Martha Funnell - Academia.edu (original) (raw)
Papers by Martha Funnell
The Diabetes Educator, May 22, 2018
The purpose of the study was to describe the perceptions of family members (FM) and people with d... more The purpose of the study was to describe the perceptions of family members (FM) and people with diabetes (PWD) regarding the frequency and helpfulness of FM support for PWD, including differences among US ethnic groups. Methods The US 2nd Diabetes Attitudes, Wishes and Needs (DAWN2) substudy was a survey of independent samples of 238 adult FM and 540 adult PWD. Outcome measures included ratings by FM and PWD of the frequency and perceived helpfulness of 7 FM support 770767T DEXXX10.
Journal of Diabetes and Its Complications, Jun 1, 2018
US Ethnic Group differences in self-management in the 2nd Diabetes Attitudes, Wishes and Needs (D... more US Ethnic Group differences in self-management in the 2nd Diabetes Attitudes, Wishes and Needs (DAWN2) study
The Joint Commission Journal On Quality And Patient Safety, Nov 1, 2003
ost health care systems in the United States are attempting to address the needs of their members... more ost health care systems in the United States are attempting to address the needs of their members with chronic illness. Given demographic projections that our population will continue to age and that chronic illness problems are becoming the major health issues facing both developed and developing countries, 1 such efforts are well justified. Further, self-management support (SMS) has been identified as the area of disease management that is least often implemented 2 and most challenging to integrate into usual care. The terms self-management (SM), patient education, and self-management support (SMS) are often confused. In this article, we use the terms as defined in Barlow, et al.: Self-management refers to the individual's ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition. Efficacious self-management encompasses ability to monitor one's condition and to effect the cognitive, behavioral, and emotional responses necessary to maintain a satisfactory quality of life." 3(p. 178) SMS is defined as the process of making and refining multilevel changes in health care systems (and the community) to facilitate patient SM. In contrast, patient education is a broader, older term that is often associated with didactic, knowledge-based interventions for a specific condition. We prefer the term SMS because it emphasizes that the necessary changes involve much more than education. 4-7 The evidence supporting the effectiveness of SMS has increased dramatically during the past two decades (http://www.cochrane.org). 3,7-12 Background: Self-management support (SMS) is the area of disease management least often implemented and most challenging to integrate into usual care. This article outlines a model of SMS applicable across different chronic illnesses and health care systems, presents recommendations for assisting health care professionals and practice teams to make changes, and provides tips and lessons learned. Strategies can be applied across a wide range of conditions and settings by health educators, care managers, quality improvement specialists, researchers, program evaluators, and clinician leaders. Successful SMS programs involve changes at multiple levels: patientclinician interactions; office environment changes; and health system, policy, and environmental supports. Patient-Clinician Interaction Level: Self-management by patients is not optional but inevitable because clinicians are present for only a fraction of the patient's life, and nearly all outcomes are mediated through patient behavior. Clinicians who believe they are in control or responsible for a patient's well-being are less able to adopt an approach that acknowledges the central role of the patient in his or her care. Summary and Conclusions: Self-management should be an integral part of primary care, an ongoing iterative process, and patient centered; use collaborative goal setting and decision making; and include problem solving, outreach, and systematic follow-up.
Annals of Behavioral Medicine, May 1, 2002
Self-management is an essential but frequently neglected component of chronic illness management ... more Self-management is an essential but frequently neglected component of chronic illness management that is challenging to implement. Available effectiveness data regarding self-management interventions tend to be from stand-alone programs rather than from efforts to integrate self-management into routine medical care. This article describes efforts to integrate self-management support into broader health care systems change to improve the quality of patient care in the Chronic Illness Care Breakthrough Series. We describe the general approach to system change (the Chronic Care Model) and the more specific self-management training model used. The process used in training organizations in self-management is discussed, and data are presented on teams from 21 health care systems participating in a 13-month-long Breakthrough Series to address diabetes and heart failure care. Available system-level data suggest that teams from a variety of health care organizations made improvements in support provided for self-management. Improvements were found for both diabetes and heart failure teams, suggesting that this improvement process may be broadly applicable. Lessons learned, keys to success, and directions for future research and practice are discussed.
Journal of the American Association of Nurse Practitioners, Jun 9, 2020
Current Diabetes Reviews, Aug 1, 2006
Journal of Continuing Education in Nursing, Jun 1, 2013
ADCES in practice, Jun 29, 2020
As you start your day, you see that Dan is on your schedule. You know him well. He is often a "no... more As you start your day, you see that Dan is on your schedule. You know him well. He is often a "no show," and when he does come in, you find him very draining. Over the past 2 years, you have provided Dan a great deal of education about how to better balance his meals with his medications to achieve his treatment targets. Although he always
BACKGROUND Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) ... more BACKGROUND Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) despite using advanced technologies such as continuous glucose monitors (CGMs) or automated insulin delivery systems. Factors impacting hypoglycemia self-management behaviors (including reduced ability to detect hypoglycemia symptoms and unhelpful hypoglycemia beliefs) can lead to hypoglycemia development in T1D advanced diabetes technology users. OBJECTIVE To develop a scalable, personalized mobile health (mHealth) behavioral intervention program to improve hypoglycemia self-management and ultimately reduce hypoglycemia in T1D advanced diabetes technology users. METHODS Based on user-centered design principles, a multidisciplinary team (including clinical and health psychologists, diabetes care and education specialists, endocrinologists, mHealth interventionists and computer engineers, qualitative researchers, and patient partners) jointly developed an mHealth text messaging hypoglycem...
Diabetes
Black men are disproportionately impacted by Type 2 diabetes (T2D) and are more likely to die fro... more Black men are disproportionately impacted by Type 2 diabetes (T2D) and are more likely to die from diabetes complications than non-Hispanic White men. To address the unique challenges this group faces in diabetes self-management, we implemented a 3-month peer-led and empowerment-based DSME/S intervention in metro-Detroit. Twenty-five Black men ≥55 years of age with self-reported T2D were recruited and randomized to either the intervention group (n=12) − 10 hours of DSME and 9 hours of DSMS, or to an enhanced usual care (EUC) group (n=13) − 10 hours of DSME. Peer leaders (n=3), trained by certified diabetes care and education specialists (CDCES) who used training materials related to Black men with diabetes, led the sessions (mean age: 59.7 years; 100% Black, male, and with at least some college education). Changes in A1C levels, diabetes self-care activities, and diabetes distress levels were assessed at baseline and post-intervention. In the intervention group, the mean A1C at base...
Diabetes Technology & Therapeutics
Background: The majority of individuals referred to diabetes self-management education and suppor... more Background: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a nondidactic ''discovery learning''-based DSMES program centered on real-time flash glucose monitoring (FGM). Methods: In this single-arm pilot study, 35 adults with T2D duration 1-5 years, ages 21-75 years, not using insulin and HbA1c ‡8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants' FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures. Results: There was a significant gain in percentage time in range (% TIR) 70-180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop-in percentage time above range (TAR) >180 mg/dL from 44% to 25% (Ps = 0.01). Overall well-being rose significantly (P = 0.04), whereas diabetes distress showed a nonsignificant drop. Participants reported improvements in healthy eating (P < 0.001) and physical activity, although the latter did not reach statistical significance. Conclusions: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging patient-driven ''discovery learning'' approach to education.
Diabetes
Diabetes-related health disparities, especially for African Americans (AA) , underscore the need ... more Diabetes-related health disparities, especially for African Americans (AA) , underscore the need for effective, culturally tailored approaches to promote and sustain diabetes self-management support (DSMS) over time. The Praise study, a cluster randomized hybrid type II implementation trial recruited 21 AA churches, 28 peer leaders, 21 parish nurses, and 371 participants (100% AA, 73.8% female, 64±11.3 years of age) to determine the effectiveness of three DSMS approaches [Parish Nurse (PN) + Peer Leader (PL) DSMS vs. PN DSMS vs. PL DSMS], in comparison to enhanced usual care in improving and sustaining A1c and diabetes distress. Monthly DSMS groups were independently planned and facilitated by 28 trained PLs (100% African American, 18% male) and 14 trained PNs. A post-trial qualitative process evaluation was conducted to evaluate DSMS and ongoing support. Five focus groups were held (n=30) . Individual semi-structured interviews were completed with PLs and PNs (N=7) . Data were anal...
Approaches to Behavior Change Assessment Dealing with Emotion Choosing to Change Motivation Attit... more Approaches to Behavior Change Assessment Dealing with Emotion Choosing to Change Motivation Attitudes, Beliefs, and Values Goal-Setting Social Support Challenging Patients Eating and Physical Activity Educator-Patient Relationships Help from Other Health Professionals Educator Concerns Pediatrics
The Journal of Pain, 2018
The aim of this study is to evaluate the efficacy of two technological interventions to distract ... more The aim of this study is to evaluate the efficacy of two technological interventions to distract and alleviate distress in patients receiving a blood draw, IV placement, or port access. A projection unit called the Bedside Entertainment Theatre (BERT) displayed videos on walls and was used for children ages 2 to 7 years. Virtual reality (VR) headsets were given to children ages 8 to 18. Participants were randomized to receive either BERT/VR or standard of care (SC). We hypothesize that because both interventions create a novel and immersive experience for children, they would be effective distractors. Out of 194 patients (mean age = 12.36), 93 (47.9%) reported being fearful of their upcoming VA, as designated by a score above 0 on the Children's Fear Scale. These fearful children reported a mean pain score of 3.05 out of 10 during their VA, compared to those who were not fearful (mean = 1.84; P = .00). Mean pain scores for fearful children who received BERT was 3.27 compared to 6.20 with SC, but these scores were not significantly different (t = 1.95; P = .07). Mean pain scores were not significantly different between fearful youths who received VR versus SC (mean = 2.84 vs. 2.79; t =-.29; P = .93). These results demonstrate that BERT may reduce VA-related pain perception in younger children. However as enrollment is currently ongoing, further analysis is necessary to draw stronger conclusions.
Pediatric Clinical Practice Guidelines & Policies, 2014
This guide was produced by the National Diabetes Education Program (NDEP), a federally sponsored ... more This guide was produced by the National Diabetes Education Program (NDEP), a federally sponsored partnership of the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health and the Division of Diabetes Translation of the Centers for Disease Control and Prevention, and more than 200 partner organizations. The following organizations support its use by school personnel.
The Diabetes Educator, May 22, 2018
The purpose of the study was to describe the perceptions of family members (FM) and people with d... more The purpose of the study was to describe the perceptions of family members (FM) and people with diabetes (PWD) regarding the frequency and helpfulness of FM support for PWD, including differences among US ethnic groups. Methods The US 2nd Diabetes Attitudes, Wishes and Needs (DAWN2) substudy was a survey of independent samples of 238 adult FM and 540 adult PWD. Outcome measures included ratings by FM and PWD of the frequency and perceived helpfulness of 7 FM support 770767T DEXXX10.
Journal of Diabetes and Its Complications, Jun 1, 2018
US Ethnic Group differences in self-management in the 2nd Diabetes Attitudes, Wishes and Needs (D... more US Ethnic Group differences in self-management in the 2nd Diabetes Attitudes, Wishes and Needs (DAWN2) study
The Joint Commission Journal On Quality And Patient Safety, Nov 1, 2003
ost health care systems in the United States are attempting to address the needs of their members... more ost health care systems in the United States are attempting to address the needs of their members with chronic illness. Given demographic projections that our population will continue to age and that chronic illness problems are becoming the major health issues facing both developed and developing countries, 1 such efforts are well justified. Further, self-management support (SMS) has been identified as the area of disease management that is least often implemented 2 and most challenging to integrate into usual care. The terms self-management (SM), patient education, and self-management support (SMS) are often confused. In this article, we use the terms as defined in Barlow, et al.: Self-management refers to the individual's ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition. Efficacious self-management encompasses ability to monitor one's condition and to effect the cognitive, behavioral, and emotional responses necessary to maintain a satisfactory quality of life." 3(p. 178) SMS is defined as the process of making and refining multilevel changes in health care systems (and the community) to facilitate patient SM. In contrast, patient education is a broader, older term that is often associated with didactic, knowledge-based interventions for a specific condition. We prefer the term SMS because it emphasizes that the necessary changes involve much more than education. 4-7 The evidence supporting the effectiveness of SMS has increased dramatically during the past two decades (http://www.cochrane.org). 3,7-12 Background: Self-management support (SMS) is the area of disease management least often implemented and most challenging to integrate into usual care. This article outlines a model of SMS applicable across different chronic illnesses and health care systems, presents recommendations for assisting health care professionals and practice teams to make changes, and provides tips and lessons learned. Strategies can be applied across a wide range of conditions and settings by health educators, care managers, quality improvement specialists, researchers, program evaluators, and clinician leaders. Successful SMS programs involve changes at multiple levels: patientclinician interactions; office environment changes; and health system, policy, and environmental supports. Patient-Clinician Interaction Level: Self-management by patients is not optional but inevitable because clinicians are present for only a fraction of the patient's life, and nearly all outcomes are mediated through patient behavior. Clinicians who believe they are in control or responsible for a patient's well-being are less able to adopt an approach that acknowledges the central role of the patient in his or her care. Summary and Conclusions: Self-management should be an integral part of primary care, an ongoing iterative process, and patient centered; use collaborative goal setting and decision making; and include problem solving, outreach, and systematic follow-up.
Annals of Behavioral Medicine, May 1, 2002
Self-management is an essential but frequently neglected component of chronic illness management ... more Self-management is an essential but frequently neglected component of chronic illness management that is challenging to implement. Available effectiveness data regarding self-management interventions tend to be from stand-alone programs rather than from efforts to integrate self-management into routine medical care. This article describes efforts to integrate self-management support into broader health care systems change to improve the quality of patient care in the Chronic Illness Care Breakthrough Series. We describe the general approach to system change (the Chronic Care Model) and the more specific self-management training model used. The process used in training organizations in self-management is discussed, and data are presented on teams from 21 health care systems participating in a 13-month-long Breakthrough Series to address diabetes and heart failure care. Available system-level data suggest that teams from a variety of health care organizations made improvements in support provided for self-management. Improvements were found for both diabetes and heart failure teams, suggesting that this improvement process may be broadly applicable. Lessons learned, keys to success, and directions for future research and practice are discussed.
Journal of the American Association of Nurse Practitioners, Jun 9, 2020
Current Diabetes Reviews, Aug 1, 2006
Journal of Continuing Education in Nursing, Jun 1, 2013
ADCES in practice, Jun 29, 2020
As you start your day, you see that Dan is on your schedule. You know him well. He is often a "no... more As you start your day, you see that Dan is on your schedule. You know him well. He is often a "no show," and when he does come in, you find him very draining. Over the past 2 years, you have provided Dan a great deal of education about how to better balance his meals with his medications to achieve his treatment targets. Although he always
BACKGROUND Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) ... more BACKGROUND Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) despite using advanced technologies such as continuous glucose monitors (CGMs) or automated insulin delivery systems. Factors impacting hypoglycemia self-management behaviors (including reduced ability to detect hypoglycemia symptoms and unhelpful hypoglycemia beliefs) can lead to hypoglycemia development in T1D advanced diabetes technology users. OBJECTIVE To develop a scalable, personalized mobile health (mHealth) behavioral intervention program to improve hypoglycemia self-management and ultimately reduce hypoglycemia in T1D advanced diabetes technology users. METHODS Based on user-centered design principles, a multidisciplinary team (including clinical and health psychologists, diabetes care and education specialists, endocrinologists, mHealth interventionists and computer engineers, qualitative researchers, and patient partners) jointly developed an mHealth text messaging hypoglycem...
Diabetes
Black men are disproportionately impacted by Type 2 diabetes (T2D) and are more likely to die fro... more Black men are disproportionately impacted by Type 2 diabetes (T2D) and are more likely to die from diabetes complications than non-Hispanic White men. To address the unique challenges this group faces in diabetes self-management, we implemented a 3-month peer-led and empowerment-based DSME/S intervention in metro-Detroit. Twenty-five Black men ≥55 years of age with self-reported T2D were recruited and randomized to either the intervention group (n=12) − 10 hours of DSME and 9 hours of DSMS, or to an enhanced usual care (EUC) group (n=13) − 10 hours of DSME. Peer leaders (n=3), trained by certified diabetes care and education specialists (CDCES) who used training materials related to Black men with diabetes, led the sessions (mean age: 59.7 years; 100% Black, male, and with at least some college education). Changes in A1C levels, diabetes self-care activities, and diabetes distress levels were assessed at baseline and post-intervention. In the intervention group, the mean A1C at base...
Diabetes Technology & Therapeutics
Background: The majority of individuals referred to diabetes self-management education and suppor... more Background: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a nondidactic ''discovery learning''-based DSMES program centered on real-time flash glucose monitoring (FGM). Methods: In this single-arm pilot study, 35 adults with T2D duration 1-5 years, ages 21-75 years, not using insulin and HbA1c ‡8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants' FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures. Results: There was a significant gain in percentage time in range (% TIR) 70-180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop-in percentage time above range (TAR) >180 mg/dL from 44% to 25% (Ps = 0.01). Overall well-being rose significantly (P = 0.04), whereas diabetes distress showed a nonsignificant drop. Participants reported improvements in healthy eating (P < 0.001) and physical activity, although the latter did not reach statistical significance. Conclusions: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging patient-driven ''discovery learning'' approach to education.
Diabetes
Diabetes-related health disparities, especially for African Americans (AA) , underscore the need ... more Diabetes-related health disparities, especially for African Americans (AA) , underscore the need for effective, culturally tailored approaches to promote and sustain diabetes self-management support (DSMS) over time. The Praise study, a cluster randomized hybrid type II implementation trial recruited 21 AA churches, 28 peer leaders, 21 parish nurses, and 371 participants (100% AA, 73.8% female, 64±11.3 years of age) to determine the effectiveness of three DSMS approaches [Parish Nurse (PN) + Peer Leader (PL) DSMS vs. PN DSMS vs. PL DSMS], in comparison to enhanced usual care in improving and sustaining A1c and diabetes distress. Monthly DSMS groups were independently planned and facilitated by 28 trained PLs (100% African American, 18% male) and 14 trained PNs. A post-trial qualitative process evaluation was conducted to evaluate DSMS and ongoing support. Five focus groups were held (n=30) . Individual semi-structured interviews were completed with PLs and PNs (N=7) . Data were anal...
Approaches to Behavior Change Assessment Dealing with Emotion Choosing to Change Motivation Attit... more Approaches to Behavior Change Assessment Dealing with Emotion Choosing to Change Motivation Attitudes, Beliefs, and Values Goal-Setting Social Support Challenging Patients Eating and Physical Activity Educator-Patient Relationships Help from Other Health Professionals Educator Concerns Pediatrics
The Journal of Pain, 2018
The aim of this study is to evaluate the efficacy of two technological interventions to distract ... more The aim of this study is to evaluate the efficacy of two technological interventions to distract and alleviate distress in patients receiving a blood draw, IV placement, or port access. A projection unit called the Bedside Entertainment Theatre (BERT) displayed videos on walls and was used for children ages 2 to 7 years. Virtual reality (VR) headsets were given to children ages 8 to 18. Participants were randomized to receive either BERT/VR or standard of care (SC). We hypothesize that because both interventions create a novel and immersive experience for children, they would be effective distractors. Out of 194 patients (mean age = 12.36), 93 (47.9%) reported being fearful of their upcoming VA, as designated by a score above 0 on the Children's Fear Scale. These fearful children reported a mean pain score of 3.05 out of 10 during their VA, compared to those who were not fearful (mean = 1.84; P = .00). Mean pain scores for fearful children who received BERT was 3.27 compared to 6.20 with SC, but these scores were not significantly different (t = 1.95; P = .07). Mean pain scores were not significantly different between fearful youths who received VR versus SC (mean = 2.84 vs. 2.79; t =-.29; P = .93). These results demonstrate that BERT may reduce VA-related pain perception in younger children. However as enrollment is currently ongoing, further analysis is necessary to draw stronger conclusions.
Pediatric Clinical Practice Guidelines & Policies, 2014
This guide was produced by the National Diabetes Education Program (NDEP), a federally sponsored ... more This guide was produced by the National Diabetes Education Program (NDEP), a federally sponsored partnership of the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health and the Division of Diabetes Translation of the Centers for Disease Control and Prevention, and more than 200 partner organizations. The following organizations support its use by school personnel.