach design with the patient perspective in focus.
Background Type 2 diabetes (T2D) is increasing as the population ages. The development of new medical treatments is promising and important, but the basic treatment remains self-management, even if adherence to lifestyle advice is low. Electronic health (eHealth) or mHealth interventions can increase empowerment among people living with T2D and may compensate for the lack of professional resources and geographical distances. The interactive self-management support (iSMS) project aims at including digital tools to support people living with T2D in their self-management and facilitating their interaction with diabetes specialist nurses (DSNs). This protocol outlines a study with the purpose of developing and evaluating an intervention where people living with T2D can increase self-efficacy and empowerment through digital self-monitoring and interaction with DSNs. Objective To develop and evaluate a person-centered iSMS intervention in primary health care for people with T2D in addition to their usual diabetes care. Methods This study is a 12-month, 3-armed, nonblinded randomized controlled trial (RCT), which will be conducted in 6 primary health care centers (HCCs) in northern Sweden. Eligible participants will be randomized to either an intervention group (n=46), a control group (n=46), or an external group (n=46) for comparison. The intervention group will receive the mobile app, and the control group will receive a minimal intervention (diabetes brochure) and the usual standard of care. Changes in glycated hemoglobin (HbA 1c ) will be the primary outcome measure. Results This trial is currently open for recruitment. The first results are expected to be submitted for publication in Autumn 2019. Conclusions This study, with its focus on iSMS, will provide insights regarding suitable ways to promote and develop a person-centered intervention. If successful, the intervention has the potential to become a model for the provision of self-management support to people with T2D. International Registered Report Identifier (IRRID) DERR1-10.2196/10250
Background Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses’ experiences using a digitalized scale for measuring patients’ needs for self-management support in primary health care settings has been found. Objective This paper describes diabetes specialist nurses’ (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support. Methods This qualitative study is based on observations and interviews analyzed using qualitative content analysis. Results From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient’s term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration. Conclusions Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalized care. Using a screening instrument in a patient meeting may also contribute to a role change in the work and practice of DSNs.
BACKGROUND Most countries worldwide face a common challenge by moving towards a population structure with more elderly people, living with chronic conditions, such as type 2 diabetes (T2D). This creates a considerable burden on healthcare services. The use of digital tools in health-care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as the management of the day-to-day impact of a condition, something that often is a lifelong task. The use of a screening instrument, such as the SMASc, offers a potential to guide primary healthcare nurses into person-centred self-management support which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses' experiences using a digitalised scale for measuring patient’s needs for self-management support in primary healthcare settings has been found. OBJECTIVE To describe diabetes specialist nurses’ experiences of a pilot implementation of the SMASc instrument as a basis for person-centred digital self-management support. METHODS This is a qualitative study based on observations and interviews analysed using qualitative content analysis. RESULTS Findings revealed that from diabetes specialist nurses´ (DSN) perspectives, the SMASc instrument offered insights that contributed to strengthened self-management support for persons with T2D by a new way of thinking and acting on patient´s term. Furthermore, the SMASc was seen as a screening instrument with good potential; embraces more than medical issues; it contributed to strengthen person-centred self-management support, and finally, the instrument was considered to contribute both parts to develop through collaboration. CONCLUSIONS Person-centred care is advocated as a model for good clinical practice; however, this is not always complied. A screening instrument, such as the SMASc, may support both nurses and patients with T2D to a more personalized care. Using a screening instrument in the patient meeting, may also contribute to a role change in the DSNs work and practice. CLINICALTRIAL ClinicalTrials.gov (NCT03165084).
Background: Digital health services are increasing rapidly worldwide.
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