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Patient-provider perspectives on self-management support and patient empowerment in chronic care: a mixed-methods study in a rural sub-Saharan setting. / Angwenyi, Vibian; Aantjes, Carolien; Bunders-Aelen, Joske; Lazarus, Jeffrey V.; Criel, Bart.

In: Journal of Advanced Nursing, 2019.

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@article{74f24ec78a1e4e26b29d154ef8912686,
title = "Patient-provider perspectives on self-management support and patient empowerment in chronic care: a mixed-methods study in a rural sub-Saharan setting",
abstract = "Aim To explore how provision of self-management support to chronically-ill patients in resource-limited settings contributes to patient empowerment in chronic care. Design Concurrent descriptive mixed methods research. Methods A survey of 140 patients with chronic conditions administered at four time-points in 12 months. We conducted 14 interviews and four focus-group discussions with patients (N = 31); 13 healthcare provider interviews; and observations of four patient-support group meetings. Data were collected between April 2016 - May 2017 in rural Malawi. Qualitative data were analysed using a thematic approach and descriptive statistical analysis performed on survey data. Results Healthcare professionals facilitated patient empowerment through health education, although literacy levels and environmental factors affected self-management guidance. Information exchanged during patient-provider interactions varied and discussions centred around medical aspects and health promoting behaviour. Less than 40{\%} of survey patients prepared questions prior to clinic consultations. Health education was often unstructured and delegated to non-physician providers, mostly untrained in chronic care. Patients accessed psychosocial support from volunteer-led community home-based care programmes. HIV support-groups regularly interacted with peers and practical skills exchanged in a supportive environment, reinforcing patient's self-mangement competence and proactiveness in health care. Conclusion For optimal self-management, reforms at inter-personal and organizational level are needed including; mutual patient-provider collaboration, diversifying access to self-management support resources and restructuring patient support-groups to cater to diverse chronic conditions. Impact Our study provides insights and framing of self-management support and empowerment for patients in long-term care in sub-Saharan Africa. Lessons drawn could feed into designing and delivering responsive chronic care interventions.",
keywords = "chronic care, hiv, mixed methods, non-communicable diseases, nurse practitioners, nursing care, patient empowerment, self-management support, sub-saharan africa, CHRONIC DISEASE, NONCOMMUNICABLE DISEASES, CHRONIC ILLNESS, FRAMEWORK, PROGRAMS",
author = "Vibian Angwenyi and Carolien Aantjes and Joske Bunders-Aelen and Lazarus, {Jeffrey V.} and Bart Criel",
note = "CPDF; CUNIT",
year = "2019",
doi = "10.1111/jan.14116",
language = "English",
journal = "Journal of Advanced Nursing",
issn = "0309-2402",
publisher = "Wiley",

}

RIS

TY - JOUR

T1 - Patient-provider perspectives on self-management support and patient empowerment in chronic care: a mixed-methods study in a rural sub-Saharan setting

AU - Angwenyi, Vibian

AU - Aantjes, Carolien

AU - Bunders-Aelen, Joske

AU - Lazarus, Jeffrey V.

AU - Criel, Bart

N1 - CPDF; CUNIT

PY - 2019

Y1 - 2019

N2 - Aim To explore how provision of self-management support to chronically-ill patients in resource-limited settings contributes to patient empowerment in chronic care. Design Concurrent descriptive mixed methods research. Methods A survey of 140 patients with chronic conditions administered at four time-points in 12 months. We conducted 14 interviews and four focus-group discussions with patients (N = 31); 13 healthcare provider interviews; and observations of four patient-support group meetings. Data were collected between April 2016 - May 2017 in rural Malawi. Qualitative data were analysed using a thematic approach and descriptive statistical analysis performed on survey data. Results Healthcare professionals facilitated patient empowerment through health education, although literacy levels and environmental factors affected self-management guidance. Information exchanged during patient-provider interactions varied and discussions centred around medical aspects and health promoting behaviour. Less than 40% of survey patients prepared questions prior to clinic consultations. Health education was often unstructured and delegated to non-physician providers, mostly untrained in chronic care. Patients accessed psychosocial support from volunteer-led community home-based care programmes. HIV support-groups regularly interacted with peers and practical skills exchanged in a supportive environment, reinforcing patient's self-mangement competence and proactiveness in health care. Conclusion For optimal self-management, reforms at inter-personal and organizational level are needed including; mutual patient-provider collaboration, diversifying access to self-management support resources and restructuring patient support-groups to cater to diverse chronic conditions. Impact Our study provides insights and framing of self-management support and empowerment for patients in long-term care in sub-Saharan Africa. Lessons drawn could feed into designing and delivering responsive chronic care interventions.

AB - Aim To explore how provision of self-management support to chronically-ill patients in resource-limited settings contributes to patient empowerment in chronic care. Design Concurrent descriptive mixed methods research. Methods A survey of 140 patients with chronic conditions administered at four time-points in 12 months. We conducted 14 interviews and four focus-group discussions with patients (N = 31); 13 healthcare provider interviews; and observations of four patient-support group meetings. Data were collected between April 2016 - May 2017 in rural Malawi. Qualitative data were analysed using a thematic approach and descriptive statistical analysis performed on survey data. Results Healthcare professionals facilitated patient empowerment through health education, although literacy levels and environmental factors affected self-management guidance. Information exchanged during patient-provider interactions varied and discussions centred around medical aspects and health promoting behaviour. Less than 40% of survey patients prepared questions prior to clinic consultations. Health education was often unstructured and delegated to non-physician providers, mostly untrained in chronic care. Patients accessed psychosocial support from volunteer-led community home-based care programmes. HIV support-groups regularly interacted with peers and practical skills exchanged in a supportive environment, reinforcing patient's self-mangement competence and proactiveness in health care. Conclusion For optimal self-management, reforms at inter-personal and organizational level are needed including; mutual patient-provider collaboration, diversifying access to self-management support resources and restructuring patient support-groups to cater to diverse chronic conditions. Impact Our study provides insights and framing of self-management support and empowerment for patients in long-term care in sub-Saharan Africa. Lessons drawn could feed into designing and delivering responsive chronic care interventions.

KW - chronic care

KW - hiv

KW - mixed methods

KW - non-communicable diseases

KW - nurse practitioners

KW - nursing care

KW - patient empowerment

KW - self-management support

KW - sub-saharan africa

KW - CHRONIC DISEASE

KW - NONCOMMUNICABLE DISEASES

KW - CHRONIC ILLNESS

KW - FRAMEWORK

KW - PROGRAMS

U2 - 10.1111/jan.14116

DO - 10.1111/jan.14116

M3 - A1: Web of Science-article

JO - Journal of Advanced Nursing

T2 - Journal of Advanced Nursing

JF - Journal of Advanced Nursing

SN - 0309-2402

ER -

ID: 3014416