The Individual and Family Self-Management Theory: background and perspectives on context, process, and outcomes

Understanding crisis needs among family caregivers of patients in critical care: A qualitative analysis

BACKGROUND

Family caregivers often experience shock and disorientation when a patient is admitted to critical care. Developing interventions to assist caregivers during this crisis requires a more in-depth understanding of their needs.

OBJECTIVE

Our aim was to understand family caregivers' needs during a patient's critical care admission and early hospitalisation and differences in needs by caregiver anxiety level.

METHODS

We conducted a descriptive mixed-method study. Forty semistructured interviews were conducted with family caregivers of mechanically ventilated critical care patients. The Hospital Anxiety and Depression Scale was also administered. Crisis theory was used to guide this analysis. The data were analysed by content analysis and then stratified by anxiety level to examine differences across groups. Consolidated Criteria for Reporting Qualitative Research were followed.

SETTING

Two intensive care units at a large, tertiary academic medical centre were a part of this study.

FINDINGS

Caregivers at all anxiety levels described needs involving information and emotional processing, social support, and self-care, with differences across anxiety groups. Caregivers with anxiety and borderline anxiety expressed limited capacity to think past the current moment, whilst caregivers with low anxiety actively used information to consider next steps and prepare others. Emotional processing appeared more limited in the anxiety and borderline-anxiety groups. Whilst most caregivers reported receiving some degree of social support, some caregivers with anxiety noted family tension, whilst caregivers with borderline and low anxiety had a wider variety of supportive relationships. Caregivers with anxiety reported distress influenced their self-care, whilst caregivers with borderline and low anxiety received tangible help from other family members for self-care.

CONCLUSION

Family caregivers of critical care patients experience needs during early hospitalisation, although the specific needs differ by caregiver anxiety level.

The Process of Inefficient Self-Management in Patients With Myocardial Infarction in Prehospital: A Grounded Theory

Introduction

Myocardial infarction (MI) is a cardiovascular emergency that needs immediate diagnosis and treatment. utilizing incorrect strategies during a MI may lead to adverse consequences and complications. This study was conducted to explore the process of prehospital management of patients with MI.

Methods

This study was conducted using the grounded theory design. fifteen patients with MI and six family members were purposefully and theoretically selected from a leading hospital in Kashan, Iran. Data were collected using unstructured and semi-structured interviews and were analyzed through the constant comparison method proposed by Corbin and Strauss (2015). The length of the interviews was 40-60 min and data collection were kept on to reach data saturation.

Results

The patients' mean age was 70.06 years, and 53.3% of them were male. The findings were categorized into three major categories and nine subcategories. The three major categories of "fighting between awareness and preference," "taking problematic arbitrary measures," and "consulting lay people" emerged from the participants' experiences, along with the theme of "inefficient self-management."

Conclusion

Complex situation, unfamiliarity with MI and its management makes MI management very difficult for patients and family members. Therefore, MI-specific educations are needed to improve patients' self-management abilities.

Predictors of self-management behaviors among patients undergoing hemodialysis

Inadequate self-management has a significant impact on the mortality and morbidity of patients undergoing hemodialysis. The capacity for self-management is contingent on demographic, clinical, psychosocial, and cognitive factors. In particular, the role of family support and quality social interactions in this process is significant. The Individual and Family Self-Management Theory (IFSMT) emphasizes the integration of self-management into the lifestyles of the individual and family. Therefore, this study aimed to investigate the factors that affect self-management in patients undergoing hemodialysis based on IFSMT. Data were collected from three tertiary-level hospitals in Korea from May to October 2021. A total of 140 patients with chronic kidney disease undergoing hemodialysis completed a structured self-report questionnaire comprising questions on general characteristics, complexity of disease management, accessibility to healthcare services, health literacy, family functioning, self-efficacy, self-regulation, social support, and self-management behaviors. Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA with Scheffé test as post-hoc analysis, Pearson's correlation analysis, and hierarchical multiple regression analysis. The study found that self-management in patients undergoing hemodialysis was influenced by "health literacy" contextual factor and "self-efficacy," "self-regulation," and "social support" process factors, based on the IFSMT framework. These factors accounted for 45.0% of the variance in self-management. These findings highlight the importance of the IFSMT in predicting self-management behavior in patients undergoing hemodialysis. It is essential to develop a comprehensive intervention that incorporates these contextual and process factors within the family setting, and future research should evaluate its effectiveness.

Development and Systematic Evaluation of a Progressive Web Application for Women With Cardiac Pain: Usability Study

BACKGROUND

Cardiac pain has been widely considered to be the primary indicator of coronary artery disease. The presentation of cardiac pain and associated symptoms vary in women, making it challenging to interpret as cardiac, possibly cardiac, or noncardiac. Women prefer to consult with family and friends instead of seeking immediate medical care.

OBJECTIVE

This study aimed to assess the user performance (ie, ease of use, efficiency, and errors) and user satisfaction (System Usability Scale; SUS) of a progressive web application for women with cardiac pain.

METHODS

Following ethics approval, a purposive sample of women aged >18 years with cardiac pain or associated symptoms lasting >3 months and able to speak and read English was recruited to participate in 2 iterative usability testing cycles. The first cycle assessed the performance of and satisfaction with at heart using a web application, and the second cycle assessed the performance of and satisfaction with at heart across various Android and iOS devices. In total, 2 investigators recorded user comments and documented problems. At the end of the testing session, the participants completed the SUS and 4 semistructured interview questions.

RESULTS

In total, 10 eligible women participated in usability testing from March 31, 2020, to April 17, 2020 (cycle 1), and from November 17, 2020, to November 30, 2020 (cycle 2). Women across usability testing cycles had a mean age of 55.6 (SD 7.3) years, and most (9/10, 90%) were well educated. In total, 50% (5/10) were employed full or part time, and 60% (6/10) earned >CAD $70,000 (US $48,881.80) annually. Participants across 2 testing cycles reported the overall usability of the at heart progressive web application as highly acceptable (mean SUS score 81.75, SD 10.41). In total, 90% (9/10) of participants rated the user-friendliness of at heart as good or excellent. All participants (10/10, 100%) thought at heart was easy to use and efficient. Only 2 testing errors were noted as high priority; these were low contrast or small font and clarification that the chatbot was not a real person. User satisfaction was assessed using themes that emerged from the debrief and 4 semistructured interview questions; at heart was engaging, comprehensive, understandable, credible, relevant, affirming, personalized, and innovative.

CONCLUSIONS

This study provides initial support for the at heart progressive web application for women living with cardiac pain and symptoms. Ongoing evaluations in phases 3 and 4 should aim to examine the feasibility and acceptability of and the extent of engagement with the at heart core feature set: Heart Check, Wellness Check, and the library. In addition to assessing effectiveness in the phase-4 effectiveness-implementation hybrid trial (type I), describing and better understanding the context for implementation (eg, race and ethnicity and geography) will be necessary.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2019-033092.

The mediating role of expectations regarding aging between diabetes distress and self-management behaviors in older adults with type 2 diabetes mellitus

OBJECTIVES

To investigate the relationships among diabetes stress, expectations regarding aging, and self-management behaviors in older adults with type 2 diabetes mellitus.

METHODS

In this cross-sectional study, we surveyed 257 older patients aged ≥60 years with type 2 diabetes mellitus using the Diabetes Distress Scale, the 21-item Expectations Regarding Aging Scale, and the Diabetes Self-Care Behavior Scale. We conducted correlation and mediation analyses using SPSS 26.0 and PROCESS software.

RESULTS

Diabetes distress was negatively associated with diabetes self-management and expectations regarding aging. Expectations regarding aging were positively associated with diabetes self-management. Expectations regarding aging partially mediated the relationship between diabetes distress and self-management.

CONCLUSIONS

The self-management behavior of older patients with type 2 diabetes mellitus can be improved by reducing diabetes-related distress and increasing expectations regarding aging. Therefore, healthcare professionals should emphasize the mental health of older patients with type 2 diabetes mellitus and provide timely education on healthy aging.

Development and validation of a self-management questionnaire for people living with HIV in low- and middle-income countries (HIV-SM LMIC tool)

PURPOSE

The main objective of this research is to develop and validate a comprehensive self-management tool for PLWH (HIV-SM LMIC tool) in Ethiopia.

METHOD

Item development followed a recommended procedure. Item concepts were based on two previously published articles by the same authors, guided by the Individual Family Self-management (IFSMT) theoretical framework. The developed items were translated from English into Amharic (a local language in Ethiopia). Two rounds of face and content validation were conducted with HIV program experts, academics, people outside the health sector, and HIV patients. A total of 61 participants (52 in the first round and 9 in the second round) participated in the validation process. All participants evaluated the content and face validity of each item and provided qualitative judgments, comments, and suggestions.

RESULTS

In the first round of validation, most participants were health professionals (53.8%), followed by HIV patients (19.2%) and HIV program experts/researchers (9.6%). Nine participants took part in the second round. Initially, 117 draft items were refined into 63 for validation. I-FVI (individual face validity index) values ranged from 0.56 to 0.98, with 43 items (68%) scoring ≥ 0.80, indicating high face validity. I-CVI (individual content validity index) values ranged from 0.76 to 1.00, with 61 items (97%) scoring ≥ 0.80, demonstrating high content validity. Common qualitative feedback highlighted translation and contextualization issues in the Amharic version and overlapping concepts. Based on FVI, CVI, and qualitative feedback, particularly patient comments, 26 items were dropped or merged, resulting in a 37-item tool. In the second round, 31 items scored above 0.80 on the CVI. Three items were removed due to low CVI (< 0.70) and redundancy, while two were dropped based on participant feedback. The remaining 32 items had kappa values > 0.74, indicating excellent relevance. Both English and Amharic versions were revised.

CONCLUSION

A comprehensive 32-item HIV-SM LMIC tool tailored to HIV patients in low- and middle-income countries was developed following a rigorous psychometric evaluation process. Further research on its construct validity, criterion validity and reliability are recommended before its use. In addition, future studies should assess the cross-cultural validity of the final instrument.

AI Applications for Chronic Condition Self-Management: Scoping Review

BACKGROUND

Artificial intelligence (AI) has potential in promoting and supporting self-management in patients with chronic conditions. However, the development and application of current AI technologies to meet patients' needs and improve their performance in chronic condition self-management tasks remain poorly understood. It is crucial to gather comprehensive information to guide the development and selection of effective AI solutions tailored for self-management in patients with chronic conditions.

OBJECTIVE

This scoping review aimed to provide a comprehensive overview of AI applications for chronic condition self-management based on 3 essential self-management tasks, medical, behavioral, and emotional self-management, and to identify the current developmental stages and knowledge gaps of AI applications for chronic condition self-management.

METHODS

A literature review was conducted for studies published in English between January 2011 and October 2024. In total, 4 databases, including PubMed, Web of Science, CINAHL, and PsycINFO, were searched using combined terms related to self-management and AI. The inclusion criteria included studies focused on the adult population with any type of chronic condition and AI technologies supporting self-management. This review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines.

RESULTS

Of the 1873 articles retrieved from the search, 66 (3.5%) were eligible and included in this review. The most studied chronic condition was diabetes (20/66, 30%). Regarding self-management tasks, most studies aimed to support medical (45/66, 68%) or behavioral self-management (27/66, 41%), and fewer studies focused on emotional self-management (14/66, 21%). Conversational AI (21/66, 32%) and multiple machine learning algorithms (16/66, 24%) were the most used AI technologies. However, most AI technologies remained in the algorithm development (25/66, 38%) or early feasibility testing stages (25/66, 38%).

CONCLUSIONS

A variety of AI technologies have been developed and applied in chronic condition self-management, primarily for medication, symptoms, and lifestyle self-management. Fewer AI technologies were developed for emotional self-management tasks, and most AIs remained in the early developmental stages. More research is needed to generate evidence for integrating AI into chronic condition self-management to obtain optimal health outcomes.

Family function and health self-management ability among older adults from mountainous areas in China: moderated mediation model in a cross-sectional study

BACKGROUND

Improving the health self-management ability (HSMA) of older adults is a feasible strategy for addressing population ageing and the high incidence of non-communicable diseases. Identifying psychosocial factors that facilitate better self-management of health is key to developing effective interventions. This study explored whether self-efficacy mediates the relationship between family function and HSMA and whether this mediation is moderated by personal income.

METHODS

A multicentre cross-sectional survey was conducted with 596 participants (response rate of 97.2%) in the mountainous Lishui region of China by using a multi-stage, stratified, cluster-sampling procedure. The survey included questions on sociodemographic characteristics, the Adult Health Self-Management Skills (Ability) Rating scale, family APGAR scale and General Self-Efficacy (GSE) scale. Data were analysed using descriptive statistics, Spearman's correlation, and multiple regression analysis with mediation and moderated mediation models.

RESULTS

The average score for HSMA, family function, and GSE were 149.6 ± 18.1 (out of 190), 8.2 ± 2.2 (out of 10), and 24.0 ± 6.0 (out of 40), respectively, which indicate moderate HSMA and family function levels and low GSE among older adults in Lishui. Significant correlations were observed between family function and GSE (rs = 0.150, P < 0.001), GSE and HSMA (rs = 0.336, P < 0.001), and family function and HSMA (rs = 0.297, P < 0.001). The mediation model explained 21.5% of the variance in HSMA, with significant total (c: B = 0.343, P < 0.001) and indirect effects (ab: B = 0.0505, 95% CI = [0.0227, 0.0830]). The indirect effects (family function → GSE → HSMA) decreased with decreasing income (high income, B = 0.0497; middle income, B = 0.0353; low income, B = 0.0233), while the direct effect (family function → HSMA) increased with decreasing income (high income, B = 0.189; middle income, B = 0.270; low income, B = 0.350).

CONCLUSION

HSMA, APGAR score and GSE score were positively related among older adults in the Lishui region, highlighting potential areas for improvement. The results clarify the mediating effect of GSE on the relationship between family function and HSMA along with the moderating role of personal income. Strengthening family function may enhance HSMA, especially in low income older adults, while boosting GSE may benefit those with higher incomes. Future longitudinal studies should confirm these relationships and their causal direction.

Summary of best evidence on self-management in adult patients with systemic lupus erythematosus

ObjectiveTo evaluate and summarize the best evidence on self-management in adult patients with systemic lupus erythematosus (SLE) and provide evidence-based recommendations in clinical settings.MethodsLiteratures related to self-management of SLE patients were searched in the guideline websites, professional association websites and relevant databases, including clinical decisions, guidelines, expert consensus, best practice recommendations, evidence summaries, meta-analyses, systematic reviews and randomized controlled trials, etc. The search time was from January 2018 to September 2023.ResultsA total of 19 literatures were included, consisting of 9 guidelines, 4 expert consensus, 4 clinical decisions, and 2 systematic reviews, and 49 pieces of evidence were extracted. After sorting and discussing, the evidence were integrated into six aspects: skin management, diet management, exercise management, vaccination management, complication management, as well as follow-up and lifestyle management.ConclusionThe best evidence of self-management in SLE patients summarized in this study is of high quality, which can provide evidence-based recommendations for clinical medical staff and patients, so as to help self-management of SLE patients in a more scientific and effective way.

An Integrative Review of the Use of the Individual and Family Self-Management Theory in Research

The extent of the application of the Individual and Family Self-Management Theory (IFSMT) in research has yet to be determined. The purpose of this analysis was to review the use of the IFSMT in published research and evaluate posited constructs and relationships. Dimensions and categories of the IFSMT and the interrelationships were generally supported in the 77 articles reviewed. A majority focused on self-management of chronic conditions in the adult population. More research on the strength, direction, and interaction of relationships is needed. Defining and exploring social constructs, including race, ethnicity, and gender, should be prioritized in future IFSMT research.

Impact of Depression on Activation and Summer Heat Adaptation in Older Adults With Cardiovascular Concerns: Empirical Research Quantitative

AIM

To investigate the effects of depression on patient activation and summer heat adaptation, considering important contributory factors in older adults with increased cardiovascular health concerns on extremely hot days.

DESIGN

Cross-sectional study adhering to the STROBE guidelines.

METHODS

Between July and August 2020, a questionnaire survey was administered to 245 older adults at increased risk of cardiovascular diseases in rural areas. Data were collected utilising validated and reliable tools to assess patient activation, depression, summer heat adaptation, frailty, physical activity and other health-related characteristics. Hierarchical regression, mediation and path analyses were conducted to examine the association between activation, depression and summer heat adaptation, while controlling for covariates.

RESULTS

Most participants exhibited the lowest level of activation (75.1%) and a low/moderate level of summer heat adaptation (80.4%). Depression negatively affected activation (β = -0.247), while its indirect effect on patient activation through summer heat adaptation was insignificant (p > 0.05). Education (β = 0.380) and a family history of cardiovascular disease (β = 0.121) positively influenced activation, while alcohol consumption had a negative influence (β = -0.219). When integrating the influence of these three contributory factors, the associative relationship between depression and activation through summer heat adaptation demonstrated a good model fit (chi-square = 8.944, p > 0.05; comparative fit index = 0.987; root mean square error of approximation = 0.045).

CONCLUSION

Improving older adults' activation for self-managing chronic conditions in summer requires tackling depression, enhancing heat adaptation and addressing concerns related to lack of education and alcohol consumption.

PATIENT OR PUBLIC CONTRIBUTION

Patients with cardiovascular diseases were involved in piloting the questionnaire and provided examples to address older adults' concerns related to self-management and heat adaptation.

Factors associated with patient activation in people with heart failure based on the individual and family self-management theory: a cross-sectional study

AIMS

Patient activation (PA) is crucial for effective self-management of people with heart failure (HF). Clarifying factors associated with PA might be important to develop interventions to promote PA. This study aimed to explore context factors associated with PA in people with HF.

METHODS AND RESULTS

Two hundred and sixty-eight patients were enrolled in a cross-sectional study (median age = 65 years). We surveyed variables based on context factors of the individual and family self-management theory, including demographic and disease factors, quality of chronic care, family function, and depression. Correlation analysis was conducted for data analysis, and path analysis was used to verify our hypothesis model about context factors and PA. The median PA score was 51.10. Path analysis showed that age, educational level, living arrangement, device therapy, quality of chronic care, family function, and depression were directly or indirectly related to PA. The quality of chronic care mediated the associations between device therapy and educational level and PA. Age, educational level, living arrangement, and quality of chronic care affected family function and then affected activation. Depression mediated the relationships between the quality of chronic care, educational level, family function, and PA.

CONCLUSION

This study increased the understanding of factors associated with PA in the HF population. When assessing PA in people with HF, those who are older, have a low educational level, and living alone need more attention from healthcare professionals. Interventions focusing on improving the quality of chronic care, family function, and depression might help activate people to practice self-management.

Hypertension self-management trajectory patterns and associated factors among Chinese patients with aortic dissection after surgical repair: a longitudinal study

AIMS

In patients with aortic dissection (AD) after surgical repair, especially those with hypertension, better management of blood pressure is associated with better health outcomes. The aim of this study is to identify hypertension self-management trajectory patterns and associated factors among Chinese aortic dissection patients after surgical repair to assist in developing tailored behavioural interventions for this population.

METHODS AND RESULTS

178 patients with aortic dissection who underwent surgical repair were followed for 3 months. Data on hypertension self-management, hypertension knowledge, self-efficacy, and social support were collected before discharge and at 1 and 3 months after discharge. Sociodemographic and clinical data were also collected. A latent class growth model and generalized estimating equations were used to explore hypertension self-management trajectory patterns and factors associated with each pattern. The participants' average age was 57.95 (± 11.27) years. Two hypertension self-management trajectory patterns were identified: 'rapid ascent then suppressed growth' (93.4%) and 'continuously slow ascent' (6.6%). For the 'rapid ascent then suppressed growth' pattern, age, educational background, type of health insurance, family monthly income, self-efficacy, and social support were associated with this pattern (P < 0.05).

CONCLUSION

Healthcare providers may prioritize hypertension self-management for patients who are younger, have lower educational levels, have resident or employee medical insurance and have a family monthly income between 5001 and 10 000 yuan. Self-efficacy and social support might serve as targets for future intervention to improve hypertension self-management.

REGISTRATION

ChiCTR2100050542.

Navigating life after gastric cancer surgery: a qualitative exploration of the dyadic patient-caregiver perspective on quality of life outcomes

INTRODUCTION

Gastric cancer (GC) families as a whole face the stressful time of cancer together, and the quality of life (QoL) of both the patient and the caregiver can be affected. Most past researchers have focused on the QoL of GC patients, but have neglected the role that caregivers play in the treatment process. The purpose of this study was to examine the factors influencing QoL of GC patients and their family caregivers, to compare the interactions and similarities and differences between the two influences, and to construct a conceptual model of the influences on QoL of GC patients and their caregivers based on the results of the study.

METHODS

This descriptive qualitative study was conducted in 2024 at two branches of a tertiary hospital in China, and participants were recruited by adopting a purposive sampling approach, where participants were patients with GC who met the criteria recommended by gastrointestinal surgeons and nurses, and caregivers were designated by patients. The sample was selected considering maximum differentiation, such as age, gender, cancer stage, and disease duration of the respondents. The sample size was based on data saturation with no new themes emerging. Based on the results of the pre-interviews, we made some adjustments to the interview format, i.e., interviewing some informants individually and others jointly. We used semi-structured interviews for data collection for the qualitative study, where participants were informed about the study, their roles, the risks and benefits of the study, and signed an informed consent form before the interviews began. In addition, the quality of field notes was assessed after each session. The process was the same for all interviews. To ensure the accuracy of the information, all information transmitted on paper was reviewed while listening to the recorded voice. We used directed content analysis to analyze the content of the interviews.

RESULTS

A total of 30 patients and 26 caregivers were interviewed. Four themes emerged from the study, which were contextual factors (disease-specific factors, physical and social environments and individual and family characteristics), knowledge and belief factors (self symptom assessment and healthcare seeking behavior, health information delivery and accessibility, life priority adjustment), self-regulation factors (strategies for health behavior change, role adaptation and emotion regulation) and social facilitators (positive motivation and emotional support from family, friends, and society, missing companionship and challenges encountered by family and friends visiting the patient after surgery, caregiving burdens and challenges). In addition, the study confirmed a high correlation between the QoL of patients and caregivers.

CONCLUSION

Our results address past gaps in the understanding of QoL for families with GC and update the concept of QoL by constructing a conceptual model of the factors that influence QoL for GC survivors and caregivers, as well as outlining the changes needed to improve health outcomes and QoL for survivors and their caregivers.

Parent-Adolescent Communication, Self-Efficacy, and Self-Management of Type 1 Diabetes in Adolescents

PURPOSE

The purpose of this study was to investigate adolescent perspectives of parent-adolescent communication, type 1 diabetes mellitus (T1DM)-specific family conflict, self-efficacy, and their relationship to adolescent self-management of T1DM.

METHODS

A cross-sectional survey design was employed. Adolescents completed measures of parent-adolescent communication, T1DM-specific family conflict, self-efficacy, and self-management, which included activation and division of responsibility for management tasks.

RESULTS

Surveys were completed by 113 adolescents ages 11 to 17 years (mean age 13.85 years, SD 1.78) and living with T1DM for 6 months and longer. Hierarchical multiple regression sought to determine what variables make the most unique contribution to self-management of T1DM, division of family responsibility for management tasks, and activation. Self-efficacy was a significant predictor of division of family responsibility for T1DM management, patient activation, and all self-management subscales except collaboration with parents. Openness in parent-adolescent communication was a significant predictor of the diabetes communication and goals subscale of the self-management measure and activation. Problems in communication was a significant predictor of collaboration with parents and self-management goals.

CONCLUSIONS

These findings suggest that family context characteristics, particularly parent-adolescent communication, and self-efficacy are important for engagement with self-management for adolescents living with T1DM. Findings can inform future family-focused self-management interventions to improve T1DM outcomes for adolescents living with T1DM.

The Intersection of Menopause, Lack of Physical Activity, and Cardiovascular Risk

Cardiovascular disease (CVD) is the leading cause of mortality in women in the United States, and the physiologic changes that occur during perimenopause and menopause can increase women's risk of CVD. Physical activity levels decrease with age, but physical activity can effectively reduce both menopausal symptoms and CVD risk in women. Interventions to increase physical activity and reduce menopausal symptoms and CVD risks in women are often not comprehensive and are unsustainable due to individual contextual barriers. Furthermore, there is a lack of counseling, education, and support for women related to both the menopause transition and prevention of CVD. Theory-based, collaborative interventions addressing physical, social, contextual, individual, and other socioecological factors seem to be the most effective and sustainable and are needed to increase physical activity, reduce CVD risks, and enhance quality of life in menopausal women.

Perspectives on Online Resources for People Experiencing Pain: A Qualitative Study

BACKGROUND

Innovations in technology offer potential solutions to address pain care inequities. To maximize impacts, greater understanding is needed regarding preferences and priorities of people experiencing or treating pain.

OBJECTIVES

This study conducted focus groups to investigate the perspectives of people with pain and healthcare workers regarding online resources for pain management. Researchers asked about barriers to current pain management and what resources would be most desired in an online format to meet needs.

METHODS

Participants were a randomly selected sub-sample of adults from a northwestern region of the United States who participated in an online, survey-based study. Eligible participants identified as either a person who had received treatment for pain or a healthcare worker who cared for people with pain. Of the 199 survey respondents, 30 participated in one of three focus group sessions. Focus groups were conducted using videoconferencing technology, then recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Focus group participants included 22 adults who identified as a person treated for pain of any type and 8 healthcare workers. Themes relating to eHealth use reflected desires for (1) freely accessible and vetted pain management information in one place, (2) reliable information tailored to need and pain type, and (3) easy-to-use resources. Findings revealed that some effective pain management resources do exist, yet obstacles including inflexible and inequitable healthcare practices and lack of knowledge about options may limit access to these resources.

CONCLUSION

Including preferences of user groups can assist in creating resources that are likely to be useful for those with pain and their caregivers. Innovations are needed to address persisting gaps in care.

Families' Experiences With Family-Focused Web-Based Interventions for Improving Health: Qualitative Systematic Literature Review

BACKGROUND

eHealth interventions can favorably impact health outcomes and encourage health-promoting behaviors in children. More insight is needed from the perspective of children and their families regarding eHealth interventions, including features influencing program effectiveness.

OBJECTIVE

This review aimed to explore families' experiences with family-focused web-based interventions for improving health.

METHODS

Five databases were searched on October 26, 2022-updated on October 24, 2023-for studies reporting qualitative data on participating children or their caregivers' experiences with web-based programs. Study identification was performed in duplicate and studies were independently appraised for quality. Thematic synthesis was undertaken on qualitative data extracted from the results section of each included article.

RESULTS

Of 5524 articles identified, 28 articles were included. The studies examined the experiences of school-aged children (aged 5-18 years) and their caregivers (mostly mothers) with 26 web-based interventions that were developed to manage 17 different health conditions or influence health-supporting behaviors. Six themes were identified on families' experiences: connecting with others, agency of learning, program reputability or credibility, program flexibility, meeting participants' needs regarding program content or delivery, and impact on lifestyle.

CONCLUSIONS

Families positively perceived family-focused web-based interventions, finding value in quality connections and experiencing social support; intervention features aligned with behavioral and self-management principles. Key considerations were highlighted for program developers and health care professionals on ways to adapt eHealth elements to meet families' health-related needs. Continued research examining families' experiences with eHealth interventions is needed, including the experiences of families from diverse populations and distinguishing the perspectives of children, their caregivers, and other family members, to inform the expansion of family-focused eHealth interventions in health care systems.

TRIAL REGISTRATION

PROSPERO CRD42022363874; https://tinyurl.com/3xxa8enz.

Self-Management in Children and Adolescents With Chronic Illness: An Evolutionary Analysis of the Concept

AIM

To increase conceptual clarity regarding the self-management of school-age children and adolescents with chronic illnesses in a community context.

DESIGN

Concept Analysis: Rodgers' evolutionary approach.

DATA SOURCES

Search conducted in the Cumulative Index to Nursing and Allied Health Literature, Psychology and Behavioural Sciences Collection, Nursing and Allied Health Collection, Academic Search Complete, Cochrane, Web of Science, Medical Literature Analysis and Retrieval System Online, Scopus, Repositório Científico de Acesso Aberto de Portugal, ProQuest Dissertations and Theses, Joanna Briggs Institute Evidence Synthesis. Thirty-one articles were identified, published between 2004 and 2023.

REPORTING METHOD

Followed the Enhancing the Quality and Transparency of Health Research guidelines-Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020.

RESULTS

Self-management in children and adolescents with chronic illness, in school age, in a community context, consists of a process of acquiring knowledge and beliefs that promote the self-efficacy of this population in developing skills to face needs inherent to the health condition.

CONCLUSION

Promoting self-management goes beyond simply educating for skill acquisition. Participants with stronger beliefs in their ability to control their behaviours are more successful in self-management. The activation of resources that position the child as an agent of change is recommended.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

It contributes to the development of strategies that promote self-management across different healthcare disciplines, focusing on education and change, but also on psychological encouragement to foster confidence in change.

IMPACT

Competent self-management during childhood promotes autonomy, empowerment, and control of the condition, with consequent physical and emotional well-being, quality of life, family stability, and social development.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no direct contribution from patients or the public in this work (literature review).

Assessing Family Caregiver Readiness for Hospital Discharge of Patients With Serious or Life-Limiting Illness Using Electronic Health Record (EHR) and Self-Reported Data

OBJECTIVE

To assess how patient and caregiver factors influence caregiver readiness for hospital discharge in palliative care patients.

STUDY SETTING AND DESIGN

This transitional care study uses cross-sectional data from a randomized controlled trial conducted from 2018 to 2023 testing an intervention for caregivers of hospitalized adult patients with a serious or life-limiting illness who received a palliative care consult prior to transitioning out of the hospital.

DATA SOURCES AND ANALYTICAL SAMPLE

Caregiver readiness was measured with the Family Readiness for Hospital Discharge Scale (n = 231). Caregiver demographic, intra- and interpersonal factors were self-reported. Patient demographic, comorbidity score, and risk score for complicated discharge planning were extracted from electronic health records. Stepwise regression models estimated variance explained (r2) in caregiver readiness for patient hospital discharge.

PRINCIPAL FINDINGS

Patient demographics and complexity were not statistically associated with caregiver readiness for discharge. Caregiver depressive symptoms, poor caregiver-patient relationship quality, and fewer hours spent caregiving prior to hospitalization explained 29% of the variance in caregiver readiness.

CONCLUSIONS

Reliance on patient data may not be sufficient for explaining caregiver readiness for discharge. Assessing caregiver factors may be a better alternative for identifying caregivers at risk for low discharge readiness and those in need of additional support.

TRIAL REGISTRATION

ClinicalTrials.gov on November 13, 2017, (No. NCT03339271).

Mediating role of self-efficacy in the relationship between family functioning and self-management behaviors in patients with coronary heart disease: A cross-sectional study in Jiangsu, China

Background

Self-management behaviors can prevent the negative consequences among patients with coronary heart disease (CHD). The reality of patients followed the self-management behaviors rate are unoptimistic.

Objective

This study aimed to examine whether self-efficacy serves as a mediating role between family functioning and self-management behaviors among coronary heart disease patients.

Methods

A cross-sectional approach was applied, and 140 patients with CHD were included using a cluster sampling strategy. Family functioning was assessed utilizing the Family APGAR Index, self-efficacy was evaluated using the Self-efficacy for Chronic Disease 6-item Scale, and self-management behaviors was examined utilizing the Coronary Artery Disease Self-Management Scale. Data were collected from July to October 2022 and analyzed using descriptive statistics and regression analyses to evaluate the mediating influence.

Results

The degree of self-management behaviors among patients with CHD was at a low level (Mean = 82.23, SD = 11.863). Self-efficacy had a direct and positive impact on self-management behaviors (β = 0.39, p <0.001). Moreover, self-efficacy had a partially intermediary function in the relationship between family functioning and self-management behaviors (indirect effect = 0.14, 95% CI [0.04, 0.27]; direct effect = 0.39, p <0.001).

Conclusion

Self-efficacy demonstrated an association with self-management behaviors and served as a mediation function in the relationship between self-management behaviors and family functioning. Therefore, the significance of family functioning and self-efficacy should be highlighted in nursing practice when developing methods to encourage patients with CHD to improve their self-management behaviors.

Self-management behavior and its influencing factors among adults with chronic obstructive pulmonary disease in Colombo, Sri Lanka: A cross-sectional study

Background

Self-management behaviors are essential to take care of chronic obstructive pulmonary disease (COPD). However, data on COPD self-management practices in Sri Lankan adults is limited. Therefore, identifying the level of COPD self-management and examining its influencing factors are essential for healthcare providers to manage COPD effectively.

Objectives

This research aimed to describe the level of self-management behaviors and determine whether dyspnea, perceived stress, COPD knowledge, and social support can predict self-management in adults with COPD in Colombo, Sri Lanka.

Methods

A predictive correlational study was conducted, and 108 adults with mild to moderate COPD were recruited from the central chest clinic in Colombo, Sri Lanka, from March to April 2024 using a simple random sampling technique. A self-administered questionnaire was used to gather data included demographic characteristics. The other instruments used were the COPD Self-Management Scale, the Perceived Stress Scale, the COPD Knowledge Questionnaire, and the Perceived Social Support Scale. Descriptive statistics and multiple regression were used for data analysis.

Results

The study showed a moderate self-management level with a mean of 3.04 ± 0.35. All variables could explain 41.7% of the variance in self-management among adults with mild to moderate COPD and COPD self-management behaviors significantly predicted by dyspnea (β = 0.212, p = 0.006), perceived stress (β = -0.195, p = 0.018), COPD knowledge (β = 0.263, p = 0.001), and perceived social support (β = 0.366, p <0.001).

Conclusion

The study shows evidence that a program to intervene targeting COPD knowledge and perceived social support, in addition to reducing dyspnea and perceived stress, can be beneficial in promoting better self-management behaviors among adults with mild to moderate COPD.

Experience with a Self-Management Education Program for Adolescents with Type 1 Diabetes: A Qualitative Study

Background/Objectives: Adolescents with type 1 diabetes face complex challenges associated with the disease, underscoring the importance of developing self-management skills. This study examined participants' perspectives on a type 1 diabetes self-management education program. Methods: Focus group interviews were conducted with 32 adolescents with type 1 diabetes who participated in the program and six expert patients. Both thematic analysis and content analysis were conducted using NVIVO software, version 1.6.1. Results: Two dimensions emerged: expert patient roles and program evaluation. Expert patient roles were viewed positively, with an emphasis on responsibility, sharing experiences, and being a role model. Program evaluation emphasized peer-to-peer sharing and educational sessions, with increased knowledge of the disease and management strategies. Expert patients also benefited from the program by developing a sense of responsibility, serving as role models for adolescents, and improving their disease self-management. Conclusions: The adolescents emphasized that the program was a learning tool and the expert patient's view of their role emerges, highlighting modelling as a facilitator of learning and of the responsibility and commitment of the mentors. This study reinforces the benefits of peer-to-peer interaction in a camp setting, including rich experiences.

Strategies for enhancing home-based cardiac rehabilitation self-management for patients with coronary heart disease: a qualitative study

BACKGROUND

Self-management is regarded as a crucial factor influencing the effectiveness of home-based cardiac rehabilitation for patients with coronary heart disease. In nursing practice, nurses employ a variety of strategies to enhance self-management of patients. However, there exists a disparity in nurses' perceptions and practical experiences with these strategies. This study aimed to explore the experiences and strategies of clinical nurses in enhancing home-based cardiac rehabilitation self-management for patients with coronary heart disease.

METHODS

A descriptive qualitative study was conducted across two large cardiac rehabilitation centers. Clinical nurses were selected using purposive sampling with maximum variation strategies. Semi-structured interviews were conducted to capture nurses' experiences and strategies for enhancing home-based cardiac rehabilitation self-management. Content analysis was utilized to analyze the textual data.

RESULTS

A total of 18 eligible clinical nurses participated in this study. The interviews resulted in the extraction of seven subthemes, which were consolidated into three main themes: (1) Personalized and Engaging Educational Approaches, including Precision Education-Tailored, Adaptive Approaches and Visual Aided Education-Beyond Simplification to Deep Engagement; (2) Contextual and Psychologically Grounded Nudging Strategies, comprising Information Framing-Psychological Leveraging for Informed Choices, Social Norms-Leveraging Peer Influence for Motivation, and Verbal Reminders-The Power of Consistency and Reinforcement; (3) Continuous and Personalized Support Systems, involving Regular Follow-Up-Dynamic Support for Ongoing Engagement and Collaborative Management-Building a Team for Long-Term Success. These robust strategies can effectively enhance self-management behaviors and quality of life in patients undergoing home-based cardiac rehabilitation.

CONCLUSIONS

From the perspective of clinical nurses, this study explored a variety of strategies for improving home-based cardiac rehabilitation self-management in patients with coronary heart disease. This provides theoretical support for optimizing intervention measures and promotes the effective delivery and application of self-management strategies in practice.

CLINICAL TRIAL NUMBER

Not applicable.

User-centred design of ChestCare: mHealth app for pulmonary rehabilitation for patients with COPD; a mixed-methods sequential approach

Background

The increasing prevalence and burden of chronic obstructive pulmonary disorder (COPD), the challenges in implementing pulmonary rehabilitation (PR) programs and the limited availability of alternatives and supportive programs to serve patients with COPD necessitate the development of pulmonary telerehabilitation (PTR) systems to provide patients with COPD with PR programs.

Objective

This study aimed to design and develop the ChestCare mobile Health app using user-centred design (UCD) approach. Thus, it provided PTR for patients with COPD, enhancing their self-management of symptoms and improving their compliance with PR programs.

Methods

In this mixed-methods sequential research, we deployed the UCD iterative design through the prototype app design and development sequence. The first phase was built based on the results of a previous needs assessment study and an analysis of related apps. This produced the initial mock-up, the foundation for the focus group discussions with physiotherapists and patients. Six physiotherapists with cardiorespiratory specialisation evaluated each app module and item of the latest mock-up using the content validity index (CVI) document. The I-CVI (S-CVI/Ave) and (S-CVI/UA) were computed. Qualitative and quantitative data were integrated, and decisions were made by comparing their results.

Results

The UCD iterative design through sequential MMR has generated four mock-up app versions. The latest version identified 13 modules through 150 items validated by six experts using a CVI document. The I-CVI calculation of 145 items was 1, while 0.83 for the remaining items, was within accepted values. The S-CVI scored 99.4, indicating an overall validity of the ChestCare app as a PTR system for patients with COPD.

Conclusions

The development and validation of the ChestCare app resulted from conducting UCD iterative design and sequential MMR, which identified 13 functionalities, including symptom assessment, tracking lung volume, functional capacity test, action plan, intervention program, COPD education, COPD community, monitoring and reminders.

Perspectives Regarding Engagement in Physical Activity in Women: Traditional Gender Role-Based Themes

BACKGROUND

There has not been a significant improvement in cardiovascular disease (CVD) statistics among women; 44.4% of women older than 20 years have a diagnoses of CVD. Only 24.3% of adults meet physical activity (PA) guidelines, women have significantly lower levels of PA significantly lower levels than men. There is a call to action from the American Heart Association to delineate reasons for related genderized, socially determined factors.

OBJECTIVE

The purpose of this study was to use the individual and family self-management theory to explore and describe interacting sociodemographic, family, cultural, health/access-related, and personal factors contributing to PA engagement in women living in areas of reduced socioeconomic resources.

METHODS

This study used a community-engaged, qualitative descriptive focus group design to explore PA engagement in women between 18 and 64 years old living in an area of reduced socioeconomic resources and high racial and ethnic diversity.

RESULTS

Context-related factors included cost/access, transportation, safety, and setting and interacted with family structure and functioning. Process-level factors affecting PA engagement included outcome expectancy, goal incongruence, lack of self-efficacy, self-regulation, and provider support/collaboration. Facilitators included family/friend social support.

CONCLUSIONS

The current community-engaged study reveals socially constructed gender role elements related to family dynamics, self-perception, and self-regulation that potentially impact engagement in self-management behavior. Programs to increase awareness and self-management of CVD in women exist, but there is a lack of direct effects, speaking to unknown factors. Given perpetually high rates of CVD, low levels of PA, and declining knowledge levels among women, further investigation is imperative.

Qualitative Study on the Real Experiences of Patients with Meige Syndrome Based on the Individual and Family Self-Management Theory

Objective

This study aimed to analyze the real experiences of patients with Meige Syndrome, which is an idiopathic dystonia, during the perioperative period and to explore the practical application and effectiveness of Individual and Family Self-Management Theory (IFSMT) in improving patient experiences.

Methods

A qualitative descriptive research methodology was employed to elucidate the intricate psychological and social experiences encountered by patients with Meige Syndrome throughout the perioperative phase. This study conduct face-to-face, one-on-one, semi-structured interviews with 16 Meige Syndrome patients to gain an in-depth understanding of the patients' true feelings and needs. Interview data were organized and analyzed using Colaizzi's method, and themes were refined in conjunction with IFSMT to reveal patients' self-management practices and influencing factors.

Results

Through in-depth analysis using Colaizzi's method and the application of IFSMT to the perioperative experiences of patients with Meige Syndrome, and reported according to COREQ standards, three core themes were identified: (1) Context Dimension (specific disease factors, physical and social environmental factors, personal and family factors), (2) Process Dimension (knowledge and beliefs, self-regulation and self-efficacy, social facilitation), and (3) Outcome Dimension (proximal and distal outcomes of self-management behaviors).

Conclusion

This study demonstrates that IFSMT has significant application value in the perioperative experiences of patients with Meige Syndrome. Enhancing patients' knowledge, beliefs, self-regulation abilities, and social support can promote effective self-management behaviors, thereby improving their quality of life and health status. Additionally, the study reveals the complexity of self-management in perioperative patients, emphasizing the importance of interdisciplinary collaboration and comprehensive interventions in enhancing patient experiences. Future research can further explore how to apply these theories in clinical practice to optimize perioperative management and rehabilitation processes for patients with Meige Syndrome.

Factor structure of the HIV-SM LMIC self-management questionnaire for people living with HIV in low- and middle-income countries

INTRODUCTION

Despite the need for reliable questionnaires to monitor self-management in chronic disease patients, such tools are lacking in developing countries. This study aims to pilot and assess the construct validity of the HIV-SM LMIC questionnaire.

METHOD

The validation of the HIV-SM LMIC questionnaire involved two cross-sectional studies in Ethiopia. The first round, for exploratory factor analysis (EFA), included 261 patients, while the second round, for confirmatory factor analysis (CFA), included 300 patients. Data was collected using the Kobo Collect electronic data entry template.

RESULT

The sample adequacy test showed a good value of 0.82. In the first round, 6 of the 32 items were not loaded, forming three factors in the EFA. Four of these items were dropped, but two (PSMB2 and PSMB12) were retained for their content. In the second round, CFA on the remaining 28 items led to dropping 8 more items due to conceptual overlap, resulting in a 20-item questionnaire. The final items were structured into three dimensions: awareness and well-being (4 items), self-regulation (6 items), and self-management practices (10 items).

CONCLUSION

The study refined the original 32-item HIV-SM LMIC questionnaire to a validated 20-item, three-dimensional tool with an acceptable goodness of fit. The authors recommend further cross-cultural and predictive validation and adaptation for newly diagnosed HIV patients, those with poor treatment outcomes.

'Eating with Others': planning, developing and optimising a self-management intervention to promote social eating for patients living with and beyond head and neck cancer

INTRODUCTION

After treatment for head and neck cancer (HNC), up to 90% of patients have difficulties eating and drinking. Despite the enormity of challenges explicitly relating to the social dimension of eating, there are limited extant interventions to specifically support social eating, nor any replicable for use in contemporary clinical practice. This study aims to plan, develop and optimise a self-management intervention to promote social eating for patients living with and beyond HNC.

METHODS

This research was intervention development of a self-management 'Eating with Others' resource, guided by the person-based approach (PBA) framework. Initially, a systematic review was conducted, with 24 included studies exploring HNC patients' social eating experiences, followed by thematically analysed qualitative interviews with patients (n = 14), family members (n = 12) and healthcare professionals (n = 13). Alongside this data, iterative input was sought from an advisory group (n = 22) to culminate in an intervention prototype. The intervention prototype was iteratively user-tested over three cycles for usability and acceptability, using think-aloud interviews (n = 10).

RESULTS

A patient-centred, evidence-based and theory-driven self-management resource, entitled 'Eating with Others', was designed to promote social eating for patients with HNC. Sections included the benefits of social eating; the impact of HNC on social eating, strategies and reflective activities to overcome social eating barriers; and the use of a social eating card for restaurants. The think-aloud interviews revealed that the resource was appropriate and acceptable for patients with HNC.

CONCLUSION

The systematic and iterative PBA intervention development framework enabled empirical research findings, relevant theory and extensive advisory group involvement to design an acceptable self-management social eating intervention for patients living with and beyond HNC. Mixed-methods evaluation is required to determine feasibility in clinical practice.

Dementia Prevention Self-Management in Older Thai Adults with Type 2 Diabetes: Development and Psychometric Properties of Two Questionnaires

BACKGROUND/OBJECTIVES

The prevalence of dementia, a complication of uncontrolled type 2 diabetes (T2DM), is rising among older adults. Effective self-management for dementia prevention is essential, but no validated questionnaires currently exist to evaluate these behaviors.

METHODS

The Dementia Preventive Individual and Family Self-Management Process Questionnaire (DP-IFSM-PQ) and the Dementia Preventive Self-Management Behavior Questionnaire (DPSMBQ) were developed based on the Individual and Family Self-Management Theory to evaluate dementia prevention self-management behaviors in older adults with T2DM. Items for the DP-IFSM-PQ (30 items) and DPSMBQ (29 items) were generated through literature review and tested for face validity. A quantitative cross-sectional study evaluated their psychometric properties using exploratory factor analysis (EFA) (n = 311) and confirmatory factor analysis (CFA) (n = 254).

RESULTS

The final DP-IFSM-PQ comprises four factors and 29 items, showing acceptable fit with limited discriminant validity. The DPSMBQ includes seven factors and 27 items, demonstrating good fit and acceptable discriminant validity.

CONCLUSIONS

The Thai-language DP-IFSM-PQ and DPSMBQ show reasonable psychometric properties for application in Thai older adults, but revisions of certain items and further studies are recommended to reassess their properties.

Heartfelt choices: The influence of cardiac phase on free-choice actions

The influence of cardiac phases on cognitive and sensorimotor functions is noteworthy. Specifically, during systole, as opposed to diastole, there is an observed enhancement in tasks demanding the suppression of instructed responses. This suggests that systole contributes to inhibitory control in motor functions. However, the extent to which systolic inhibition is significant in volitional free-choice actions, such as choosing to execute or refrain from a cue-initiated response, remains to be clarified. To fill this gap in the current literature, the purpose of this study was to test whether during the systole phase, compared with the diastole phase, the tendency to enact volitional actions decreased due to the systolic inhibitory effect. We used a modified version of the Go/No-Go task with an added condition for volitional free-choice actions, where participants could decide whether to respond or not, to test whether systolic inhibition could affect the volitional decision to act. The results showed that participants' responses were less frequent in systole than in diastole in the volitional action condition. Then, to test the robustness of the cardiac effect on volitional actions, we used two established manipulations: the Straw Breathing Manipulation and the Cold Pressor Test, which were able to induce anxiety and increase the heart rate, respectively. Results showed that the systole/diastole difference in the number of volitional action trials in which participants decided to respond tended to remain the same despite all manipulations. Overall, our results provide convergent evidence for the effect of the heart on the decision to act, an effect that appears independent of manipulations of both the physiological and psychological state of the individual.

Exploring the relationship between illness perception, self-management and quality of life among HIV-positive men who have sex with men

AIMS

This study aimed to explore the mediating effect of self-management (SM) on the relationship between illness perception and quality of life (QOL) among Human immunodeficiency virus (HIV)-positive men who have sex with men (MSM).

DESIGN

A cross-sectional study.

METHODS

We explored the effect of illness perception and self-management on QOL using the multiple regression model. Moreover, we conducted a simple mediation analysis to examine the role of SM in the relationship between illness perception and QOL. In addition, a parallel mediation analysis was performed to investigate the differences in domains of SM on the relationship between illness perception and QOL.

RESULTS

Among 300 Chinese HIV-positive MSM, the mean score of SM was 39.9 ± 6.97, with a range of 14.0-54.0. The higher score in SM indicated a higher level of HIV SM. SM was negatively related to illness perception (r = -0.47) while positively related to QOL (r = 0.56). SM partially mediated the relationship between illness perception and QOL, accounting for 25.3% of the total effect. Specifically, both daily self-management health practices and the chronic nature of the self-management domain played a parallel role in mediating the relationship between illness perception and QOL.

CONCLUSION

Our study demonstrated that SM was a significant factor influencing QOL among HIV-positive MSM. Focusing on daily self-management health practices and the chronic nature of self-management could be the potential key targets for enhancing HIV self-management strategies.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study emphasized the role of SM in the well-being of HIV-positive MSM and underscored the importance of developing interventions that integrate SM strategies to improve QOL in this population.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Transition to adulthood: Experience of Japanese youth with spina bifida

Background

Emerging adults with spina bifida have complex developmental and health care needs. Improvement in healthcare means there is greater interest in understanding and supporting the transition needs of children with spina bifida to adulthood. However, the experiences during transition for emerging adults with spina bifida in Japan remain unknown. The purpose of this study was to describe the experiences of transition to adulthood for emerging adults with spina bifida in Japan.

Methods

Qualitative descriptive design was used to explore experiences of emerging adults with spina bifida. Eight emerging adults between 20 and 29 years participated in semi-structured interviews.

Results

Six core themes were identified: (a) struggling with employment, (b) finding the meaning of "becoming an adult", (c) learning to implement self-management, (d) proceeding with and worrying over adult health care, (e) establishing and maintaining relationships with friends, and (f) broadening scope of experiences.

Conclusions

This study contributed to identification of both challenges and positive aspects in experiences of emerging adults with spina bifida in Japan. Participants shared the unique perspective of how to "become an adult" as a person with spina bifida in Japan. Ever-present were participants' experiences of struggling during transition to adulthood, especially when trying to find a job, establishing relationships with friends, and making the transition to adult health care. The challenges participants in this study faced striving to achieve adulthood-related milestones and transition to adult health care suggest that expansion of support and health care initiatives that reflects the Japanese social context are needed.

Self-Management and Its Associated Factors Among People Living With HIV at University of Gondar Comprehensive Specialized Hospital: A Cross-Sectional Study

Background: Self-management (SM) is the gold standard of care and is the direct active participation of patients in their disease management. Condition-specific factors, physical and social environment, individual and family, and the process of SM are factors that influence SM in people living with human immunodeficiency virus (PLHIV). Poor SM leads to high retroviral infection transmission, mortality, and morbidity. Objective: This study was aimed at assessing SM and its associated factors among PLHIV at the University of Gondar Comprehensive Specialized Hospital (UOGCSH), Northwest Ethiopia. Methods: A cross-sectional study was conducted using a systematic random sampling technique at the UOGCSH from May 20 to July 30, 2022. The data were collected using a previously validated tool and were entered and analyzed using Statistical Package for Social Sciences Version 25. A binary logistic regression analysis was used to identify factors associated with poor SM. The statistical significance was considered at a p value < 0.05. Result: Of 419 PLHIV, the median (IQR) SM score was 39 (9), and above half (52.6%, 95% CI: 48%-57%) of them had poor SM. Being unemployed (AOR = 2.49, 95%CI = 1.19, 5.19), living alone (AOR = 2.16, 95%CI = 1.12, 4.17), unfamiliar with the management of HIV-related symptoms (AOR = 3.59, 95%CI = 2.08, 6.20), poor social support (AOR = 3.02, 95%CI = 1.54, 5.93), poor self-efficacy (AOR = 3.04, 95%CI = 1.83, 5.06), and unsupported by the adherence support group (AOR = 17.17, 95%CI = 8.37, 35.22) were significantly associated with poor SM. Conclusion: The majority of PLHIV had poor SM. This study supports the findings of individual family SM theory and previously published studies regarding factors affecting SM. The government, hospital, adherence support groups, and PLHIV should work on modifiable sociodemographic, condition-specific, and process of SM to improve SM of PLHIV.

Nursing in a culture of peace

BACKGROUND

The knowledge and practice in the field of peacebuilding is congruent with nursing and offers important dimensions and insight that can strengthen the work of nurses in building healthy communities and individuals.

PURPOSE

This article summarizes key literature and discussions with faculty in each field to outline impactful opportunities for interprofessional collaboration around peace and health.

METHODS

An iterative process of reviewing theory and practice in each field produces a structured comparison of major commonalities and differences.

DISCUSSION

Collaboration between nurses and peacebuilding practitioners provides a unique opportunity to address the wicked problems of direct and indirect (structural) violence. Shared interests in a holistic systems lens approach to violence prevention and conflict transformation provide for professional synergies.

CONCLUSION

An exemplary case for collaboration between nurses and peacebuilding practitioners is found in the work of understanding and addressing direct and indirect violence locally and globally.

Family Caregivers of Persons with Bipolar Disorder: Caregiver Demographics and Need and Preference for Intervention

The unpredictability of bipolar disorder is highly distressing for family caregivers, who differ in their needs and preferences for stress-reducing or educational interventions. Applying Ryan and Sawin's model, this study examined associations between caregiver demographics (age, gender, and race) as contextual factors and caregiver needs and preferences for three interventions as process factors within a preliminary descriptive analysis of 306 family caregivers from a randomized clinical trial. Caregiver needs for education about bipolar disorder, biofeedback, and Resourcefulness Training© were determined by established cut scores on validated measures of bipolar knowledge, heart rate variability, and resourcefulness. Frequencies for need and preference for intervention were compared by caregiver age, gender, and race. Discrepancies between caregiver need and preference for interventions were analyzed. Non-White caregivers showed greater need for education (X2=33.68, p < 0.001). Middle-aged caregivers showed greatest need for biofeedback (X2=19.58, p < 0.001). Need for Resourcefulness Training© was similar across age, gender, and race. We found 58% needed biofeedback, 34% education, and 18% Resourcefulness Training©; 46% of those in the preference group chose Resourcefulness Training©. Further caregiver intervention research should consider the effect of caregiver needs and preferences on their health. The findings support the essentiality of assessing caregiver demographics, needs, and preferences before implementing interventions.

Contribution of Disease-Specific Distress, Social Support, and Self-Efficacy to Diabetes Self-Management Behaviors in Saudi Adults: A Path Analysis

Purpose

Disease-specific distress, social support, and self-efficacy have noticeable impacts on diabetes self-management. Although these three concepts are connected, their interplay and subsequent influence on diabetes self-management warrants further research.

Patients and Methods

A total of 154 individuals with type 2 diabetes mellitus were recruited to complete a survey, which included questions related to social support, diabetes self-efficacy, diabetes self-management behaviors, and disease-specific stress. The variables were examined with path analysis using Analysis of Moment Structures (AMOS) software.

Results

In the final model, diabetes self-efficacy was a significant predictor of increased diabetes self-management behaviors. Lower levels of disease-specific distress were associated with higher levels of self-efficacy. Path analysis indicated that the direct effect of social support on diabetes self-management behaviors was significant, and social support indirectly affected diabetes self-management behaviors through the mediating effect of diabetes self-efficacy. Overall, the study findings indicate that social support can exert an impact on diabetes self-management behaviors through the mediating effect of diabetes self-efficacy.

Conclusion

The study's findings support the use of Individual and Family Self-Management Theory to improve diabetes self-management. Further research is needed to better understand how factors related to the family support system influence diabetes self-management behaviors.

Evaluating a digital tool for supporting people affected by breast cancer: a prospective randomized controlled trial-the ADAPT study

PURPOSE

This study reports the findings from the ADAPT randomized controlled trial (RCT), concerning the impact of a digital tool for supported self-management in people affected by breast cancer on patient activation as the primary outcome, with health-related quality of life (HRQoL), and health status as secondary outcomes.

METHODS

Women with early-stage breast cancer were randomly assigned to standard care (control) or standard care in addition to the breast cancer digital tool (intervention). Data were collected using a demographic questionnaire, the Patient Activation Measure (PAM-13), the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), and the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) at baseline, 6 weeks, 3 months, 6 months, and 1 year from diagnosis. Linear mixed effect model regression was used to assess the effect of the digital tool over the first year from diagnosis while correcting for intra-participant correlation.

RESULTS

A total of 166 participants were included, with 85 being randomized into the intervention. No significant differences (p > 0.05) in the PAM-13 scores, EORTC QLQ-C30 scales (global QoL, physical functioning, emotional functioning, pain, fatigue), and EQ-5D-5L Index between the control and intervention groups were observed. It is important to note that there was significant non-adherence within the intervention group.

CONCLUSION

The breast cancer digital tool had no statistically significant impact on patient activation, HRQoL, and health status over time compared to standard care alone in women with early-stage breast cancer. Future research should focus on identifying and addressing barriers to digital tool engagement to improve efficacy. Clinical trial information The study was registered at https://clinicaltrials.gov (NCT03866655) on 7 March 2019 ( https://clinicaltrials.gov/study/NCT03866655 ).

Effect of self-efficacy on self-management ability for colorectal cancer patients with stoma: a path analysis

PURPOSE

Colorectal cancer threatens health and causes heavy social burdens. The purpose of this study is to analyze the pathway model for the effect of self-efficacy on self-management ability in colorectal cancer patients with stoma.

METHODS

A cross-sectional study was conducted from December 2022 to April 2023, with a convenience sample of 422 colorectal cancer patients with stoma at six tertiary grade A hospitals in Shandong Province, China. Statistical analysis was undertaken using SPSS 26.0 and Amos 24.0 software. A pathway model based on individual and family self-management theories was developed and analyzed by collecting data through onsite survey and online survey.

RESULTS

Chinese colorectal cancer patient's self-management ability score is 105.19 (17.19), which shows medium-level self-management ability. The self-efficacy of colorectal cancer patients with a stoma is influenced by social support, which ultimately leads to changes in their self-management ability.

CONCLUSION

The findings may help healthcare professionals to identify the factors that influence self-management skills of colorectal cancer patients with stoma and provide a basis for developing interventions.

Development of a Symptom Self-Management Guide for Older Chinese Americans Kidney Receiving Replacement Therapy

Aim

To assess the acceptability of a symptom self-management booklet among older Chinese Americans receiving kidney replacement therapy.

Background

In previous work, we identified commonly occurring, bothersome symptoms and strategies used in this population to ameliorate symptoms. We used these data to develop a symptom self-management booklet in English, traditional, and simplified Chinese.

Introduction

In the United States, the prevalence of kidney disease is 1.5 times higher in Asians compared to whites. With the many symptoms associated with this disease, self-management of symptoms would be particularly helpful.

Methods

Seven older Chinese Americans receiving kidney replacement therapy and their caregivers were interviewed to assess the acceptability of the booklets. We reviewed participant feedback on content, graphics, and design, reading experience, suggestions for improvement, and health information sources using the inductive thematic method.

Results

Overall, patients confirmed acceptability of these self-management booklets across all domains. Discussion. This study validated the booklet as a source of health information for older Chinese American patients with kidney disease, which some studies suggest are preferred to electronic materials or methods in this population. Health care providers can use the resultant booklets when caring for these patients to provide culturally sensitive information on self-management of symptoms. Conclusion and Implications for Nursing. These booklets provide a free resource tailored to an underserved population and may help nurses and nurse practitioners provide care with cultural humility. Implications for Health Policy. Embracing community-based participatory research, as was done in this study, can help create culturally appropriate patient education materials that empower patient symptom self-management and promote informative and culturally sensitive conversations between patients, families, and providers.

Heart failure self-management: a scoping review of interventions implemented by allied health professionals

BACKGROUND

Heart failure (HF) is typically managed using both medical and patient self-management interventions. Individuals with HF often have frequent readmissions to hospital for medical management. Effective self-management can help to reduce the exacerbation of HF symptoms and the frequency of readmissions.

METHODS

A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines was conducted to identify literature on the interventions used by allied health professionals to promote HF self-management. A search strategy was implemented, and articles were reviewed by two independent reviewers.

RESULTS

Twenty articles met the inclusion criteria. Articles included interventions from physical therapy, nutrition, social work, and occupational therapy, as well as other health professions in team-based programs. The most common interventions were verbal education, textual information, monitoring resources, and skills practice. Interventions addressed diet/fluid control, exercise and activity, symptom monitoring, medication management, cardiovascular disease knowledge, and mental health. Many interventions were theory informed.

CONCLUSION

There is nascent evidence that interventions promoting HF self-management positively impact health and quality of life outcomes. HF self-management is multi-faceted and requires interprofessional collaboration. Further work is warranted exploring the impact of theory-informed interventions, and the effectiveness of interventions on self-management competence and desired health outcomes.

Impact of Gender on Patient Experiences of Self-Management in Type 2 Diabetes: A Qualitative Study

Purpose

This study aims to identify gender disparities in knowledge, attitudes and behaviors related to self-management and control of Type 2 diabetes Mellitus (T2DM) among primary care patients. The research was conducted across multiple Spanish cities.

Patients and Methods

The study involved 8 Primary Care Centres located in four distinct regions of Spain: East (Barcelona), Centre (Madrid), North (Pamplona and Zumaia) and South (Vélez-Málaga and Málaga). A total of 111 individuals diagnosed with T2DM, comprising 52 women and 59 men, participated in 12 group discussions at these primary healthcare centers from February to June 2015. Participation was voluntary, and all participants provided informed consent by signing the consent form. A qualitative hermeneutic phenomenological study with a maximum variation sample was done. Participant profiles were defined based on gender, age, place of residence, type of treatment, years living with T2DM and the presence or absence of a cardiovascular event. Thematic analysis was used to analyze the data.

Results

Participants were aware that diabetes is a chronic condition, with varied levels of concern regarding the diagnosis. Participants' locus of control influenced their perception of the disease's cause, with women attributing it to stress and emotional situations, while men linked it to risky behaviors. Self-management strategies were shaped by beliefs about diabetes, with both genders facing challenges in implementing recommended practices. Gender differences were also evident in caregiving roles, with men receiving more family support for diet adherence, while women prioritized family needs over their self-care. Participants expressed satisfaction with professional-patient interactions but highlighted the need for more accessible information and specialist care, suggesting support groups for women and clear health guidelines for men.

Conclusion

Gender differences significantly influence how patients perceive and manage type 2 diabetes, with women experiencing greater concern and care burden compared to men. Effective diabetes management requires tailored support that addresses these gender-specific challenges. Enhancing healthcare services with clear guidelines and support groups can improve self-management outcomes in both men and women.

Self-management needs, strategies and support for individuals with sickle cell disease in developing countries: a scoping review

INTRODUCTION

Sickle cell disease (SCD) poses a significant global health burden, particularly affecting individuals in developing countries with constrained healthcare resources. While research on self-management in the context of SCD is emerging, it has predominantly focused on primary studies. The aim of the scoping review was to identify and map self-management needs of individuals living with SCD, the strategies they employed to meet those needs, and the support interventions available to them.

METHODS AND ANALYSIS

The review was conducted following the Askey and O'Malley's framework to examine the landscape of SCD self-management research. Searches were conducted in PubMed, Scopus, Embase and Dimensions AI, with additional searches in other databases from inception to June 2024 included. Evidence from 14 studies was synthesised to identify self-management needs, strategies and interventions for individuals with SCD.

RESULTS

The review identified diverse self-management needs among individuals with SCD, including knowledge deficits, emotional challenges, physical limitations and barriers to healthcare access. Various self-management strategies were reported, such as nutritional management, psychological coping techniques and proactive healthcare management. Self-management interventions, predominantly delivered by healthcare professionals, focused on providing education, skills training and support to individuals with SCD. The outcomes of self-management interventions consistently demonstrated significant improvements across various dimensions, including self-efficacy, knowledge enhancement, self-care practices and psychological well-being among individuals with SCD.

CONCLUSION

This scoping review underscores the importance of addressing the diverse self-management needs of individuals with SCD through tailored interventions and support systems to enhance overall well-being and disease management. Healthcare professionals should prioritise the implementation of multidisciplinary self-management interventions that encompass medical, emotional and social aspects of care to effectively support individuals with SCD in managing their condition. Future research should focus on longitudinal studies to assess the long-term effectiveness of self-management interventions in improving patient outcomes.

Nursing outcomes and social support intervention for diabetes self-management: consensus study

Introduction

Diabetes mellitus is one of the most prevalent chronic noncommunicable diseases in the world.

Objective

To validate by expert consensus the Nursing Outcomes Classification (NOC) self-management: diabetes (1619) and social support (1504), as well as to validate the intervention of social support for adults in the self-management of type 2 diabetes mellitus (DM2).

Materials and Methods

A consensus study. Several phases were delimited for validation: the first was to validate the results and indicators; the second was to construct and validate the conceptual and operational definitions; and the magnitude of the selected indicators; and the third was to design and validate the intervention of social support for adults in the self-management of DM2.

Results

28 indicators were selected and validated by experts out of the 44 that make up the nursing outcome of self-management: diabetes, and 9 indicators out of the 12 that make up the social support outcome, both with a Content Validity Index (CVI) of 0.98. As for the intervention, a social support intervention was designed for the self-management of DM2, individualized, and made up of 4 sessions. The components of the intervention include generalities of DM2, healthy life habits, safe care, and emotional support.

Discussion

Nursing professionals must evaluate people who experience diabetes, and their capacity for self-management and social support in order to provide appropriate interventions and evaluate their effectiveness.

Conclusions

The study significantly evidenced the validation of the two nursing outcomes and their respective indicators, added to the conceptual and operational definitions, and their magnitude.

The concept of treatment beliefs in children and adolescents with chronic health conditions: a scoping review

Children and adolescents with chronic health conditions are faced with ongoing challenges, making self-regulation crucial. As children grow up, they gradually develop differentiated beliefs about illness and treatment. While research indicates treatment beliefs as relevant factor on outcomes like adherence, the specific contents and dimensions of children's and adolescents' treatment beliefs remained unclear. This scoping review therefore aimed at the identification of treatment beliefs dimensions in children and adolescents with chronic health conditions, the underlying theoretical frameworks, and methodological operationalisation. Published literature was examined by applying systematic searches in electronic databases (Medline, PsycINFO, CINAHL) and comprehensive selection criteria, resulting in 49 included studies. The predominant treatment beliefs dimensions were necessity, concerns, perceived benefits and costs/barriers, and expectations. The latter can be differentiated into outcome, social, process, and structural expectations, and expectations of one's own role in the treatment process. In addition, dimensions that cover emotions and reasons for treatment were identified. The results are related to the methods and theoretical models applied, which were often adapted from adult research. However, additional and possibly more child-specific dimensions such as social expectations and emotions were found. This scoping review indicates several research gaps and discusses practical implications.

Interactive Health Literacy and Symptom Self-management in Patients With Lung Cancer: A Critical Realist Analysis

BACKGROUND

Patients with lung cancer experience multiple symptoms requiring self-management. Little is known about how self-management is influenced by interactive health literacy, defined as communicating with healthcare providers to obtain and process information.

OBJECTIVE

This study explored how interactive health literacy relates to symptom self-management among patients with lung cancer. A second aim explored how interactive health literacy might be integrated into the Individual and Family Self-management Theory.

METHODS

This study used a cross-sectional mixed-methods design. Quantitative data included demographics, the All Aspects of Health Literacy Scale, and the Memorial Symptom Assessment-Short Form. Qualitative data were collected using semistructured interviews. Data analysis followed a critical realist model.

RESULTS

Twelve adults who recently received treatment for lung cancer reported an average of 14 symptoms that caused moderate distress. Average interactive health literacy of the sample was in the moderate range. Participants' experiences of self-management differed based on their interactive health literacy. A generative mechanism proposes that those with higher interactive health literacy who accessed online information used this information as a basis for engaging with providers regarding potential symptom self-management strategies.

CONCLUSIONS

Interactive health literacy skills may play a role in patients' ability and confidence in symptom self-management through interactions with oncology providers. Further research should clarify the relationship between interactive health literacy, self-efficacy, and collaboration with oncology providers.

IMPLICATIONS FOR PRACTICE

The patient-provider relationship is a key factor influencing how patients obtain and process symptom self-management information. Oncology providers should implement patient-centered strategies to engage patients in symptom self-management.

Symptom experiences and self-management strategies of patients with haematological malignancy undergoing chemotherapy: A qualitative study

Objective

To explore symptom experiences and self-management strategies from the haematological malignancy patient's perspective.

Methods

A qualitative descriptive approach was used to provide a direct and comprehensive understanding of the symptoms experienced and self-management strategies during treatment among patients with haematological malignancy. Fourteen patients with haematologic malignancies who received chemotherapy at a Chinese tertiary hospital were selected using purposeful sampling. Data were collected via semi-structured interviews and one-on-one patient sessions. The collected data were analysed using the content analysis methods. Reporting adhered to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.

Results

The data from this study were categorized into four themes and eight subthemes: (1) the dynamics and complexity of symptom experience (nonlinear, and overloaded symptom burden); (2) strategies for coping with symptomatic change (actively responding to challenges, and facing symptoms negatively); (3) symptom affects interaction (symptoms affect family interactions, and symptoms affect social interactions); and (4) benefit from symptom management (promoting family relationships, and regaining a new role in society).

Conclusions

Patients with haematological malignancy undergoing chemotherapy still face complex and variable symptoms, and there are still considerable challenges in symptom management. The findings underscore that health care providers should provide the necessary symptom assessment to enhance the well-being of patients based on the characteristics of the patient's symptom experience and symptom management needs at different stages of the disease.

Nurse-led self-management support to improve symptom management and self-reported outcomes in people with irritable bowel syndrome

Objectives

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction with an unknown precise etiology. Intricate mechanisms underlying the disruption of bidirectional communication between the brain and the gut may influence the severity of symptoms as well as the response to self-management interventions. Management of IBS can be particularly challenging due to recurrent and resistant symptoms to therapeutic approaches. The present study aimed to evaluate the role of nurse-led self-management support on symptom management and self-reported outcomes in people with IBS.

Methods

In the current study, which was part of a parent randomized controlled trial, participants with IBS received one-on-one self-management intervention either by phone or in-person by Registered Nurses (RNs) in 3 sessions over 12 weeks. Each intervention was between 15 and 30 minutes. During the first intervention, the RN asked open-ended questions on symptom episodes, stress, physical activity, Quality of Life (QOL), and diet to provide recommendations for improved self-management. At the second and the third nurse-led self-management sessions, the RN helped in problem-identification and solving throughout the intervention. Quantitative content analysis was performed using the coding system developed by 2 authors for analyzing the participants' responses.

Results

In total, 24 participants with IBS completed the 3 nurse-led self-management sessions. Participants' mean age was 21.37 (±2.55) years old, and 83.33% were female. At the first nurse-led self-management session, 79% of participants reported pain, 62.5% reported bloating, 50% reported diarrhea, 37.5% reported constipation, 100% reported stress, and 95.6% had physical activity as part of their routines, while only 33.3% of the participants reported having a "high" QOL. After 3 nurse-led self-management sessions, participants reported improved IBS symptoms in pain 73%, bloating 73.7%, diarrhea 76.8%, constipation 50%, stress 42.1%, and physical activity 45%, as well as 66.7% of the participants experienced a "high" QOL. Dairy, fast/processed foods, and high-fat foods were the most frequent triggers of the symptoms, with a frequency of 40%, 24.5%, and 12%, respectively. After receiving nurse-led support, 69.20% of the participants reported improved dietary habits.

Conclusions

Nurse-led self-management can support participants to manage various IBS symptoms and improve their QOL. The unique strength of this study was evaluating participant needs and offering individualized solutions. A further study utilizing novel nurse-led self-management approaches may provide a valuable platform for empowering IBS patients' self-management.

Diabetes self-management and its influencing factors among adults with type 2 diabetes mellitus in rural Sri Lanka: A cross-sectional study

Background

Diabetes Self-Management (DSM) is pivotal in managing diabetes. However, poor engagement in DSM has been observed in rural Sri Lankan settings. Thus, identifying factors influencing DSM is crucial for nurses and other healthcare professionals.

Objectives

This study aimed to describe DSM among adults with Type 2 Diabetes Mellitus (T2DM) in rural Sri Lanka and to examine whether perceived stress, health literacy, self-efficacy, and family support can predict DSM among adults with T2DM in rural Sri Lanka.

Methods

This correlational predictive study used a simple random sampling technique to recruit 160 adults with T2DM from an outpatient clinic at a secondary care hospital in a rural area of Sri Lanka. Data were collected from March to April 2024 using socio-demographic and standardized questionnaires to examine predictive factors of DSM, including perceived stress, health literacy, self-efficacy, and family support. Data analysis was conducted using descriptive statistics and standard multiple linear regression analysis.

Results

Approximately half of the participants had uncontrolled T2DM (Fasting Plasma Glucose (FPG) >126) and sub-optimal DSM. The analysis revealed that all variables could explain 39.3% of the variance in DSM among rural Sri Lankan adults with T2DM. However, DSM was significantly predicted by self-efficacy (β = 0.530, p = 0.001), harmful family involvement (β = -0.169, p = 0.038), and health literacy (β = -0.162, p = 0.020).

Conclusion

The findings emphasized the need for further development of interventions to increase self-efficacy and reduce harmful family involvement to enhance DSM among adults with T2DM. Nurses and other healthcare providers should target family members' engagement to improve self-efficacy among this population.

Exploring the Influence of Contextual Factors and the Caregiving Process on Caregiver Burden and Quality of Life Outcomes of Heart Failure (HF) Dyads after a Hospital Discharge: A Mixed-Methods Study

Background: This study explores heart failure (HF) dyadic contextual factors and caregiver burden during acute exacerbation hospitalization and discharge. Methods: It employed a mixed-methods approach, with HF dyads completing questionnaires and semi-structured interviews at a one-week post-discharge outpatient visit. Quantitative tools included the SF-12 Quality of Life, Zarit Burden Interview (ZBI), Bakas Caregiving Outcomes Scale (BCOS), and Self-Care of Heart Failure Index v. 6 (SCHFI). Thematic analysis was conducted on interview data to assess caregiver burden, disease trajectory, comorbidities, caregiving time, and employment status. Results: Twelve HF dyads participated, with caregivers (six female, six male) averaging 65.76 years. The ZBI indicated a low caregiver burden (median score of 15), but qualitative data revealed a higher perceived burden related to social isolation, future fears, and caregiver dependence. Male caregivers reported a lower burden than females. Positive goal congruence was noted in caregiving hours and HF management compliance. HF patients had a 10-year survival prediction of 22.75% per the Charlson Comorbidity Index, with 69% in NYHA class III and an average ejection fraction of 37.7%. Caregivers working full-time and caring for higher NYHA-class patients showed higher ZBI and BCOS scores. Conclusions: The study highlights the need for mixed methods and longitudinal research to understand HF disease trajectory and caregiver burden, emphasizing the importance of including caregivers in HF education and screening for perceived burden to improve outcomes and reduce re-hospitalizations.