While the "social determinants of health" view compels us to explore how social structures shape health outcomes, it often ignores the role individual agency plays. In contrast, approaches that focus on individual choice and personal responsibility for health often overlook the influence of social structures. Amartya Sen's "capabilities" framework and its derivative the "health capabilities" (HC) approach attempts to accommodate both points of view, acknowledging that individuals function under social conditions over which they have little control, while also acting as agents in their own health and well-being. This paper explores how economic, social, and cultural resources shape the health capability of people with diabetes, focusing specifically on dietary practices. Health capability and agency are central to dietary practices, while also being shaped by immediate and broader social conditions that can generate habits and a lifestyle that constrain dietary behaviors. From January 2011 to December 2012, we interviewed 45 people with diabetes from a primary care clinic in Ontario (Canada) to examine how their economic, social, and cultural resources combine to influence dietary practices relative to their condition. We classified respondents into low, medium, and high resource groups based on economic circumstances, and compared how economic resources, social relationships, health-related knowledge and values combine to enhance or weaken health capability and dietary management. Economic, social, and cultural resources conspired to undermine dietary management among most in the low resource group, whereas social influences significantly influenced diet among many in the medium group. High resource respondents appeared most motivated to maintain a healthy diet, and also had the social and cultural resources to enable them to do so. Understanding the influence of all three types of resources is critical for constructing ways to enhance health capability, chronic disease self-management, and health.

The role of oncology nurse navigators in facilitating continuity of care within the diagnostic phase for adult patients with lung cancer

Background: Nonadherence to diet and medical therapies in heart failure (HF) contributes to poor HF outcomes. Mobile apps may be a promising way to improve adherence because they increase knowledge and behavior change via education and monitoring. Well-designed apps with input from health care providers (HCPs) can lead to successful adoption of such apps in practice. However, little is known about HCPs’ perspectives on the use of mobile apps to support HF management. Objective: The aim of this study is to determine HCPs’ perspectives (needs, motivations, and challenges) on the use of mobile apps to support patients with HF management. Methods: A qualitative descriptive study using one-on-one semistructured interviews, informed by the diffusion of innovation theory, was conducted among HF HCPs, including cardiologists, nurses, and nurse practitioners. Transcripts were independently coded by 2 researchers and analyzed using content analysis. Results: The 21 HCPs (cardiologists: n=8, 38%; nurses: n=6, 29%; and nurse practitioners: n=7, 33%) identified challenges and opportunities for app adoption across 5 themes: participant-perceived factors that affect app adoption—these include patient age, technology savviness, technology access, and ease of use; improved delivery of care—apps can support remote care; collect, share, and assess health information; identify adverse events; prevent hospitalizations; and limit clinic visits; facilitating patient engagement in care—apps can provide feedback and reinforcement, facilitate connection and communication between patients and their HCPs, support monitoring, and track self-care; providing patient support through education—apps can provide HF-related information (ie, diet and medications); and participant views on app features for their patients—HCPs felt that useful apps would have reminders and alarms and participative elements (gamification, food scanner, and quizzes). Conclusions: HCPs had positive views on the use of mobile apps to support patients with HF management. These findings can inform effective development and implementation strategies of HF management apps in clinical practice.

The role of oncology nurse navigators in enhancing patient empowerment within the diagnostic phase for adult patients with lung cancer

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Community based health and social resources can help individuals with complex health and social needs. However, there is often a discontinuation of patient care between primary care practices and community resources due to: a lack of physician or patient awareness of available resources; the presence of social barriers; the paucity of means to facilitate patients’ trajectory along the continuum of care; and more broadly, to the difficulties implementing organizational changes in primary care practices already busy providing health care services. Navigation services – where a person is tasked with helping connect patients to community resources – can strengthen continuity of care for patients. The implementation and study of the navigators’ impact is complex and warrants further investigation. Objective: Assess whether the ARC Model is feasible, including its potential to achieve its intended outcomes, and the viability of the evaluation approach. Methods: Describe the protocol of a single arm, prospective, explanatory mixed methods, pre-post design feasibility study, focusing on primary care practice settings with vulnerable populations. Participants include primary care providers, and patients. Results: Enrollment is closed with 82 patients. Navigation services have ended for 69 patients. Conclusions: Multilayered complex issues contribute to a high risk of failing to sustainably implement navigation services, thwarting randomized control trials’ effectiveness at assessing their impact. Undertaking a feasibility study from a conceptually clear and methodologically solid protocol will inform on the acceptability, ease of implementation, quality of integration, practicality and adaptation needs prior to initiating a randomized control trial. Clinical Trial: ClinicalTrials.gov, NCT03105635. Registered 10 April 2017