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Jutterström, Lena
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Öberg, U., Isaksson, U., Jutterström, L., Orre, C. & Hörnsten, Å. (2019). Person-Centered Interactive Self-Management Support in Primary Health Care for People with Type 2 Diabetes: Protocol for a Randomized Controlled Trial. JMIR Research Protocols, 8(4), Article ID e10250.
Open this publication in new window or tab >>Person-Centered Interactive Self-Management Support in Primary Health Care for People with Type 2 Diabetes: Protocol for a Randomized Controlled Trial
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2019 (English)In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 8, no 4, article id e10250Article in journal (Refereed) Published
Abstract [en]

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 (HbA1c) 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.

Place, publisher, year, edition, pages
JMIR Publications, 2019
Keywords
eHealth, internet, mobile apps, nurse specialists, primary health care, randomized controlled trial, self-management, type 2 diabetes
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158655 (URN)10.2196/10250 (DOI)000466496800003 ()30958279 (PubMedID)
Funder
Swedish Diabetes Association
Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-06-10Bibliographically approved
Öberg, U., Isaksson, U., Jutterström, L., Orre, C.-J. & Hörnsten, Å. (2018). Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support. JMIR Diabetes, 3(1), Article ID e7.
Open this publication in new window or tab >>Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support
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2018 (English)In: JMIR Diabetes, ISSN 2371-4379, Vol. 3, no 1, article id e7Article in journal (Refereed) Published
Abstract [en]

Background: Digital 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.

Objective: The 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.

Methods: This is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D.

Results: Findings 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.

Conclusions: Digital 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.

Place, publisher, year, edition, pages
JMIR Publications, 2018
Keywords
eHealth, internet, type 2 diabetes, self-management, primary health care, qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-145997 (URN)10.2196/diabetes.9059 (DOI)30291075 (PubMedID)2-s2.0-85047781902 (Scopus ID)
Available from: 2018-03-26 Created: 2018-03-26 Last updated: 2019-05-16Bibliographically approved
Jutterström, L., Hörnsten, Å., Sandström, H., Stenlund, H. & Isaksson, U. (2016). Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes: A randomized study. Patient Education and Counseling, 99(11), 1821-1829
Open this publication in new window or tab >>Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes: A randomized study
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2016 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, no 11, p. 1821-1829Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this study was to evaluate the effect of a patient-centered self-management support, in type 2 diabetes (T2D) with regard to metabolic changes.

METHODS: 182 patients were randomized into group intervention (GI), individual intervention (II) or internal controls (IC). An external control (EC) group was recruited from another county council. The intervention consisted of six sessions that featured themes, which regarded different views of their illness experiences. Data were collected in 2010 and 2011.

RESULTS: HbA1c was significantly decreased at 12-month follow-up with 5mmol/mol in the GI and 4mmol/mol in the II. In the IC group, the HbA1c was close to baseline. The EC group had increased HbA1c, though not significantly. When the HbA1c difference at baseline was adjusted, there was a significant difference between intervention groups and the EC-group.

CONCLUSION: Patient-centered self-management support, led by nurses, can lower HbA1c among patients with type 2 diabetes.

PRACTICE IMPLICATIONS: It is possible to train diabetes specialist nurses in clinical patient-centered care, and simultaneously influence patients' metabolic balance positively.

National Category
Endocrinology and Diabetes Nursing
Identifiers
urn:nbn:se:umu:diva-127491 (URN)10.1016/j.pec.2016.06.016 (DOI)000391222100011 ()27372525 (PubMedID)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2019-04-26Bibliographically approved
Isaksson, U., Hajdarevic, S., Jutterström, L. & Hörnsten, Å. (2014). Validity and reliability testing of the Swedish version of Melbourne Decision Making Questionnaire. Scandinavian Journal of Caring Sciences, 28(2), 405-412
Open this publication in new window or tab >>Validity and reliability testing of the Swedish version of Melbourne Decision Making Questionnaire
2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 405-412Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Melbourne Decision-Making Questionnaire (MDMQ) is an attempt to capture and measure coping strategies that people use. The instrument had not previously been translated into Swedish. The aim of this study was to evaluate validity and reliability of the Swedish version of the MDMQ.

METHOD: A Swedish translation was performed and back-translated. A group of five pilot readers evaluated content validity. The translated questionnaire was tested among 735 patients, healthcare workers, healthcare students and teachers. A parallel analysis (PA), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed.

RESULT: An initial EFA with a four-factor solution showed a low concordance with the original 22-item four-factor model with a very low Cronbach's alpha in one of the dimensions. However, a second EFA with a three-factor solution showed a good model fit for the Swedish translation of the Melbourne Decision-Making Questionnaire (MDMQ-S) with a satisfactory Cronbach's alpha. A CFA showed a goodness of fit after deleting six items.

CONCLUSION: After testing the MDMQ-S, we found support for validity and reliability of the instrument. We found the 16-item version of MDMQ-S to be satisfactory concerning the subscales vigilance, procrastination and buck-passing. However, we found no support that the hypervigilance dimension could be measured by the MDMQ-S.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014
Keywords
Confirmatory factor analysis, coping, decision-making, exploratory factor analysis, parallel analysis, reproducibility of results, reliability, validity
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-74487 (URN)10.1111/scs.12052 (DOI)000334503400023 ()23647465 (PubMedID)
Available from: 2013-07-01 Created: 2013-07-01 Last updated: 2018-06-08Bibliographically approved
Jutterström, L. (2013). Illness integration, self-management and patient-centred support in type 2 diabetes. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Illness integration, self-management and patient-centred support in type 2 diabetes
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Integration av sjukdom, sjukdomshantering och patientcentrerad support vid typ 2 diabetes
Abstract [en]

Background: Type 2 diabetes is a serious disease that is increasing globally. The focus of diabetes care has been to prevent diabetes related complications and thereby reduce mortality. An older population, the disease progression and decreased ability to perform self-management activities increases the risk for complications. Group education and patient-centred care are recommended to improve self-management through increased patient empowerment. Despite these recommendations, professionals have been reluctant to adopt these methods referring to lack of knowledge, time and tools to deliver patient-centred care in diabetes. Focusing on the patient’s illness integration process has in the literature been suggested to improve self-management and metabolic balance.

Aim: The overall aim of the thesis was to describe the experiences of illness integration, self-management and support in type 2 diabetes and to evaluate the metabolic effects of a nurse-led patient-centred model for self-management support.

Methods: The study setting was primary health care in Västerbotten County, Sweden. In total, 21 diabetes nurses (Study I) and 257 patients (Studies II-IV) participated in the four studies (Study II, n=44; Study III, n= 18; Study IV, n= 195). Data consisted of focus group interviews (Study I), individual semi-structured interviews (Studies II-III) and laboratory measurements (Study IV). Methods for analyses were qualitative content analysis (Studies I-III) and statistics (Study IV).

Results: Study I revealed that diabetes nurses found the ideal diabetes care complex to achieve. Conflicting paradigms, power relations and departmentalisation of work were described. Study II describes a process whereby illness integration and self-management in type 2 diabetes develop simultaneously. When a turning-point occurs, people view self-management as both necessary and feasible. In study III, turning points in self-management are illuminated. Turning-point transitions include existential and emotional aspects that increase inner motivation and power for lifestyle change. Study IV evaluates the effects of a nurse-led intervention in which haemoglobin A1c (HbA1c) was significantly decreased at 12 months’ follow-up. Group intervention and individual intervention were both effective compared to traditional diabetes care.

Conclusions: There is a potential for improvement of type 2 diabetes care. Increased patient-centredness is important to support patients towards illness integration and self-management. Focusing on the patients’ illness experiences, including the existential and emotional aspects of having and managing type 2 diabetes, in counselling can lead to improved self-management and glycaemic control. Patients’ experiences of illness are central to their inner motives for change, and patient-centred self-management support and patient education preferably emanate from this perspective.

Abstract [sv]

Bakgrund: Typ 2 diabetes är en allvarlig sjukdom som ökar globalt. Fokus i diabetesvården har varit att förebygga diabetesrelaterade komplikationer och därmed minska dödligheten. En åldrande befolkning, progression av sjukdomen samt en begränsad förmåga att utföra egenvårdsaktiviteter ökar risken för komplikationer. Grupputbildning och patientcentrerad vård rekommenderas för att förbättra egenvården genom ökad empowerment. Trots dessa rekommendationer har läkare och sjuksköterskor rapporterats vara tveksamma till dessa metoder och hänvisat till bristande kunskap, tidsbrist och avsaknad av verktyg. Att fokusera på patienters sjukdomsintegrationsprocess har i litteraturen föreslagits förbättra såväl egenvård som metabol balans.

Syfte: Avhandlingens övergripande syfte var att beskriva erfarenheter av sjukdomsintegration, sjukdomshantering och support vid typ 2 diabetes samt att utvärdera effekter av en sjuksköterskeledd patientcentrerad modell för egenvårdssupport.

Metod: Studierna genomfördes inom primärvården i Västerbottens läns landsting. Totalt deltog 21 diabetessjuksköterskor (Studie I) och 257 patienter (Studie II-IV), i de fyra studierna (Studie II, n=44; Studie III, n= 18; Studie IV, n= 195). Data bestod av fokusgruppsintervjuer (Studie I), individuella halvstrukturerade intervjuer (Studie II-III) och laboratoriemätningar (Studie IV). Analysmetoderna var kvalitativ innehållsanalys (Studie I-III) och statistik (Studie IV).

Resultat: Studie I visade att en ideal diabetesvård är svår att uppnå enligt diabetessjuksköterskorna. Paradigmkrockar, maktrelationer och splittrade arbetsuppgifter beskrevs. Studie II beskriver en modell där sjukdomsintegration och sjukdomshantering utvecklas samtidigt. När en ”turning point” nåddes såg patienterna sjukdomshanteringen som både nödvändig och möjlig att genomföra. I studie III belystes ”turning points” och som omfattar både existentiella och emotionella aspekter som kan öka inre motivation och egenkraft att utföra livsstilsförändringar. Studie IV utvärderade 12-månaderseffekterna av en sjuksköterskeledd intervention och HbA1c sänktes signifikant. Gruppintervention och individuell intervention visades vara effektiva metoder i jämförelse med traditionell diabetesvård.

Slutsatser: Det finns en förbättringspotential inom diabetesvården och ökad patientcentrering är viktig för att stödja patienter att integrera sjukdom och egenvård i livet. Att i diabetesvården fokusera på patienters sjukdomsupplevelser inklusive de existentiella och emotionella aspekterna av att leva med och hantera en sjukdom kan innebära förbättrad sjukdomshantering och metabol balans. Patienters sjukdomsupplevelser är centrala för deras inre motiv till förändring och patientcentrerad egenvårdssupport och patientutbildning bör utgå från detta perspektiv.

 

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2013. p. 91
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1560
Keywords
Type 2 diabetes, illness integration, turning points, self-management, patient-centredness, diabetes care, primary health care, intervention, randomised controlled study
National Category
General Practice
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-67847 (URN)978-91-7459-576-5 (ISBN)
Public defence
2013-05-03, Aulan, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-12 Created: 2013-04-04 Last updated: 2018-06-08Bibliographically approved
Jutterström, L., Hällgren Graneheim, U., Isaksson, U. & Hörnsten, Å. (2012). Ideal versus real conditions for type 2 diabetes care: diabetes specialty nurses’ perspectives. The Internet Journal of Advanced Nursing Practice, 11(2)
Open this publication in new window or tab >>Ideal versus real conditions for type 2 diabetes care: diabetes specialty nurses’ perspectives
2012 (English)In: The Internet Journal of Advanced Nursing Practice, ISSN 1523-6064, Vol. 11, no 2Article in journal (Refereed) Published
Abstract [en]

Background: Since diabetes specialty nurses are the professionals who spend the most time with patients living with diabetes, they probably have the greatest influence on the quality of diabetes care. Therefore, their personal perceptions about what constitutes “good care” in type 2 diabetes care are important to explore.

Aim: The aim of this study was to describe conditions for “good care” in type 2-diabetes as perceived by diabetes specialty nurses.

Method: Twenty-one experienced diabetes specialty nurses participated in three focus group interviews. Data were analyzed using qualitative content analysis.

Findings: The findings are presented in four themes describing diabetes specialty nurses’ perspectives on ideal versus real conditions for type 2 diabetes care: 1) Diabetes counseling built on empowerment versus governance; 2) Diabetes management built on comprehensive versus biomedical views; 3) Diabetes organization built on nurse-led versus physician-led care; and 4) Diabetes policies built on quality versus equality.

Conclusion: The ideal diabetes care is perceived as complex to achieve. Conflicting paradigms, power relations, and departmentalization of work are influencing the potential to deliver ideal diabetes care and to increase satisfaction among diabetes specialty nurses and patients. The diabetes specialty nurses described themselves as the “hub” of diabetes care, and they perceived conflicts between ideal versus real conditions in type 2 diabetes care. Patient centredness is not a real condition in diabetes care.

Keywords
Diabetes nursing, health care organization, nurse-physician collaboration, patient empowerment, patient centered care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-67943 (URN)
Available from: 2013-04-11 Created: 2013-04-09 Last updated: 2018-06-08Bibliographically approved
Jutterström, L., Isaksson, U., Sandström, H. & Hörnsten, Å. (2012). Turning points in self-management of type 2 diabetes. European Diabetes Nursing, 9(2), 46-50
Open this publication in new window or tab >>Turning points in self-management of type 2 diabetes
2012 (English)In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 9, no 2, p. 46-50Article in journal (Refereed) Published
Abstract [en]

A turning point is described in the literature as a powerful emotional experience or insight leading to a fundamental change in a person’s life, and requires a new way of managing the illness. However, turning points are not sufficiently described in the literature, particularly not with respect to diabetes.

The aim of this study was to throw light on turning points in self-management asdescribed by people with type 2 diabetes.

Eighteen participants diagnosed with type 2 diabetes within the previous two years, and who received treatment in primary health care, were invited to participate. Semi-structured interviews were analysed using qualitative content analysis.

The findings demonstrated that the turning point in self-management among individuals living with type 2 diabetes included four themes: being in a life and death struggle, being at a crossroads with no return, being the one who decides, and being the one who can change the outcome.

Turning point transitions include existential and emotional aspects that can increase inner motivation and power for changed behaviour. Turning points are possible to identify, and self-management could be facilitated if more attention is paid to the emotional and existential aspects of having an illness.

Place, publisher, year, edition, pages
John Wiley & Sons, 2012
Keywords
type 2 diabetes, turning point, self-management, illness integration, patient centredness
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-55195 (URN)10.1002/edn.205 (DOI)
Available from: 2012-05-11 Created: 2012-05-11 Last updated: 2018-06-08Bibliographically approved
Hörnsten, Å., Jutterström, L., Audulv, Å. & Lundman, B. (2011). A model of integration of illness and self-management in type 2 diabetes. Journal of Nursing and Healthcare of Chronic Illness, 3(1), 41-51
Open this publication in new window or tab >>A model of integration of illness and self-management in type 2 diabetes
2011 (English)In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 3, no 1, p. 41-51Article in journal (Refereed) Published
Abstract [en]

Aim. To describe the process of illness integration and self-management among people with type 2 diabetes.

Background. Integration of illness is a developmental process referring to the emotional and existential aspects of being ill. It is an overarching concept that describes the process that a person undergoes in living with a chronic disease, from prediagnosis to adaptation to illness as a natural part of life. Despite the common use of terms such as illness integration and self-management, there exists little research that investigates how these concepts relate to one another.

Methods. A narrative interview study applying qualitative content analysis was conducted with people diagnosed with type 2 diabetes. The study focused on their personal understandings of illness, and particularly, the relationship of the participants’ illness integration to self-management of the disease. Data were collected in 2002.

Results. In the trajectory from prediagnosis to adaptation, there is a turning point when people seem to integrate the illness emotionally and existentially, and in relation to their self-management practice. The trajectory includes the phases of suspecting illness/being diagnosed, understanding and explaining the illness, and negotiating illness and taking stands about self-management. These phases in turn are influenced by perceptions of the seriousness and threat of the disease; the intensity and nature of the ill person’s emotional response to the disease and its management; goals and expectations for living with the disease and for living in general; and lastly, perceptions of the outcomes and impacts of self-management.

Conclusion. Illness integration and self-management processes develop simultaneously. In some cases, a turning point occurs that causes the person to view self-management as both necessary and feasible.

Relevance to clinical practice. Nurses may influence the illness integration trajectory and assist people with type 2 diabetes to integrate the disease and its management more readily.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
Keywords
chronic illness, nursing research, patients’ experience, qualitative study, self-management, type 2 diabetes
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-41257 (URN)10.1111/j.1752-9824.2010.01078.x (DOI)
Available from: 2011-03-22 Created: 2011-03-22 Last updated: 2018-06-08Bibliographically approved
Jutterström, L., Isaksson, U., Sandström, H., Stenlund, H. & Hörnsten, Å. Diabetes control by patient-centred self-management support: a randomised controlled trial.
Open this publication in new window or tab >>Diabetes control by patient-centred self-management support: a randomised controlled trial
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(English)Article in journal (Refereed) Submitted
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-67842 (URN)
Available from: 2013-04-04 Created: 2013-04-04 Last updated: 2018-06-08Bibliographically approved
Öberg, U., Orre, C. J., Hörnsten, Å., Jutterström, L. & Isaksson, U.Using the Self‐Management Assessment Scale (SMASc) as an instrument for screening self-management support needs in type 2 diabetes: experiences from nurse-led digital self-management support in Swedish primary health care.
Open this publication in new window or tab >>Using the Self‐Management Assessment Scale (SMASc) as an instrument for screening self-management support needs in type 2 diabetes: experiences from nurse-led digital self-management support in Swedish primary health care
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(English)Manuscript (preprint) (Other academic)
National Category
Health Sciences
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-158985 (URN)
Available from: 2019-05-15 Created: 2019-05-15 Last updated: 2019-06-13
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