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Can a telecare case management program delivered by a nurse case manager supported by a health-social team improve self-efficacy, health-related measures, and health care service utilization outcomes among older adults who are homebound?
In this randomized clinical trial with 68 participants, there was no statistical difference in self-efficacy between the telecare group and control group at 3 months according to the Chinese version of the 10-item, 4-point General Self-efficacy Scale. Scores for self-efficacy improved in both groups over time.
While the intervention did not increase self-efficacy, the findings suggest that telecare case management may increase quality of life and rates of medication adherence among older adults who are homebound.
Older adults who are homebound can be difficult to reach owing to their functional limitations and social distancing during the COVID-19 pandemic, leaving their health needs unrecognized at an earlier stage.
To determine the effectiveness of a telecare case management program for older adults who are homebound during the COVID-19 pandemic.
Design, Setting, and Participants
This randomized clinical trial was conducted among 68 older adults in Hong Kong from May 21 to July 20, 2020, with a last follow-up date of October 20, 2020. Inclusion criteria were being 60 years or older, owning a smartphone, and going outside less than once a week in the previous 6 months.
Participants in the telecare group received weekly case management from a nurse supported by a social service team via telephone call and weekly video messages covering self-care topics delivered via smartphone for 3 months. Participants in the control group received monthly social telephone calls.
Main Outcomes and Measures
The primary outcome was the change in general self-efficacy from before the intervention to after the intervention at 3 months. Self-efficacy was measured by the Chinese version of the 10-item, 4-point General Self-efficacy Scale, with higher scores representing higher self-efficacy levels. Analysis was performed on an intention-to-treat basis.
A total of 68 participants who fulfilled the criteria were enrolled (34 in the control group and 34 in the intervention group; 56 [82.4%] were women; and mean [SD] age, 71.8 [6.1] years). At 3 months, there was no statistical difference in self-efficacy between the telecare group and the control group. Scores for self-efficacy improved in both groups (β = 1.68; 95% CI, −0.68 to 4.03; P = .16). No significant differences were found in basic and instrumental activities of daily living, depression, and use of health care services. However, the telecare group showed statistically significant interactions of group and time effects on medication adherence (β = −8.30; 95% CI, −13.14 to −3.47; P = .001) and quality of life (physical component score: β = 4.99; 95% CI, 0.29-9.69; P = .04).
Conclusions and Relevance
In this randomized clinical trial, participants who received the telecare program were statistically no different from the control group with respect to changes in self-efficacy, although scores in both groups improved. After the intervention, the telecare group had better medication adherence and quality of life than the control group, although the small sample size may limit generalizability. A large-scale study is needed to confirm these results.
ClinicalTrials.gov Identifier: NCT04304989
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: June 27, 2021.
Published: September 9, 2021. doi:10.1001/jamanetworkopen.2021.23453
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Wong AKC et al. JAMA Network Open.
Corresponding Author: Arkers Kwan Ching Wong, PhD, RN, School of Nursing, The Hong Kong Polytechnic University, One Cheong Wan Road, Hung Hom, Hong Kong (email@example.com).
Author Contributions: Drs A. K. C. Wong and F. K. Y. Wong had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: A. K. C. Wong, F. K. Y. Wong, Chow, S. M. Wong.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: A. K. C. Wong.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: A. K. C. Wong, Lee.
Obtained funding: A. K. C. Wong, F. K. Y. Wong, Chow.
Administrative, technical, or material support: S. M. Wong.
Supervision: F. K. Y. Wong, Chow.
Conflict of Interest Disclosures: Drs A. K. C. Wong, F. K. Y. Wong, and S. M. Wong and Ms Chow reported receiving grants from the Nethersole Institute of Continuing Holistic Health Education (NICHE) during the conduct of the study. Dr A. K. C. Wong reported receiving grants from the NICHE outside the submitted work. No other disclosures were reported.
Funding/Support: This work was supported by grant P0031004 from the NICHE (Dr A. K. C. Wong).
Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Data Sharing Statement: See Supplement 2.
Additional Contributions: We thank all of the community centers for their collaboration with the research team.
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