Self-monitoring procedures are commonly used to assess environmentally sustainable behavior. The current experiment evaluated the effects of a self-monitoring procedure on two sustainable behaviors within a university office. A senior assistant was asked to report on light usage and energy-saver use on the copier in an office break room. Her reports were then compared with independent observations. Results showed that her reports were highly correspondent with independent observations although no change in target behaviors occurred. Changes in behavior occurred when she was asked to engage in the target behaviors. Results suggest that although self-monitoring procedures can correctly assess sustainable behaviors, they may not be suitable for behavior change.

Patient self-monitoring of blood pressure (SMBP) has shown promise in contributing towards improving ongoing management of hypertension, however it has yet to be fully integrated into guidelines or routine general practice in the UK. The aims of this thesis were to investigate the role of SMBP in the management of hypertension to better understand: patient and clinician attitudes to SMBP; what behaviour change SMBP targets in patients to bring about better BP outcomes; to what extent SMBP is utilised as part of routine hypertension management in the UK; and to understand patient preferences for hypertension management in light of effective models of care. A mixed methods approach was used including: systematic reviews of qualitative and quantitative evidence; semi-structured interviews with patients; a cross sectional survey; and a discrete choice experiment. Self-monitoring was associated with better medication adherence, which could have significant impact at a population level given the high proportion of non-adherent hypertensive patients. Use of SMBP should be seen as a continuum from being used solely to inform clinical decisions, through facilitating interaction between patients and clinicians, to empowering patients to be autonomous for example in self-management. SMBP was most effective when patients had the knowledge and skills to make improvements in their lifestyle, and this has been shown in clinical trials and through qualitative investigation. Clinicians recognise the potential benefits of SMBP, but are concerned that patients may become burdened. Clinicians should feel encouraged that patients are supportive of self-monitoring, but they must ensure that patients who wish to self-manage are equipped with the skills to do so. Lack of facility to make positive change may lead some patients to feeling disempowered and clinicians need to be cognisant of this fact.

Beneficial consumer outcomes are most likely when behavior-analytic interventions are implemented with high procedural fidelity (i.e., degree to which the procedure is implemented as intended). Video self-monitoring, which involves teaching staff members to monitor their own procedural fidelity when watching recordings of themselves, can be used to improve and maintain high procedural fidelity, but video self-monitoring requires additional staff time and resources. In-vivo self-monitoring, which involves monitoring procedural fidelity during or immediately following implementing a behavior-analytic intervention, could be a cost-effective option. However, in-vivo self-monitoring needs additional research to understand its effects on procedural fidelity. This current study analyzed the effects of in-vivo self-monitoring on the procedural fidelity of three behavior technicians implementing discrete trial instruction with children with autism. We used a nonconcurrent multiple baseline across participants design to teach participants how to score their procedural fidelity during their discrete trial instruction session. Data suggested that in-vivo self-monitoring was effective for two out of three participants, and those two participants were more likely to be accurate in their self-scored procedural fidelity. Procedural fidelity for the third participant did not increase with in-vivo or video self-monitoring, and the third participant was less likely to be accurate in their self-scored procedural fidelity. During baseline and intervention, two out of three participants were more likely to error on the consequence portion of discrete trial instruction. Results of this evaluation were used to inform the supervisors about the efficacy of self-monitoring for each staff member, and implications of using self-monitoring in practice is discussed.

Thesis (M.S.)--University of Missouri--Columbia, 1995. / "May 1995." Typescript. Includes bibliographical references (leaves 35-37). Also available on the Internet.

The purpose of this study was to analyze the experiences of self-monitoring of blood glucose (SMBG) usage of adults with type 2 diabetes mellitus (T2DM) who are not using insulin. The sample consisted of 11 women and 8 men who were Caucasian Americans, 38 to 79 years of age. Data were analyzed using the grounded theory method including open and axial coding and the constant comparative method. The theory of "SMBG as a Cue in T2DM Self-Care" emerged from the data and is composed of four categories (a) Engaging, (b) Checking, (c) Responding, and (d) Establishing a Pattern. Engaging marks the beginning of SMBG. Participants began on the recommendation of their physician and monitored between 2-6 times a day. Participants monitored because of curiosity and over time reduced or kept their initial frequency. Checking occurs when the blood glucose is obtained. Two subcategories emerged: Evaluating and Validating. The main items participants evaluated or validated were the effects of foods in relation to blood glucose levels. Responding involves reacting to SMBG. Two subcategories emerged: Taking Action and Experiencing Emotion. Most actions involved changing foods consumed. Participants described feeling conflicted and "being bad" when not following through with an action. Emotions such as blame and fear were experienced when blood glucose levels were higher than normal, while happiness was experienced with normal levels. Establishing a Pattern occurs when participants decide on how often to monitor. Two subcategories emerged: Using Regularly and Using Sporadically. The pattern developed was based on obtaining "normal" blood glucose patterns or on the absence of ill symptoms of T2DM. Healthcare provider disinterest in SMBG and fingertip pain contributed to a decreased monitoring frequency. Participants described cyclical, iterative episodes of Checking, Responding, and varying their established patterns throughout their experiences with monitoring. Participants discussed the value and struggles of SMBG in a T2DM self-care regimen. The theory of SMBG as a Cue in T2DM Self-Care could be used to guide the development of effective intervention strategies to help individuals with T2DM achieve blood glucose control which, in turn, leads to avoidance of ill symptoms and complications of T2DM.

Self-monitoring involves teaching students to be aware of their own behavior, and be able to record whether the behavior happened or not. The present study uses meta-analysis of single case design (SCD) studies to evaluate the effectiveness of self-monitoring interventions that use electronic devices during implementation for individuals with autism spectrum disorder (ASD). Eligible studies were accessed to determine design quality, and examine the use of self-monitoring for individuals diagnosed with ASD. Studies were evaluated against inclusion-exclusion criteria. The studies that met inclusion criteria (n = 15) were assessed with the What Works Clearinghouse (WWC) standards for methodological rigor. The WWC standards were applied to baseline and intervention phases. There were a total of 12 studies with 32 students diagnosed with ASD that met SCD standards without, and with reservations. The 12 studies were evaluated using the Tau-U effect size metric to quantify the percentage of change that was attributed to the self-monitoring intervention. Overall, omnibus Tau-U was 0.96 (95% confidence interval [CI] = [0.89, 1.0]). Limitations and directions for future research are discussed.

Smartphones continue to grow increasingly ubiquitous for a variety of reasons. This study employed an online survey experiment in order to determine whether perceptions of environmental/locational privacy or individual levels of self-monitoring have any effect on smartphone uses and gratifications. While perceptions of locational privacy did indeed have a modest effect on smartphone gratifications sought, self-monitoring did not, and no interactions were detected between locational privacy and self-monitoring. Implications for these findings as well as avenues for future research are discussed.

Consumer health information technologies (CHITs) are emerging as promising tools for delivering healthcare services and facilitating patient self-management of chronic diseases; however, the use of the CHITs is largely constrained by usability problems and unclear evidence on the effectiveness of the technologies. The ergonomics research team of The University of Hong Kong developed a patient-centered computerized self-monitoring system that appeared to be useful and easy to use; with the system, this thesis focuses on the examination of the short-term impacts of the technology on patient outcomes for diabetic and hypertensive patients. The self-monitoring technology was designed using user-centered approaches and relevant human factors principles. Iterative usability evaluations were conducted to assess and improve the usability of the technology with 97 chronically ill patients. Also, using data from a larger randomized controlled trial (RCT) of technology-based disease self-management to improve patients’ outcomes, this thesis compared the short-term effects of the use of a computerized self-monitoring system to usual care using 63 patients with type 2 diabetes and hypertension for four weeks. Thirty-three patients were randomized into intervention group, whose disease care was supported by the self-monitoring system, while 30 patients into control group, who continued with their usual care. A pretest-posttest repeated measures design was employed to determine the effects of the technology on clinical, psychosocial, behavioral, usage, and technology perception outcomes over time. Measurements were obtained at baseline, and after 2 and 4 weeks. The iterative usability studies improved and verified the usability of the self-monitoring system for chronically ill patients. Results from the RCT showed that after four weeks, there were significant decreases in systolic blood pressure (p < 0.001) and diastolic blood pressure (p < 0.001), self-efficacy for managing chronic disease (p = 0.001), and adherence to treatment (p = 0.001) in the intervention group compared with the control group. Significant differences in favor of intervention group after four weeks were also documented for changes of several quality of life subscales (i.e., general health (p = 0.010), role physical (p = 0.001), role emotional (p = 0.002), bodily pain (p = 0.050), and physical component summary score (p = 0.005)), and perceived ease of use (p = 0.007). No significant difference was found between groups for fasting blood glucose (p = 0.687), perceived usefulness (p = 0.661), frequency of self-monitoring of blood pressure (p = 0.230) and self-monitoring of blood glucose (p = 0.993), and several other quality of life subscales over time. The usability evaluation presented in this thesis report demonstrated that the method was effective and efficient in identifying potential usability problems at the early stage of system development for CHITs. The findings from the RCT indicated that the use of the human factored-engineered self-monitoring technology had short-term effectiveness in improving blood pressure control, self-efficacy for managing chronic disease, adherence to treatment, and quality of life for patients with type 2 diabetes and hypertension. A human factored-engineered self-management technology appears to be an effective tool in patient self-management of chronic diseases. / published_or_final_version / Industrial and Manufacturing Systems Engineering / Doctoral / Doctor of Philosophy

The phenomenon whereby people suffering from an illness or disability seem to be unaware of their symptoms was termed anosognosia, by Joseph Babinksi in 1914 (Langer & Levine, 2014). Originally described as a specific inability to recognise or acknowledge left-sided hemiplegia after lesions to the right hemisphere of the brain, the term now incorporates unawareness of a range of post-stroke impairments, such as hemianopia (Bisiach, Vallar, Perani, Papagno & Berti, 1986), hemianaesthesia (Pia et al., 2014), aphasia (Cocchini, Gregg, Beschin, Dean & Della Sala, 2010) and unilateral neglect (Jehkonen, Ahonen, Dastidar, Laippala & Vilkki, 2000). Anosognosia has also been observed in association with several other disorders, including Alzheimer’s disease (Agnew & Morris, 1998) and traumatic brain injury (Prigatano, 2010a). While advances have been made in understanding anosognosia, there are still many contradictory findings in relation to the nature and expression of impaired self-awareness (Prigatano, 2010a), which are partly attributable to diverse methodological approaches. Furthermore, research into anosognosia frequently rests on the assumption that neurologically intact individuals have accurate insight into their own abilities, particularly in regard to motor skill. The experiments reported in this thesis highlight that this may be a false assumption. Through a series of interrelated studies, I demonstrate that the type of questions typically asked of anosognosic patients may be inappropriate to elicit the manifestations of chronic stage unawareness after a stroke, that underestimation may be just as prevalent as overestimation, and that healthy individuals are not always able to monitor whether their executed movements match their intended movements. Moreover, those with poorer motor skills are less able to judge movement successes and failures than their more skilled counterparts, suggesting a mechanism analogous to the anosognosia observed in clinical populations. Chapter 1 provides an overview of the main neuropsychological models that have been proposed to account for anosognosia for hemiplegia (AHP); unawareness in the context of other impairments is discussed in the introductions to individual chapters. Chapter 2 presents some background research investigating stroke clinicians’ knowledge of the lateralization of right hemisphere cognitive symptoms, and their judgements of the impact of selected symptoms on the lives of patients and caregivers. While the clinicians were equally able to identify cognitive symptoms associated with left or right brain damage, they were far more likely to misattribute symptoms to right brain damage, suggesting a lack of confidence in their knowledge of the cognitive functions of the right hemisphere. They also regarded anosognosia as having relatively low impact on the lives of patients and caregivers, in stark contrast with the highly negative impact reported in the literature (Jehkonen, Laihosalo & Kettunen, 2006a). Chapters 3 and 4 present two experimental studies investigating different facets of awareness in two groups of stroke patients. Chapter 3 reports the development and testing of a tool designed to measure chronic unawareness of functional difficulties, the Visual Analogue Test of Anosognosia for impairments in Activities of Daily Living (VATA-ADL), with preliminary data from a group of chronic stroke patients. Approximately one third of the patients exhibited mild or moderate levels of overestimation of their ability to carry out day-to-day activities. This contrasts with previous reports that anosognosia is rare in the chronic stages, a discrepancy that may be explained in part by the inappropriateness of the measures typically used to measure it. Overestimation was observed in both right-brain-damaged and left-brain-damaged patients, and was not associated with higher levels of cognitive impairment. The study reported in Chapter 4 examined whether acute stage stroke patients who under- or overestimated their motor skills, similarly under- or overestimated performance on cognitive tasks in the domains of language, memory and attention and executive function. Contrary to the many dissociations between unawareness of different impairment reported in the neuropsychological literature, this study found that patients classed as overestimators of motor ability were also overly optimistic about their cognitive abilities. Overestimators were more likely to have right hemisphere lesions, higher levels of general cognitive impairments, and specific deficits in attention and executive function. Furthermore, by including patients with a range of functional ability, this study revealed that participants were just as likely to underestimate as overestimate their abilities. This unique finding presents a challenge to anosognosia research, suggesting that there may be factors other than neurological damage that predispose stroke patients to over- or under-estimate their abilities and that a baseline of accurate self-insight among control populations cannot be assumed. Chapter 5 reports three different experiments conducted with younger and older, neurologically healthy adults. Using a target-directed reaching task, these experiments investigated whether the participants’ ability to monitor the success of their movements, on a trial by trial basis, depended upon their motor skill level, and whether participants with lower skill were inclined to overestimate their ability, in line with a famous observation from cognitive psychology that people who perform worst in a given task tend to be unaware of how poorly they are performing (Kruger and Dunning, 1999). Overall, the results demonstrated an association between higher accuracy levels and faster movement times, and better ability to monitor success and failure. To my knowledge, this represents that first evidence of a relationship between motor performance ability and self-monitoring ability in healthy individuals, highlighting that some of the mechanisms underpinning anosognosia may also be evident in neurologically intact populations. However, contrary to the findings from cognitive psychology, poor performance was not associated with a specific bias toward overestimation. A similar relationship between task performance and self-monitoring ability was also observed for a visual memory task. Chapter 6 discusses the implications of the results of the clinical and self-monitoring studies for neuropsychological models of anosognosia, particularly those based on motor planning and control, and considers potential ways forward for research in this field.

Made available in DSpace on 2014-06-11T19:28:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-08Bitstream added on 2014-06-13T20:17:56Z : No. of bitstreams: 1 augusto_mc_me_botfm.pdf: 755696 bytes, checksum: 013fce5c0003baac24d4efc967e33be0 (MD5) / Ministério da Saúde / Avaliar consiste em um julgamento de valor acerca de uma intervenção, programa ou serviço, com objetivo de tomada de decisões (17) e atualmente processos de avaliação têm sido amplamente estimulados pelos gestores, para favorecimento de planejamentos em saúde. Este estudo teve como objetivo avaliar o Programa de Dispensação de Glicosímetros e Insumos para Automonitorização da Glicemia Capilar (AMGC), implantado em 2006 no município de Botucatu. O processo de implantação em Botucatu ocorreu sem planejamento e coordenação centralizados, e até o momento nenhuma avaliação do Programa foi realizada. O presente estudo tem como finalidade preencher esta lacuna, avaliando como ocorreu e vem ocorrendo o Programa no município. Estudou-se amostra representativa (n=288) dos usuários inscritos e 96 profissionais de saúde que atuavam no Programa desde sua implantação. Tomando como referencial teórico metodológico a tríade proposta por Donabediam - avaliação dos componentes Estrutura, Processo e Resultado - foram coletados dados sobre a capacitação prévia de usuários e profissionais, regularidade da disponibilidade dos insumos; seguimentos clínicos e laboratoriais normatizados, capacidade de autonomia para autocuidado do usuário e satisfação com o Programa, sendo apartir destes construídos os indicadores de qualidade. Foram detectadas falhas importantes na capacitação dos profissionais e usuários, os primeiros desconheciam parâmetros oficiais de controle glicêmicos e critérios para inserção do usuário no Programa, os segundos, relataram falta de orientações quanto a utilização do aparelho e valores de normalidade. Os indicadores de processo foram muito insatisfatórios: apenas 2,5% profissionais relataram verificar os controles glicêmicos domiciliares nas consultas, solicitar todos os exames laboratoriais, orientar plano alimentar, atividade física e... / Evaluating consists in the value judgment of an intervention, program or service for decision-making purposes. At present, evaluation processes have been largely encouraged by managers in favor of health care planning. This study aimed at evaluating the Program for Delivery of Glucometers and Materials for Capillary Glycemia Self-monitoring (Programa de Dispensação de Glicosímetros e Insumos para Automonitorização da Glicemia Capilar - AMGC) for individuals with diabetes mellitus using insulin, which was implemented in the city of Botucatu in 2006. A representative sample (n=288) of registered users and 96 health care professionals working for the program since its implementation were studied. Based on the triad proposed by Donabediam – evaluation of the following components: Structure, Process and Result – as a theoretical and methodological framework, data were collected concerning the previous training of users and professionals and the regularity of material availability; performance and adequacy of the actions developed in relation to technical recommendations; users’ capacity of self-monitoring and the effects of the program in the view of users and professionals. From this information, the quality indicators adopted were designed. Important failures were detected in professionals’ and users’ training: the former were not knowledgeable about official parameters for glycemia control or about the criteria for registering users in the program; the latter reported lack of orientation concerning the use of the device and normality values. Process indicators were also very unsatisfactory: only 2.5% of the professionals reported to check on home glycemic control during consultations, to order all laboratory tests, to provide guidance for a dietary plan, physical education and smoking cessation, as recommended by the program; only 15.3% of users reported to take ... (Complete abstract click electronic access below)