Multimorbidity, defined as the co-occurrence of two or more long-term conditions, is increasing rapidly and poses challenges for healthcare systems. Advances in digital technologies offer solutions by facilitating personalised, scalable care interventions that empower individuals to manage their conditions more effectively. These applications have potential to improve access to care, enhance patient engagement, and support tailored approaches to self-management.

This scoping review aims to synthesise current evidence on the use of digital applications for self-management in adults with multimorbidity.

A scoping review was conducted, systematically searching PubMed, Web of Science, OVID, CINAHL, EMBASE, and additional manual searches. Boolean operators and targeted key terms were employed to retrieve relevant studies from database inception to 16th January 2024.

The search yielded 1,974 articles, of which 31 met the inclusion criteria. Digital applications for self-management in multimorbidity demonstrated high acceptability and varying efficacy. Key benefits included improved communication, symptom tracking, and autonomy. Barriers included privacy concerns, additional patient burden, and engagement challenges. Socio-demographics, self-efficacy, and digital literacy influenced both barriers and facilitators to tool usage. Theoretical models underpinning digital applications were limited. Older adults and the working-age population were rarely included.

The current evidence base does not fully address the needs of older adults with low digital literacy or working-age populations with multimorbidity. Our model highlights the importance of broader contextual mechanisms in digital tool adoption. Future research should prioritise theory-driven tool development tailored to disease clusters and aligned with sociodemographic profiles, health risks, and social care needs. Addressing these gaps could improve self-management and health outcomes for high-risk populations.

Effective self-management is crucial for individuals undergoing haemodialysis to prevent complications, which can lead to morbidity and mortality. However, among this population self-management behaviours are often inadequate. To improve patient outcomes interventions that promote and enhance self-management behaviours are essential.

This study aimed to provide an overview of the current body of evidence from randomized controlled trials (RCTs) on self-management interventions for haemodialysis patients. First, we aimed to present the outcomes investigated, their corresponding measurement tools and the significant results of each study. Second, we examined the presence of various self-management components and activities within the interventions. We aimed to identify new, underrepresented, and absent self-management components and activities found in the interventions.

Following the scoping review process, a systematic literature search was conducted across six databases (MedLine All, Emcare, CINAHL, PsycINFO, Web of Science, Cochrane) to identify relevant studies. The search focused on RCTs involving adult haemodialysis patients. The review utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statements for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute (JBI) approach. The included studies were required to address either self-management theories or self-management support interventions. Data were synthesized using a tabular format. The findings were analysed using content analysis based on the self-management concept.

Overall, fourteen articles from eight countries were included. The findings illustrate the broad thematic scope of self-management interventions. Most frequent intervention outcomes were 'quality of life', 'self-management' and 'self-efficacy'. The most used instrument was 'Strategies used by people to promote health' for measuring self-care self-efficacy. All authors of the included studies reported significant results of the intervention. The content analysis identified commonly employed self-management components and activities for haemodialysis patients, such as 'emotion regulation', 'medication adherence', and 'diet management'. It revealed underrepresented (infection control), absent (smoking cessation), and new (stress management) self-management dimensions.

This innovative scoping review represents the first comprehensive overview of self-management intervention outcomes, their measurements, and significant results while simultaneously highlighting the complex self-management components and activities that haemodialysis patients must navigate on a daily basis. The identified gaps and opportunities underscore important areas for future intervention development.

Not applicable.

Self-management support is widely considered a critical aspect of nursing. Still, many studies indicate that nurses frequently experience difficulties in daily practice.

To gain a deeper understanding of the factors perceived by nurses to impede or promote their support of patients' self-management within the dynamic environment of the in-patient hospital setting.

Mixed methods design.

Nurses (n = 269) working in a teaching hospital in the Netherlands completed a questionnaire. Subsequently, 38 nurses participated in interviews.

The SEPSS-36 questionnaire assessed nurses' self-efficacy and performance in self-management support. Semi-structured interviews were conducted to address salient results from the questionnaire, focusing on factors influencing self-management support, goal setting, follow-up care, and the nurse's role in a hospital setting.

the response rate for the questionnaire study was 62 %. A paired t-test revealed a significant mean difference of 6.30 95 % CI [5.91-6.69] p ≤ 0.001 between nurses' perceived self-efficacy (mean = 18.34/24) and their actual performance (mean = 12.03/24) in self-management support. The interviews revealed that nurses typically focus on medical procedures and maintaining patients' functional status. Spending time with patients to offer emotional support was viewed as 'something extra' rather than a core part of their job. High patient turnover hindered nurses from having meaningful conversations with patients.

Short-term priorities such as 'getting the work done' dominate nurses' daily tasks in hospital wards, leading them to overlook often the benefits of supporting patient self-management. This narrow view of their responsibilities can hinder patient care, whereas adopting a broader perspective on the patient journey could be very beneficial.

Pain self-management (PSM) programs have demonstrated effectiveness as a pain management strategy, yet evidence remains scarce for patients with chronic pain treated with medical cannabis. We aimed to explore feasibility aspects and practical applications of developing and implementing a group-based PSM intervention in this context.

Twenty-two semi-structured qualitative interviews were conducted with 10 chronic pain patients treated with cannabis and 12 clinicians from a range of expertise.

Overall, the interviewees believed that the proposed intervention is feasible; yet it is essential to consider the following aspects during program planning and implementation. Inductive thematic analysis of interview transcripts identified five major themes. The first is that the program enablers include the intrinsic benefits of therapeutic group dynamics, aligning expectations, and setting individual goals at program initiation. The second theme is the program barriers. These include expected challenges for participants due to behavioral and mental changes that necessitate high commitment, the challenge for the group leader in delivering an appropriate response to each participant's emotional narrative; and managing logistical issues. The third theme is the psychological experience of living with pain, with an emphasis on addressing patients' emotional perspectives within the program's framework, namely, their perceptions of pain, fear of pain, and the relations of such to past experiences. The fourth theme is the psychoeducation on pain and cannabis use, including the brain-pain connection and informed guidance regarding cannabis use. The fifth theme is the integration of guided movement and relaxation techniques in pain management, thus underscoring the importance of practice during the group sessions.

Our findings suggest key elements that may inform planning PSM-approach therapy groups, tailored to the particular needs of patients with chronic pain using medical cannabis.

To explore the content, style, and initiation of medication-related discussions between nurses and patients to understand how nurses support patients with heart failure, especially those with inadequate health literacy.

A cross-sectional design was conducted to observe medication-related conversations between nurses and patients with heart failure in four Dutch outpatient clinics. Conversations were audio-recorded and analyzed using MEDICODE, focusing on content, communication style (monologue or a dialogue), and initiation of the content themes. Health literacy was assessed using the NVS-D and the SBSQ. Results between health literacy groups were compared with descriptive analyses.

A total of 56 patients and 14 nurses participated in the study. Patients classified by one or both of the instruments as having inadequate health literacy (n = 33; 59 %) were generally older, had lower educational levels, and were more often accompanied by informal caregivers. Key themes discussed in the medication-related conversations included how the medication was identified ('medication designation), its dosage and instruction, main effects, side effects, attitude or emotions and other ('various') themes. The 'medication designation' theme was significantly more frequently discussed in the group with adequate health literacy, whereas 'attitude or emotions' and 'various themes' were more commonly discussed among those with inadequate health literacy. Most conversations were nurse-initiated and tended to be monologues, with nurses mainly serving as information providers.

Nurses primarily initiated and dominated medication-related discussions with a focus on factual aspects of medication, while patients initiated more discussions about their concerns regarding medication. While there was overlap in the topics discussed, notable differences emerged between patients with adequate and inadequate health literacy.

Improving communication strategies, such as structuring conversations and adopting dialogic approaches may improve patients' engagement and understanding of medication use, leading to more effective management of their condition, particularly benefiting patients with lower health literacy.

The prevalence of diabetes is increasing globally, and glucose management is essential for the treatment of diabetes. Most guidelines recommend early intensive therapy and individualized approaches. Although many countries have implemented various guidelines and educational programs to enhance glucose management, the target achievement rate still remains very low. Studies from several countries and regions have identified various factors that influence blood glucose management, either positively or negatively. These factors have been comprehensively incorporated into guidelines to assist people with diabetes and healthcare professionals in following them and/or developing additional guidelines through further research. We and others have suggested that diverse factors should be considered-including comorbidities, age, complications, life expectancy, and pathophysiologic characteristics, such as ethnic differences in insulin sensitivity and secretion. The Western Pacific (WP) region, comprising countries with significant cultural and racial diversity, necessitates customized programs and community-based management strategies. In this review, we present specific challenges and opportunities for diabetes management identified through a systematic review of the literature from the WP region, along with those common to other regions. To improve healthcare policy and management in the WP region, it is essential to address regional characteristics and the factors that act as either barriers or facilitators to develop strategies for early intensive and individualized therapeutic approaches. Moreover, additional studies on diabetes pathophysiology and management-including pharmacotherapy-are urgently needed.

Self-management has increased in recognition in stroke research and rehabilitation along with growing trends of shorter hospital stays and more patient-centred care. Family members are key persons in the self-management process, but their views and experiences of self-management have not been studied in detail. This study aimed to explore family members' understanding of self-management, the strategies they use and the challenges they face when providing support.

For this descriptive study, semi-structured interviews with family members (n = 27) were conducted. Data were analysed using inductive content analysis.

The analysis resulted in three main categories and eight subcategories. Most family members saw self-management as performing practical tasks, such as daily living activities and rehabilitation training. However, family members described a broad range of actions to support self-management, including emotional and motivational support. They found it challenging to give the right amount of support and expressed a need of more information after discharge.

Family members' conceptualisations of self-management differ from the strategies they use to provide support. A clearer understanding of self-management as a collective process can benefit the development and delivery of efficient self-management support.

Back related leg pain (BRLP) is a problematic subset of low back pain, leading to greater pain, loss of function and health related care costs. While evidence suggests self-management is effective, patient implementation can be sub-optimal. The purpose of this study is to identify barriers and facilitators to self-management for persons experiencing BRLP within the context of a controlled clinical trial and to map these to theory-informed intervention elements that can be addressed by front-line healthcare providers, informing the design and implementation of future theory-driven self-management interventions for this population.

This study was a qualitative secondary analysis of a 2-site, pragmatic, parallel group, randomized clinical trial (participants enrolled 2007-10) of spinal manipulative therapy (SMT) and home exercise and advice (HEA) compared to HEA alone for persons with subacute or chronic BRLP. We used deductive and inductive content analysis, to describe self-management facilitators and barriers among trial participants, map these to behavior change elements in the Behavior Change Wheel (BCW) Framework, and identify potentially modifiable, theory-intervention elements which may be addressed with guidance by healthcare providers. Baseline characteristics of participants were descriptively analyzed using SAS (University Edition).

Of 40 participants, the majority identified as white (n = 24, 85%) and of non-Hispanic or Latino ethnicity (n = 38, 95%). Average participant age was 57 years old (range 29-80). Frequent facilitators included ease of exercises, knowing how to manage condition, atmosphere created by staff, therapeutic alliance, effectiveness of exercises or treatment, goal of reducing pain, and intentions of continuing exercises. Frequent barriers included time constraints, pain, and lacking confidence in treatment. Barriers were mapped to all 9 Intervention Functions, most common being modelling and education. Frequently identified Behavior Change Techniques included information, feedback, self-monitoring, graded tasks, restructuring, social support, goal setting, reviewing goals, and action planning.

This study identified barriers and facilitators to engaging in self-management for participants in a pragmatic, randomized clinical trial. A rigorous systematic intervention mapping process utilizing the BCW was used for describing what participants need and how their needs may be met. These findings may support the design of future self-management interventions for persons experiencing BRLP.

A key role of specialist palliative care occupational therapy is to enable patients to self-manage symptoms associated with a life-limiting illness. EMPOWER, a 4-week group programme, provides self-management interventions for stress and anxiety. The aim of this study is to evaluate the EMPOWER programme for community-based specialist palliative care patients.

An action research feasibility study employing a mixed methods approach was undertaken. Self-reporting outcome measures were administered pre-EMPOWER and post-EMPOWER. Qualitative focus groups and feedback forms were completed postintervention. Ethical approval for this study was obtained from the Research Ethics Committee of the service site.

Six virtual and five inperson EMPOWER group programmes were facilitated with 33 participants. Twenty-five participants completed the preoutcome and postoutcome measures. Statistically significant improvements in anxiety (p=0.002), occupational performance (p=0.003) and satisfaction (p<0.001) were observed from preintervention to postintervention. Qualitative data analysis identified three main themes: (1) living with symptoms, (2) management of symptoms and (3) programme design and delivery.

EMPOWER is considered an acceptable intervention by community-based palliative care patients. Improved understanding of self-management skills to manage anxiety encouraged participants to implement strategies and re-engage in meaningful goals. Recommendations were provided on the programme's design. Further research is required to evaluate the effectiveness of EMPOWER in a larger group of community-based palliative care patients.

Current therapeutic approaches are inaccessible to many people with chronic pain and frequently fail to address emotion dysregulation as a key factor in psychological comorbidity and pain intensity. An effective and accessible emotion regulation-focused intervention is needed.

To compare the efficacy of online dialectical behavioral therapy for chronic pain plus treatment as usual (iDBT-Pain) with only treatment as usual on emotion dysregulation in people with chronic pain.

This 2-arm randomized clinical trial was conducted from March 2023 to September 2024 in Australia. Participants were adults with chronic pain (lasting ≥3 months) and weekly pain intensity of 3 or higher out of 10 (10 indicating worst pain), without psychotic or personality disorders, and without dementia. Eligible participants were randomly assigned (1:1 ratio) to receive either iDBT-Pain for 9 weeks or treatment as usual only. Intention-to-treat data analyses were performed between August and September 2024.

The iDBT-Pain group received 8 group-based 90-minute therapist-guided online sessions as well as an app and a handbook for self-learning. Content focused on DBT skills training, including pain science education. Participants in the treatment-as-usual group continued usual care, which consisted of treatment options that can be accessed in the community.

The primary outcome was emotion dysregulation at 9 weeks after randomization. The Difficulties in Emotion Regulation Scale (score range: 18-90, with higher scores indicating higher emotion dysregulation) was used in assessment.

Among 89 participants (mean [SD] age, 51.5 [14.2] years; 74 females [83%]), 44 (49%) were randomly assigned to the treatment-as-usual group and 45 (51%) were randomly assigned to the iDBT-Pain group. Overall, 79 participants (89%) completed the 9-week assessment. Between-group difference in emotion dysregulation over time favored iDBT-Pain over treatment as usual at 9 weeks (-4.88; 95% CI, -9.20 to -0.55; P = .03; Cohen d = -0.46 [95% CI, -0.87 to -0.08]).

In this randomized clinical trial, the iDBT-Pain intervention, delivered through a self-learning and therapist-guided hybrid approach, resulted in sustained improvements in emotion dysregulation in people with chronic pain.

Anzctr.org.au Identifier: ACTRN12622000113752.

Dynamic Bayesian Networks (DBNs) are temporal probabilistic graphical models with a set of random variables and dependencies between them. DBNs have a meaningful structure and can model the continuity of events in discrete time-slices. In this study, we aimed to show how to build DBN models for self-management of chronic diseases using multiple sources of evidence. Chronic diseases need a life-long treatment. People with chronic diseases are commonly provided fixed-interval clinic visits, but they can suffer from sudden increases of disease activity. We proposed an approach to build DBN models for self-management of chronic diseases in order to advise on treatment decisions. We used Rheumatoid Arthritis (RA) as a case-study, and employed rheumatology experts' knowledge, clinical data, clinical guidelines, and established literature to identify the variables, their states, dependencies between the variables, and parameters of the model. Due to the unavailability of the ideal data (i.e., large data with enough frequency), we adopted two approaches to make inferences for initial evaluation of the model: manipulation of the clinical data to increase their frequency and creating dummy patient scenarios. The initial evaluation indicated promising results for treatment decisions. The proposed approach used multiple sources of evidence to build DBN models for self-management of chronic diseases. The resulting DBN for RA case-study had a clinically meaningful structure, although it needed to be further evaluated and calibrated. Resulting DBN model has the potential to be used as a decision-support tool to help patients and clinicians better manage RA.

Changes in health behavior are key to maintaining health, safety, and independence of older adults. The purpose of this study was to explore factors impacting training in self-management and behavior change in older adults with and without traumatic brain injury (TBI), informing efforts to improve safety and independent function.

Forty-one older adults, 19 with TBI, completed a self-regulation intervention (mental contrasting with implementation intentions; MCII) to promote fall prevention behavior change. Participant outcomes were related to single and recurring behavior changes; implementation outcomes were measured as modifications to treatment.

Although participants with TBI performed more poorly on tests of neurocognitive function, there were no differences in behavior change rates following MCII, suggesting the treatment worked similarly for participants with and without TBI. Across both groups, those with higher executive function scores were more likely to complete recurring behavior changes. Participants with higher stress, higher Fall Risk Scores, or history of TBI were more likely to need modifications to treatment.

This quasi-experimental pilot study describes cognitive and psychosocial predictors that may be critical for participation and success in health behavior change and self-management of fall prevention for older adults with and without TBI.

The aim of this work was to determine whether smartphone applications could support the self-management of RA and to investigate engagement and potential negative psychological effects with app-use.

App-based Education and GOal-setting in RA (AEGORA) was a multicentre randomized controlled trial with 2:1:1 allocation to usual care or two versions of an app-based self-management intervention for RA. The 16-week programme involved patient education, goal-setting and remote monitoring of the Rheumatoid Arthritis Impact of Disease (RAID) instrument, either weekly or monthly depending on randomization. The primary end point was improvement in the Arthritis Self-Efficacy Scale (ASES) after 16 weeks. Secondary endpoints included non-inferiority regarding the Pain Catastrophizing Scale (PCS) and superiority regarding patient-reported physical activity, sleep quality and RAID. App engagement and RAID scores were analysed descriptively.

Overall, 122 patients were included: mean (s.d.) disease duration 12 (9) years, age 58 (11), 68% female, DAS28-CRP 2.4 (0.9). The intervention did not improve the ASES score over usual care (β 0.44, P = 0.87). Non-inferiority was established for the PCS (β -0.95 [95% CI -3.30, +1.40] favouring the intervention). Other predefined outcomes did not differ. App retention steadily declined to 43% by 16 weeks. Although the RAID remained stable over time overall, 35% of app users reported ≥1 episode of clinically relevant worsening over 16 weeks.

This app-based self-management intervention was not superior to usual care regarding self-efficacy improvement. However, remote symptom monitoring provided valuable insight and did not increase pain catastrophizing, alleviating concerns regarding the psychological impact of remote monitoring with apps.

clinicaltrials.gov, NCT05888181.

Good self-management behaviors can improve the physical function and quality of life of patients with heart failure and reduce hospitalization, mortality, and medical expenses. While the overall self-management level among patients with chronic heart failure (CHF) in China is low, previous studies have often used a cross-sectional design, and few have followed up on patients' self-management beyond 6 months after discharge. This study aimed to explore the factors influencing and the changes in the self-management level of patients with CHF and provide a basis for the timing and choice of interventions within 1 year after discharge.

A longitudinal study was conducted from December 2021 to June 2022, including patients with CHF who met all the inclusion criteria. Data on demographics, disease-related details, social support, self-efficacy, and other information were collected during hospitalization (T0) and reevaluated at 1 month (T1), 3 months (T2), 6 months (T3), and 12 months (T4) after discharge.

A total of 213 patients were enrolled at T0, with 206, 201, 189, and 173 patients completing follow-up at T1, T2, T3, and T4, respectively. The self-management score was lowest at T0, highest at T1, began to decline at T2, and stabilized at T3; however, T3 remained higher than T0. Social support, self-efficacy, disease course, medication type, education level, and personal monthly income were identified as factors influencing self-management.

The study findings indicate that self-management is a dynamic process of change. The level of self-management was at a high level 3 months after the patients were discharged from the hospital, but showed a decreasing trend from 6 months, which was related to numerous factors. This study helps to provide a theoretical basis for the timing and content of self-management intervention for patients with CHF by clinical healthcare professionals.

Patients with long-term health needs are often expected to actively participate in outpatient care, assuming that they have appropriate health literacy and digital health literacy. However, the association between participation in a digital outpatient service and health literacy remain unclear.

This study aims to evaluate whether digital outpatient care for 6 months improved health literacy, health-related quality of life (HRQoL), digital/eHealth literacy, and the use of health care services compared with usual care.

We conducted a multicenter nonrandomized trial with 1 intervention arm and 1 control arm. Patients aged ≥18 years receiving outpatient care in the pain, lung, neurology, or cancer departments at 2 Norwegian university hospitals were allocated in a 1:2 ratio, favoring the intervention arm. The intervention arm received digital outpatient care using tailored patient-reported outcome measures, self-monitoring, and chats for timely contact with the outpatient clinic. Patient responses were assessed by health care workers via a dashboard with a traffic light system to draw attention to the most urgent reports. The control arm received usual care. The data were collected at baseline and after 3 and 6 months. The primary outcome was the change in health literacy according to the Health Literacy Questionnaire domain understanding health information well enough to know what to do from baseline to 6 months. The mean difference in change between the 2 treatment arms was the effect measure. The secondary outcomes were additional domains from the Health Literacy Questionnaire, digital/eHealth literacy, HRQoL, acceptability of the digital intervention, and health service use.

Overall, 162 patients were recruited, 55 (34%) in the control arm and 107 (66%) in the intervention arm, with a 17.3% attrition rate after 6 months. There was no statistically significant difference in the primary outcome, "understanding health information well enough to know what to do," between the arms at 6 months (mean difference -0.05, 95% CI -0.20 to 0.10; P=.53). After 3 months, the health literacy domains actively managing my own health (-0.15, 95% CI -0.30 to -0.00; P=.048) and understanding health information well enough to know what to do (-0.17, 95% CI -0.34 to -0.00; P=.03), as well as both physical (-3.29, 95% CI -5.62 to -0.96; P=.006) and mental HRQoL (-3.08, 95% CI -5.64 to -0.52; P=.02), improved in the digital outpatient intervention arm compared with the control arm.

This study explored digital outpatient care. Although no statistical differences were observed in patients' health literacy after 6 months, our data indicate an improvement in health literacy domains and HRQoL at 3 months. The participants reported high satisfaction with the digital outpatient care intervention, and our findings highlight the potential of digital interventions in outpatient care.

ClinicalTrials.gov NCT05068869; https://clinicaltrials.gov/ct2/show/NCT05068869.

RR2-10.2196/46649.

Cardiac pain has been widely considered to be the primary indicator of coronary artery disease. The presentation of cardiac pain and associated symptoms vary in women, making it challenging to interpret as cardiac, possibly cardiac, or noncardiac. Women prefer to consult with family and friends instead of seeking immediate medical care.

This study aimed to assess the user performance (ie, ease of use, efficiency, and errors) and user satisfaction (System Usability Scale; SUS) of a progressive web application for women with cardiac pain.

Following ethics approval, a purposive sample of women aged >18 years with cardiac pain or associated symptoms lasting >3 months and able to speak and read English was recruited to participate in 2 iterative usability testing cycles. The first cycle assessed the performance of and satisfaction with at heart using a web application, and the second cycle assessed the performance of and satisfaction with at heart across various Android and iOS devices. In total, 2 investigators recorded user comments and documented problems. At the end of the testing session, the participants completed the SUS and 4 semistructured interview questions.

In total, 10 eligible women participated in usability testing from March 31, 2020, to April 17, 2020 (cycle 1), and from November 17, 2020, to November 30, 2020 (cycle 2). Women across usability testing cycles had a mean age of 55.6 (SD 7.3) years, and most (9/10, 90%) were well educated. In total, 50% (5/10) were employed full or part time, and 60% (6/10) earned >CAD $70,000 (US $48,881.80) annually. Participants across 2 testing cycles reported the overall usability of the at heart progressive web application as highly acceptable (mean SUS score 81.75, SD 10.41). In total, 90% (9/10) of participants rated the user-friendliness of at heart as good or excellent. All participants (10/10, 100%) thought at heart was easy to use and efficient. Only 2 testing errors were noted as high priority; these were low contrast or small font and clarification that the chatbot was not a real person. User satisfaction was assessed using themes that emerged from the debrief and 4 semistructured interview questions; at heart was engaging, comprehensive, understandable, credible, relevant, affirming, personalized, and innovative.

This study provides initial support for the at heart progressive web application for women living with cardiac pain and symptoms. Ongoing evaluations in phases 3 and 4 should aim to examine the feasibility and acceptability of and the extent of engagement with the at heart core feature set: Heart Check, Wellness Check, and the library. In addition to assessing effectiveness in the phase-4 effectiveness-implementation hybrid trial (type I), describing and better understanding the context for implementation (eg, race and ethnicity and geography) will be necessary.

RR2-10.1136/bmjopen-2019-033092.

Postpartum women with urinary incontinence (UI) frequently struggle to control their UI. By practicing self-management, patients can effectively manage their UI. A digital human could be used to support self-management. In addition to understanding the perception by postpartum women with UI of UI threats, self-management, and application of the digital human, this study attempts to collect related functional needs of the digital human.

Semi-structured interviews were used to recruit 16 postpartum urine leakage-afflicted women who attended a tertiary hospital in Shenzhen, China, in July 2024, to this study. The interview transcripts, based on the traditional content analysis, were summarized and analyzed using the Technology Acceptance Model and the Health Belief Model.

One self-management behavior that postpartum women with UI often reported was seeking health care. Regarding perceived UI threats, these women typically engage in self-management at the social contact level. Patients noted a variety of barriers to self-management. Patients' attitudes toward the digital human assisting with UI self-management were positive and skeptical. Patients characterized their functional needs as a digital human in two areas: access to health care and home self-management. When asked about their intention to use the digital human, patients showed both willingness to try and a lack of interest.

Postpartum women face various challenges with UI self-management, and health care organizations should provide specific support. The digital human can provide necessary assistance. To increase the digital human's applicability, the researchers will gather more patient perceptions and needs in a subsequent step, spanning a wider range of backgrounds.

Artificial intelligence (AI) has potential in promoting and supporting self-management in patients with chronic conditions. However, the development and application of current AI technologies to meet patients' needs and improve their performance in chronic condition self-management tasks remain poorly understood. It is crucial to gather comprehensive information to guide the development and selection of effective AI solutions tailored for self-management in patients with chronic conditions.

This scoping review aimed to provide a comprehensive overview of AI applications for chronic condition self-management based on 3 essential self-management tasks, medical, behavioral, and emotional self-management, and to identify the current developmental stages and knowledge gaps of AI applications for chronic condition self-management.

A literature review was conducted for studies published in English between January 2011 and October 2024. In total, 4 databases, including PubMed, Web of Science, CINAHL, and PsycINFO, were searched using combined terms related to self-management and AI. The inclusion criteria included studies focused on the adult population with any type of chronic condition and AI technologies supporting self-management. This review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines.

Of the 1873 articles retrieved from the search, 66 (3.5%) were eligible and included in this review. The most studied chronic condition was diabetes (20/66, 30%). Regarding self-management tasks, most studies aimed to support medical (45/66, 68%) or behavioral self-management (27/66, 41%), and fewer studies focused on emotional self-management (14/66, 21%). Conversational AI (21/66, 32%) and multiple machine learning algorithms (16/66, 24%) were the most used AI technologies. However, most AI technologies remained in the algorithm development (25/66, 38%) or early feasibility testing stages (25/66, 38%).

A variety of AI technologies have been developed and applied in chronic condition self-management, primarily for medication, symptoms, and lifestyle self-management. Fewer AI technologies were developed for emotional self-management tasks, and most AIs remained in the early developmental stages. More research is needed to generate evidence for integrating AI into chronic condition self-management to obtain optimal health outcomes.

Chronic health conditions are the leading causes of morbidity and mortality worldwide, with a disproportionately high burden in low-income and middle-income countries. The burden arising from these conditions presents immense challenges to countries with dysfunctional public healthcare systems, such as South Africa. This necessitates patients to have a good understanding of the conditions and optimal self-management approaches. We explored patients' understanding of chronic health conditions and self-management practices, including self-monitoring, in the rural South African community of Agincourt in the subdistrict of Bushbuckridge, Mpumalanga Province.

We randomly selected patients receiving routine care for chronic health conditions in primary healthcare facilities who were linked to the Agincourt Health and Demographic Surveillance System to participate in focus group discussions. Six focus groups (three with men and three with women) were conducted, with 17 male and 19 female participants (n=35) living with different chronic health conditions. Data were collected using body mapping exercises and semistructured focus group discussions facilitated by two experienced qualitative research assistants. An inclusive thematic approach was used for analysis.

Participants identified most chronic health conditions and their progression. Participants expressed that some consequences of chronic health conditions were unavoidable and some were attributed to medications. Three themes emerged on the management of chronic health conditions: (1) individual-level management, where participants actively changed or managed lifestyle factors associated with the conditions; (2) clinic-level management and support, where participants believed that following instructions from healthcare providers facilitates better management of their condition(s); and (3) prevention and screening, to prevent disease progression and development of complications. Participants also highlighted the role of religion in the control of chronic disease risk factors and traditional treatments for uncommon conditions such as epilepsy. Costs associated with lifestyle changes and equipment to manage and monitor health were highlighted as barriers to self-management of chronic health conditions.

Our findings contribute to emerging research on chronic health conditions and self-management approaches. Participants in our study demonstrated a good understanding of various chronic health conditions but lacked knowledge of self-management practices and faced barriers to self-management. There is a need for further studies on self-management of chronic health conditions, including self-monitoring among patients in rural sub-Saharan settings.

This study aimed to identify modifiable determinants of self-management behavior in patients with gout.

Four databases (Medline, Embase, PsycINFO, and CINAHL) were searched using terms related to gout, self-management, and determinants of behavior as described in the Theoretical Domains Framework (TDF). Two reviewers independently selected relevant studies via screening of title/abstract and full text. Thematic synthesis was performed for qualitative data; quantitative data were summarized using cross-tabulation displaying the investigated associations of determinants with self-management behavior. The TDF facilitated identification and grouping of determinants.

From 2,087 unique articles found, 56 studies were included in this review, of which there were 27 qualitative and 29 quantitative studies. Eight themes were identified: knowledge and skills for self-management, acceptance of disease, beliefs about necessity of self-management to improve gout-related health, resistance and reluctance for medication adherence and dietary alteration/changes, negative emotions influencing self-management, social support and interactions, environmental context, and self-regulation of behavior. Quantitative determinants associated with self-management behavior, predominantly medication adherence, were mapped to 12 of the 14 domains of the TDF. No determinants regarding skills and goals have been identified in quantitative research.

Intervention targets for self-management behavior in patients with gout mainly included determinants related to knowledge, implicit and explicit beliefs and attitudes, the environmental context and resources, and (social) support and reinforcement.

Low back pain is highly prevalent and a leading cause of disability. Internet-delivered interventions may provide rapid and scalable support for behavioural self-management. There is a need to determine the effectiveness of highly accessible, internet-delivered support for self-management of low back pain.

To determine the clinical and cost-effectiveness of an accessible internet intervention, with and without physiotherapist telephone support, on low back pain-related disability.

A multicentre, pragmatic, three parallel-arm randomised controlled trial with parallel economic evaluation.

Participants were recruited from 179 United Kingdom primary care practices.

Participants had current low back pain without indicators of serious spinal pathology.

Participants were block randomised by a computer algorithm (stratified by severity and centre) to one of three trial arms: (1) usual care, (2) usual care + internet intervention and (3) usual care + internet intervention + telephone support. 'SupportBack' was an accessible internet intervention. A physiotherapist telephone support protocol was integrated with the internet programme, creating a combined intervention with three brief calls from a physiotherapist.

The primary outcome was low back pain-related disability over 12 months using the Roland-Morris Disability Questionnaire with measures at 6 weeks, 3, 6 and 12 months. Analyses used repeated measures over 12 months, were by intention to treat and used 97.5% confidence intervals. The economic evaluation estimated costs and effects from the National Health Service perspective. A cost-utility study was conducted using quality-adjusted life-years estimated from the EuroQol-5 Dimensions, five-level version. A cost-effectiveness study estimated cost per point improvement in the Roland-Morris Disability Questionnaire. Costs were estimated using data from general practice patient records. Researchers involved in data collection and statistical analysis were blind to group allocation.

Eight hundred and twenty-five participants were randomised (274 to usual primary care, 275 to usual care + internet intervention and 276 to the physiotherapist-supported arm). Follow-up rates were 83% at 6 weeks, 72% at 3 months, 70% at 6 months and 79% at 12 months. For the primary analysis, 736 participants were analysed (249 usual care, 245 internet intervention, 242 telephone support). There was a small reduction in the Roland-Morris Disability Questionnaire over 12 months compared to usual care following the internet intervention without physiotherapist support (adjusted mean difference of -0.5, 97.5% confidence interval -1.2 to 0.2; p = 0.085) and the internet intervention with physiotherapist support (-0.6, 97.5% confidence interval -1.2 to 0.1; p = 0.048). These differences were not statistically significant at the level of 0.025. There were no related serious adverse events. Base-case results indicated that both interventions could be considered cost-effective compared to usual care at a value of a quality-adjusted life-year of £20,000; however, the SupportBack group dominated usual care, being both more effective and less costly.

The internet intervention, with or without physiotherapist telephone support, did not significantly reduce low back pain-related disability across 12 months, compared to usual primary care. The interventions were safe and likely to be cost-effective. Balancing clinical effectiveness, cost-effectiveness, accessibility and safety findings will be necessary when considering the use of these interventions in practice.

This trial is registered as ISRCTN14736486.

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/111/78) and is published in full in Health Technology Assessment; Vol. 29, No. 7. See the NIHR Funding and Awards website for further award information.

Rheumatoid Arthritis(RA) can result in significant joint destruction and work disability which needs physical and psychosocial adjustment to deal with pain, and fatigue.

True experimental parallel arm design with a pre-test post-test wait-listed control group was used to assess the impact of self-management training on Quality of life, medication adherence and self-efficacy among patients with RA. Participants were randomly allocated to the study(70) or control(70)group by simple randomization by the researcher. The study group underwent a self-management training consisting of six sessions over a 12-week period, while the control group received routine care. Importantly, the research assistant responsible for outcome assessment remained blinded to the treatment allocation at 1st, 3rd and 5th month post intervention using Short form- 36, Compliance Questionnaire, Rheumatology and Arthritis self efficacy scale.

The SMT led to significant improvements in QoL-physical components including Pain (p = 0.001, partial eta squared(η²) = 0.372) and General Health (p = 0.001, η² = 0.320). Significant between-group differences were observed for Pain (p = 0.007), while other measures showed no differences. Mental health components also improved significantly in the study group, particularly in Energy (p = 0.001, η² = 0.344). Medication adherence improved initially but stabilized over time. The study group showed significant improvements in self-efficacy for pain, function, and other symptoms (p < 0.009), with large effect sizes and sustained progress.

By empowering patients with knowledge, skills, and confidence to effectively manage their condition, such health educations can contribute significantly improve overall health outcomes.

The purpose of this article is to describe a model of chronic disease self-management that incorporates the complexity of social and environmental interactions experienced by people who self-manage chronic conditions. This study combines quantitative data from a large national research cohort and qualitative interviews to test and refine a self-management model. The self-management within a syndemic model depicts the contextual, psychological, and social factors that predict self-management behaviors and clinical and long-term outcomes.

Chronic pain affects 1.9 billion people worldwide and wait times for interprofessional pain management programs can be extensive. The existing wait times provide an opportunity to introduce internet-based interventions that enhance self-management ability.

The purpose of this study was to examine the feasibility, acceptability, engagement, and meaningfulness of an online program designed to enhance the readiness for change and self-management.

Participants (N = 61) waiting for interprofessional chronic pain care at two centers were assigned to engage in either a series of eight self-directed web-based modules or engage in the modules with the addition of four one-on-one sessions delivered by coaches trained in motivational interviewing techniques.

We collected participant demographics, feasibility and engagement metrics, and pre and post intervention questionnaires. A subset of participants from each group participated in an interview (n = 22).

The use of online modules was found to be feasible and acceptable for participants and engagement varied depending on individual preference and between modules. Participants noted that the content and approach were relevant and meaningful, influencing changes in thinking and behaviour around pain self-management. Exploratory analyses were performed and supported improvement in self-efficacy and chronic pain acceptance outcomes in both groups. Coaching did not augment improvements in any of our outcomes.

The use of a self-directed web-based chronic pain and motivational empowerment program appears to be a promising option to support people waiting for specialist care and may influence readiness for interprofessional care.

The fight against sepsis is an ongoing healthcare challenge, where digital tools are increasingly used with some promising results. The experience of survivors and their family members can help optimize digital alerts for sepsis/deterioration. This study pairs the experiences of survivors of their sepsis journey and family members with their knowledge and views on the role of digital alerts.

A qualitative study with online, semi-structured interviews and focus groups with sepsis survivors and family members in England. Data were analyzed inductively using thematic analysis.

We included 11 survivors, and 5 family members recruited via sepsis charities and other social media, for a total of 15 sepsis cases. Identified categories correspond to the three stages of the sepsis journey: 1. Pre-hospital, onset symptoms and help-seeking; 2. Hospital admission and stay; 3. Post-sepsis syndrome. The role of digital alerts at each stage of the sepsis journey is discussed. Participants' experiences were varied, previous sepsis awareness scant, and knowledge of digital alerts minimal. However, participants were confident in the potential of alerts contributing along the sepsis journey. They perceived digital alerts as important in healthcare professionals' decision-making to expedite identification and treatment of sepsis and suggested their expansion across healthcare services. Participants expressed that awareness should be increased among the general public about digital alerts for sepsis/deterioration.

In light of sepsis' insidious and variable manifestation, the involvement of patients and family members in the development of digital alerts is crucial to optimize their design and deployment towards improving outcomes. Digital alerts should enhance the connection across healthcare services as well as the care quality. They should also enhance the communication between patients and healthcare professionals.

The ClinicalTrials.gov registration identifier for this study is NCT05741801; the protocol ID is 16347.

Background/Objectives: One-third of breast cancer (BC) survivors experience chronic treatment-related pain (CTP) that requires multimodal management strategies, which may include pain self-management behaviors (PSMBs). Most studies exploring PSMBs focus on patients with advanced cancer, who may differ from survivors in their pain management needs and access to resources. This mixed-methods study explored PSMBs of survivors of BC, referral sources, and goals for pain relief, and examined the relationship between PSMB engagement and pain intensity/interference. Methods: Survivors of BC who were six months post-treatment completed measures assessing their pain intensity/interference and PSMB engagement. Purposive sampling identified a subset of participants who completed interviews, which were analyzed using thematic analysis. Results: Participants (n = 60) were 60 ± 10 years old. Worst Pain Intensity and Pain Interference were 3.93 ± 2.36 and 2.09 ± 2.11, respectively. Participants engaged in 7 ± 3.5 PSMBs. The most common were walking (76%) and distraction (76%). PSMBs described in the interviews (n = 10) were arm stretching and strengthening exercises, seeking specialized pain management services, and avoidance. Most PSMBs were self-directed or suggested by friends. All pain relief goals were to minimize pain interference. PSMB engagement was not associated with Worst, Least, or Average Pain Intensity (all rs ≤ -0.2, p ≥ 0.05) but was associated with Pain Interference (rs = 0.3, p ≤ 0.01). Conclusions: The survivors of BC engaged in many PSMBs, with varying levels of effectiveness and a varying quality of supporting evidence. Most PSMBs were self-directed and some required intervention from healthcare providers or other people, while others required access to limited specialized pain management services.

Improvements in the quality of penile cancer management are difficult due to the rarity of the condition and a limited evidence base for treatment decisions. Penile cancer and some of its highly morbid treatments can cause profound psychosexual and physical effects that negatively impact quality of life. Multidisciplinary interventions are required to equip patients with the support necessary to manage their emotional, physical, work, and lifestyle challenges to optimize health, well-being, and recovery. This paper outlines a model of supported self-management, which is a novel model of care for people with penile cancer to mitigate disease and treatment morbidity.

Osteoarthritis (OA) is characterized by pain, functional impairments, muscle weakness, and joint stiffness. Since OA heightens reliance on heath care resources and exacerbates socioeconomic burden, remote OA rehabilitation using digital technologies is rapidly evolving.

The aim of this study was to analyze the efficacy of behavioral therapy-based digital interventions for patients with OA.

This study is a systematic review of randomized controlled trials (RCTs) that assessed the effects of behavioral therapy-based digital intervention tools for OA. These RCTs were searched from inception to June 2023 in the Web of Science, Embase, Cochrane Library, Ovid, and PubMed databases.

Ten eligible RCTs comprising 1895 patients with OA were included. Digital tools based on either cognitive behavioral therapy (CBT) or behavior change technique (BCT) were investigated. All studies demonstrated low-to-moderate effects on pain reduction in the short term (standardized mean difference [SMD] -0.20, 95% CI -0.35 to -0.05). Six studies reported improvement in physical function (SMD -0.20, 95% CI -0.41 to 0.00), and 5 confirmed increased pain self-efficacy (SMD 0.22, 95% CI 0.02-0.42). In subgroup analysis, compared with CBT, BCT-based digital interventions demonstrated their effects on pain reduction (SMD -0.25, 95% CI -0.49 to 0.00) and physical function (SMD -0.26, 95% CI -0.54 to -0.01) in the short term. In addition, physiotherapist involvement in treatment had a positive effect on pain control (SMD -0.14, 95% CI -0.27 to -0.02). Furthermore, web-based digital tools improved physical function in the short term (SMD -0.28, 95% CI -0.54 to -0.01).

Moderate- and low-quality evidence supported that behavioral therapy-based digital tools improved pain intensity, physical function, and self-efficacy in the short term. However, affective interactions between patients and professionals may affect the clinical outcomes.

PROSPERO CRD42023430716; https://tinyurl.com/yc49vzyy.

Research regarding the effectiveness of digital health interventions (DHIs) for people living with chronic pain is widely documented, although it is often measured against changes in clinical outcomes. To gain a comprehensive understanding of the full impact of DHIs, it is vital to understand the experience of individuals who are using them. An exploration of qualitative data regarding the experience of people living with chronic pain engaging with DHIs could provide a more in-depth account of how individuals interact and engage with such tools, uncovering the overall impact DHIs can have on the lives of people living with chronic pain.

This qualitative systematic review and thematic synthesis aimed to appraise and synthesize relevant qualitative evidence on patients' experiences of engaging with DHIs for the self-management of chronic pain symptoms.

A systematic literature search of qualitative and mixed methods studies published between 2013 and 2023 was conducted across 6 databases: MEDLINE, PubMed, Embase, CINAHL, PsycINFO, and Scopus. Eligible studies included adult patients aged ≥18 years with a chronic pain diagnosis (ie, >12 weeks) reporting on the experience of engaging in a DHI for the self-management of chronic pain. The Critical Appraisal Skills Program checklist for qualitative research was used to appraise each study. Following a 3-step inductive thematic synthesis approach, the researcher performed line-by-line coding of each eligible article to identify descriptive themes. Through iterative evaluation of the descriptive themes, analytical themes that facilitated a deeper understanding of the data were derived.

In total, 37 qualitative and mixed methods studies were included in the review. Thematic synthesis revealed three overarching themes encompassing five subthemes: (1) personal growth, with 2 subthemes (gaining new insights and renewed mindset); (2) active involvement, with 3 subthemes (motivation, improved access, and health care decision-making); and (3) connectedness and support.

A positive experience with DHIs among people living with chronic pain is achieved through an improved understanding of their condition, greater self-awareness of how symptoms impact their lives, and an increase in motivation to play an active role in their health care. DHIs promote the confidence and independence of people living with chronic pain, as well as facilitate a sense of ongoing support between routine appointments. However, DHIs may disempower people living with chronic pain by placing too much focus on their pain and should be used as an adjunct to existing care as opposed to replacing in-person appointments. To appropriately meet the needs of people living with chronic pain, the content and features of DHIs should be personalized. Development of future DHIs should use a co-design approach involving key stakeholders to ensure the needs of people living with chronic pain are met.

PROSPERO CRD42023445100; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023445100.

RR2-10.2196/52469.

Myeloproliferative neoplasms (MPNs) can cause a high symptom burden that negatively affects quality of life (QoL). The way patients deal with their disease and how this impacts their QoL is important to understand, yet virtually unknown. The aim of this study is to investigate whether and how psychosocial adjustment affects QoL in MPN patients.

A longitudinal study was conducted in 338 patients with MPN to investigate whether and how baseline measurements of psychosocial adjustment could predict QoL outcomes six months later. Psychosocial adjustment to illness was operationalized by: coping, self-management, resilience and illness identity (II). We tested the hypotheses that high scores on respectively problem-solving coping, self-management, resilience, II-subscales acceptance and enrichment, and low scores on II-subscales rejection and engulfment are associated with high scores on QoL. We performed a multiple hierarchical regression analysis including sociodemographic and disease-related variables and baseline QoL as control variables.

II-subscale engulfment had the most pronounced negative impact on QoL (β.47, p < .001). After the introduction of the control variables, the effect of engulfment remained statistically significant (β.16, p < .01). Additionally, baseline QoL (β.32, p < .001), treatment option wait-and-see (β.11, p < .05), and MPN symptom burden at T2 (β.36, p < .001) demonstrated significance. The other variables measuring psychosocial adjustment did not relate significantly to QoL.

The findings of this study illustrate the significant adverse effect of engulfment on patients' QoL, underscoring the importance of providing psychosocial guidance to mitigate the patients' feelings of being overwhelmed by the disease.

Sexual dysfunction is a common adverse effect of prostate cancer treatment, and current management strategies do not adequately address physical and psychological causes. Exercise is a potential therapy in the management of sexual dysfunction.

To investigate the effects of supervised, clinic-based, resistance and aerobic exercise with and without a brief psychosexual education and self-management intervention (PESM) on sexual function in men with prostate cancer compared with usual care.

A 3-arm, parallel-group, single-center randomized clinical trial was undertaken at university-affiliated exercise clinics between July 24, 2014, and August 22, 2019. Eligible participants were men with prostate cancer who had previously undergone or were currently undergoing treatment and were concerned about sexual dysfunction. Data analysis was undertaken October 8 to December 23, 2024.

Participants were randomized to (1) 6 months of supervised, group-based resistance and aerobic exercise (n = 39 [34.8%]), (2) the same exercise program plus PESM (n = 36 [32.1%]), or (3) usual care (n = 37 [33.0%]). Exercise was to be undertaken 3 days per week.

The primary outcome was sexual function assessed with the International Index of Erectile Function (IIEF). Secondary outcomes included body composition, physical function, and muscle strength. Analyses were undertaken using an intention-to-treat approach.

In total, 112 participants (mean [SD] age, 66.3 [7.1] years) were randomized. Mean adjusted difference in IIEF score at 6 months favored exercise compared with usual care (3.5; 95% CI, 0.3-6.6; P = .04). The mean adjusted difference for intercourse satisfaction was not significant (1.7; 95% CI, 0.1-3.2; P = .05). PESM did not result in additional improvements. Compared with usual care, exercise also significantly improved fat mass (mean adjusted difference, -0.9 kg; 95% CI, -1.8 to -0.1 kg; P = .02), chair rise performance (mean adjusted difference, -1.8 seconds; 95% CI, -3.2 to -0.5 seconds; P = .002), and upper (mean adjusted difference, 9.4 kg; 95% CI, 6.9-11.9 kg; P < .001) and lower (mean adjusted difference, 17.9 kg; 95% CI, 7.6-28.2 kg; P < .001) body muscle strength.

In this randomized clinical trial of supervised exercise, erectile function in patients with prostate cancer was improved. PESM resulted in no additional improvements. Patients with prostate cancer should be offered exercise following treatment as a potential rehabilitation measure.

ANZCTR Identifier: ACTRN12613001179729.

This study aims to explore the meaningful contributions of rehabilitation for participants living with persistent pain.

A phenomenological methodology was used. Thirteen purposefully selected participants, who self-identified as substantially improved from persistent pain due to rehabilitation, were interviewed in-depth. Data were analyzed using reflexive thematic analyses.

Participants included three men and ten women, age ranging from 22-69 years, pain duration was 2-30 years. Seven interconnected themes were developed: 1) indication of negative pain and health care experiences, 2) supporting working alliance with healthcare professionals, 3) Pain Dialogue, 4) improved self-awareness and self-regulation, 5) different view on pain, 6) autonomy and personal growth and 7) hope and new perspective. Integration of these themes provided a framework for understanding meaningful contributions of rehabilitation from the participants' perspective.

The study identified seven interconnected themes enhancing meaningful contributions of rehabilitation for participants who have substantially improved from persistent pain. These findings provide a novel conceptual understanding of how rehabilitation can foster recovery. The themes strongly support person-centred care, an understanding of Pain Dialogue and personal growth through the lens of the lived experience. The quality of the therapeutic relationship is considered a central vehicle for improved health outcomes.

The cause of lipoedema remains unclear, and the condition is currently incurable. Effective self-management is therefore essential for coping with its physical and psychological impacts and the necessary lifestyle adjustments. This study aimed to assess the needs, barriers, and facilitators for enhancing self-management and self-management support from the perspectives of people with lipoedema and the healthcare professionals (HCPs) involved in their care.

The study used a mixed-methods approach, incorporating a narrative review focused on people with chronic conditions and their HCPs, along with focus groups involving people diagnosed with lipoedema and the HCPs involved in their care. The Core Processes of the Intervention Mapping method guided a systematic approach to address the study's objectives. Qualitative data were analyzed using a grounded theory approach.

Findings revealed unique self-management barriers for people with lipoedema, including limited awareness and expertise among HCPs, as well as stigmatization from both HCPs and society. Participants identified a need for tailored lifestyle plans, guidance, and support for monitoring progress. Key facilitators included self-management skills, supportive networks, and role models. HCPs noted barriers in communication and collaboration due to a lack of specialized professionals and negative attitudes toward lipoedema. They expressed a need for multidisciplinary/interprofessional teams, accurate diagnosis, patient openness, and reliable information resources. Facilitators included fostering trust, encouraging patient participation, and setting achievable goals.

This study underscores the need for tailored self-management interventions for people with lipoedema. The adaptation of existing self-management strategies from other chronic conditions should take into account the specific needs, barriers, and facilitators of people with lipoedema and their HCPs.

eHealth has enormous potential to support the self-management of depressive symptoms in people living with HIV. However, a lack of personalization is an important barrier to user engagement with eHealth. According to goal-directed design, personalized eHealth requires the identification of user personas before concrete design to understand the goals and needs of different users.

This study aimed to identify user personas for eHealth regarding the self-management of depressive symptoms in people living with HIV and explore the goals and needs of different user personas for future eHealth.

We used an explanatory sequential mixed methods design at the First Hospital of Changsha City, Hunan Province, China, from April to October 2022. In the quantitative phase, 572 people living with HIV completed validated questionnaires with questions related to demographics, self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Latent profile analysis was performed to identify different user personas. In the qualitative phase, 43 one-to-one semistructured interviews across different user personas were conducted, transcribed verbatim, and analyzed using conventional content analysis. The findings from both phases were integrated during the interpretation phase.

Three types of user personas could be identified, including "high-level self-managers" (254/572, 44.4%), "medium-level self-managers" (283/572, 49.5%), and "low-level self-managers" (35/572, 6.1%). High-level self-managers had relatively high levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. High-level self-managers had a positive attitude toward using eHealth for the self-management of depressive symptoms and desired access to self-management support for depressive symptoms from eHealth with high usability. Medium-level self-managers had relatively medium levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Medium-level self-managers felt burdened by using eHealth for the self-management of depressive symptoms and preferred to access self-management support for HIV from eHealth with privacy. Low-level self-managers had relatively low levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Low-level self-managers had an acceptable attitude toward using eHealth for the self-management of depressive symptoms and desired access to professional guidance from eHealth with privacy and no cost ("free of charge").

The 3 user personas shed light on the possibility of personalized eHealth to support the self-management of depressive symptoms in different people living with HIV. Further research is needed to examine the generalizability of the user personas across study sites.

Inflammatory arthritis affects approximately 2-3% of adults worldwide. For patients newly diagnosed with arthritis, effective self-management is crucial, as they often face several physiological, emotional, and social challenges. A self-management intervention called NISMA was thus developed to cater to this group. This study aimed to evaluate the feasibility and fidelity of this intervention before conducting a full-scale randomized controlled trial.

This feasibility study was conducted as a single-center randomized controlled trial. Twenty participants were expected to be sufficient for assessing the feasibility outcomes. The control group received only the usual care, while the intervention group received the NISMA intervention in addition, which involved individual and group sessions in a multidisciplinary setting. Feasibility was evaluated based on the recruitment, data collection, retention, and randomization processes. The patient-reported outcome measures and clinical measures were collected to review their potential for inclusion in a future randomized controlled trial. Fidelity was assessed by using documentation sheets filled in by the health professionals and audio recordings of the sessions to examine whether the intervention's principles and components were adequately addressed.

Among 47 eligible patients, we recruited 23 participants during a period of 4 months. The recruitment rate was 47% and the retention rate 91%. Randomization, although accepted, led to some disappointment in the control group. Data collection was effective, with only minimal missing data (< 1%). The fidelity was considered as high, as results indicated that nurses effectively engaged in collaborative partnerships with patients, utilizing planned questioning techniques and self-management strategies for problem-solving and resource utilization. However, action planning was inconsistently applied.

The study demonstrated the feasibility and the overall high fidelity of delivering the NISMA intervention to patients newly diagnosed with inflammatory arthritis. The insights from the study are useful for identifying the areas that require modifications before initiating a randomized controlled trial.

ClinicalTrials.gov ID: NCT06063252. Registered 02 October 2023 - retrospectively registered.

Self-management is important for people coping with chronic diseases. The self-determination theory (SDT) emphasizes the role of healthcare professionals' (HCPs) (de)motivating interaction styles in either supporting or thwarting patients' self-management behavior. Since developing (de)motivating interaction styles starts during education, this study aimed to identify profiles among HCPs in training based on their (de)motivating interaction styles and to assess how these profiles differ in sample characteristics, SDT-beliefs, and self-efficacy in self-management support. Cross-sectional data were collected using self-reported questionnaires among nurses (n = 125) and physiotherapists (n = 257) in training (total participants: n = 382). Cluster analyses were performed to identify the profiles followed by chi-square tests and MANCOVA-tests to assess profile differences. Five profiles were identified, labelled as: motivating (16%), active (22%), undifferentiated (29%), demotivating (17%) and inactive (17%). The motivating profile contained fewer men (10%), while the demotivating profile had a higher proportion of men (52%) compared to the whole sample distribution (28%). Fewer nursing students were categorized to the active profile (20%) compared to the overall sample distribution (33%). Higher SDT-beliefs and self-efficacy in self-management support were noted in the motivating and active profiles as opposed to the demotivating and inactive profiles. These results contribute to a better understanding of healthcare students' interaction styles during patient self-management support. In education of HCPs, a focus on improving SDT-beliefs and self-efficacy in self-management support, may help HCPs to improve their interaction profile towards people with chronic diseases.