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Background: Individuals who are newly diagnosed with inflammatory arthritis face challenges such as lifelong pharmacological treatment, coping with symptoms like pain, fatigue, and sleep disturbances, and elevated risk of developing co-morbidities. Research shows that self-management significantly improves quality of life for patients with chronic illness. However, existing interventions for arthritis have confliction evidence and none are developed especially for the newly diagnosed. To address this, we developed a tailored self-management intervention, NISMA. The NISMA intervention (Figure 1) spans a nine-month duration and is rooted in Social Cognitive Theory [1] supplemented by elements of Acceptance and Commitment Therapy [2] to enhance self-efficacy. It consist of both individual and group sessions in a multidisciplinary setting, each session with a specific topic [3]. We followed the Medical Research Council’s framework, which included a feasibility test and process evaluation [4,5].
Objectives: As a part of this, the present study aimed to evaluate the acceptability, mechanism of impact, and contextual factors associated with the NISMA intervention from the perspectives of patients and healthcare professionals.
Methods: We used a qualitative longitudinal design, with four focus group interviews with healthcare professionals at baseline, before group sessions, after group sessions and follow-up (N = 4) and baseline and follow-up individual interviews with patients (baseline N =12, follow-up N = 10) (Figure 2). Interview guides was drafted with open-ended questions, and the guides were revised from interview to interview to match the evolving stages of the intervention. Data was analyzed using template analysis, and we developed two predetermined templates for the analyses.
Results: Patients and healthcare professionals highly accepted the intervention. Patients found the individual sessions particularly beneficial for understanding their condition, and its emotional impact. Group sessions received mixed feedback, with calls for more structure. Overall, the intervention supported patients in managing symptoms, make informed lifestyle choices, and improve their work-life balance. Also, the intervention provided a platform for sharing experiences, thereby reducing feelings of isolation and empowering patients to navigate the healthcare system. Healthcare professionals appreciated the patient-centered approach and professional development opportunities. They highlighted the importance of training and management support, especially for sensitive discussions with patients. Challenges included balancing session scheduling with regular work in clinical practice.
Conclusion: Our self-management intervention for newly diagnosed patients with IA patients was highly accepted by both patients and healthcare professionals. The healthcare professionals experienced professional growth and received support but scheduling occasionally conflicted with affected regular work. Key impact mechanisms were the proactive management of symptoms and lifestyle, and the intervention’s tailored support and emotional guidance.
This study has provided valuable information in understanding intervention mechanisms. Findings from the evaluation will be used to refine the NISMA intervention and enhance its implementation in a future RCT.
REFERENCES: [1]
[2]
[3]
[4]
[5]
The NISMA intervention
Data collection timepoints and major intervention activities
Acknowledgements: We would like to thank the patients and healthcare professionals who participated.
Disclosure of Interests: Luise Lindgren: None declared, Tanja Thomsen: None declared, Pernille Friis Rønne: None declared, Nadine Blum: None declared, Merete L. Hetland Speaker for Pfizer, Medac, Sandoz (no personal income, institution), Research grants (institution) from Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Medac, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis, Nordforsk, Mette Aadahl: None declared, Sara Kristensen: None declared, Annette de Thurah: None declared, Bente Appel Esbensen: None declared.