Psychometric Testing of the Self-Care of Coronary Heart Disease Inventory (SC-CHDI)

Network pharmacology combined with experimental analysis to explore the mechanism of the XinShuaiNing formula on heart failure

This study was conducted to elucidate the mechanism of action of the Traditional Chinese Medicine XinShuaiNing (XSN) formula in CHF based on network pharmacology. A total of 489 compounds in the XSN formula were screened. These compounds predicted 778 targets. A search of CHF yielded 789 corresponding targets, and 151 intersections between the potential targets of the XSN formula and CHF, involving AKT1, AGT, eNOS, and VEGF. Abdominal aortic coarctation (AAC) was used to establish a CHF rat model, and isoproterenol-induced H9c2 cells to establish a myocardial injury cell model. The results showed that the XSN formula downregulated ET-1, BNP, and Hcy and upregulated the ALB levels and also relieved cardiac histopathological damage. The XSN formula reduced the content of pro-inflammatory factors and inhibited the apoptosis of cardiomyocytes. In addition, the expression of fibronectin, α-SMA, collagen 1, and collagen 3 was downregulated by XSN formula treatment, and the fibrotic areas of myocardial tissue were reduced. The XSN formula promoted phosphorylation of AKT1-induced VEGF and eNOS signaling and inhibited AGT signaling. Besides, the XSN formula can affect the apoptosis of H9c2 cells by affecting AKT1, AGT, eNOS, and VEGF. The XSN formula regulates inflammatory factors by inducing phosphorylation of AKT1, upregulating eNOS and VEGF, and downregulating AGT to protect cardiomyocytes from apoptosis and myocardial fibrosis to alleviate CHF. In conclusion, this study identified the target of XSN prescription through network pharmacology screening and experimental validation and confirmed its anti-inflammatory, antiapoptotic, and antifibrotic effects.

The effect of education using the interactive avatar application on self-care and the ability to identify and respond to the symptoms of heart attack in patients with acute coronary syndrome: a randomized clinical trial

BACKGROUND

This study aimed to assess the effectiveness of an interactive avatar application in enhancing self-care behaviors and improving recognition and response to heart attack symptoms among patients with Acute Coronary Syndrome (ACS).

METHODS

A non-blinded, two-arm, randomized controlled trial was conducted with 78 ACS patients randomly allocated to either an intervention group or a control group. The control group received conventional education, while the intervention group received conventional education supplemented with training via an interactive avatar application. The application provided guidance on self-care practices, recognition of heart attack symptoms, and appropriate responses. Data were collected at baseline, 1 month, and 3 months post-discharge using demographic questionnaires, the Self-Care of Coronary Heart Disease Inventory, and the ACS Response Index. Statistical analyses included chi-square tests, independent samples t-tests, and Mann-Whitney U tests.

RESULTS

At the 3-month follow-up, participants in the intervention group exhibited significantly higher scores on both the Self-Care of Coronary Heart Disease Inventory and ACS Response Index compared to the control group (P < 0.05). Furthermore, during the 3-month follow-up period, all patients in the intervention group (100%) ceased activity and took sublingual nitroglycerin upon experiencing heart attack symptoms, compared to 80% in the control group.

CONCLUSIONS

The interactive avatar application proved effective in improving knowledge, attitudes, beliefs, and self-care behaviors among ACS patients. This innovative educational tool holds promise for enhancing patient outcomes in ACS management.

TRIAL REGISTRATION

This study was registered at the Iranian Registration Clinical Trial Center (Code: IRCT20220920056001N1, Date: 2023-01-03).

Self-Care Levels and Related Factors in Patients With Coronary Artery Disease: A Cross-Sectional Study in the Southeast of Iran

BACKGROUND

Coronary artery disease (CAD) is a major cause of death worldwide. Uptake of self-care behaviors by patients with CAD could reduce hospital costs and negative social effects. Self-care among patients with CAD has not been studied in Iran.

OBJECTIVE

In the present study, we assessed self-care levels and related factors in patients with CAD in Iran.

METHODS

In this cross-sectional study, 250 patients hospitalized in Razi hospital in Birjand city between 2023 and 2024 were selected. Data were collected by demographic questionnaire and the Inventory of Self-care in Coronary Heart Disease. Bivariate analyses and multiple linear regression were used to analyze the data.

RESULTS

Study participants were mostly male (62%), with elementary education (43.6%). The highest and the lowest scores were related to self-care maintenance (62.26 ± 15.14) and monitoring (45.66 ± 23.46), respectively. Smoking ( P < .001), employment status ( P = .020), hospitalization frequency, once ( P = .003) or twice ( P = .015), and emergency visits ( P = .008) were predictors of self-care maintenance. Gender ( P = .010), emergency visits ( P = .016), and comorbidities (diabetes, hyperlipidemia, and high blood pressure) or risk factors (2: P = .016; and 3: P = .003) were strong predictors of better self-care monitoring. Employment status ( P = .007), disease duration ( P = .011), and hospitalization frequency ( P = .033) were significant determinants of better self-care management.

CONCLUSIONS

Demographic characteristics and social context influence self-care levels of patients with CAD living in Iran. Therefore, person-oriented and gender-focused interventions may empower these patients to engage in self-care. We recommend development and testing of such interventions in Iran.

Measuring Self-Care: A Description of the Family of Disease-Specific and Generic Instruments Based on the Theory of Self-Care of Chronic Illness

BACKGROUND

In recent years, there has been an exponential increase in attention paid to the patient-reported outcome of self-care. Many investigators have used one of the families of self-care instruments freely available on the website www.self-care-measures.com . These self-care measures have been translated into many languages, which are also available on the website. The measures include both disease-specific and generic instruments, which are based on a common theoretical framework, the Middle Range Theory of Self-Care of Chronic Illness.

PURPOSE

The purpose of this article is to illustrate similarities among the instruments and to standardize their scoring, analysis, and use. We describe the Self-Care of Heart Failure Index, the Self-Care of Coronary Heart Disease Inventory, the Self-Care of Hypertension Inventory, the Self-Care of Diabetes Inventory, the Self-Care of Chronic Obstructive Pulmonary Disease Inventory, the Self-Care of Chronic Illness Inventory, and the Self-Care Inventory. Detailed guidance on scoring, translation, and analysis is provided. Complementary measures of self-care self-efficacy and those used to measure caregiver contributions to patient self-care are briefly described.

CONCLUSIONS

Many of the common questions of instrument users are answered in this article. Following this guidance will facilitate consistent use of the instruments, which will enable users to compare their results to those of others worldwide and facilitate future reviews and meta-analyses.Clinical ImplicationsThis review, emphasizing standard scoring and interpretation, is useful for clinicians and researchers across various populations and settings.

Psychometric Testing of the Thai Version of Self-Care of Chronic Illness Inventory Version 4c in Patients With Stroke

BACKGROUND

Self-Care of Chronic Illness Inventory version 4c is a non-disease-specific self-care measure used in individuals with multiple chronic conditions. This instrument may be applied to patients with specific diseases such as stroke.

OBJECTIVE

The aim of this study was to evaluate the psychometric properties of the Thai version of the Self-Care of Chronic Illness Inventory version 4c in patients with stroke.

METHODS

This multicenter, cross-sectional study adhered to the COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) guidelines and enrolled patients with stroke from 16 primary care centers in southern Thailand. Structural validity was assessed using confirmatory factor analysis, internal consistency reliability using Cronbach α coefficient and global reliability index, and test-retest reliability using intraclass correlation coefficients.

RESULTS

The final analysis included a total of 350 participants. Confirmatory factor analysis supported the 2-factor Self-Care Maintenance scale structure, although the item allocation to the dimensions differed from that of the original model. The Self-Care Monitoring scale demonstrated a 1-factor structure with permitted residual covariance. The Self-Care Management scale maintained a 2-factor structure, similar to that of the original model. Simultaneous confirmatory factor analysis of the combined items supported the general model with the 3 scales. The Self-Care Maintenance scale exhibited marginally adequate α (0.68) and ω (0.66) coefficients, and an adequate composite reliability index (0.79). The other 2 scales demonstrated adequate α (range, 0.79-0.86), ω (range, 0.75-0.86), and composite reliability (range, 0.83-0.86) indices. Intraclass correlation coefficients showed adequate test-retest reliability for all scales (range, 0.76-0.90).

CONCLUSIONS

The generic self-care measure, Self-Care of Chronic Illness Inventory version 4c, demonstrated strong psychometric properties in patients with stroke. This instrument may be a valuable tool for assessing stroke self-care in Thailand.

Mediating effect of illness perception between self-care ability and health-promoting behaviors among patients with stable coronary artery disease

BACKGROUND

The interaction between illness perception, self-care ability, and health-promoting behaviors (HPB) in stable coronary artery disease (SCAD) patients remains uncertain. We conducted a cross-sectional survey to explore the correlation between self-care ability, illness perception, and HPB among patients with SCAD, as well as the potential mediating role of illness perception between self-care ability and HPB.

METHODS

A cross-sectional study was carried out among 184 inpatients with SCAD in Hefei, China, from December 2022 to March 2023. The Self-Care of Coronary Heart Disease Inventory (SC-CHDI, containing three dimensions: self-care maintenance, self-care management, and self-care confidence), Revised Illness Perception Questionnaire (IPQ-R, containing seven dimensions: illness duration, illness consequence, personal control, treatment control, illness coherence, cyclical timeline, emotional distress), Health-Promoting Lifestyle Profile Ⅱ (HPLP-Ⅱ) were used in the questionnaires. SPSS 25.0 software and PROCESS version 4.2 plug-in was used to analyze the mediating effect.

RESULTS

HPB of SCAD patients was at moderate level. A range of factors including education level, marital status, self-care maintenance, self-care management, self-care confidence, illness coherence, and emotional distress are potential influencers of HPB. Illness coherence had a partially mediated effect between self-care maintenance and HPB (β = 0.063, 95% CI: 0.021~0.111), accounting for 20.59% of the total effect. Similarly, illness coherence had a partially mediated effect between self-care management and HPB (β = 0.055, 95% CI: 0.016~0.105), accounting for 13.78% of the total effect. However, none of the dimensions of illness perception mediated between self-care confidence and HPB. Self-care confidence directly influenced HPB, accounting for 92.40% of the total effect.

CONCLUSION

It is necessary for hospital healthcare workers, community workers, and patients' families to work together to focus on the self-care ability and positive illness perception of patients with cardiovascular disease, so as to increase patients' motivation to participate in HPB and improve their quality of life.

Association of depressive symptoms and engagement in physical activity with event-free survival in patients with heart failure

BACKGROUND

Heart failure (HF) subtype, depressive symptoms, and physical inactivity independently contribute to survival outcomes, but the effect of the interaction of these variables on survival outcomes remains unknown.

OBJECTIVES

We aimed to determine whether depressive symptoms and engagement in physical activity differentially interact to predict the combined endpoint of all-cause death or rehospitalization among patients with HF and reduced (HFrEF) or preserved ejection fraction (HFpEF).

METHODS

This study was a secondary analysis. The sample was categorized by the presence or absence of depressive symptoms, and engagement or non-engagement in physical activity. Cox proportional hazard modeling was used to predict the combined endpoint of all-cause death or rehospitalization.

RESULTS

A total of 1002 patients with HF were included (mean age 64.3 ± 12.7 years; 637 males [64 %]; 844 White [84 %]). Among them, 35.3 % did not engage in physical activity, while 64.7 % engaged in any level of physical activity, and 29.7 % had depressive symptoms. In both subtypes, depressive symptoms were associated with the highest risk of all-cause death or rehospitalization. Among patients with HFrEF, those with depressive symptoms who did not engage in physical activity were associated with a 136 % higher risk of the combined endpoint, while among those with HFpEF, depressive symptoms and engagement in physical activity were associated with a 78 % higher risk.

CONCLUSIONS

Depressive symptoms and lack of physical activity predicted the combined endpoint of all-cause death or rehospitalization among patients with HFrEF, while depressive symptoms alone were the strongest predictor among patients with HFpEF.

Happiness, sleep quality, and self-care ability among community-dwelling older adults in Tehran, 2023

BACKGROUND

Population aging presents a significant challenge that requires comprehensive planning. Limited research has been done on the interconnections between happiness, sleep, and self-care in older adults. This study aimed to determine the Happiness, Sleep quality, and Self-care ability among community-dwelling older adults in Tehran, 2023.

METHODS

This is a cross-sectional study. We selected 306 eligible, community-dwelling older adults through multistage sampling. Participants were recruited from comprehensive health service centers. We employed three assessments: the Oxford Happiness Inventory (OHI), the Pittsburgh Sleep Quality Index (PSQI), and the Self-Care Ability Scale for the Elderly (SASE). Data analysis was conducted using SPSS version 27, the Spearman correlation test, and univariate and multivariate linear regression analyses.

RESULTS

The results indicated that 58% of older adults were male, 67.6% were married, and 44% were retired. A multivariate linear regression analysis revealed a significant association with happiness. Self-care ability had a negative impact (β = -1.50, p < 0.001), while sleep quality had a positive effect (β = 0.50, p < 0.001).

CONCLUSION

Self-care and sleep quality are associated with overall happiness. Policymakers and planners should prioritize happiness enhancement by addressing its relationship with sleep and self-care practices.

Evaluating a New Short Self-Management Tool in Heart Failure Against the Traditional Flinders Program

Background/Objective: Heart failure (HF) is a complex syndrome, with multiple causes. Numerous pathophysiological pathways are activated. Comprehensive and guideline-derived care is complex. A multidisciplinary approach is required. The current guidelines report little evidence for chronic disease self-management (CDSM) programs for reducing readmission and major adverse cardiovascular events (MACE). CDSM programs can be complex and are not user-friendly in clinical settings, particularly for vulnerable patients. The aim of this study was to investigate whether a simplified one-page CDSM tool, the SCReening in Heart Failure (SCRinHF), is comparable to a comprehensive Flinders Program of Chronic Disease Management, specifically in triaging self-management capabilities and in predicting readmission and MACE. Methods:SELFMAN-HF is a prospective, observational study based on community cardiology. Eligible patients, consecutively recruited, had HF with left ventricular ejection fraction <40% and were placed on sodium-glucose co-transporter-2 inhibitors (SGLT2-i) within 3 months of recruitment. SGLT2-i is the newest of the four HF treatment pillars; self-management skills are assessed at this juncture. CDSM was assessed and scored independently via the long-form (LF) and short-form (SF) tools, and concordance between forms was estimated. The primary endpoint is the 80% concordance across the two CDSM scales for predicting hospital readmission and MACE. Results: Of the 117 patients, aged 66.8 years (±SD 13.5), 88 (75%) were male. The direct comparisons for SF versus LF patient scores are as follows: "good self-managers", 13 vs. 30 patients (11.1% vs. 25.6%); "average", 46 vs. 21 patients (39.3% vs. 17.9%), "borderline", 20 vs. 31 patients (17.1% vs. 26.5%), and "poor self-managers" (vulnerable), 38 vs. 35 patients (32.5% vs. 29.9%). These findings underscore the possibility of SF tools in picking up patients whose scores infer poor self-management capabilities. This concordance of the SF with the LF scores for patients who have poor self-management capabilities (38 vs. 35 patients p = 0.01), alongside readmission (31/38 vs. 31/35 p = 0.01) or readmission risk for poor self-managers versus good self-managers (31/38 vs. 5/13 p = 0.01), validates the simplification of the CDSM tools for the vulnerable population with HF. Similarly, when concurrent and predictive validity was tested on 52 patients, the results were 39 (75%) for poor self-managers and 14 (27%) for good self-managers in both groups, who demonstrated significant correlations between SF and LF scores. Conclusions: Simplifying self-management scoring with an SF tool to improve clinical translation is justifiable, particularly for vulnerable populations. Poor self-management capabilities and readmission risk for poor self-managers can be significantly predicted, and trends for good self-managers are observed. However, correlations of SF to LF scores across an HF cohort for self-management abilities and MACE are more complex. Translation to patients of all skill levels requires further research.

Self-care trajectories of patients with coronary heart disease: a longitudinal, observational study

AIMS

To determine if distinct trajectories of coronary heart disease (CHD) self-care behaviours could be identified, linked to differences in quality of life (QoL), and predicted based on baseline characteristics.

METHODS AND RESULTS

A secondary analysis of a prospective, longitudinal, observational study. Patients with CHD answered questionnaires at study enrolment and six months later: Self-Care of Coronary Heart Disease Inventory (three subscales: maintenance, management, and confidence, scored 0-100, higher score = better self-care), Hospital Anxiety and Depression Scale, 12-Item Short Form Survey, 16-Item European Health Literacy Survey Questionnaire, and CHD Education Questionnaire. Latent growth mixture modelling was used to identify distinct self-care trajectories over time. On average, patients (n = 430, mean age 64.3 ± 8.9, 79% male) reported inadequate self-care (maintenance 61.6 ± 15.4, management 53.5 ± 18.5) at enrolment. Two distinct trajectories of self-care behaviours were identified: first, an 'inadequate-and-worsening' (IN-WORSE) trajectory (57.2%), characterized by inadequate self-care, improvement in maintenance (4.0 ± 14.5-point improvement, P < 0.001), and worsening of management over time (6.3 ± 24.4-point worsening, P = 0.005). Second, an 'inadequate-but-maintaining' (IN-MAIN) trajectory (42.8%), characterized by inadequate self-care, improvement in maintenance (5.0 ± 16.2-point improvement, P < 0.001), and stability in management over time (0.8 ± 21.9-point worsening, P = 0.713). In comparison, patients in the IN-WORSE trajectory had less favourable characteristics (including lower health literacy, knowledge, confidence) and significantly lower QoL. Not attending rehabilitation (OR 2.175; CI 1.020-4.637, P = 0.044) and older age (OR 0.959; CI 0.924-0.994, P = 0.024) predicted (IN-WORSE) trajectory inclusion.

CONCLUSION

Two self-care trajectories were identified, both suboptimal. Rehabilitation predicted membership in the more favourable trajectory and some positive characteristics were identified among patients in that group. Therefore, interventions supporting these factors may benefit patients' self-care and QoL.

APPROACH e-PROM system: a user-centered development and evaluation of an electronic patient-reported outcomes measurement system for management of coronary artery disease

BACKGROUND

Coronary artery disease (CAD) confers increased risks of premature mortality, non-fatal morbidity, and significant impairment in functional status and health-related quality of life. Routine administration of electronic patient-reported outcome measures (PROMs) and its real time delivery to care providers is known to have the potential to inform routine cardiac care and to improve quality of care and patient outcomes. This study describes a user-centered development and evaluation of the Alberta Provincial Project for Outcomes Assessment (APPROACH) electronic Patient Reported Outcomes Measurement (e-PROM) system. This e-PROM system is an electronic system for the administration of PROMs to patients with CAD and the delivery of the summarized information to their care providers to facilitate patient-physician communication and shared decision-making. This electronic platform was designed to be accessible via web-based and hand-held devices. Heuristic and user acceptance evaluation were conducted with patients and attending care providers.

RESULTS

The APPROACH e-PROM system was co-developed with patients and care providers, research investigators, informaticians and information technology experts. Five PROMs were selected for inclusion in the online platform after consultations with patient partners, care providers, and PROMs experts: the Seattle Angina Questionnaire, Patient Health Questionnaire, EuroQOL, and Medical Outcomes Study Social Support Survey, and Self-Care of Coronary Heart Disease Inventory. The heuristic evaluation was completed by four design experts who examined the usability of the prototype interfaces. User acceptance testing was completed with 13 patients and 10 cardiologists who evaluated prototype user interfaces of the e-PROM system.

CONCLUSION

Both patients and physicians found the APPROACH e-PROM system to be easy to use, understandable, and acceptable. The APPROACH e-PROM system provides a user-informed electronic platform designed to incorporate PROMs into the delivery of individualized cardiac care for persons with CAD.

Psychometric Testing of the Korean Version of the Self-Care of Coronary Heart Disease Inventory Version 3

PURPOSE

This methodological study evaluated the psychometric properties of the Self-Care of Coronary Heart Disease Inventory version 3 (SC-CHDI v3) in a Korean context.

METHODS

The SC-CHDI v3 was translated into Korean following a rigorous translation process. Participants were 452 patients who had experienced coronary heart disease (CHD), all recruited from a tertiary hospital in Korea. Exploratory and confirmatory factor analyses were performed to test construct validity. Concurrent validity was examined by correlating scores from the Korean version of the SC-CHDI v3 with those from the Cardiac Self-Efficacy Scale. Internal consistency was analyzed using Cronbach's alpha and McDonald's omega.

RESULTS

The Korean version of the SC-CHDI v3 consists of 21 items, excluding two from the original instrument. The self-care maintenance subscale identified a two-factor structure: "treatment adherence" and "health-promoting behaviors." The goodness-of-fit indices were satisfied: χ2 = 18.19, p = .110, comparative fit index (CFI) = .97, Tucker-Lewis Index (TLI) = .95, and standardized root mean square residual (SRMR) = .04. The self-care monitoring subscale consisted of a one-dimensional structure ("monitoring behaviors") and the goodness-of-fit indices were satisfied: χ2 = 19.19, p = .059, CFI = .99, TLI = .99, and SRMR = .04. The self-care management subscales had a two-factor structure of "consulting behaviors" and "problem-solving behaviors." The goodness-of-fit indices were satisfied: χ2 = 16.44, p = .037, CFI = .99, TLI = .98, and SRMR = .03. Scores from the Cardiac Self-Efficacy Scale showed a positive correlation with the Korean version of SC-CHDI v3 subscales. Reliability estimates were ≥ .80 for all subscales except for the self-care maintenance subscale.

CONCLUSIONS

The Korean version of the SC-CHDI v3 consists of 21 items in 3 subscales and is a valid and reliable instrument. Therefore, healthcare providers can effectively utilize it to assess the self-care levels of patients with CHD.

Development and psychometric properties of a self-medication behavior inventory

Introduction

Self-medication is a prevalent behavior with significant health implications. Understanding its psychosocial determinants can inform preventative strategies and interventions.

Methods

We evaluated the psychometric properties of the Self-Medication Behavior Inventory (SMBI-9) in a binational study with 779 Colombian and Mexican participants. Concurrent validity was assessed through correlations with related inventories, and confirmatory factor analysis tested the proposed four-factor model.

Results

The SMBI-9 demonstrated high model fit (CFI = 0.995, TLI = 0.991) and invariance across countries. The factors-Social Influence, Attitude toward Medicine, Avoidance, and Prevention-varied significantly with knowledge of medicine, schooling, health insurance status and gender, underscoring the role of social and personal beliefs in self-medication practices.

Discussion

SMBI-9 emerged as a reliable tool for capturing the multifaceted nature of self-medication behaviors. Findings highlight the influence of social norms and personal attitudes, suggesting targeted approaches for behavioral interventions.

Changes in disease-related knowledge and educational needs of patients with coronary heart disease over a six-month period between hospital discharge and follow-up

OBJECTIVE

To describe changes in the disease-related knowledge and educational needs of individuals with coronary heart disease (CHD).

METHODS

Patients hospitalized for CHD answered questionnaires about disease-related knowledge (Coronary Artery Disease Education Questionnaire-short version (CADE-Q-SV), score 0-20), educational needs (investigator-designed questions), health literacy (Short version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16)), self-care (Self-Care of Coronary Heart Disease Inventory version (SC-CHDI)), and physical activity (Leisure-time Physical Activity Questionnaire) at discharge (T1) and six months later (T2).

RESULTS

Participants' (N = 308; mean [M] age=65.5 years [SD=8.7]; 81.5% male) knowledge scores increased from M= 13.8 (SD=3.2) to M= 14.8 (SD=2.8) (p < 0.001). At T1, educational level, age, health literacy, smoking, and self-care maintenance explained 14.5% of knowledge variability. At T2, these variables plus lack of awareness of CHD diagnosis explained 20.3% of the variability. Substantial educational needs were reported at both time points, although 89% received predischarge education.

CONCLUSION

The patients' educational needs were unfulfilled despite an increase in disease-related knowledge over time. Improved evidence-based patient education and follow-ups that address diagnosis, treatment, and self-care are needed.

PRACTICE IMPLICATIONS

Healthcare professionals can improve care of patients with CHD by providing focused patient education, prioritizing "need-to-know" topics and considering patients' health literacy.

Cross-cultural adaptation and psychometric evaluation of the Thai version of Self-Care of Chronic Illness Inventory Version 4.c

Objectives

To translate and validate the Thai Self-Care of Chronic Illness Inventory version 4.c (Thai SC-CII v4.c) in individuals with chronic illnesses.

Methods

A scale translation and cross-sectional validation study was conducted. The English version was translated for Thai involved nine steps: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing and finalization, and proofreading. A cross-sectional study was conducted from July to November 2022 at 16 primary care centers in southern Thailand, involving 410 participants with at least one chronic condition. Validity assessments included structural, convergent, and discriminant validity. Concurrent validity examined correlations between SC-CII v4.c with the Self-Care Self-Efficacy Scale (SCSES) and self-perceived health. Internal coherence reliability was calculated using Cronbach's α coefficient, item-total correlation coefficients, and the composite reliability (CR) index.

Results

Thai SC-CII v4.c demonstrated excellent translational validity (κ = 0.99). The specified Self-Care Maintenance model fit well, with minor differences in health promoting behavior and illness-related behavior items compared to the original model. The original Self-Care Monitoring, and Self-Care Management models fit well with Thai data. Simultaneous confirmatory factor analysis confirmed a satisfactory fit of the full SC-CII v4.c. Convergent validity had partial support (average variance extracted = 0.23-0.51), and discriminant validity was established (heterotrait-monotrait ratios = 0.37-0.88). Concurrent validity was supported by positive correlations between each scale and overall SC-CII v.4c with SCSES (r = 0.25-0.65) and self-perceived health (r = 0.09-0.35). The Cronbach's α coefficient were adequate for all scales except the Self-Care Maintenance scale (Cronbach's α = 0.68), but the CR estimate improved the reliability of all three scales (ranging 0.80-0.82). All items had satisfactory item-total correlation coefficients (ranging 0.34-0.71), except the one pertaining to sleep.

Conclusions

The Thai SC-CII v4.c is valid and reliable for assessing self-care in various chronic illnesses. Further testing is recommended for patients with specific diseases.

Instruments Measuring Self-Care and Self-Management of Chronic Conditions by Community-Dwelling Older Adults: A Scoping Review

Given the high prevalence of chronic conditions and multimorbidity in older adults, there is a need to better conceptualize and measure self-care and self-management to promote a person-centered approach. This scoping review aimed to identify and map instruments measuring self-care and self-management of chronic conditions by older adults. We searched six electronic databases, charted data from the studies and tools and reported the results in accordance with the PRISMA-ScR guidelines. A total of 107 articles (103 studies) containing 40 tools were included in the review. There was substantial variation in the tools in terms of their aims and scope, structure, theoretical foundations, how they were developed, and the settings in which they have been used. The quantity of tools demonstrates the importance of assessing self-care and self-management. Consideration of the purpose, scope, and theoretical foundation should guide decisions about tools suitable for use in research and clinical practice.

Self-care in coronary heart disease patient and caregiver dyads (HEARTS-IN-DYADS)-Protocol of a multicenter longitudinal study

Self-care performed by patients and the caregiver contribution to this self-care are essential for improving cardiovascular outcomes; however, so far, no studies have sufficiently investigated this field in Italy. This paper describes a research protocol of a multi-center longitudinal study designed to investigate the self-care of patients affected by coronary heart disease (CHD), the caregiver's contribution to this self-care, the predictors of patient and caregiver self-care, the mediating role of self-efficacy, and the self-care outcomes. Data collection will be performed across seven Italian inpatient settings at baseline and 3 and 6 months from enrollment. Multilevel modeling and actor partner interdependence models will be implemented on a sample of 330 patient-caregiver dyads to adjust for the interdependence of measurements. The study received approval from an ethics committee in Italy and was financed in January 2021 by a grant from the Solidal Foundation in Alessandria. This research will advance the knowledge about the self-care process in CHD. The results will guide research and clinical practice by identifying variables sensitive to educational interventions.

Associations of perceived and common dyadic coping with self-care in older couples with cardiovascular disease: A dyadic analysis

BACKGROUND

Dyadic engagement of patients and caregivers in self-care is essential for management of heart disease. However, little is known how dyadic coping at individual and partner levels is associated with self-care in couples living with cardiovascular disease.

OBJECTIVE

This study examined whether dyadic coping at self, partner, and common levels was associated with patients' engagement in self-care and spouses' contribution to self-care in older couples living with cardiovascular disease.

METHODS

In this cross-sectional study, 288 older patients and spouses were recruited from outpatient heart clinics in Qazvin, north of Iran. Data were collected using the Dyadic Coping Inventory, the Self-care of Coronary Heart Disease Inventory, and the Caregiver's Contribution to Self-care of Coronary Heart Disease. Dyadic data were analyzed using the actor-partner interdependence model.

RESULTS

The results showed that patients' engagement in self-care maintenance was associated with partner dyadic coping in patients, self and common dyadic coping in spouses. Patients' engagement in self-care monitoring was only associated with self dyadic coping in spouses. Dyadic analysis also showed that self-care confidence in patients was only associated with by partner dyadic coping in spouses.

CONCLUSIONS

This study revealed that self-care was associated with dyadic coping employed by each member of the dyad at self, partner and common levels. Findings of this study suggest that perceived and provided levels of dyadic coping can be employed for maintaining or restoring self-management in older couples living with cardiovascular disease.

Patient-centered care in Coronary Heart Disease: what do you want to measure? A systematic review of reviews on patient-reported outcome measures

Background

The number of published articles on Patient-Reported Outcomes Measures (PROMs) in Coronary Heart Disease (CHD), a leading cause of disability-adjusted life years lost worldwide, has been growing in the last decades. The aim of this study was to identify all the disease-specific PROMs developed for or used in CHD and summarize their characteristics (regardless of the construct), to facilitate the selection of the most adequate one for each purpose.

Methods

A systematic review of reviews was conducted in MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews. PROQOLID and BiblioPRO libraries were also checked. PROMs were classified by construct and information was extracted from different sources regarding their main characteristics such as aim, number of items, specific dimensions, original language, and metric properties that have been assessed.

Results

After title and abstract screening of 1224 articles, 114 publications were included for full text review. Finally, we identified 56 PROMs: 12 symptoms scales, 3 measuring functional status, 21 measuring Health-Related Quality of Life (HRQL), and 20 focused on other constructs. Three of the symptoms scales were specifically designed for a study (no metric properties evaluated), and only five have been included in a published study in the last decade. Regarding functional status, reliability and validity have been assessed for Duke Activity Index and Seattle Angina Questionnaire, which present multiple language versions. For HRQL, most of the PROMs included physical, emotional, and social domains. Responsiveness has only been evaluated for 10 out the 21 HRQL PROMs identified. Other constructs included psychological aspects, self-efficacy, attitudes, perceptions, threats and expectations about the treatment, knowledge, adjustment, or limitation for work, social support, or self-care.

Conclusions

There is a wide variety of instruments to assess the patients’ perspective in CHD, covering several constructs. This is the first systematic review of specific PROMs for CHD including all constructs. It has practical significance, as it summarizes relevant information that may help clinicians, researchers, and other healthcare stakeholders to choose the most adequate instrument for promoting shared decision making in a trend towards value-based healthcare.

Psychometric Testing of the Self-Care of Coronary Heart Disease Inventory Version 3.0

BACKGROUND

In this updated Self-Care of Coronary Heart Disease Inventory (SC-CHDI) v3.0, items were added to better reflect the theory of self-care of chronic illness and revised based on recent research. The expanded SC-CHDI now reflects the theoretical concepts of self-care maintenance, monitoring, and management.

OBJECTIVE

The aim of this study was to evaluate the psychometric properties of the SC-CHDI v3.0.

METHODS

In a sample of adults with coronary heart disease, we tested the SC-CHDI v3.0 validity with confirmatory factor analysis. Reliability was calculated using Cronbach α, factor score determinacy coefficient, and global reliability index for multidimensional scales, with values > 0.70 considered adequate.

RESULTS

The sample (n = 205) was predominantly male (79%) with a mean age of 65.3 ± 11.1 years. The self-care maintenance scale encompassed 2 distinct behaviors, namely, "illness related behaviors" and "health promoting behaviors," which reflect consulting and autonomous dimensions, respectively. The goodness-of-fit indices were adequate: χ2(25, N = 205) =31.86, P = .16, comparative fit index = 0.97, Tucker-Lewis Index = 0.95, root mean square error of approximation = 0.04 (90% confidence interval, 0.00-0.07), P = .705, and standardized root mean square residual = 0.045. Analysis of the new self-care monitoring scale yielded a single factor; goodness-of-fit indices were excellent: χ2(12, N = 205) =11.56, P = .48, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation < 0.001 (90% confidence interval, 0.000-0.07), P = .86, and standardized root mean square residual = 0.02. The self-care management scale had 2 dimensions of autonomous and consulting behavior with strong goodness-of-fit indices: χ2(7, N = 205) =6.57, P = .47, comparative fit index = 1.00, Tucker-Lewis Index = 1.00, root mean square error of approximation ≤ 0.001 (90% confidence interval, 0.00-0.08), P = .76, and standardized root mean square residual = 0.02. Reliability estimates were ≥0.80 for all scales.

CONCLUSIONS

Our testing suggests that the SC-CHDI v3.0 is a sound measure of the essential elements of self-care for adults with coronary heart disease.

Psychometric evaluation of the Thai version of the Self-Care of Coronary Heart Disease Inventory Version 3 (SC-CHDI-V3)

AIMS

Engaging in self-care is an important aspect of the prevention and management of coronary heart disease (CHD), the leading cause of premature death in Thailand. As no validated tool exists to measure self-care in Thai people with CHD, we translated and examined the psychometric properties of the Self-Care of Coronary Heart Disease Inventory (SC-CHDI) Version 3 (V3) in a Thai population.

METHODS AND RESULTS

The SC-CHDI-V3 was translated into Thai using the standard forward and backward translation procedure for self-care instruments. A cross-sectional design was used to examine the psychometric properties of the Thai version of the SC-CHDI-V3 in 250 patients with confirmed CHD in a tertiary hospital in Southern Thailand. Cronbach's alpha and McDonald's omega coefficients were used to assess internal consistency, and confirmatory factor analysis was performed to assess construct validity. The Thai version of the SC-CHDI-V3 demonstrated acceptable internal consistency (Cronbach's alpha and McDonald's omega coefficients of each scale ranged from 0.821 - 0.910). Reliability estimates were adequate for each scale (range 0.863 - 0.906). Confirmatory factor analysis supported the original factor structure of the instrument, with good fit indices for all three scales (comparative fit index = 0.996 - 1.000; root-mean-square error of approximation = <0.001 - 0.040).

CONCLUSIONS

The Thai version of the SC-CHDI-V3 appears to be a valid and reliable instrument for measuring engagement in self-care maintenance, self-care monitoring and self-care management among Thai people with CHD.

Development and Validation of a Scale to Measure Self-efficacy and Self-management in People With Coronary Heart Disease

BACKGROUND

Self-management is important in reducing coronary risk factors and in preventing recurrent cardiac events. An enabling factor that promotes self-management among patients with coronary heart disease (CHD) is self-efficacy. However, there is no standardized measure that captures self-efficacy and self-management concurrently in this population.

AIM

The authors of this study report on the development and validation of a brief scale to measure self-efficacy and self-management in patients with CHD.

METHODS

Scale development and testing comprised (1) item generation, (2) content validity, and (3) pilot testing. The Heart Health Self-Efficacy and Self-Management (HH-SESM) scale includes 2 constructs: self-efficacy and self-management, measured concurrently. Components of the HH-SESM scale consisted of items related to behavioral and coronary risk factor modification. Survey data from 143 participants were used in exploratory factor analyses to test the factorial validity and internal consistency of the scale.

RESULTS

Twelve items with the same response format were included in the exploratory factor analysis. The factor analysis revealed a single-factor solution accounting for 36.7% and 36.5% of the variance in scores of the self-efficacy and self-management scales, respectively. The correlation ( r = 0.72, P < .001) between the self-efficacy and self-management constructs indicates moderate convergent validity. Cronbach α of self-efficacy (0.83) and self-management (0.81) constructs showed good internal consistency.

CONCLUSION

The HH-SESM is a brief, easy-to-administer, and reliable measure of self-efficacy and self-management in patients with CHD.

Effect of Mobile Internet on Attitude and Self-Efficacy of Patients with Coronary Heart Disease Diagnosed by 12-Lead Holter ECG

Objective

To explore the effect of mobile Internet on attitude and self-efficacy of patients with coronary heart disease (CHD) diagnosed by 12-lead Holter ECG.

Methods

The clinical data of 62 patients with CHD who underwent routine ECG examination (control group I) and 12-lead dynamic electrocardiogram (control group II) in our hospital (June 2017–December 2020) were retrospectively analyzed, and the clinical data of another 62 patients with CHD who received 12-lead Holter ECG examination combined with mobile Internet in our hospital at the same time (study group) were retrospectively analyzed. The clinical observation indexes of the three groups were compared.

Results

No obvious difference in general data among groups (P > 0.05). Compared with the control group I, the positive detection rate (PDR) of the study group and the control group II was obviously higher (P < 0.05), and the PDR of the study group was obviously higher than that of the control group II, without remarkable difference between both groups (P > 0.05). Compared with the control group, the scores of CAS-R of the study group were obviously higher (P < 0.05), and self-efficacy of daily life, health behaviors, medication compliance, and compliance behavior of the study group was obviously better (P < 0.05). The diagnostic efficacy was derived by ROC curve analysis, 12-lead Holter ECG combined with mobile Internet + routine ECG > 12-lead Holter ECG combined with mobile Internet > 12-lead Holter ECG > routine ECG.

Conclusion

Compared with the routine ECG, the sensitivity of 12-lead Holter ECG in the diagnosis of CHD is conspicuously higher. Meanwhile, 12-lead Holter ECG combined with mobile Internet can enhance the diagnostic efficiency and improve patients' perceived control attitude and self-efficacy.

The status and predictors of self-care among older adults with hypertension in China using the Chinese version of Self-Care of Hypertension Inventory - A cross-sectional study

AIM

To investigate the status and predictors of self-care among older adults with hypertension in China by the Chinese version of Self-Care of Hypertension Inventory.

DESIGN

A cross-sectional questionnaire survey.

METHODS

A convenience sampling of 544 older adults with hypertension was surveyed using the Chinese version of Self-Care of Hypertension Inventory. SPSS25.0 software was used for statistical analysis of the data. Generalized liner model univariate analysis and the optimal scaling regression analysis were performed to investigate the predictors of self-care.

RESULTS

The status of self-care was poor with the median and inter-quartile range of total scores of self-care (140.00 ± 67), the scores of self-care maintenance (50 ± 24.76), the scores of self-care management (56.25 ± 29.41) and the scores of self-care confidence (54.79 ± 29.17). Age, family model, primary caregiver, maximum systolic blood pressure, coverage of medical insurance, disease duration, receiving self-care education, education level, economic burden and family history of hypertension were the most powerful predictors of self-care among older adults with hypertension.

Effect of nursing intervention based on Maslow's hierarchy of needs in patients with coronary heart disease interventional surgery

BACKGROUND

It is very important to provide effective nursing programs to regulate the physical and mental state of patients and to improve treatment compliance after interventional surgery for coronary heart disease (CHD).

AIM

To explore the effect of a nursing intervention based on Maslow’s hierarchy of needs theory on patients with CHD undergoing percutaneous coronary intervention.

METHODS

Ninety-four patients with CHD undergoing interventional surgery in our hospital from January 2020 to February 2021 were randomly divided into a research group (n = 47) and a control group (n = 47). The control group received routine nursing, and the research group received a nursing intervention based on Maslow’s hierarchy of needs theory. The scores of self-efficacy, negative emotion [depression (SDS), anxiety (SAS)], intervention compliance (standardized medication, moderate exercise, healthy diet, and regular review), and nursing satisfaction were calculated before and after intervention for the two groups.

RESULTS

Before intervention, there was no significant difference in the scores of disease general management self-efficacy, disease management self-efficacy, and total self-efficacy between the two groups (P = 0.795, 0.479, and 0.659, respectively). After intervention, these three scores in the research group were higher than those in the control group (P < 0.001). Before intervention, there was no significant difference in the scores of SAS and SDS between the two groups (P = 0.149 and 0.347, respectively). After intervention, the scores of SAS and SDS in the research group were lower than those in the control group (P < 0.001). The standardized drug use rate (97.87%), moderate exercise rate (97.87%), healthy diet rate (95.74%), and regular reexamination rate (97.87%) in the research group were higher than those in the control group (85.11%, 82.98%, 80.85%, and 87.23%, respectively) (P = 0.027, 0.014, 0.025, and 0.049, respectively). Nursing job satisfaction in the research group (93.62%) was higher than that in the control group (78.72%) (P = 0.036).

CONCLUSION

A nursing program based on Maslow’s hierarchy of needs theory can effectively alleviate negative emotion, enhance self-efficacy and intervention compliance, and ensure that the patients are highly satisfied with the nursing work.

Self-care in spinal cord injuries inventory (SC-SCII) and self-care self-efficacy scale in spinal cord injuries (SCSES-SCI): development and psychometric properties

STUDY DESIGN

Validation cross-sectional study.

OBJECTIVES

To develop and assess the psychometric properties of two instruments based on the middle-range theory of self-care in chronic illness: the Self-Care in Spinal Cord Injuries Inventory (SC-SCII) and the Self-Care Self-Efficacy Scale in Spinal Cord Injuries (SCSES-SCI).

SETTING

Multicenter study in five spinal units across Italy and Ireland.

METHODS

Instrument development was based on self-care behaviours identified in the scientific literature. Behaviours were grouped into four dimensions during a consensus conference: self-care maintenance, self-care monitoring, self-care management and self-care self-efficacy. Sixty-seven items were subsequently generated based on these dimensions. A multidisciplinary group of 40 experts evaluated content validity. Dimensionality of the final items was tested by confirmatory factor analyses (CFA) with a sample of 318 participants. Internal consistency and test-retest reliability were evaluated for each dimension. Construct validity was assessed using correlations between items and scoring differences amongst participants with more severe conditions and secondary complications.

RESULTS

Content validity of the SC-SCII and SCSES-SCI was satisfactory for thirty-five of the previously generated items, which were further refined. CFA showed comparative fit indexes ranging from 0.94 to 0.97 and root mean square errors of approximation from 0.03 to 0.07. Internal consistency ranged from 0.71 to 0.85, and intraclass correlation coefficients were higher than 0.70. Correlations among dimensions were moderate, and the theoretical hypotheses formulated when designing the instruments were largely confirmed.

CONCLUSIONS

The SC-SCII and the SCSES-SCI represent valid and reliable theoretically-grounded instruments to assess self-care in people with spinal cord injury.

Psychometric Testing of the Self-care of Hypertension Inventory Version 3.0

In this updated Self-care of Hypertension Inventory Version 3.0 (SC-HI v3.0), items were added to better reflect the Theory of Self-care of Chronic Illness and revised based on recent research. The reorganized and expanded SC-HI now reflects the theoretical concepts of self-care maintenance, monitoring, and management.

OBJECTIVE

To evaluate the psychometric properties of the SC-HI v3.0, we conducted exploratory factor analyses. Here, we report on its reliability and construct validity.

METHODS

A sample of 200 adults with chronic hypertension completed a sociodemographic survey and the SC-HI v3.0. Exploratory factor analyses were conducted on item sets using principal factor method for analyzing the correlation matrix. Reliability was calculated using common factor coefficient of determinacy for multidimensional scales, for which values greater than 0.80 are considered adequate.

RESULTS

The sample was 83.4% non-Hispanic White; 56% were women, with a mean age of 62.2 ± 12.5 years. The self-care maintenance scale (mean, 75.9 ± 13.6) had adequate reliability (ρ = 0.81, 0.80) for a 2-dimensional model of self-care maintenance identified as autonomous and consultative behaviors. The new self-care monitoring scale (mean score, 58.5 ± 21.99) had a single-factor solution with very good reliability (ρ = 0.94). The self-care management scale (mean score, 64.5 ± 19.5) had a single-factor solution, with moderate to strong factor loadings (0.22-0.68) and acceptable reliability (ρ = 0.84).

CONCLUSIONS

Initial testing suggests that the SC-HI v3.0 is a sound measure of the essential elements of self-care for adults with chronic hypertension. With the new self-care monitoring scale, the SC-HI v3.0 is a valid reflection of the theory on which it is based.

Comparing medication adherence using a smartphone application and electronic monitoring among patients with acute coronary syndrome

AIM

The purpose of this study was to determine the extent of agreement between adherence measures obtained using two technological interventions, electronic monitoring (EM) and a smartphone application (App).

BACKGROUND

Clinicians, patients, and researchers depend on valid measurements of medication adherence to inform the delivery of preemptive care when needed. Technology is routinely used for monitoring medication adherence in both clinical practice and research, yet there is a dearth of research comparing novel App based approaches to traditional approaches used for assessing medication adherence.

METHODS

Adherence rates were captured on both the EM and the App for 3697 daily observations from 44 participants with acute coronary syndrome over 90 days immediately following discharge from acute care. For EM, adherence was measured using EM equipped pill bottles. For the App, adherence was measured by having participants upload daily photos to the App prior to taking their daily aspirin. Agreement was assessed using a Bland-Altman analysis.

RESULTS

The mean adherence rate was higher on the App, 92%, than the EM, 78% (p < 0.001). The mean difference in adherence rates between these methods was 14% (95% Confidence Interval: -23%, -5%).

CONCLUSIONS

These findings illustrate a lack of agreement between technological interventions used for measuring adherence in cardiovascular patient populations, with higher adherence rates observed with the App compared to EM. These findings are salient given the increased reliance on telehealth due to the ongoing COVID-19 pandemic.

Chronic disease self-care: A concept analysis

The purpose of this concept analysis is to clarify and analyze the concept of self-care. Self-care is vital in the prevention, control, and management of chronic disease. It is substantially important in all aspects of health and all levels of care, and it is key to chronic disease management. Walker and Avant's (2011) method for concept analysis was used. A literature search was performed using the Cumulative Index to Nursing and Allied Health Literature, Psych INFO, Cochrane Library, Embase, Medline, and Google Scholar databases for relevant articles published between 2000 and 2020 using the search terms self-care, chronic illness, and chronic disease. A total of 22 articles were found for the final analysis. The three defining attributes of self-care include readiness, ability, and activity/practice. Similarly, antecedents (illness/treatment, health systems, and environment) and consequences (health status improvement and wellbeing-related, symptom management-related, cost reduction-related, and personal development-related) of self-care were derived from literature. Constructed cases were created to illustrate these aspects of self-care. Through this concept analysis, the complexity and breadth of the self-care concept are elucidated.

A mixed methods study describing the self-care practices in an older working population with cardiovascular disease (CVD): Balancing work, life and health

BACKGROUND

Self-care is essential to cardiovascular disease (CVD) health outcomes, but may be challenging for older working adults.

OBJECTIVE

Describe self-care and the relationship of work-related characteristics to self-care among older workers with CVD.

METHODS

Convergent mixed methods design (n = 108) assessed self-care, organization of work, job-level and clinical factors; qualitative data (n = 40) explored self-care and working. Data integrated in the final analytic phase.

RESULTS

Sixty-eight percent reported adequate self-care maintenance (SC-CHDI maintenance ≥70); only 22% had adequate self-care management (SC-CHDI management ≥ 70). Controlling for physical capacity, work-related factors explained 22% variance in self-care maintenance; physical capacity was only significant determinant of self-care management. Individuals with poor self-care described low job control, job stress and work-life imbalance that interfered with routine self-care. Individuals with poor self-care management reported "feeling stressed out" and "extreme fatigue" attributed to their job.

CONCLUSIONS

Interventions targeting self-care, stress management and work-life balance among older workers with CVD are needed.

Psychometric testing of the Chinese version of Self-Care of Coronary Heart Disease Inventory

AIM

To psychometrically test the Chinese version of Self-Care of Coronary Heart Disease Inventory.

BACKGROUND

Self-care is a significant step to impede the progression of coronary heart disease and serves as the primary outcome in self-care interventions. In China, however, no instrument is available to measure self-care in patients with coronary heart disease. To address this gap, we introduce the Self-Care of Coronary Heart Disease Inventory into China.

DESIGN

A cross-sectional design.

METHODS

We translated the inventory into Chinese using standardized methods. Then, it was psychometrically tested on a convenience sample of 301 patients with coronary heart disease (October 2017 to May 2018). Construct validity was evaluated via exploratory factor analysis and testing hypotheses. Internal consistency reliability was measured with Cronbach's alpha or composite reliability.

RESULTS

Both self-care maintenance and management subscales showed a two-factor structure, whereas self-care confidence subscale showed a one-dimension structure. All subscales were significantly correlated with associated variables (disease-related knowledge and perceived control). The internal consistency reliability for all three subscales was acceptable.

CONCLUSION

The Chinese version showed acceptable psychometric properties when applied to the sample group of this study. It is recommended for use in self-care interventions targeting coronary heart disease.

The effectiveness of dialectical behavior therapy on adherence to treatment and self-caring behavior in patients with coronary heart disease

BACKGROUND

The aim of this study was to investigate the effectiveness of dialectical behavior therapy (DBT) on adherence to treatment and self-caring behavior in patients with coronary heart disease (CHD).

METHODS

This was an experimental study based on control and experimental groups with pre-test and post-test. 32 male and female patients with CHD having at least high school diploma, referring to Isfahan cardiovascular research institute, Isfahan, Iran, were selected and placed randomly in two groups of control and experimental. Pre-test stage was done for both two groups by 8-item Morisky Medication Adherence Scale (MMAS-8) and Self-Care of Coronary Heart Disease Inventory (SC-CHDI). The experimental group was placed under the intervention of DBT for 8 sessions of 2 hours (once a week). Afterwards, the post-test was done for both groups.

RESULTS

It was shown by analyzing results from t-test that adherence to treatment and self-care behavior significantly increased in experimental group comparing to control group [(1.81 ± 0.75 vs. 5.19 ± 1.22, P < 0.001) and (72.50 ± 4.38 vs. 55.50 ± 7.42, P < 0.001), respectively]. Also results showed that self-caring and adherence to treatment significantly increased after being adjusted for baseline measurement (P < 0.001). The findings showed that DBT had effect on adherence to treatment and self-caring behavior of patients with CHD.

CONCLUSION

On the basis of results, it could be said that DBT intervention can have positive impact on adherence to treatment and self-caring behavior of patients with CHD.

Development of an Instrument for Measuring Self-Care Behaviors After Left Ventricular Assist Device Implantation

Background:

Successful long-term left ventricular assist device (LVAD) therapy necessitates a high degree of self-care. We aimed to develop an instrument that measures self-care behaviors in adult patients living with an LVAD.

Methods:

We used the method to develop patient-reported outcomes recommended by the US Food and Drug Administration. Prior to developing the instrument, a literature review was conducted to generate items using the middle-range theory of self-care of chronic illness as a guiding framework. A 2-round Delphi method, involving 17 clinicians with expertise in heart failure and assist devices from the Netherlands, Israel, United States, Canada, and Japan, was used to generate and select items. In the first Delphi survey, the levels of importance, relevance, and clarity of items in the instrument were evaluated. The second Delphi survey was performed to gain consensus on the final selection of items. We also examined face validity.

Results:

A preliminary 37-item version of the Self-Care Behavior Scale was produced. The first panel judged 33 items as important and relevant, taking out 4 items due to vague wording and duplication and adding in 4 items. In the final 33-item version, 19 items address self-care maintenance behaviors, 10 items address self-care monitoring behaviors, and 4 items address self-care management behaviors. Patients (N = 25) did not have any difficulties understanding items and report any missing items.

Conclusion:

The 33-item Self-Care Behavior Scale for patients with heart failure having an LVAD has been developed and is ready for further psychometric testing.

Application of meta-summary to derive a measurement instrument from the literature: a method exemplar

BACKGROUND

Measurement tools are a common method to collect data in observational and survey research. Nurse researchers have developed numerous scales and instruments, many derived from published literature. However, few studies report systematic or replicable approaches to analysing the literature from which measures were derived. This is a significant challenge to construct validity.

AIM

To provide a method exemplar of meta-summary and categorical factor analysis to refine scale items and establish construct definition.

DISCUSSION

A rigorous method for deriving items from the literature is largely absent from nursing literature. This exemplar addresses the often-cited limitation of scales that authors rarely assure content validity before experts assess their newly derived scales.

CONCLUSION

Without sufficient methodological rigour, practitioners and researchers must speculate about the content validity of newly derived instruments. Meta-summary provides a useful approach to developing scales from the literature.

IMPLICATIONS FOR PRACTICE

The method detailed here is of use when deriving measurement instruments from the literature. It provides a systematic and replicable strategy that assures construct validity.

Therapeutic effect of irbesartan combined with atorvastatin calcium in the treatment of rats with coronary heart disease

This study aimed to investigate the therapeutic effect of irbesartan combined with atorvastatin calcium in the treatment of rats with coronary heart disease. One hundred sixty Wistar rats were selected to establish coronary heart disease model. Rats with coronary heart disease were randomly divided into 4 groups: Model, irbesartan, atorvastatin calcium and combination groups (irbesartan combined with atorvastatin calcium group). Rats in irbesartan group were treated with 50 mg/(kg.day) irbesartan; rats in atorvastatin calcium group were given atorvastatin calcium at a dose of 10 mg/(kg.day); rats in combination group were subjected to atorvastatin calcium at a dose of 10 mg/(kg.day) and irbesartan at a dose of 50 mg/(kg.day), while rats in model groups were given intragastric administration of normal saline at a dose of 2 ml/day. Serum lipids, including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and TC/HDL-C, were measured by automatic biochemical analyzer. Expression of sPLA2-V in myocardium and aortic trunk of rats was detected by reverse transcription-PCR (RT-PCR) and western blot analysis. After treatment, levels of serum TC, TG, LDL-C, HDL-C and TC/HDL-C in rats of each treatment group were better than those in model group (p<0.05). Expression level of sPLA2-V in myocardium and aortic trunk in model group was significantly higher than that in other groups (p<0.05). Expression level of sPLA2-V in combination group was significantly lower than that in irbesartan and atorvastatin calcium groups (p<0.05). Combination of irbesartan and atorvastatin calcium is superior to irbesartan or atorvastatin calcium alone in the treatment of rats with coronary heart disease. The possible explanation is that the two drugs can reduce the expression of sPLA2-V in myocardium and aortic trunk, which in turn relieved atherosclerosis and achieved better therapeutic effect.

Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association

Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.