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ABSTRACT: BACKGROUND: Family physicians frequently interact with people affected by chronic diseases, placing them in a privileged position to enable patients to gain control over and improve their health. Soliciting patients' perceptions about how their family physician can help them in this process is an essential step to promoting enabling attitudes among these health professionals. In this study, we aimed to identify family physician enabling attitudes and behaviours from the perspective of patients with chronic diseases. METHODS: We conducted a descriptive qualitative study with 30 patients, 35 to 75 years of age presenting at least one common chronic disease, recruited in primary care clinics in two regions of Quebec, Canada. Data were collected through in-depth interviews and were analyzed using thematic analysis. RESULTS: Family physician involvement in a partnership was perceived by participants as the main attribute of enablement. Promoting patient interests in the health care system was also important. Participants considered that having their situation taken into account maximized the impact of their physician's interventions and allowed the legitimization of their feelings. They found their family physician to be in a good position to acknowledge and promote their expertise, and to help them maintain hope. CONCLUSIONS: From the patient's perspective, their partnership with their family physician is the most important aspect of enablement.
BMC Family Practice 01/2013; 14(1):8. · 1.80 Impact Factor
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ABSTRACT: The enablement process is defined as a professional intervention aiming to recognize, support and emphasize the patient's capacity to have control over her or his health and life. The purpose of this article was to study the enablement concept through a concept analysis in the health care context to identify: (1) its attributes and (2) its antecedents and consequents.
A concept analysis was performed according to the method of Rodgers. The literature was reviewed from 1980 to June 2008, using search strategies adapted to the databases Cinahl, Medline, Embase, PsycInfo and Social Works Abstract, and hand searching. All articles contributing to a deeper understanding of the concept were included. The analysis was carried out according to a thematic analysis procedure, as described by Miles & Huberman.
The search identified 1305 citations. After in-depth assessment of 148 potentially eligible citations, 61 articles were included in the review. Five articles were added with hand searching. Sixty-seven per cent of these articles were related to nursing. The attributes of the enablement concept included: contribution to the therapeutic relationship; consideration of the person as a whole; facilitation of learning; valorization of the person's strengths; implication and support to decision making; and broadening of the possibilities.
These attributes could be used as a basis for other studies on enablement. Conceptual and empirical work is still needed to better position this concept among others such as patient-centred care, shared decision making and patient's participation.
Journal of Evaluation in Clinical Practice 02/2011; 17(1):143-9. · 1.23 Impact Factor
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ABSTRACT: Enablement is an intervention by which the health care provider recognizes, promotes and enhances patients' ability to control their health and life. An abundant health literature suggests that enablement is associated with good outcomes. In this review, we aimed at identifying and comparing instruments that assess enablement in the health care context.
We conducted a systematic literature review using Medline, Embase, Cochrane, Cinahl and PsycINFO databases, 1980 through March 2009, with specific search strategy for each database. Citations were included if they reported: (1) development and/or validation of an instrument; (2) evaluation of enablement in a health care context; and (3) quantitative results following administration of the instrument. The quality of each main retained citation was assessed using a modified version of the Standards for Reporting of Diagnostic Accuracy. Results: Of 3135 citations identified, 53 were retrieved for detailed evaluation. Four articles were included. Two instruments were found: the Patient Empowerment Scale (PES) and the Empowering Speech Practices Scale (ESPS). Both instruments assessed enablement in hospital setting, one from the inpatient's perspective (PES) and the other from both perspectives (ESPS).
Two instruments assess enablement in hospital setting. No instrument is currently available to assess enablement in an ambulatory care context.
Journal of Evaluation in Clinical Practice 12/2010; 16(6):1301-8. · 1.23 Impact Factor
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ABSTRACT: This study explored the perceptions and lived experience of community-dwelling older adults about their quality of life (QOL) in regards to personal factors, social participation and environment. A qualitative design was used to extend existing work on QOL focusing on human functioning components and advanced QOL conceptualization. Based on a semi-structured interview guide, two individual in-depth interviews were conducted with 18 participants (aged 63-92; 12 women) having various levels of ability and QOL. Personal factors, such as health, inner life and behavioral abilities, were found to be essential for QOL. Being occupied and doing activities associated with good health habits are also important. Accomplishment of social roles is, for the majority of participants, more significant than daily activities. The physical and social environment must be adapted to the person's needs and preferences. Participants' perceptions differed only slightly according to their ability and QOL levels. Findings show the critical role of adaptation to disabilities and aging for better QOL. A sense of control over one's own life also has beneficial effects. These results point up the importance of considering perceptions about personal factors, social participation and environmental factors in older adults' QOL. Other theoretical as well as methodological implications for further QOL study are highlighted.
Archives of gerontology and geriatrics 11/2008; 49(2):e91-100. · 1.36 Impact Factor
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ABSTRACT: To study changes in quality of life (QOL) and to explore predictors of QOL of community-dwelling older adults with physical disabilities.
A 2-yr longitudinal study involved a convenience sample of 49 people with physical disabilities aged 60-94 yrs. QOL was estimated twice at a 2-yr interval with the Quality of Life Index, which includes four domains: health and functioning, socioeconomic, psychological/spiritual, and family. The potential predictors evaluated at baseline were health condition, activity, participation (level and satisfaction), personal factors, and environmental factors (obstacles and facilitators).
No change over time in QOL mean score was observed (mean: -0.41; SD: 2.5; 95% confidence interval: -1.1 to 0.30; P = 0.25). However, about half the participants had a clinically significant change (either increase or decrease). Greater satisfaction with participation in social roles and fewer obstacles in the physical environment were identified as the best predictors (R2 = 0.27; P = 0.001) of better QOL. Greater participation in daily activities, fewer obstacles in the physical environment, and greater satisfaction with participation in social roles were found to be the best predictors (R2 = 0.49; P < 0.001) of high health and functioning QOL. Finally, increased QOL score over the 2-yr period was best predicted by initial lower socioeconomic QOL and activity level perceived as unstable (R2 = 0.27; P = 0.001).
QOL is partially explained by participation and environmental factors. These factors may be positively modified and thus may warrant special attention in health interventions. Identified predictors of QOL changes over time need to be considered in intervention studies.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 10/2008; 87(10):830-41. · 1.56 Impact Factor
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ABSTRACT: Activity limitation is one of the most frequent geriatric clinical syndromes that have significant individual and societal impacts. People living with activity limitations might have fewer opportunities to be satisfied with life or experience happiness, which can have a negative effect on their quality of life. Participation and environment are also important modifiable variables that influence community living and are targeted by health interventions. However, little is known about how quality of life, participation and environment differ according to activity level. This study examines if quality of life, participation (level and satisfaction) and perceived quality of the environment (facilitators or obstacles in the physical or social environment) of community-dwelling older adults differ according to level of activity.
A cross-sectional design was used with a convenience sample of 156 older adults (mean age = 73.7; 76.9% women), living at home and having good cognitive functions, recruited according to three levels of activity limitations (none, slight to moderate and moderate to severe). Quality of life was estimated with the Quality of Life Index, participation with the Assessment of Life Habits and environment with the Measure of the Quality of the Environment. Analysis of variance (ANOVA) or Welch F-ratio indicated if the main variables differed according to activity level.
Quality of life and satisfaction with participation were greater with a higher activity level (p < 0.001). However, these differences were clinically significant only between participants without activity limitations and those with moderate to severe activity limitations. When activity level was more limited, participation level was further restricted (p < 0.001) and the physical environment was perceived as having more obstacles (p < 0.001). No differences were observed for facilitators in the physical and social environment or for obstacles in the social environment.
This study suggests that older adults' participation level and obstacles in the physical environment differ according to level of activity. Quality of life and satisfaction with participation also differ but only when activity level is sufficiently disrupted. The study suggests the importance of looking beyond activity when helping older adults live in the community.
Health and Quality of Life Outcomes 02/2008; 6:30. · 2.11 Impact Factor
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ABSTRACT: Few studies have examined empowerment interventions as they actually unfold in home care in the context of chronic health problems. This study aims to document the empowerment process as it plays out in interventions with adults receiving home care services.
The qualitative design chosen is a fourth generation evaluation combined with case studies. A home care team of a health and social services center situated in the Eastern Townships (Québec, Canada) will be involved at every step in the study. A sample will be formed of 15 health care professionals and 30 of their home care clients and caregiver. Semi-structured interviews, observations of home care interventions and socio-demographic questionnaires will be used to collect the data. Nine instruments used by the team in prior studies will be adapted and reviewed. A personal log will document the observers' perspectives in order to foster objectivity and the focus on the intervention. The in-depth qualitative analysis of the data will illustrate profiles of enabling interventions and individual empowerment.
The ongoing process to transform the health care and social services network creates a growing need to examine intervention practices of health care professionals working with clients receiving home care services. This study will provide the opportunity to examine how the intervention process plays out in real-life situations and how health care professionals, clients and caregivers experience it. The intervention process and individual empowerment examined in this study will enhance the growing body of knowledge about empowerment.
BMC Health Services Research 02/2008; 8:177. · 1.66 Impact Factor
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ABSTRACT: To determine whether the recommendations health care professionals make to women of childbearing age on the importance of taking folic acid encourage these women to take folic acid supplements.
Survey.
The Centre de santé et de services sociaux at the Institut universitaire de gériatrie de Sherbrooke in Sherbrooke, Que.
A total of 323 Francophone women 18 to 45 years old.
Whether or not women had consumed vitamin and mineral supplements during the past year. Descriptive, bivariate statistical analyses and logistic regression modeling were carried out to determine whether the association between health care professionals' recommendations and the consumption of vitamin and mineral supplements persisted after controlling for certain variables (consulting documentation, knowledge, sources of information, perception, age, education, income, marital status, and plans to become pregnant).
About 41% of the women reported that their physicians had recommended that they take vitamin and mineral supplements. After adjusting for all the variables in the model, it became clear that there was a significant association between the recommendations of healthcare professionals and the consumption of vitamins and minerals by women of childbearing age.
Health care professionals can improve the health of the population through preventive clinical practices. It is important that we support them in their efforts to integrate and apply scientific knowledge in their practice.
Canadian family physician Medecin de famille canadien 01/2008; 53(12):2142-3. · 1.19 Impact Factor
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ABSTRACT: To describe changes in the adaptation process (appraisal and coping) in the six months after a first stroke and identify domains of the adaptation process related to participation and depressive symptoms for both affected individuals and spouses.
A short-longitudinal study where data of the two groups were collected at three times: in the first two weeks post stroke (T1), at three months (T2) and six months (T3) post stroke.
Individuals with a first stroke and spouses. Main measures: The Stress Appraisal Measure (SAM) for appraisal, Revised Ways of Coping Questionnaire (RWCQ) for coping strategies, Assessment of Life Habits (LIFE-H) for participation, and Beck Depression Inventory (BDI) for depressive symptoms.
Mean (SD) ages of the stroke group (n = 88) and spouse group (n = 47) were 71.8 (10.8) and 69.2 (11.2) years respectively. The Threat, Challenge and Stressfulness scales of the SAM decreased significantly (P < 0.02) from T1 to T3 in both groups whereas perceived uncontrollability of the situation increased significantly (P = 0.003) for spouses in the first six months. RWCQ Rationalisation and Giving control to others scales decreased in the stroke group (P = 0.008 and 0.002 respectively) but not in the spouse group (P = 0.07 and 0.39 respectively). Several components of adaptation at T1 could explain between 18% and 27% of the variance observed in the LIFE-H and BDI at T3.
Appraisal and coping strategies change over time. Initial adaptation could partially predict participation level and depressive symptoms six months post stroke for affected individuals as well as spouses.
Clinical Rehabilitation 07/2007; 21(6):554-62. · 2.12 Impact Factor
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ABSTRACT: This study examined the interrelatedness of mother-infant and father-infant relationships as they develop over the first 4 months postpartum as well as the dynamics used by the couple to balance these relationships. First-time mother-father couples (n = 18) were interviewed separately at 1, 6, and 16 weeks postpartum using the Parent-Infant Relationship Interview. The data were analyzed using in-depth qualitative strategies. The parents' core themes of their early family relationships ranged from an undifferentiated unit at 1 week, to being a highly disorganized unit at 6 weeks, to a more integrated unit at 16 weeks. These results suggest that one should be thinking of early family relationships and parenting in terms of "messy processes" out of which new ways of being together are created. This disorganization plays a fundamental role in the establishment of early family relationships and warrants further empirical and clinical attention.
Journal of Family Nursing 06/2007; 13(2):179-200. · 0.95 Impact Factor
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ABSTRACT: Nearly 50% of Canadians are overweight and their number is increasing rapidly. The majority of obese subjects are treated by primary care physicians (PCPs) who often feel uncomfortable with the management of obesity. The current research proposal is aimed at the development and implementation of an innovative, integrated, interdisciplinary obesity care management system involving both primary and secondary care professionals.
We will use both action and evaluative research in order to achieve the following specific objectives. The first one is to develop and implement a preceptorship-based continuing medical education (CME) program complemented by a web site for physicians and nurses working in Family Medicine Groups (FMGs). This CME will be based on needs assessment and will be validated by one FMG using questionnaires and semi structured interviews. Also, references and teaching tools will be available for participants on the web site. Our second objective is to establish a collaborative intra and inter-regional interdisciplinary network to enable on-going expertise update and networking for FMG teams. This tool consists of a discussion forum and monthly virtual meetings of all participants. Our third objective is to evaluate the implementation of our program for its ability to train 8 FMGs per year, the access and utilization of electronic tools and the participants' satisfaction. This will be measured with questionnaires, web logging tools and group interviews. Our fourth objective is to determine the impact for the participants regarding knowledge and expertise, attitudes and perceptions, self-efficacy for the management of obesity, and changes in FMG organization for obesity management. Questionnaires and interviews will be used for this purpose. Our fifth objective is to deliver transferable knowledge for health professionals and decision-makers. Strategies and pitfalls of setting up this program will also be identified.
This project is relevant to health system's decision-makers who are confronted with an important increase in the prevalence of obesity. It is therefore critical to develop strategies allowing the management of obesity in the 1st line setting. Results of this research project could therefore influence health care organization in the field of obesity but also eventually for other chronic diseases.
BMC Health Services Research 02/2007; 7:163. · 1.66 Impact Factor
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ABSTRACT: No comprehensive data are available on the impact of stroke on the spouse's participation level. The purpose of this study was to document changes in participation level over time and explore associations between changes in participation level, burden and depressive symptoms for spouses of people who had had a first stroke.
Participants were spouses recruited in the first 2 weeks after admission of individuals with a first stroke to acute care. Prestroke measures (T0) were collected at recruitment, simultaneously with the first measure (T1); further measures were collected 6 months after the stroke event (T2). Participation level was measured with the LIFE-H, perceived burden with the Caregiver Strain Index and depressive symptoms using the Beck Depression Inventory (BDI).
Mean age of participants (n = 54) was 69 years (SD 10.9) and the majority were female (75.9%). Changes in participation include small but significant increases at T1 for the nutrition (effect size, ES, 0.34) and responsibilities (ES 0.22) domains, and large significant persistent decreases at T2 compared to T0 were found for personal relationships (ES 0.83), employment (ES 0.63) and recreation (ES 0.93). Changes in these last three participation domains are associated with a higher Caregiver Strain Index score (p < 0.01) but not with the BDI.
Participation domains mostly affected for spouses after stroke were personal relationships, employment and recreation which could be addressed by clinicians in their provision of support.
Cerebrovascular Diseases 01/2007; 24(2-3):255-60. · 2.72 Impact Factor
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ABSTRACT: Stroke can have consequences in all areas of a person's life. If not coped with optimally, this life event will have a deleterious effect on the quality of life. The aim of this study was to improve understanding of appraisal and coping, post-stroke. Ten individuals were purposely recruited upon admission for a first stroke to participate in this qualitative study. Participants were asked to share their personal experiences with regard to their efforts to deal with the consequences of the stroke. In-depth interviews were transcribed verbatim and the content was analyzed using a rigorous method, inspired by a phenomenological orientation. Seven themes related to appraisal (unpredictability, overwhelming, feeling out of control, threat, turning point, acceptance/resignation and future prospects) and five themes related to coping (active and passive compensation, escape, change how the situation is perceived and utilization of resources) emerged from the content analysis of the in-depth interviews. In conclusion, since returning to the previous life style and activities is rather improbable, changing how the situation is perceived appears to be the most effective way of coping, in order to reach a state of acceptance/resignation favourable to an optimal quality of life.
International Journal of Rehabilitation Research 10/2006; 29(3):247-9. · 1.08 Impact Factor
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ABSTRACT: The ultimate goal of the occupational therapist is to enhance or maintain a client's quality of life.
It is difficult, however, to find an operational definition of this concept. This article presents the results of a concept analysis of quality of life in the context of older adults with physical disabilities.
Quality of life is defined by a subjective evaluation of the life circumstances of an individual with respect to his/her values. The results indicate the importance of physical, psychological, social and spiritual well-being, the satisfaction with life and the accomplishment of meaningful occupations. A satisfying functional state, manifested by the presence of adapted behaviors and the feeling of control over one's life are also useful to consider.
This definition suggests that occupational therapists should broaden the vision of their treatment objectives (beyond the realization of activities of daily living and instrumental activities of daily living) and offer some avenues for the enhancement of quality of life.
Canadian Journal of Occupational Therapy 07/2006; 73(3):163-77.
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ABSTRACT: Description générale. L'objectif ultime de l'ergothérapeute est d'améliorer ou de maintenir la qualité de vie de sa clientèle. But. Il est cependant difficile de trouver une définition opérationnelle de ce concept. Cet article présente les résultats d'une analyse du concept qualité de vie dans le contexte des personnes âgées avec incapacités physiques. Résultats. La qualité de vie se définit par une évaluation subjective des circonstances de vie d'un individu, compte tenu de ses valeurs. Les résultats indiquent l'importance du bien-être physique, psychique, social et spirituel, de la satisfaction envers sa vie et de la réalisation d'occupations valorisantes. Un état fonctionnel satisfaisant, manifesté par la présence de comportements adaptés, et un sentiment de contrôle sur sa vie sont aussi jugés utiles. Conséquences pour la pratique. Cette définition suggère aux ergothérapeutes d'avoir une vision plus élargie de leurs objectifs d'intervention (au-delà de la réalisation des activités de la vie quotidienne et domestiques) et offre certaines pistes d'intervention pour l'amélioration de la qualité de vie.
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Background. The ultimate goal of the occupational therapist is to enhance or maintain a client's quality of life. Purpose. It is difficult, however, to find an operational definition of this concept. This article presents the results of a concept analysis of quality of life in the context of older adults with physical disabilities. Results. Quality of life is defined by a subjective evaluation of the life circumstances of an individual with respect to his/her values. The results indicate the importance of physical, psychological, social and spiritual well-being, the satisfaction with life and the accomplishment of meaningful occupations. A satisfying functional state, manifested by the presence of adapted behaviors and the feeling of control over one's life are also useful to consider. Practice Implications. This definition suggests that occupational therapists should broaden the vision of their treatment objectives (beyond the realization of activities of daily living and instrumental activities of daily living) and offer some avenues for the enhancement of quality of life.
Canadian Journal of Occupational Therapy 05/2006; 73(3):163-177.
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ABSTRACT: This study validated a measure of pregnancy planning effort based on Miller's conceptual framework in two clinical settings. The questionnaire's main items deal with general behaviour with regard to pregnancy, timing and proception (proception being the reverse of contraception). Values for these three items are added to yield a continuous score ranging from 0 to 12. The study population comprised 448 women of different cultural backgrounds recruited in prenatal, fertility and family planning clinics in Quebec and North Carolina. The results indicate that the internal consistency between the three items pertaining to pregnancy planning was excellent (Cronbach's alpha of 0.83). Test-retest reliability after a 4-week interval was excellent, with an intraclass correlation coefficient of 0.86 for the planning score. The planning score median for women attending family planning clinics (1.00) was significantly lower than that for those recruited in fertility clinics (11.00), confirming the discriminant ability of the instrument. Path analysis shows that the conceptual model corroborates the observed data and explains 53% of the pregnancy planning variability. In conclusion, this is the first questionnaire specifically designed to assess the intensity of pregnancy planning effort, a potentially important variable in epidemiological studies and clinical practice.
Paediatric and Perinatal Epidemiology 02/2003; 17(1):97-105. · 2.31 Impact Factor
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ABSTRACT: To decrease the risk of neural tube defects, all women planning pregnancy or capable of becoming pregnant should take folic acid supplements. The aim of the study was to describe the association between pregnancy planning and vitamin supplement use.
A total of 1,858 pregnant women registered for a prenatal ultrasound examination in the Montérégie region, Province of Quebec, Canada, completed a questionnaire between November 1997 and May 1998. Pregnancy planning was described by six ordinal variables, which were included in a nonlinear principal component analysis. The main dimension representing the intensity of pregnancy planning was used as the dependent variable in a multivariate linear regression model, and as a basis for assessing vitamin use according to four levels of planning.
A majority of women scored high for intensity of pregnancy planning. Planning intensity score increased with age and was higher among women who attended university, had a family income greater than CAD $30,000, and were married. Vitamin use in the period prior to conception occurred with a frequency of 27.5%, increasing moderately with planning intensity scores. Overall, only 13.5% of fetuses were exposed to adequate doses of folic acid.
A promotion campaign selectively targeting women likely to plan a pregnancy could have a significant impact in reducing neural tube defect incidence.
Preventive Medicine 09/2002; 35(2):143-9. · 3.22 Impact Factor
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ABSTRACT: To document breastfeeding rates from birth to six months as well as the factors facilitating and constraining the continuation of breastfeeding in women in the Eastern Townships of Quebec and to compare these to the results obtained in 1999.
Postal questionnaire sent to 374 mothers who had breastfed and analysis of archival data.
Breastfeeding rates were 86.3% at birth and 75% at discharge from hospital in all mothers who gave birth to a child in 2004-2005. Breastfeeding rates in the 272 mothers who answered the questionnaire were reported to be 67.3% and 47.4% at three and six months respectively. Results indicate that 8.9% of infants were still receiving breast milk exclusively after the third month. However, 27.9% of the mothers had stopped breastfeeding during the infant's first week. Support from the nurses was the primary factor facilitating breastfeeding. The main reasons the mothers gave for stopping breastfeeding were problems with breastfeeding and fatigue.
Breastfeeding rates in this area of Quebec have increased significantly in the past five years and are comparable with those in the rest of Canada. Breastfeeding exclusively up to six months is rare, and initiatives to support breastfeeding mothers in the hospital and in the community are having success.
Canadian journal of public health. Revue canadienne de santé publique 99(3):212-5. · 1.02 Impact Factor
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ABSTRACT: PURPOSE AND METHOD: This descriptive study is aimed at documenting changes in participation level (accomplishment of daily activities and social roles) from quantitative (n = 35) and qualitative (n = 5) perspectives in individuals who have had a first "mild" stroke compared to their prestroke level. With advances in technology (e.g., increased use of thrombolitic therapy), the prevalence of mild stroke is expected to increase. Yet these strokes are rarely referred to rehabilitation, and little is known about the consequences of stroke on patients' lives. CONCLUSION: Results of both methods confirmed significant impact of the stroke on participation level that is persistent even 6 months poststroke.
Topics in Stroke Rehabilitation 14(3):59-68. · 0.95 Impact Factor
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Perspective infirmière: revue officielle de l'Ordre des infirmières et infirmiers du Québec 1(6):32-6.
