1
|
Zou X, Sun P, Chen M, Nan J, Gao J, Huang X, Hou Y, Jiang Y. Experience of Older Patients with COPD Using Disease Management Apps: A Qualitative Study. Healthcare (Basel) 2024; 12:802. [PMID: 38610224 PMCID: PMC11011793 DOI: 10.3390/healthcare12070802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Digital medicine is developing in the management of chronic diseases in older people, but there is still a lack of information on the use of disease management apps in older patients with COPD. This study aims to explore the views and experience of older patients with COPD on disease management apps to provide a basis for the development and promotion of apps for geriatric diseases. (2) Methods: A descriptive qualitative research method was used. Older patients with COPD (N = 32) with experience using disease management apps participated in semi-structured interviews. Thematic analysis was used to analyze the data. (3) Results: Seven themes were defined: (a) feeling curious and worried when facing disease management apps for the first time; (b) actively overcoming barriers to use; (c) gradually becoming independent by continuous online learning; (d) feeling safe in the virtual environment; (e) gradually feeling new value in online interactions; (f) relying on disease management apps under long-term use; (g) expecting disease management apps to meet personalized needs. (4) Conclusions: The adoption and use of disease management apps by older people is a gradual process of acceptance, and they can obtain a wide range of benefits in health and life.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Yuyu Jiang
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (X.Z.); (P.S.); (M.C.); (J.N.); (J.G.); (X.H.); (Y.H.)
| |
Collapse
|
2
|
Skeens R, Cavanaugh KL, Cronin R, Chen Q, Liu Y, Huth H, Jackson GP. Parent Activation in the Neonatal Intensive Care Unit. Am J Perinatol 2023; 40:1413-1420. [PMID: 34638138 DOI: 10.1055/s-0041-1736294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Patient activation is the knowledge, skills, and confidence to manage one's health; parent activation is a comparable concept related to a parent's ability to manage a child's health. Activation in adults is a modifiable risk factor and associated with clinical outcomes and health care utilization. We examined activation in parents of hospitalized newborns observing temporal trends and associations with sociodemographic characteristics, neonate characteristics, and outcomes. STUDY DESIGN Participants included adult parents of neonates admitted to a level-IV neonatal intensive care unit in an academic medical center. Activation was measured with the 10-item Parent version of the Patient Activation Measure (P-PAM) at admission, discharge, and 30 days after discharge. Associations with sociodemographic variables, health literacy, clinical variables, and health care utilization were evaluated. RESULTS A total of 96 adults of 64 neonates were enrolled. The overall mean P-PAM score on admission was 81.8 (standard deviation [SD] = 18), 88.8 (SD = 13) at discharge, and 86.8 (SD = 16) at 30-day follow-up. Using linear mixed regression model, P-PAM score was significantly associated with timing of measurement. Higher P-PAM scores were associated with higher health literacy (p = 0.002) and higher in mothers compared to fathers (p = 0.040). There were no significant associations of admission P-PAM scores with sociodemographic characteristics. Parents of neonates who had a surgical diagnosis had a statistically significant (p = 0.003) lower score than those who did not. There were no associations between discharge P-PAM scores and neonates' lengths of stay or other indicators of illness severity. CONCLUSION Parental activation in the NICU setting was higher than reported in the adult and limited pediatric literature; scores increased from admission to discharge and 30-day postdischarge. Activation was higher in mothers and parents with higher health literacy. Additional larger scale studies are needed to determine whether parental activation is associated with long-term health care outcomes as seen in adults. KEY POINTS · Little is known about activation in parents of neonates.. · Activation plays a role in health outcomes in adults.. · Larger studies are needed to explore parent activation..
Collapse
Affiliation(s)
- Ryan Skeens
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kerri L Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Cronin
- Department of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - QinGxia Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuhan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hannah Huth
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gretchen P Jackson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- IBM Watson Health, Cambridge, Massachusetts
| |
Collapse
|
3
|
Rojo MO, Prince LY, Li C, McSweeney JC. Heart Disease Knowledge and Awareness in African American and Hispanic Women. South Med J 2023; 116:783-789. [PMID: 37788811 PMCID: PMC10558080 DOI: 10.14423/smj.0000000000001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Coronary heart disease (CHD) is the leading cause of morbidity and mortality among US women. Minority women have higher rates of CHD and are more likely to experience adverse outcomes. Because of racial disparities in CHD outcomes, the purpose of this study was to assess CHD knowledge and awareness in African American and Hispanic women. METHODS Using a survey research design, a convenience sample of African American and Hispanic women was surveyed in their local communities. CHD knowledge, awareness, and demographic data were collected using an online survey. The survey was administered in English and Spanish using an iPad. CHD knowledge was assessed using a 7-item survey based on the American Heart Association's Life's Simple 7 brochure. CHD awareness was assessed using a 7-item survey adapted from the American Heart Association's Survey of Women's Cardiovascular Disease Awareness. CHD knowledge was scored on a scale of 0 to 7, and awareness was assessed based on responses to each question. The data analysis consisted of cross-tabulations and multivariable repeated measures analysis. We assessed differences in CHD knowledge and awareness based on race/ethnicity. We hypothesized that there would be statistically significant differences in CHD knowledge and awareness based on specific demographic factors (eg, age, income, education, health literacy). RESULTS A total of 100 African American (n=50) and Hispanic (n = 50) women participated in the study. Results revealed that CHD knowledge and awareness were limited for both groups. Seventy-three percent of participants (African American 66%; Hispanic 80%) did not know that CHD is the leading cause of death in women and 75% (African American 60%; Hispanic 90%) were moderately or not at all informed about CHD. CONCLUSIONS These findings support the need for more research on innovative strategies to improve CHD knowledge and awareness, particularly in African American and Hispanic women who are at highest risk, thereby addressing racial/ethnic and gender disparities in CHD morbidity and mortality.
Collapse
Affiliation(s)
| | | | - Chenghui Li
- the College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | |
Collapse
|
4
|
Meraz R, McGee J, Caldwell EP, Ke W, Osteen K. The Impact of Resilience, Health Literacy, and Social Support on Medication Adherence and Self-care Among Adults With Heart Failure. J Cardiovasc Nurs 2023; 38:415-424. [PMID: 36103430 DOI: 10.1097/jcn.0000000000000948] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Personal and psychological factors, such as depression, have a considerable influence on nonadherence to medications and self-care in those with heart failure. More evidence is needed about positive personal factors that motivate adherence to medications and self-care in those with heart failure. OBJECTIVE The purpose of this study was to investigate whether there was a relationship between the personal resources of resilience, hope, health literacy, social support, and self-care activation and adherence to HF self-care and medications and whether race impacts adherence. METHODS This study used a cross-sectional, correlational design. Stepwise regression was used to test whether resilience, hope, health literacy, self-care activation, and race significantly predicted medication adherence and self-care. A diverse sample was recruited for this study. RESULTS Of the 174 participants, 51% were female, 51.7% were White, and the mean age was 62 years. After adjustment for differences in age and depressive symptoms, a predictive relationship remained between resilience, health literacy, and medication adherence. Hope, activation, and race were not selected in the final regression model. A high level of perceived social support was the only predictor of better HF self-care. CONCLUSION Persons with heart failure may have better medication adherence and overall self-care if sufficiently resilient, health literate, and supported regardless of their degree of hope or activation. Race and age may be important factors to consider. More research is needed to understand the connection between resilience and medication adherence.
Collapse
|
5
|
Dinh TTH, Bonner A. Exploring the relationships between health literacy, social support, self-efficacy and self-management in adults with multiple chronic diseases. BMC Health Serv Res 2023; 23:923. [PMID: 37649013 PMCID: PMC10466814 DOI: 10.1186/s12913-023-09907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/12/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Self-management in chronic diseases is essential to slowing disease progression and preventing complications. However, empirical research on the associations of critical factors, such as health literacy, social support, and self-efficacy with self-management in the context of multiple chronic diseases is scarce. This study aimed to investigate these associations and provides insights for healthcare providers to develop effective educational strategies for people with multiple chronic diseases. METHODS Using a cross-sectional survey design, adults (n = 600) diagnosed with at least two chronic diseases were conveniently recruited. To measure health literacy, social support, self-efficacy, and chronic disease self-management behaviours, the Health Literacy Questionnaire (HLQ), Medical Outcome Study - Social Support Survey, Self-efficacy in Managing Chronic Disease, and Self-management in Chronic Diseases instruments were utilized respectively. Comorbidity status was assessed using Age-adjusted Charlson Comorbidity Index (ACCI). A generalised linear regression model was used with a backward technique to identify variables associated with self-management. RESULTS Participants' mean age was 61 years (SD = 15.3), 46% were female, and most had up to 12 years of education (82.3%). Mean scores for HLQ domains 1-5 varied from 2.61 to 3.24 (possible score 1-4); domains 6-9 from 3.29 to 3.65 (possible score 1-5). The mean scores were 52.7 (SD = 10.4, possible score 0-95), 5.46 (SD = 1.9, possible score 0-10) and 82.1 (SD = 12.4, possible score 30-120) for social support, self-efficacy, and self-management, respectively. Mean ACCI was 6.7 (SD = 2.1). Eight factors (age > 65 years, being female, 4 health literacy domains, greater social support, and higher self-efficacy levels) were significantly associated with greater self-management behaviours while comorbidity status was not. The factors that showed the strongest associations with self-management were critical health literacy domains: appraisal of health information, social support for health, and healthcare provider support. CONCLUSIONS Developing critical health literacy abilities is a more effective way to enhance self-management behaviours than relying solely on self-confidence or social support, especially for people with multiple chronic diseases. By facilitating communication and patient education, healthcare providers can help patients improve their critical health literacy, which in turn can enhance their self-management behaviours.
Collapse
Affiliation(s)
- Thi Thuy Ha Dinh
- School of Nursing, University of Tasmania, Launceston, TAS, Australia.
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia.
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| |
Collapse
|
6
|
Zhao Q, Zhang Y, Dong X, Zhang X, Fan X. The effects of weight management on heart failure: A systematic review and meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs 2023. [PMID: 37368482 DOI: 10.1111/wvn.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 05/18/2023] [Accepted: 05/27/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Weight management is an important part of disease management in patients with heart failure. However, the effectiveness of reported weight management interventions is inconclusive. AIMS The aim of this systematic review and meta-analysis was to assess the effects of weight management on functional status, heart failure-related hospitalizations, and all-cause mortality in patients with heart failure. METHODS PubMed, Web of Science, Embase, and the Cochrane Library were searched on April 3, 2022. This study was registered with PROSPERO (CRD42021283817). Eligible studies assessed functional status, heart failure-related hospitalizations, and all-cause mortality in patients with heart failure. Two researchers independently screened the articles, extracted data, and evaluated the risk bias of each study. Dichotomous variables were presented as OR with a 95% confidence interval (CI). The data were analyzed using a fixed effect or random effect model, and heterogeneity was determined using I2 statistics. All statistical analyses were conducted using RevMan 5.3. RESULTS Among 4279 studies screened, seven randomized controlled trials were included in this study. The results showed that weight management significantly improved functional status (OR = 0.15, 95% CI [0.07, 0.35], I2 = 52%) and reduced the risk of all-cause mortality (OR = 0.54, 95% CI [0.34, 0.85], I2 = 0%), but had no significant effect on heart failure-related hospitalizations (OR = 0.72, 95% CI [0.20, 2.66]). LINKING EVIDENCE TO ACTION Weight management has effects on improved functional status and reduced all-cause mortality in patients with heart failure. It is necessary to strengthen the weight management interventions of patients with heart failure to improve patients' functional status and reduce all-cause mortality.
Collapse
Affiliation(s)
- Qiuge Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yilin Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoyu Dong
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiuting Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiuzhen Fan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
7
|
Passi R, Kaur M, Lakshmi PVM, Cheng C, Hawkins M, Osborne RH. Health literacy strengths and challenges among residents of a resource-poor village in rural India: Epidemiological and cluster analyses. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001595. [PMID: 36963029 PMCID: PMC10022012 DOI: 10.1371/journal.pgph.0001595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 02/19/2023]
Abstract
Cluster analysis can complement and extend the information learned through epidemiological analysis. The aim of this study was to determine the relative merits of these two data analysis methods for describing the multidimensional health literacy strengths and challenges in a resource poor rural community in northern India. A cross-sectional survey (N = 510) using the Health Literacy Questionnaire (HLQ) was undertaken. Descriptive epidemiology included mean scores and effect sizes among sociodemographic characteristics. Cluster analysis was based on the nine HLQ scales to determine different health literacy profiles within the population. Participants reported highest mean scores for Scale 4. Social support for health (2.88) and Scale 6. Ability to actively engage with healthcare professionals (3.66). Lower scores were reported for Scale 3. Actively managing my health (1.81) and Scale 8. Ability to find good health information (2.65). Younger people (<35 years) had much higher scores than older people (ES >1.0) for social support. Eight clusters were identified. In Cluster A, educated younger men (mean age 27 years) reported higher scores on all scales except one (Scale 1. Feeling understood and supported by a healthcare professional) and were the cluster with the highest number (43%) of new hypertension diagnoses. In contrast, Cluster H also had young participants (mean age 30 years) but with low education (72% illiterate) who scored lowest across all nine scales. While epidemiological analysis provided overall health literacy scores and associations between health literacy and other characteristics, cluster analysis provided nuanced health literacy profiles with the potential to inform development of solutions tailored to the needs of specific population subgroups.
Collapse
Affiliation(s)
- Reetu Passi
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| |
Collapse
|
8
|
Chung SY, Bakas T, Rawl SM, Welch J, Jones J, Ellis R, Hacker ED. The Kidney Transplant Self-Management Scale: Instrument Development and Psychometric Testing. West J Nurs Res 2023; 45:34-45. [PMID: 35148648 DOI: 10.1177/01939459211072368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study reports the development and psychometric testing of the Kidney Transplant Self-Management Scale (KT-SMS). The instrument development phase included the following: (a) conceptual definition, item generation, and framework; (b) face validity assessment; and (c) content validity assessment. The psychometric testing phase included the following: (a) construct validity testing; (b) internal consistency reliability testing; (c) convergent validity testing; and (d) predictive power of the KT-SMS using a cross-sectional sample of kidney transplant recipients (N = 153). Factor analysis results supported the 16-item KT-SMS as multidimensional with five domains (medication adherence, cardiovascular risk reduction, protecting kidney, ownership, and skin cancer prevention). Internal consistency reliability for the total scale and five subscales was adequate. Convergent validity was supported as the intercorrelations of the KT-SMS total score with the five subscales were significant. The KT-SMS total score and five subscales were significantly correlated with self-efficacy for managing chronic disease, patient activation, and health-related quality of life.
Collapse
Affiliation(s)
- Shu-Yu Chung
- School of Nursing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Susan M Rawl
- School of Nursing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Janet Welch
- School of Nursing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Josette Jones
- School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Rebecca Ellis
- School of Nursing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Eileen D Hacker
- School of Nursing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| |
Collapse
|
9
|
The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care. J Cardiovasc Nurs 2022; 37:515-529. [PMID: 35482335 PMCID: PMC9561231 DOI: 10.1097/jcn.0000000000000919] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care.
Collapse
|
10
|
Zhao Q, Zhang J, Ye Y, Chen C, Fan X. Experiences of Disease Adaptationin Patients With Heart Failure: A Qualitative Study. Clin Nurs Res 2022; 31:1287-1295. [PMID: 35301880 DOI: 10.1177/10547738221082208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to explore the experiences of adaptation in heart failure (HF) patients according to the Roy adaptation model. A qualitative study was conducted between December 2020 and March 2021 in China. A total of 21 patients with HF were recruited at of two general hospitals. Semi structured face-to-face interviews were conducted with each participant. NVivo 11 was used to encode the transcription and thematic analysis was preformed to analyze the transcripts. Eleven minor themes emerged from the data, namely unbalanced nutrition, inappropriate activities, unrestricted liquid intake, excessive sodium intake, worrying about the future, negative emotions, poor spiritual aspect, unable to fulfill social roles, forced to stop work, interpersonal alienation, and less communication with friends or family. Most participants with HF experienced poor disease adaptation. The themes that emerged offer a new perspective on the experiences of disease adaptation in patients with HF.
Collapse
Affiliation(s)
- Qiuge Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jie Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yi Ye
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Cancan Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiuzhen Fan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| |
Collapse
|
11
|
da Costa Ferreira N, Takao Lopes C, Moorhead S, Gengo E Silva Butcher RDC. Content validation of the nursing outcome Knowledge Heart Failure Management: Brazilian nurses' opinions. Int J Nurs Knowl 2021; 32:206-214. [PMID: 33438336 DOI: 10.1111/2047-3095.12312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/30/2020] [Accepted: 12/27/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To estimate the content validity of the outcome Knowledge: Heart Failure Management (1835) of the Nursing Outcomes Classification (NOC). METHODS A methodological study conducted in Brazil with nurses with expertise in cardiovascular nursing and nursing process. The nurse experts evaluated the relevance of the indicators for the nursing outcome on a 5-point Likert scale. A total of 55 indicators were analyzed, including 50 NOC indicators, four indicators located from a scoping review, and one suggested by an expert during the content validation process. The relevance ratio supported the categorization of indicators as critical, supplemental, or unnecessary. Relevance ratios of critical and supplemental indicators were summed and divided by the total number of the indicators to calculate the outcome content validity (OCV) score of the nursing outcome. FINDINGS Fifteen nurse experts, mostly females (n = 13) with a mean age of 36.0 ± 6.3 years, 13.9 ± 6.5 years of professional experience, and extensive use of the nursing process in their clinical practice (n = 10), teaching (n = 13), and research (n = 11), participated in this study. Regarding the content validation, 43 (78.2%) out of 55 indicators were categorized as critical (relevance ratio .80-.98), 11 (20%) as supplemental (relevance ratio .67-.79), and one indicator (1.8%) was categorized as unnecessary (relevance ratio .48). The OCV score of the nursing outcome was .87. CONCLUSION The study provided evidence of content validity of 49 indicators of the NOC outcome, Knowledge: Heart Failure Management, and five new indicators identified through the validation process based on nurse experts' opinions. IMPLICATIONS FOR THE NURSING PRACTICE These findings provide evidence-based indicators for the measurement of heart failure patients' knowledge about disease management. As a result, nurses can test the effectiveness of nursing interventions based on valid outcome indicators.
Collapse
Affiliation(s)
| | - Camila Takao Lopes
- Adjunct Professor in the Clinical and Surgical Nursing Department of the Paulista School of Nursing, Sao Paulo, SP, Brazil
| | - Sue Moorhead
- Associate Professor, College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Rita de Cassia Gengo E Silva Butcher
- Adjunct Faculty (courtesy), Graduate Program in Adult Health Nursing (PROESA), School of Nursing, University of Sao Paulo, Sao Paulo, SP, Brazil.,Post-doctoral fellow, The Marjory Gordon Program for Clinical Reasoning and Knowledge Development at Boston College, William F. Connell School of Nursing, Boston, Massachusetts, USA
| |
Collapse
|
12
|
|
13
|
Toscos TR, Coupe A, Wagner S, Drouin M, Roebuck AE, Daley CN, Carpenter MD, Mirro MJ. Can nurses help improve self-care of patients living with atrial fibrillation? A focus group study exploring patients' disease knowledge gaps. Nurs Open 2020; 7:998-1010. [PMID: 32587718 PMCID: PMC7308702 DOI: 10.1002/nop2.472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/07/2019] [Accepted: 02/16/2020] [Indexed: 12/18/2022] Open
Abstract
Aims To identify knowledge gaps and preferences for educational material to improve nurse-patient communication and self-care. Design Using a mixed-methods design, we conducted focus groups and quantitative surveys. Methods We conducted three focus groups with atrial fibrillation (AF) patients and support persons (N = 17 participants; 66 ± 16 years) at critical treatment junctures (recent diagnosis or medication switch). Patients and support persons were also surveyed on patient activation (self-management skills and knowledge), medication adherence, AF knowledge and health literacy. Iterative thematic analysis was performed using focus group transcripts. Results Although most participants had adequate health literacy, most reported gaps in AF knowledge. Participants lacked disease-related knowledge and were unsure how to manage health behaviours (e.g. diet and exercise). Few felt they received adequate education from their healthcare provider. Results emphasize the need for consistent information from nursing staff, in lay language, via both electronic and printed means.
Collapse
Affiliation(s)
- Tammy R. Toscos
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Indiana University School of Informatics and ComputingIndianapolisIndiana
| | - Amanda Coupe
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Shauna Wagner
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Michelle Drouin
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Psychology DepartmentPurdue University Fort WayneFort WayneIndiana
| | - Amelia E. Roebuck
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Carly N. Daley
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Indiana University School of Informatics and ComputingIndianapolisIndiana
| | - Maria D. Carpenter
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Michael J. Mirro
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Indiana University School of Informatics and ComputingIndianapolisIndiana
- Indiana University School of MedicineIndianapolisIndiana
| |
Collapse
|
14
|
Abstract
Heart failure is a complex clinical syndrome most commonly encountered among older adults. This complex clinical syndrome is associated with poor health outcomes such as frequent admissions and mortality. These adverse outcomes are commonly associated with poor self-care and lower health literacy. Literacy is a combination of knowledge and skills and often reflected by appropriate interaction with the community, while health literacy is the cognitive and social skills reflected by accessing and comprehending health information and making appropriate health decisions. These decisions are common and challenging to patients with heart failure. Poor outcomes are said to be reduced by adequate self-care, which is associated with health literacy among heart failure patients. Better self-care was also shown to be associated with self-efficacy and self-confidence that were in turn associated with health literacy. Hence, enhancing health literacy among patient with heart failure is critical to enable them to increase control over their disease by better understanding and participating in health care, while being empowered to take part in designing health care services and even tailoring research to serve their needs and consequently improve outcome at the individual and community level. In clinical practice, assessing health literacy, measuring health literacy, and identifying patients at risk of low nutrition literacy is important to enhance health literacy and health outcomes. Hence, developing reliable and valid methods and tools for assessment and developing tailored and targeted interventions is of critical importance.
Collapse
|
15
|
Yadav UN, Lloyd J, Hosseinzadeh H, Baral KP, Bhatta N, Harris MF. Self-management practice, associated factors and its relationship with health literacy and patient activation among multi-morbid COPD patients from rural Nepal. BMC Public Health 2020; 20:300. [PMID: 32143673 PMCID: PMC7060575 DOI: 10.1186/s12889-020-8404-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/25/2020] [Indexed: 02/08/2023] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is a progressive and debilitating condition that affects individuals’ quality of life. COPD self-management and supports provided by carers is key to the quality of life people living with COPD. Health literacy (HL) and Patient Activation (PA) are main drivers of self-management practices (SMPs). However, their contribution remains to be fully explored. This study aimed to examine the level of self-management practices, and the relationship with socio-demographic factors, HL and PA among multi-morbid COPD patients from rural Nepal. Methods This is a cross-sectional study conducted between July 2018 and January 2019. Patients completed a survey, including Self-management Practices questionnaire (SMPQ), five domains of the Health Literacy Questionnaire (HLQ), and Patient Activation Measure (PAM). The relationship between HL, PAM, and SMPs was examined using univariate statistics. Multivariable analysis was conducted to identify the factors associated with SMPs. Results A total of 238 patients responded to the study. The mean score of SMPQ was 45.31(SD = 9.00). The HLQ and PAM scores were positively correlated with the total score of SMPQ. Low level of SMPs were found to be positively associated with being uneducated (β = − 0.43, p = .001), having a low family income (β = − 5.22, p = .002), and, negatively associated with the presence of more than one co-morbidity (β = 3.58, p = 0.007) after controlling for other socio-demographic variables in the multivariable analysis. Conclusion The overall SMPs among this sample of Nepalese with COPD were low. Our findings highlight the need to implement a self-management intervention program involving patient activation and health literacy-focused activities for COPD, creating a support system for patients from low-income families and low education.
Collapse
Affiliation(s)
- Uday Narayan Yadav
- Centre for Primary Health Care and Equity, UNSW, Sydney, Australia. .,Forum for Health Research and Development, Dharan, Nepal.
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, UNSW, Sydney, Australia
| | | | - Kedar Prasad Baral
- School of Public Health, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Narendra Bhatta
- Department of Pulmonary, Critical Care and Sleep Medicine, B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Mark Fort Harris
- Centre for Primary Health Care and Equity, UNSW, Sydney, Australia
| |
Collapse
|
16
|
Do Chronic Obstructive Pulmonary Diseases (COPD) Self-Management Interventions Consider Health Literacy and Patient Activation? A Systematic Review. J Clin Med 2020; 9:jcm9030646. [PMID: 32121180 PMCID: PMC7141381 DOI: 10.3390/jcm9030646] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/14/2020] [Accepted: 02/26/2020] [Indexed: 12/27/2022] Open
Abstract
Self-management (SM) includes activities that patients initiate and perform in the interest of controlling their disease and maintaining good health and well-being. This review examines the health literacy and patient activation elements of self-management interventions for Chronic Obstructive Pulmonary Diseases (COPD) patients. We investigated the effects of the intervention on health-related quality of life, self-efficacy, depression, and anxiety among people with COPD. We conducted a systematic review of studies evaluating the efficacy of self-management interventions among COPD patients that also included health literacy or patient activation as keywords. Four electronic databases Medline, EMBASE, PsycINFO, and Google Scholar, were searched to identify eligible studies. These studies were screened against predetermined inclusion criteria. Data were extracted according to the review questions. Twenty-seven studies met the criteria for inclusion. All of the included studies incorporated health literacy components and focused on COPD and self-management skills. Three studies measured health literacy; two showed improvements in disease knowledge, and one reported a significant change in health-related behaviors. Seventeen studies aimed to build and measured self-efficacy, but none measured patient activation. Eleven studies with multicomponent interventions showed an improvement in quality of life. Six studies that focused on specific behavioral changes with frequent counseling and monitoring demonstrated improvement in self-efficacy. Two interventions that used psychosocial counseling and patient empowerment methods showed improvement in anxiety and depression. Most self-management interventions did not measure health literacy or patient activation as an outcome. Successful interventions were multicomponent and comprehensive in addressing self-management. There is a need to evaluate the impact of comprehensive self-management interventions that address and measure both health literacy and patient activation on health outcomes for COPD patients.
Collapse
|
17
|
Kong LN, Zhu WF, Li L, Lei QS, Wang T, Li YL. Self-management behaviors in adults with chronic hepatitis B: A structural equation model. Int J Nurs Stud 2019; 116:103382. [PMID: 31402047 DOI: 10.1016/j.ijnurstu.2019.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Chronic hepatitis B is a serious and chronic health problem, requiring self-management to control the disease and related complications. OBJECTIVES To develop a structural model to identify how social support, self-efficacy and disease knowledge contribute to their self-management behaviors in adults with chronic hepatitis B. DESIGN A cross-sectional study. SETTINGS Hepatology units in two hospitals in Chongqing, China. PARTICIPANTS A total of 306 patients with chronic hepatitis B were recruited. METHODS Data were collected using Social Support Rating Scale, Self-Efficacy for Managing Chronic Disease, Hepatitis B Knowledge Questionnaire and Chronic Hepatitis B Self-Management Scale. Structural equation model was applied to analyze the data. RESULTS The final model showed good model fit. Social support directly influenced self-management behaviors (β = 0.19, p < 0.01), and indirectly influenced self-management behaviors (β = 0.20, p < 0.01) through self-efficacy. Self-efficacy directly influenced self-management behaviors (β = 0.37, p < 0.05). Disease knowledge indirectly influenced self-management behaviors (β = 0.12, p < 0.05) through self-efficacy. CONCLUSIONS Our findings indicated that social support, self-efficacy and disease knowledge directly or indirectly affected self-management behaviors in adults with chronic hepatitis B. This provides a theoretical basis for developing self-management interventions for patients with chronic hepatitis B, which may lead to health improvements in this population.
Collapse
Affiliation(s)
- Ling-Na Kong
- School of Nursing, Chongqing Medical University, Chongqing, PR China; School of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.
| | - Wen-Fen Zhu
- School of Nursing, Chongqing Medical University, Chongqing, PR China
| | - Lin Li
- Department of Liver Disease, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, PR China
| | - Qing-Song Lei
- Department of Oncology Radiotherapy Center, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, PR China
| | - Tian Wang
- Department of Infectious Disease, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yi-Lan Li
- Department of Infectious Disease, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| |
Collapse
|