ObjectivesThis study explores how organizational conditions affect the development and implementation of dialogue-based methods for patients with cardiac disease or type 2 diabetes, focusing on hard-to-reach groups.MethodsUtilizing audio recordings, transcripts, and field notes from 2018-2019, we applied the Theoretical Domains Framework to analyze how individual and group processes influenced the development and implementation of initiatives.ResultsThe study identified five key themes: environmental context and resources, social influences, skills, professional roles and identity, and optimism. A significant variation in resources and attitudes between cardiac and diabetes outpatient clinics was observed, affecting the success of dialogue-based rehabilitation strategies Cardiac nurses were more optimistic and proactive, unlike their counterparts in diabetes clinics who faced challenges related to longer disease duration and less obvious complications. Specifically, cardiac clinics had structured programs and consistent resources, while diabetes clinics faced sporadic patient engagement and limited support.DiscussionThe study advocates for a shift toward organizationally supported, comprehensive programs, emphasizing the need for a holistic approach in the healthcare sector to enhance the effectiveness of lifestyle interventions for chronic diseases. It further stresses the value of addressing the psychosocial factors within healthcare settings to improve patient care quality and employee well-being.
BackgroundPatients on hemodialysis commonly experience poor sleep quality, fatigue, and depression. Chronotype may influence these outcomes, but its role in this population remains unclear.ObjectivesThis study examined associations among chronotype, sleep quality, fatigue, and depression, and tested the mediating role of sleep quality.MethodsIn this cross-sectional study of 157 patients on hemodialysis (mean age, 63.99 years; 58.6% male), chronotype (Morningness-Eveningness Questionnaire), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), fatigue (Fatigue Severity Scale [FSS]), and depression (Beck Depression Inventory [BDI]-II) were assessed. Correlation and mediation analyses were used to examine these relationships.ResultsEvening types (38.2%) had significantly poorer mean ± standard deviation PSQI scores (12.57 ± 3.37) than neither types (53.5%; 9.73 ± 4.23, p < 0.001) and morning types (8.3%; 8.23 ± 4.36, p = 0.001), particularly in terms of sleep duration, efficiency, and medication use. Fatigue (FSS score=4.63 ± 1.17) and depression (BDI-II score=9.07 ± 7.81) did not differ according to chronotype.DiscussionEvening chronotype was associated with poorer sleep quality, which in turn was linked to increased fatigue and depression. Targeted sleep interventions for evening types may improve outcomes by correcting circadian misalignment and enhancing sleep efficiency. Sleep hygiene education and timed light exposure may offer clinically meaningful benefits in terms of sleep and psychological well-being.
Objective This qualitative exploratory study aimed to deepen the understanding of selective disclosure among adolescents and young adults (AYAs) living with chronic conditions, particularly in the context of intimate relationships. The project created a space for AYAs to reflect on and share their lived experiences of managing chronic illness and disclosing it to potential partners. Methods The study used a participatory design that combined elements of Youth Participatory Action Research (YPAR) with citizen science. Four YPAR partners, young people with lived experience of chronic illness, were actively involved in all stages of the research process, including topic selection, recruitment, development of questions, data collection, analysis, and dissemination. Additionally, 44 AYAs participated as respondents to a longitudinal qualitative survey consisting of 35 open-ended questions that focused on intimacy, challenges, coping mechanisms, and support systems. NVivo 14 was used to code and analyze responses thematically. Results Of the 44 AYAs contacted, 27 answered all survey questions. The sample had a high representation of young women with diabetes and LGBTQ + individuals with ADHD and other chronic conditions. Levels of self-acceptance, feelings of empowerment, and previous experiences of disclosure shaped participants’ willingness to disclose their health conditions in intimate situations. Supportive social and relational environments, including open-minded partners and trusted peer networks, encouraged disclosure. In contrast, experiences of stigma, fear of rejection, and concerns about being misunderstood or reduced to their diagnosis acted as barriers. Additionally, the presence of visible medication use or physical symptoms contributed to a sense of vulnerability, further complicating the decision to disclose. Conclusion The study sheds light on the nuanced relationship between chronic conditions, self-identity, and intimacy among AYAs. It highlights the importance of creating supportive environments and promoting open communication in both clinical and social settings. By integrating YPAR partners throughout the research process, the study highlights the value of participatory methods in capturing diverse youth perspectives and promoting more empathetic approaches to addressing intimacy related challenges in healthcare contexts. MESH terms Chronic Disease / psychology*; Qualitative Research; Truth Disclosure*; Young Adult.
ObjectivesThe study aimed to determine the multidimensional impact of pruritus, to define the impact on quality of life and to identify the experiences of patients with the symptom.MethodsA mixed-methods study with sequential quantitative and qualitative method with 57 patients experiencing pruritus in the hepatology and internal medicine clinics.ResultsA pruritus prevalence of 37.7% was found, with a mean score of 19.4 ± 3.4 (0-25) and the daily duration was 18-23 h/day (43.9%). The mean total score of the Liver Disease Symptom Index 2.0 was 66.57 ± 9.13 (0-96). A correlation was found between elevated GGT levels and pruritus. The qualitative content analysis consisted of three main themes: the meaning of pruritus and scratching; impact on quality of life; and ways of coping/dealing with pruritus symptom.DiscussionThe study shows that quantitative and qualitative results concurred that pruritus impairs patient's quality of life in regards to sleep, social isolation, daily living activities, and eating habits.
ObjectivesThe aim of this study is to answer two research questions: 1. How do people with inflammatory bowel disease (IBD) disclose their condition to others? 2. How do non-affected people respond to disclosure of IBD? The findings complement our previous research with people suffering from IBD on their concepts of a 'good life'.MethodsWe conducted 10 qualitative interviews with individuals with IBD and analyzed them with interpretative phenomenological analysis.ResultsParticipants with IBD reported that non-affected people appear to have only marginal knowledge about this disease and they tend to trivialize the illness. They described stigmatizing responses which make them experience shame or lack of dignity. To deal with difficult responses, participants sometimes try to avoid embarrassing situations and limit the information they give others about their illness. Sometimes they break social relationships. They disclose their illness for strategic reasons, for example to generate understanding from their employers. But they also experience understanding from others after revealing their illness.DiscussionOur study expands the evidence on experiences of stigma and the difficulties regarding disclosure in IBD, but also on the positive experiences of disclosure. Future research should focus on developing and evaluating appropriate methods for counseling on stigma and disclosure.
ObjectivesThe aim is to uncover the perspectives of Twitter users on Multiple Sclerosis (MS) in English tweets by: (i) determining the sentiment of the text (ii) identifying the discussed topics.MethodsThe tweets were scanned in April 2023 using the keywords "multiple sclerosis, multiplesclerosis". Artificial intelligence-based sentiment analysis was conducted on a total of 1168 tweets and content analysis was performed on 17.4% of these tweets.ResultsTweets of 44% are positive and 22.3% are negative sentiment. As a result of content analysis, three themes and their sub-themes were identified: (i) announcement sharing: invitation to support, promotion of academic publications, (ii) information sharing: information providers, information seekers, news providers, (iii) experience sharing: challenging MS, facilitated MS, emotionally impactful MS, comparative MS, misunderstood MS. Subjective content such as experiences is shared less frequently compared to objective content such as announcements and information.DiscussionThe findings of this study can serve as a guiding factor in supporting positive views, managing negative views, and promoting the expression of subjective experiences.
ObjectiveSystemic lupus erythematosus (SLE) flares are psychosocially influenced, but there are few culturally sensitive models. This study aims to explore psychosocial factors contributing to lupus flares in women and co-construct a novel framework, grounded in their lived experiences, to guide clinical practice.MethodsUtilizing Charmaz's constructivist grounded theory, we conducted a comprehensive study that included semi-structured interviews with 20 Iranian women who have SLE. Iterative open, focused, and theoretical coding was used to analyze data, with reflexive practices applied to address researchers' cultural assumptions and maintain rigor. Thematic saturation was achieved, situating the developing model within participants' lived experiences.ResultsA new four-domain model was constructed, representing a cyclical process reflecting lupus flare susceptibility. Predisposing Conditions consisted of marital dissatisfaction (e.g., felt spousal invalidation) and extrinsic stressors, with low socio-cultural status (economic distress, cultural divorce taboos) and stressful life events (infidelity, coerced marriages) shaping heightened distress. Mediating Factors-unresolved grief, sleep disturbance, and alexithymia-were viewed to exacerbate emotional and physiological reactions, with sleep disturbance often described by participants as coinciding with inflammatory markers. Responses included non-adaptive illness perception (e.g., "it is uncontrollable and there is no cure"), damaged sense of self, and conflicted parental roles, capturing socio-cultural effects. The Implication was difficulty in psychological adjustment to illness, linked with flare. Participants' accounts highlighted a recurring theme linking relational stressors to illness misperceptions, shaped by marital conflict and perceived lack of support.ConclusionsThis culturally informed model reveals new associations among socio-cultural stressors, such as divorce taboos, and lupus flare vulnerability among Iranian women. While acknowledging limitations (the potential influence of anti-inflammatory medications on participants' lived experiences, and also most participants were from lower socio-economic backgrounds), it suggested interventions (e.g., couple therapy, sleep therapy, grief counseling) and research on inflammatory markers. Reflexive grounding underpins equitable progress in SLE care.
ObjectivesThis study aimed to investigate the obstacles, problems, and facilitating factors in receiving healthcare services for patients with diabetes during the COVID-19 pandemic in Iran.MethodsA total of 18 patients with diabetes, 3 family members of the patients, and 10 healthcare staff members, using purposive sampling, with maximum diversity in demographic variables, were interviewed. Semi-structured in-depth interviews were used to collect the data. Data were analyzed using the content analysis method with Graneheim and Lundman's approach. Guba and Lincoln's criteria were used to measure the quality and validity of the data.ResultsWe extracted one theme, two sub-themes, four secondary categories, and 13 primary categories (443 codes). The theme of the ups and downs of receiving services was divided into two sub-themes obstacles and challenges of receiving services, and facilitators for receiving services; four secondary categories: obstacles and challenges of seeking service from the patients, and the patient's family, obstacles and challenges of receiving services by the system, solutions made by patients to solve psychological problems caused by the epidemic and facilitators to receive healthcare services from the system.DiscussionGiven the disruptions caused by COVID-19 and similar epidemics, it is crucial to develop strategies for improving healthcare access for people with diabetes. Identifying barriers and facilitators to service access is essential for policymakers to formulate more effective plans.
ObjectivesLong COVID following SARS-CoV-2 and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) following infectious mononucleosis (IM) are examples of post-infectious chronic illnesses. Behavioral and pathophysiological underpinnings of both ME/CFS following IM and Long COVID are not well understood.MethodsWe studied ME/CFS development following IM in a diverse group of college students who were enrolled before the onset of IM. We categorized those meeting either moderate or severe ME/CFS criteria. We subsequently recruited a matched sample of those infected with SARS-CoV-2, some of whom recovered and others of whom developed Long COVID. We compared and contrasted ME/CFS and Long COVID following IM and SARS-CoV-2 infection in terms of somatic symptoms, coping strategies, depression and anxiety symptoms, and functional status.ResultsIn general, the Long COVID group's symptom burden was less than that of the Severe ME/CFS group but more than that of the Moderate ME/CFS group.DiscussionThese findings may allow investigators a better understanding of these post-viral illness pathophysiologies.
Fibromyalgia (FM) is a chronic disorder characterized mainly by pain, fatigue, and sleep disturbances. Its etiology and pathophysiology are not yet well understood, but central sensitization is considered to be the main mechanism involved, although genetic, immune, and hormonal factors have also been proposed to play an essential role in the disease. Currently, fibromyalgia is diagnosed by clinical examination of the patient and the use of clinimetric scales. However, there are no laboratory tests for it, so finding potential biomarkers of this condition will be of great utility for its diagnosis. The aim of this work was to find potential biomarkers of fibromyalgia in peripheral blood mononuclear cells (PBMCs) from patients with FM. Using Tandem Mass Tag (TMT) mass spectrometry coupled to Synchronized Precursor Selection (SPS-MS3), we obtained a differential proteomic profile of PBMCs from fibromyalgia patients. The proteomic profile contains 251 proteins, of which 47 were dysregulated in fibromyalgia patients and could be potential biomarkers of this disorder.
PurposeLittle is known about characteristics of workers' self-management of long-term health conditions or their changeability. Specifically, little insight exists into self-management confidence and specifically whether engaged workers are likely to be confident in self-managing a long-term condition at work.MethodsUsing an online diary with six timepoints over a 10-week period, UK workers with long-term health conditions were asked to report on their self-management confidence and work engagement fortnightly.ResultsSixty-seven workers made at least one diary entry. Fifty-seven participated at timepoint 1, 39 in three or more timepoints and 11 in all six. Multi-level modelling revealed workers' self-management confidence not significantly changing over time. Consistent with one study hypothesis, modelling revealed work engagement having an effect on people's self-management confidence.ConclusionWork engagement might promote workers' long-term condition self-management. Providing support for work engagement could benefit people's self-management confidence although more research is needed to ascertain the relationship between the variables.
ObjectivesThe 2025 recognition of type 5 diabetes by the International Diabetes Federation has significant implications for healthcare professionals, particularly diabetes educators. This study explores educators' perceptions and responses to this emerging classification, focusing on undernourished populations in low-resource settings.MethodsA qualitative descriptive design was used, with semi-structured interviews conducted with 16 certified diabetes educators in Indonesia, including nurses, nutritionists, pharmacists, and doctors. Interviews were held in April and May 2025, and data were analyzed thematically using Braun and Clarke's framework.ResultsFour themes emerged: (1) Early-stage Awareness, educators were unfamiliar with the classification but recognized similar clinical patterns; (2) We're Not Prepared, highlighting gaps in training and resources; (3)ContextMatters, linking type 5 diabetes to malnutrition and socioeconomic inequities; and (4) Ready to Respond, If Equipped, with educators expressing willingness to adapt if provided with appropriate training. Participants also emphasized the need for national education programs, culturally relevant materials, and cross-sector collaboration.DiscussionWhile educators' preparedness is limited, their willingness to respond is strong. Targeted training, culturally relevant resources, and collaborative support are essential for effective education. Future research should evaluate the effectiveness of these strategies across different settings.
ObjectiveDetermining the factors affecting the continuity of care (CoC) levels of people with chronic conditions, is critical to enhancing the quality of health care and patient outcomes. The objective of this study is to identify CoC levels in patients with rheumatoid arthritis (RA) and the factors that influence CoC levels.MethodsThe study's sample consists of 440 RA patients. The survey was used to collect data for this study, which is a cross-sectional study. The CoC level of the patients was determined using the "CoC Scale."ResultsThe mean total CoC score was 60.19, slightly above the midpoint of the 0-100 scale. Multivariate analysis showed that disease-related parameters including drug regimen complexity, comorbidity status, receipt of RA training, and disease duration were significantly associated with CoC (p < .05). Additionally, socio-demographic characteristics such as educational level, smoking status, place of residence, and age also showed statistically significant associations with CoC (p < .05).Discussion: The findings of the study are expected to provide significant data and information to physicians in order to raise the CoC level, which is anticipated to play a key role in enhancing treatment outcomes, lowering disease costs, and improving health-care quality.
Background and ObjectivesDiabetes is a chronic condition that requires intensive management for optimal health. This study investigated the relationship between children's involvement in household chores, their independence in completing these tasks, and their diabetes self-management.MethodsData for this cross-sectional study was collected from a Pediatric Diabetes Clinic. Fifty-four children participated (average age 13.5 ± 2.53). The CHORES questionnaire was utilized to determine participation and independence in completing chores. For diabetes management, the SCI-R questionnaire was used to measure adherence to recommended blood sugar monitoring, exercise, nutrition, and medication regimens.ResultsThere were positive correlations between SCI-R scores and the participation CHORES scale (r = .462, p = <.00), assistance CHORES scale (r = .564, p = <.001). Chores participation predicted diabetes management (participation CHORES with β = .56, p = <.01, participation self-care CHORES with β = .38, p = <.05, assistance CHORES with β = .67, p = <.01, and assistance in family care CHORES with β = .35, p = <.05).ConclusionsOur findings suggest that children who not only participate in more chores but are also more independent in their completion report a greater ability of diabetes self-management. Implications for healthcare providers and parents are discussed.
ObjectiveCommunity-acquired pneumonia (CAP) is a serious infection in patients with cirrhosis. This study aimed to describe clinical features of patients with cirrhosis and CAP, and to determinate whether cirrhosis is consistently associated with poor outcomes.MethodsDatabases were systematically searched for full-text articles comparing patients with and without cirrhosis with CAP and evaluating the impact of cirrhosis on clinical profile and outcomes, from inception to February 2021.ResultsTotals of 1485 and 114740 patients with cirrhosis and without cirrhosis with CAP were included, respectively. Patients with cirrhosis had different characteristics and more severe disease at admission compared to patients without cirrhosis (hypotension, altered mental status, hyponatremia, hypoalbuminemia were more frequent in patients with cirrhosis). Streptococcus pneumoniae was more frequently identified as the causative pathogen of CAP in patients with cirrhosis, and bloodstream infections were also more common. Likewise, risk of intensive care unit admission and mortality was higher in patients with cirrhosis than in patients without cirrhosis (range 11.1%-23.3% versus 8.8%-17.2% and 2.7%-23% compared with 14.4%-34.5%, respectively).DiscussionPatients with cirrhosis and CAP have a poorer prognosis than patients without cirrhosis. Information on the clinical features of CAP in patients with cirrhosis and on risk factors for poor outcomes remains limited.
Objectives Type 1 diabetes (T1D) is a complex and chronic disease that often requires management within an interpersonal context. Young couples may face unique challenges as they integrate and negotiate diabetes routines into their lives. The purpose of this study is to examine the experiences of young adult couples as they adjust and adapt to the management of T1D in their relationship.Methods Young adults (25-40 years) living with T1D and their romantic partners (77 couples, 154 individuals) were separately interviewed. A constant comparison approach was used to qualitatively analyze the data for similarities and differences in perceptions of diabetes management as a dyad. Themes were then identified.Results Three themes emerged from the data: learning to incorporate diabetes into the relationship, working together to manage diabetes, and parenting with T1D. Young adult couples are developing coping mechanisms to manage diabetes together. Partners must learn to balance being supportive without being over controlling.Discussion Young adults with T1D and partners adjust to diabetes as a couple. Diabetes education for the partner is important to the relationship. Interventions developed to support couples establish collaboration earlier in their relationship may be beneficial for clinical and relationship outcomes.
ObjectivesTo address the challenges of tuberculosis (TB) control in the United States post-COVID-19, focusing on high-risk populations, current diagnostic and treatment strategies, and the importance of addressing clinical and social determinants of health to achieve TB elimination goals.MethodsA review of the latest evidence-based guidelines and literature on TB diagnostics, treatment regimens, and latent TB infection (LTBI) management was conducted. Key public health challenges and interventions targeting socioeconomic disparities, stigma, and healthcare access among high-risk populations were analyzed.ResultsHigh-risk groups, including immigrants and ethnic minorities, continue to bear a disproportionate burden of TB due to socioeconomic disparities and comorbidities. Advancements in diagnostic modalities and treatment regimens offer promising outcomes, but gaps remain in LTBI screening and management. Addressing social determinants, such as healthcare access and stigma, is essential for enhancing TB control efforts.DiscussionEffective TB elimination requires collaborative efforts among healthcare professionals, policymakers, and communities to implement evidence-based strategies. Prioritizing both clinical precision and social interventions is critical for overcoming barriers and achieving national TB control and elimination goals.
Background and PurposeWhile empirical studies in Iraq have examined sociodemographic characteristics and modes of human immunodeficiency virus (HIV) transmission, including but not limited to those involving key populations, there remains a critical lack of synthesizing these studies. Therefore, the purpose of this syetematic review is to comprehensively synthesis the available empirical evidence to understand the sociodemographic characteristics and modes of HIV transmission in Iraq, with the goal of informing future strategies for prevention, treatment, and care.MethodThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used. Seven electronic databases (PubMed, CINAHL with Full text, PsychINFO, Google Scholar, Web of Science, Scopus, MEDLINE with FULL Text (EBSCO)) were searched between 1986 and December 2024. Inclusion criteria were original studies that reported sociodemographic factors and modes of HIV transmission among people living with HIV. A total of 854325 records were identified, but 6 studies met the inclusion criteria. We synthesized data using a convergent integrated approach to identify key themes.FindingsHIV prevalence was high in urban areas, single, low educational levels, employed, and low economic status people. The most common modes of HIV transmission were heterosexual, followed by blood transfusion, man who have sex with man, bisexual, and mother to infant, and surgery.ConclusionThe HIV is steady increasing. Therefore, enhancing HIV prevention, early detection, and treatment access are required.
ObjectivesTo examine whether illness or healthcare experiences have a more significant influence on living well, and which factors in these experiences have the most influence.MethodsInformation collected included demographic data, illness and healthcare experience, and the LTCQ to measure living well. Data was collected via online survey platform Qualtrics. Two separate 2-stage hierarchical multiple regressions were run to investigate how much variance in living well with long-term conditions is accounted for by established and exploratory illness and healthcare experience factors.Results70 participants met the inclusion criteria of the study, with 54 included in the analysis. Results showed that illness experience had a significant influence on living well while healthcare experience did not. The factors of illness intrusiveness in illness experience and patient assessment of chronic illness care in healthcare experience significantly impacted living well.Discussion: This study examines the influences of illness and healthcare experiences on the ability to live well with LTCs. Future research could focus on specific LTCs and compare which factors they find significantly affect living well. The findings pave the way for future explorations into the factors influencing living well differ between LTCs and the best interventions to improve living well with LTCs.
ObjectivesThis study aims to examine the relationships between health literacy, patient participation and patient activation variables, and to investigate whether patient activation has a mediating effect on the impact of health literacy on patient participation.MethodsThe population of the study consists of individuals with chronic diseases who applied to different outpatient clinics of a city hospital in Türkiye. Data was collected from 671 individuals using the convenience sampling method in the study.ResultsAccording to the results of the correlation analysis conducted in the study, statistically significant, positive relationships were found between health literacy and patient activation, health literacy and patient participation, patient activation and patient participation. The results of the regression analysis showed that health literacy explained 10% of the total variance in patient participation and 8% of the total variance in patient activation, while patient activation explained 11% of the total variance in patient participation. Additionally, the study determined that patient activation plays a statistically significant and positive mediating role in the relationship between health literacy and patient participation.DiscussionThe results show that as the level of health literacy increases in individuals with chronic diseases, patient participation and patient activation may also increase.
