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Dr. Manuela Glattacker

Institut für Qualitätsmanagement und Sozialmedizin Universitätsklinikum Freiburg Engelbergerstraße 21

79106 Freiburg

Tel.: +49 (0)761 270-36940

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Project “Improving self-regulation of patients with chronic diseases (SELF)” 

The SELF project continued the project “Individualized patient information following patient’s illness beliefs and treatment beliefs (SubKon)” from the first phase of the research funding programme “Patient-Oriented Research”. The aim of the SELF project was to develop an intervention that adapts information individually to patients’ beliefs about illness and treatment to meet their individual information needs. In this way, starting points should be found to support the self-regulation of patients with either (1) chronic back pain or (2) depressive disorders. The intervention was developed on the basis of the Common-Sense Model of self-regulation (CSM) by Howard Leventhal and his colleagues. Taking into account the central components of this model, the intervention was designed to incorporate three aspects: (1) patients’ perceptions about illness and treatment; (2) patients’ coping behaviour and (3) the appraisal of the coping behaviour.

 

In the first phase of the project (June to December 2011), a CSM-based questionnaire to collect information about patients’ action plans and their appraisal was developed to complement existing instruments that assess patient beliefs about illness and treatment. The questionnaire content was developed multimodally, that is literature and theory-based using current assessment tools as well as guided focus groups conducted with patients and clinicians. As a result, a comprehensive, diagnosis-specific item pool for differentiated identification and assessment of patients’ coping behaviour and its assessment could be developed for both diagnosis groups (chronic back pain and depressive disorders).

 

In the next phase (February to November 2012), the instruments we developed underwent comprehensive psychometric testing with a sample of N=203 patients with chronic back pain and N=210 patients with depressive disorders. Constructing a rating scale for the questionnaire was possible for “chronic back pain” group, but was deemed not meaningful for the “depressive disorders” group. On a single item level, however, the questionnaires for both groups showed satisfactory distributions. The questionnaires were shown to be particularly strong in the structure and wording of the items that allow individual coping strategies, their goals and their level of success to be identified and evaluated.

 

Another important work package (January 2012 to April 2013) was the conceptual development of the “SELF-Intervention”. The intervention concept was initially developed on the basis of the SubKon-Intervention and available literature and then discussed with N=20 clinicians from four participating rehabilitation centres using an expert groups approach. The literature review and the results of the expert groups indicated numerous aspects that required further development of the intervention. The concept of the SELF-Intervention was then written up into an intervention manual.

 

Between July 2013 and March 2014, the intervention was then implemented and formatively evaluated in two orthopaedic and two psychosomatic rehabilitation centres to gain a deeper insight into the process of implementation of the intervention and to evaluate both its feasibility in clinical practice (clinician assessment) and its perceived benefit and acceptance (patient and clinician assessment). In a first step, N=16 clinicians were interviewed by telephone. In a second step, semi-structured interviews with clinicians (N=15) and patients (N=17) were performed. The interviews were analysed using Mayring’s (2008) qualitative content analysis approach and used the Atlas.ti (Muhr, 2007) software. In addition, N=88 patients were surveyed by questionnaire as were another N=27 clinicians. The clinicians were asked to document and evaluate the intervention and its effectiveness for each individual patient. At the end of the study phase, the clinicians also completed a final evaluation of the intervention. The qualitative and quantitative evaluations provided a wealth of information about the implementation, feasibility and acceptance of the SELF Intervention. The results indicate good treatment integrity. Participating patients and clinicians alike also evaluated the intervention as positive in terms of promoting a patient-centred treatment, which we consider a positive assessment of the intervention’s intended goal of “tailoring” rehabilitation treatment. Six key insights were obtained concerning the implementation and feasibility of the SELF-Intervention: 1) organisational barriers to implementation have been successfully handled; 2) implementation barriers at the personal level play an important role in the intervention’s success; 3) implementation barriers affect the appraisal and acceptance of the intervention; 4) the results of the SELF project contribute to a deeper understanding of the results of the earlier “SubKon” project; 5) the results of the SELF project indicate potential for further development of the intervention; and 6) the results of the SELF project indicate potential for further development of the research design used in this project.




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