SELF-MANAGEMENT STRATEGIES FOR ADULTS AGING WITH HIV

Transcription

1 SELF-MANAGEMENT STRATEGIES FOR ADULTS AGING WITH HIV Gayle Restall, O.T. Reg. (MB), PhD Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba 3rd International Forum on HIV and Rehabilitation Research May 12, 2016 Winnipeg, Manitoba

2 Acknowledgements Hal Loewen, Librarian, University of Manitoba

3 Objectives 1. Become aware of the knowledge, skills, attitudes and outcomes that are targeted in selfmanagement interventions with people living with HIV 2. Identify current trends in self-management strategies with people aging with HIV 3. Examine potential issues and gaps specific to self-management and people aging with HIV

4 What is Self-Management? The tasks that people do to manage: their medical condition meaningful activities and life roles, and emotional well-being (Lorig & Holman, 2003) Self-management skills involve: problem solving decision making resource utilization forming partnerships with heath care providers and taking action (Lorig & Holman, 2003, p.2)

5 Self-Management Interventions Can be important to many people living with HIV because of stigma, relationship and social concerns, and psychological distress (Martin et al., 2014) Aging with HIV can mean that self-management becomes more complex when people experience complications of HIV, the long term side-effects of medications, other chronic health conditions, and life transitions

6 Sources of Evidence Scoping review of self-management strategies (Bernardin et al., 2013) Updated with more recent literature using a scoping review of reviews (Arskey & O Malley, 2005; Halas et al., 2015) as a rapid knowledge synthesis of literature published since the previous review

7 Content Self care Roles Interpersonal skills Planning for the future Self Management Programs Technical knowledge Positive attitude Cognitive skills (Aantjes et al., 2014; Bernardin et al, 2013)

8 Well-being and quality of life (physical, physiological, psychological, social) Outcomes Health and illness management (e.g., medication adherence, sexual practices, self-care and interpersonal skills) Use of health services (e.g., hospitalizations, access to health services, communication with health care providers, linkage to care) (Aantjes et al., 2014; Bernardin et al., 2013; Brennan et al., 2014; Millard et al., 2013)

9 Formats Individual and group-based Face-to-face and technology-based (e-health, m-health) Professional and peer led (Aantjes et al., 2014; Bernardin et al., 2013; Millard et al., 2013)

10 Effectiveness Some evidence of positive short-term outcomes for physical health status, emotional status and health knowledge and behaviour (Aantjes et al., 2014; Millard et al., 2013). International Advisory Panel on HIV Care Continuum Optimization (IAPAC) has recommended, on the basis of excellent quality evidence, strategies to enable self-management and user-driven care to be important to the HIV medical care continuum (IAPAC, 2015).

11 Participant Experiences Important intervention and positive experience for many participants Challenges specific concerns not being addressed questioning cultural relevance (Bernardin et al., 2013)

12 Current Trends Increasing diversity of formats Technology based delivery mechanisms: M-health (e.g., Mbuagbaw et al., 2015; Schnall et al., 2015; Tufts et al., 2015) Mailed self-management tool kit (Lorig et al., 2015)

13 Issues and Gaps Self-management as individual behaviour that can ignore the social context and structural barriers to managing health and well-being: Social capital Determinants of health Geographic location Access to health care Stigma and discrimination

14 Expanded Chronic Care Model (Barr et al., 2003)

15 Issues and Gaps Very little self-management literature related specifically to older adults with HIV who may have aging-specific concerns such as: Menopause Multiple medical conditions Roles of grand parenting and volunteering Comparison of acceptability and effectiveness of various formats of self-management interventions

16 Issues and Gaps Diversity of needs across sub-groups and populations related to sex, gender, social roles, age, length of time since diagnosis, literacy, comorbidities, culture, geography and access to health services Lack of studies related to long term outcomes and changing needs of individuals over time Lack of studies related to involvement of families and communities (Aantjes et al., 2014)

17 Raising the Bar of Self-management Greater involvement of people living with HIV Self-management in context of socio-political structures Diversity of content, methods & formats Attention to people s changing needs and goals while aging with HIV

18 Objectives Revisited 1. Become aware of the knowledge, skills, attitudes and outcomes that are targeted in selfmanagement interventions with people living with HIV 2. Identify current trends in self-management strategies with people aging with HIV 3. Examine potential issues and gaps specific to self-management and people aging with HIV

19 Contact Information

20 References Aantjes, C. J., Ramerman, L., & Bunders, J. F. (2014). A systematic review of the literature on self-management interventions and discussion of their potential relevance for people living with HIV in sub-saharan Africa. Patient Education & Counseling, 95(2), Arksey H., O'Malley L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology,8, doi: / Barr, V., Robinson, S., Marin-Link, B., Underhill, L., Dotts, A., Ravensdale, D. & Salivaras, S. (2003). The expanded chronic care model: An integration of concepts and strategies from population health promotion and the chronic care model. Healthcare Quarterly, 7, doi: /hcq Bernardin, K. N., Toews, D. N., Restall, G., & Vuongphan, L. (2013). Self-management interventions for people living with human immunodeficiency virus: a scoping review. Canadian Journal of Occupational Therapy, 80, doi: / Brennan, A., Browne, J. P., & Horgan, M. (2014). A systematic review of health service interventions to improve linkage with or retention in HIV care. AIDS Care, 26(7), Halas, G., Schultz, A., Rothney, J., Goertzen, L., Wener, P., & Katz, A. (2015). A scoping review protocol to map the research foci trends in tobacco control over the last decade. BMJ Open, 5:e doi: /bmjopen IAPAC. (2015). IAPAC Guidelines for optimizing the HIV care continuum for adults and adolescents. Journal of the International Association of Providers of AIDS Care, 14 (S1), S3-34. doi: / Levac, D., Colquhoun, H., O'Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5,69. doi: / Lorig, K. & Holman, H. (2003). Self-management education: History, definition, outcomes and mechanisms. Annals of Behavioral Medicine, 26, 1-7. Lorig, K,, Ritter, P., Moreland, C., & Laurent, D. (2015). Can a box of mailed materials achieve the triple aims of health care? The mailed chronic disease self-management tool kit. Health Promotion Practice, 16, doi: / Mbuagbaw, L., Mursleen, S., Lytvyn, L., Smieja, M., Dolovich, L., & Thabane, L. (2015). Mobile phone text messaging interventions for HIV and other chronic diseases: an overview of systematic reviews and framework for evidence transfer. BMC Health Services Research, 15, 33. Schnall, R., Mosley, J. P., Iribarren, S. J., Bakken, S., Carballo-Dieguez, A., & Brown Iii, W. (2015). Comparison of a user-centered design, self-management app to existing mhealth apps for persons living with HIV. JMIR MHealth and UHealth, 3(3), e91. Tufts, K. A., Johnson, K. F., Shepherd, J. G., Lee, J. Y., Bait Ajzoon, M. S., Mahan, L. B., & Kim, M. T. (2015). Novel interventions for HIV self-management in African American women: a systematic review of mhealth interventions. Journal of the Association of Nurses in AIDS Care, 26(2),