Previous researchers have identified that participation in a pulmonary rehabilitation program improves health outcomes yet, continuation in a weekly maintenance program yielded mixed results. Self-management programs have had reported use in chronic obstructive pulmonary disease (COPD). A meta analysis has identified that no self-management program had evaluated the effect of this type of intervention on the functional status of the participant with COPD. Reduced functional status is well reported as an indicator of disease progression in COPD. Adjuvant therapies for people with COPD need to demonstrate an effect in this domain. The Stanford model chronic disease self-management program (CDSMP) had been reported as a program that may optimise the health of people with chronic health conditions. However, its utility has not been formally evaluated for people with COPD. There have not been any reports of a comparison of the Stanford model CDSMP with pulmonary rehabilitation via a randomised controlled study in COPD. Aim: To compare and evaluate the health outcomes from participation in nurse ledwellness-promoting interventions conducted in the ambulatory care setting of a metropolitan hospital. Participants were randomised to either a six-week behavioural intervention: the Stanford model CDSMP or, a six-week pulmonary rehabilitation program and results compared to usual care (a historical control group). The efficacy of the interventions was measured at week seven and repeated at week 26 and 52. Following the week seven evaluation, the pulmonary rehabilitation program participants were rerandomised to usual care or, weekly maintenance pulmonary rehabilitation for 18 weeks and, followed up until the study completion at week 52.Little is reported about the costs of care for people with COPD in Australia. This study prospectively evaluated the costs of the interventions and health resource for the 52 weeks and undertook a cost utility analysis. Methods: Walking tests (The Incremental Shuttle Walking Test) and questionnaires asking participants about their health related quality of life, mood status, dyspnoea and self efficacy were assessed prior to randomisation to either six week intervention and repeated at weeks 7, 26 and 52. The implementation of these adjuvant therapies enabled all costs associated with the interventions to be prospectively examined and compared. Results: During the two years of recruitment 252 people (54% males) with a mean age 71 years (SD 11, range 39-93 years) were referred to the study. Student’s ttests identified that there were no statistically significant differences (P=0.16) between all those referred by age and gender as compared to all those admitted to Hospital A with an exacerbation of COPD. Ninety-seven people (51% male) with a mean age of 68 years (SD 9, range 39-87 years) agreed to participate in the study. Follow up in the study continued for 12 months following enrolment with only a modest level of attrition by week seven (3%) and week 52 (25%). Following the six-week interventions, both the pulmonary rehabilitation and CDSMP groups recorded statistically significant increases in functional capacity, self-efficacy and health related quality of life.Functional performance was additionally evaluated in the intervention arms with participants wearing pedometers for the six-week period of the interventions. There were no statistically significant differences between steps per week (P=0.15) and kilometres per week (P=0.17) walked between these two groups in functional performance. The Spearman rho statistic identified no statistically significant relationship between functional performance and the severity of COPD (rs (33) = 0.19, P = 0.26). No significant correlation between functional capacity and functional performance was identified (rs (32) = 0.19, P = 0.29). This suggests that other factors contribute to daily functional performance. The largest cost of care for people with COPD has been reported to be unplanned admissions due to an exacerbation of COPD.In this study there were no statistically significant differences between the three intervention groups in the prospective measurement of ambulatory care visits, Emergency Department presentations and admissions to hospital. The calculation of costs illuminated the costs of care in COPD are greater than the population norm. In addition, maintenance pulmonary rehabilitation generated a greater quality adjusted life year (QALY) than a six-week program. Despite the strength of the participants preferences (as measured by the QALY) for maintenance PRP, there were no significant differences in use of hospital resources throughout the study period by the three intervention groups, which suggests some degree of equivalence.

Osteoarthritis (OA), the most common form of arthritis in older adults, often results in pain, disability and poor psychological well-being. Compared to White adults, Black adults consistently report more pain, more activity limitations, and have different perceptions about OA. Racial disparities also exist in treatments, and prevalence of arthritis. It is imperative to have effective interventions and treatment options for older Blacks. Yet, few arthritis interventions have included Black participants in their samples, and nearly all of those have failed to report separate analyses indicating the effectiveness for Black adults, thus leaving a gap in the literature. The purpose of this study is to begin to identify factors needed to design arthritis interventions that will reduce barriers and increase appeal to Blacks. The present dissertation consists of one study with two related parts. The first part consists of a needs assessment that examined intervention preferences, barriers to healthcare, knowledge about interventions and care, utilization, and health beliefs among Black and White adults with self-reported physician-diagnosed OA. The second part evaluated materials used in an existing arthritis intervention for acceptability. The study was based on the Arthritis Self Management Program (ASMP). Frequencies were examined to determine needs related to arthritis healthcare of Blacks and Whites recruited from the community. Independent samples t-tests and Pearson’s Chi-square analyses were examined to determine group differences between Blacks and Whites. Blacks were more likely to report cost, lack of trust, fear of being the only person of their race, lack of recommendation from their doctor, and lack of recommendation of a family or friends as barriers to participating in arthritis interventions. In addition, Blacks were more likely to prefer the intervention content, structure and delivery, and arthritis resources presented in the needs assessment in comparison to Whites. As for the evaluation of the intervention materials, Blacks and Whites were similar on most sections. Based on our findings we suggest that practical adaptations (e.g., cost) be made to existing arthritis interventions to increase cultural sensitivity. Such adaptations have the potential to minimize barriers and offer a program that would be appealing to Blacks with OA.

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Bakgrund: Hjärtsvikt är en kronisk sjukdom som är bland den vanligaste orsaken till sjukhusinläggning i Sverige. Egenvård är en viktig del av behandlingen vid hjärtsvikt. Syftet med egenvården är att underhålla eller återhämta hälsa och livskvalitet samt att förebygga försämring och hantera sjukdomen. Syfte: Syftet med studien var att undersöka om egenvårdsutbildningar förbättrar livskvaliteten för personer med hjärtsvikt. Metod: Totalt inklulderades tio empiriska artiklar med kvantitativ metod. Databassökningen för artiklarna genomfördes i Cinahl och Pubmed. Efter sökningen kvalitetsgranskades, analyserades och sammanställdes dessa.   Resultat: Litteraturstudiens resultat visade att i åtta av tio studier hade deltagarna en signifikant förbättrad livskvalitet efter genomförd utbildning. Studierna mätte effekten av interventionerna med hjälp av olika mätinstrument för livskvalitet och studien varade mellan tre till tolv månader. Majoriteten av egenvårdsutbildningarna som inkluderade en sjuksköterska hade en signifikant förbättring på livskvaliteten.  Konklusion: Enligt litteraturstudien kan olika egenvårdsutbildningar förbättra livskvaliteten för en person som lever med hjärtsvikt. Sjuksköterskan har en viktig roll när det handlar om att sprida kunskap, information och ge råd för att hjärtsviktspatienter ska kunna förbättra egenvården. Framtida forskning bör utföras på längre interventioner för att utvärdera hur livskvaliteten påverkas på lång sikt. / Background: Heart failure is a chronic disease and is one of the main reasons for hospitalization in Sweden. Self-care is an essential part of the treatment for people with heart failure. The purpose of self-care is to maintain or restore health and quality of life and also to prevent deterioration and handle the disease. Aim: The purpose of this study was to explore if self-care programs improved quality of life for people with heart failure. Methods: A total of ten empirical articles with a quantitative method were included. The database search was conducted in Cinahl and Pubmed. The articles were quality reviewed, analyzed and compiled after the search. Results: The result of the study showed that the participants had a significant improvement in quality of life, after the intervention, in eight out of ten studies. The effects of the interventions were calculated by different measurements for quality of life and the study lasted for three to twelve months. Most of the studies that included a nurse improved quality of life significantly.  Conclusion: According to the study, different self care educations can improve quality of life for people living with heart failure. Nurses have an important role when it comes to spread knowledge, give information and advice to heart failure patients to improve self-care. Future studies should be performed on longer interventions to evaluate the long-term effects on quality of life.