The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial

The effects of education based on the Roy adaptation model on medication adherence and psychosocial adjustment in hypertensive patients

BACKGROUND AND AIM

Patient education utilizing nursing theory can enhance patient adherence to treatment and potentially decrease mortality rates. The objective of this investigation was to assess the impact of Roy's adaptation Model-focused education on medication adherence and psychosocial compliance in hypertensive patients.

METHODS

This study was conducted in N = 60 hypertensive patients (n = 30 control group and n = 30 experimental group) based on a randomized controlled trial design. In the pre-test phase of the study, data was collected using the Patient Information Form, the medication adherence rating scale (MARS), and the psychosocial adjustment to illness scale-self-report (PAIS-SR). After the pre-test phase, the experimental group received hypertension education and the "Hypertension Education Booklet" for a duration of four weeks. No education was provided to the control group patients; only routine follow-ups were conducted. In the post-test phase (after four weeks), both groups were reassessed using MARS and PAIS-SR. After completing the study, the control group patients who volunteered to participate in the education were provided with hypertension education and the "Hypertension Education Booklet" for a duration of four weeks (n = 4).

RESULTS

The post-test measurements of patients in the experimental group (after 4 weeks of education) revealed an increase in the mean MARS scores (6.50 ± 0.86) and a significant decrease in the total and subscale mean scores of PAIS-SR (24.12 ± 7.08) (p < 0.05). No changes were observed in the control group patients.

CONCLUSION

The results of the study revealed that the education based on the Roy's Adaptation Model increased hypertensive individuals' medication adherence and physiological, psychological, and social adjustment to the disease.

RELEVANCE TO CLINICAL PRACTICE

The education based on the Roy's Adaptation Model seems to be effective in increasing patients' adherence to treatment and adjustment to the disease. This model can be used in various diseases and societies, since it increases adjustment to the disease and the effectiveness of treatment.

Concept analysis of "Insufficient health literacy" in older adults and refinement of a diagnosis proposal

PURPOSE

This study aims to conduct a thorough analysis of the concept of insufficient health literacy (IHL) in older adults and to refine a nursing diagnosis proposal while considering the specific characteristics of this demographic.

METHODS

A comprehensive concept analysis was undertaken using Walker & Avant's method as a framework.

FINDINGS

A systematic search across seventeen databases yielded 29 relevant studies for inclusion. Through analysis, we identified 15 antecedents, 3 attributes, and 7 consequents associated with IHL in older adults.

CONCLUSIONS

The concept analysis brought clarity to the understanding of IHL within older adults, facilitating the refinement of a diagnosis proposal. This process was instrumental in establishing a diagnostic structure that accounts for the unique needs and challenges faced by older adults.

IMPLICATIONS FOR NURSING PRACTICE

The structured diagnosis derived from the concept analysis provides a solid theoretical foundation for nurses specializing in Gerontology. By tailoring care interventions to address the specific requirements of older adults, this framework enhances the quality of nursing practice and contributes to improved patient outcomes in geriatric care settings.

Pandemic Pressure: Changes in Hypertensive Management Adherence in Indonesia

PURPOSE

This study aimed to determine factors associated with changes in adherence to hypertension management (medication adherence and blood pressure control) in respondents with hypertension before and during the COVID-19 pandemic in Bogor city, Indonesia.

METHODS

An observational study was conducted using two sources of data (before and during COVID-19 pandemic). Data before the pandemic were derived from the 2019 Cohort Study of non-communicable disease risk factors. Data during the pandemic were derived from an online survey conducted in September and October 2020. Information from 880 participants were analyzed. The dependent variable was the change in adherence to hypertension management before and during the COVID-19 pandemic. Multivariate analysis was performed using logistic polynomial regression.

RESULTS

Respondents who adhered to hypertension management decreased from 82.0% in 2019 to 47.8% in 2020. The likelihood of non-adherence (respondents who did not adhere to hypertension management both before and during the pandemic) increased in respondents below 55 years old, who did not own any healthcare insurance, who were not obese, and who had no other comorbidities. In the partial adherence group (respondents who did not adhere to hypertension management either before or during the pandemic), we found that most respondents adhered before the pandemic but no longer adhered during the COVID-19 pandemic. We found an increased partial adherence in young and highly educated respondents.

CONCLUSIONS

Efforts to improve adherence to hypertension management after the COVID-19 pandemic should target those who were young, highly educated, who did not have any healthcare insurance, and who did not perceive themselves as not having comorbidities.

Knowledge and acceptance associated with medication adherence among hypertension individuals in Aceh province, Indonesia

Low adherence to anti-hypertensive medication is observed among individuals in Aceh, the westernmost province of Indonesia. Since uncontrolled hypertension has the potential to develop into a life-threatening disease, exploring medication adherence among this specific population is essential. Therefore, this study aimed to evaluate knowledge and acceptance associated with medication adherence among hypertensive individuals in Aceh Province. A cross-sectional study was conducted from March to July 2023 on 534 respondents diagnosed with hypertension, who were selected using the random sampling method. Demographic characteristics collected included body height and weight, age, gender, education, ethnicity, and occupation. Acceptance and knowledge were measured through a set of standardized questionnaires while the Morisky Medication Adherence Scale-8 was used for evaluating medication adherence. Logistic regression with a multinomial model was used to assess the correlations of acceptance and knowledge with medication adherence. The results showed that only 28.5 % of the respondents had high adherence to anti-hypertensive medication. Furthermore, a high level of acceptance towards hypertension significantly predicted medication adherence (p < 0.001; OR = 9.14 [95%CI: 3.49-23.94]). Knowledge about dosing frequency, the benefits of low-fat and sodium diets, and the negative impacts of drinking alcohol were correlated with high-level adherence (p < 0.01). Meanwhile, knowledge about renal complications correlated negatively with adherence level (p = 0.002; OR = 0.32 [95%CI: 0.16-0.66]). In conclusion, this study showed that acceptance and knowledge of hypertension correlated with the level of medication adherence.

The Relationship Between a Healthy People 2030 Health Literacy-Related Objective (HC/HIT02) and Cancer Prevention and Screening Behaviors

Healthy People 2030 highlights the importance of both personal and organizational health literacy (HL) to improving population health. Yet, most research focuses on personal-level HL or fails to study the effect of both types of HL on health behavior. This study explored the relationships between organizational HL (Healthy People 2030 objective: decrease the proportion of adults who report poor communication with their health care provider), personal-level HL, and cancer prevention and screening behaviors. Data were collected using Qualtrics Panel. Participants who indicated they had a non-emergency room provider visit in the last 12 months were included in the analyses. Participants (n=549, Mean age = 41.44 years, SD = 15.91; 51.9% female; 54.3% White, 28.8% Hispanic/Latino/a/x) completed measures of personal and organizational HL and reported on their cancer prevention (e.g., cigarette smoking) and screening (e.g., mammogram) behaviors. Hierarchical linear and logistic regressions predicting cancer prevention and screening behaviors, respectively, from organizational HL, personal HL, and demographic covariates, were estimated. Regarding the results, higher organizational HL was related to higher fruit and vegetables consumption and physical activity after accounting for personal-level HL and demographic covariates. Higher personal-level HL was related to lower physical activity, binge-drinking, and cigarette smoking, and higher odds of pap smear screening, prostate-specific antigen testing, and completing all eligible screenings after accounting for organizational-level HL and demographic covariates. The findings support that personal-level and organizational HL may be differentially important to improving cancer prevention and screening behaviors. Policies that address improving both personal-level and organizational-level HL are needed.

Tobacco use and its associated factors among middle and old-aged women in India using LASI wave-1 data

BACKGROUND

Despite a global decline in tobacco use reported by the Global Adult Tobacco Survey (GATS), India stands out for its high number of tobacco users. While research in India often focuses on tobacco use among young adults, there's a notable lack of studies addressing tobacco use among middle and old-aged women. However, the national prevalence of tobacco use among middle and old-aged (45 years and above) women in India is 18.2%. Thus, this study seeks to identify the factors influencing tobacco consumption among middle and old-aged women in the country.

METHODS

The study has utilized secondary data from Longitudinal Aging Study in India (LASI) conducted in 2017-18. This study exclusively included a total of 38,180 middle and old-aged women who reported tobacco use. The analysis encompassed the utilization of Chi-square tests and Binary logistic regression to pinpoint the risk factors linked to tobacco use among middle and old-aged women.

RESULTS

Our study reveals a heightened likelihood of tobacco use among middle and old-aged women residing in the northeastern region of India. The study underscores the imperative to direct targeted efforts toward middle and old-aged women who fall into specific categories, including those who are widowed, separated, or unmarried, individuals who consume alcohol, those with lower socioeconomic and educational standings, residents of rural areas, those living in solitude, individuals experiencing depressive symptoms, and those who self-report poor health.

CONCLUSION

Given the heightened susceptibility of these demographic groups to tobacco use, it is crucial to prioritize tobacco prevention and cessation initiatives specifically tailored to their needs and circumstances.

The impact of non-pharmacological interventions on adherence to medication and persistence in dyslipidaemia and hypertension: a systematic review

INTRODUCTION

Suboptimal medication adherence is common among patients with cardiovascular diseases. We sought evidence on non-pharmacological interventions used to support adherence for patients with hypertension and/or dyslipidemia.

METHODS

We searched MEDLINE, EMBASE, MEDLINE In-Process, ClinicalTrials.gov, EUCTR, and conference proceedings from July 2011 to July 2021 to identify trials evaluating effects of health education, phone reminders, or digital interventions on medication adherence or persistence of adult patients with hypertension and/or dyslipidemia. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool v2.

RESULTS

Of 64 studies, 62 used health education approaches (e.g. educational interviews, motivational meetings, advice from physicians, and mobile health content), 16 phone reminders (e.g. text reminders, electronic pill-box linked reminders, bi-directional text messaging), and 10 digital applications as interventions (e.g., various self-management applications). All studies assessed medication adherence; only two persistence. Overall, 30 studies (83%) assessing health education approaches alone and 25 (78%) combined with other strategies, 12 (75%) phone reminders and eight studies (80%) digital applications combined with other strategies reported improved medication adherence. Two studies assessing health education approaches reported improved persistence.

CONCLUSIONS

Our findings indicate non-pharmacological interventions may positively impact adherence. Therefore, 'beyond the pill' approaches could play a role in preventing cardiovascular diseases.

Opinions and perceptions of patients with cardiovascular disease on adherence: a qualitative study of focus groups

BACKGROUND

Cardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difficulties associated with therapeutic adherence.

METHODS

An interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identified.

RESULTS

Two in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions . The main themes identified were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system.

CONCLUSIONS

Adhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difficult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.

Motivational Interviewing as a Tool to Increase Motivation and Adherence to a Long COVID Telerehabilitation Intervention: Secondary Data Analysis from a Randomized Clinical Trial

Background

Although motivational interviewing was originally developed to address abuse disorders, scientific evidence confirms that it is an increasingly used and effective approach in a wide range of therapeutic interventions. To date, however, no studies have analyzed the use of this tool in patients with persistent symptoms following coronavirus disease 2019, a condition known as Long COVID.

Purpose

To analyze the effectiveness of motivational interviewing with regard to the adherence to telerehabilitation for Long COVID using a mobile application. As a secondary objective, factors related to greater motivation before and after the motivational interviewing techniques were analyzed.

Patients and Methods

This longitudinal design substudy used a sample of 52 adult patients with Long COVID participating in the intervention group of a randomized clinical trial. This trial examined the effectiveness of a telerehabilitation program for this population using a mobile application. This program included three motivational interviews to achieve maximum treatment adherence. In this study, the main variables were motivation and adherence to application use. Sociodemographic and clinical data, personal constructs, and affective state were also collected. Subsequently, a descriptive, correlational, and regression statistical analysis was performed using the SPSS Statistics program.

Results

The median motivation prior to the first motivational interview was 8 (IQR 2), the median at the end of the last motivational interview was 8.5 (IQR 2.75), and the change in motivation levels after the three motivational interviews was 0.5 (IQR 1). Affective state and final motivation scores were predictors of greater adherence to telerehabilitation treatment.

Conclusion

A high level of motivation after participating in motivational interviewing appears to be related to higher levels of adherence to telerehabilitation in patients with Long COVID. This suggests that motivational interviewing may be an effective tool in the treatment of this disease.

Antihypertensive drug concentration measurement combined with personalized feedback in resistant hypertension: a randomized controlled trial

BACKGROUND

Adherence to antihypertensive drugs (AHDs) is crucial for controlling blood pressure (BP). We aimed to determine the effectiveness of measuring AHD concentrations using a dried blood spot (DBS) sampling method to identify nonadherence, combined with personalized feedback, in reducing resistant hypertension.

METHODS

We conducted a multicenter, randomized, controlled trial (RHYME-RCT, ICTRP NTR6914) in patients with established resistant hypertension. Patients were randomized to receive either an intervention with standard of care (SoC) or SoC alone. SoC consisted of BP measurement and DBS sampling at baseline, 3 months (t3), 6 months (t6), and 12 months (t12); AHD concentrations were measured but not reported in this arm. In the intervention arm, results on AHD concentrations were discussed during a personalized feedback conversation at baseline and t3. Study endpoints included the proportion of patients with RH and AHD adherence at t12.

RESULTS

Forty-nine patients were randomized to receive the intervention+SoC, and 51 were randomized to receive SoC alone. The proportion of adherent patients improved from 70.0 to 92.5% in the intervention+SoC arm ( P  = 0.008, n  = 40) and remained the same in the SoC arm (71.4%, n  = 42). The difference in adherence between the arms was statistically significant ( P  = 0.014). The prevalence of resistant hypertension decreased to 75.0% in the intervention+SoC arm ( P  < 0.001, n  = 40) and 59.5% in the SoC arm ( P  < 0.001, n  = 42) at t12; the difference between the arms was statistically nonsignificant ( P  = 0.14).

CONCLUSION

Personalized feedback conversations based on DBS-derived AHD concentrations improved AHD adherence but did not reduce the prevalence of RH.

Content and delivery preferences for information to support the management of high blood pressure

Blood pressure(BP) management interventions have been shown to be more effective when accompanied by appropriate patient education. As high BP remains poorly controlled, there may be gaps in patient knowledge and education. Therefore, this study aimed to identify specific content and delivery preferences for information to support BP management among Australian adults from the general public. Given that BP management is predominantly undertaken by general practitioners(GPs), information preferences to support BP management were also ascertained from a small sample of Australian GPs. An online survey of adults was conducted to identify areas of concern for BP management to inform content preferences and preferred format for information delivery. A separate online survey was also delivered to GPs to determine preferred information sources to support BP management. Participants were recruited via social media. General public participants (n = 465) were mostly female (68%), >60 years (57%) and 49% were taking BP-lowering medications. The management of BP without medications, and role of lifestyle in BP management were of concern among 30% and 26% of adults respectively. Most adults (73%) preferred to access BP management information from their GP. 57% of GPs (total n = 23) preferred information for supporting BP management to be delivered via one-page summaries. This study identified that Australian adults would prefer more information about the management of BP without medications and via lifestyle delivered by their GP. This could be achieved by providing GPs with one-page summaries on relevant topics to support patient education and ultimately improve BP management.

Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model

Objective

Medication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level.

Methods

This cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman's correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively.

Results

Data from 388 participants were analyzed. The median (IQR [P25-P75]) score for medication adherence was 4.00 (2.00-4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (βtotal -0.236 [95% confidence interval (CI) -0.333 to -0.140]). Medication adherence was influenced by frailty (βdirect -0.192 [95% CI -0.284 to -0.099]) both directly and indirectly through health literacy (βindirect -0.044 [95% CI -0.077 to -0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect -0.052 [95% CI -0.092 to -0.106]; effect -0.041 [95% CI -0.071 to -0.012]; effect -0.026 [95% CI -0.051 to -0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects.

Conclusion

A moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.

Factors influencing self-quantification for patients with hypertension: A cross-sectional Study

This study aimed to investigate the level of self-quantification among patients with hypertension and identify the factors influencing this behavior. This study aimed to investigate self-quantification levels and identify influencing factors among 400 patients diagnosed with hypertension. Employing a convenience sampling method, the research was conducted across diverse healthcare settings, including a tertiary hospital, 2 community hospitals, 2 pension institutions, and 5 residential areas. Participants underwent assessment using a self-quantification scale. The collected data underwent thorough analysis using various statistical methods, including descriptive analysis for an overview, 2 independent samples t test for mean comparisons, one-way analysis of variance for variations among groups, and multiple linear regression analysis to identify influential factors. This robust methodology was applied to gain comprehensive insights into the self-quantification behaviors of patients with hypertension. The total self-quantification score for patients with hypertension was found to be (96.64 ± 14.16). The average value for all dimensions was (3.22 ± 0.47). Notably, medical insurance type, education level, age, and complications were identified as significant factors influencing self-quantification among patients with hypertension. The study concludes that patients without medical insurance, with lower education levels, older age, and no complications tended to have lower levels of self-quantification. These findings underscore the necessity for targeted interventions to improve self-quantification in these specific patient groups. By addressing the identified influencing factors, healthcare providers can implement measures to enhance self-quantification among patients with hypertension.

Understanding health literacy of deaf persons with hypertension in South Korea: A cross-sectional study

BACKGROUND

Health literacy is strongly associated with health inequality among persons with deafness, and hypertension (HTN) is the most prevalent chronic disease among persons with deafness in South Korea. Despite its importance, research regarding the health literacy levels of persons with deafness with HTN in South Korea is lacking. This study aimed to comprehensively assess the health literacy levels of persons with deafness with HTN in South Korea, including linguistic, functional, and internet health literacy.

METHODS

In this descriptive cross-sectional study, 95 persons with deafness with HTN were recruited through facilities associated with the deaf community. From August 2022 to February 2023, data were collected through face-to-face surveys attended by a sign language interpreter and online surveys. The data were analyzed using descriptive statistics and Spearman's correlation.

RESULTS

Approximately 62.1% of the participants exhibited a linguistic health literacy level corresponding to less than that of middle school students, and the total percentage correct of functional health literacy was 17.9%. Each domain of internet health literacy was low. Significant correlations were found between some aspects of health literacy.

CONCLUSIONS

The study's findings highlight the low health literacy levels across various facets among persons with deafness with HTN in South Korea. Based on these findings, several strategies are suggested for developing HTN self-management interventions for persons with deafness. This study contributes to the foundational understanding of health literacy among persons with deafness with HTN in South Korea and provides valuable insights and guidance for developing HTN self-management interventions.

Factors related to medication adherence in patients with hypertension in Iran: a systematic review study

OBJECTIVES

This study aimed to review the available studies of the factors in Iranian hypertensive patients' adherence to drug treatment.

METHODS

Four Persian databases and seven English databases were searched. The articles, which were published from 2000 to 2022 in Persian and English and examined the adherence to drug treatment in the Iranian population of adults with high blood pressure, were reviewed. Based on the primary examination, 31 of the initial 1062 articles met the inclusion criteria and were included in the analysis. The evidence, which was provided by the examined articles, was summarized and discussed using the 5-dimensional framework of adherence to long-term treatments, which was developed by WHO.

RESULTS

The factors that significantly correlated with adherence to drug treatment in the examined studies were: (1) factors that were related to the health team or the health system: patients' satisfaction with their doctor-patient relationship; (2) factors that were related to the conditions: the number of concomitant diseases, high quality of life and the implementation of effective interventions; (3) factors which were related to the treatment: long duration of illness, short intervals between the visits, duration of treatment, lower numbers of drugs, and the patient's blood pressure control; and (4) factors that were related to the patient: self-efficacy, health literacy, social support, locus of control, illness perception, beliefs, attitude, knowledge, and cues to action.

CONCLUSION

It is possible to draw definite conclusions about the factors which affect adherence to drug treatment in patients with high blood pressure because most of the relevant studies have been cross-sectional. Therefore, in the future, valuable results can be obtained by conducting more studies that preferably use objective instruments for assessing adherence to drug treatment.

Comparative Different Interventions to Improve Medication Adherence in Patients with Hypertension: A Network Meta-analysis

BACKGROUND

Hypertension has become a major public problem. One of every 4 adults has hypertension. Medications are critical in controlling blood pressure, but patient medication adherence is low. Therefore, it is very crucial to promote medication adherence. However, the complexity and variety of interventions cause clinical decision-making difficulties for health managers and patients.

OBJECTIVE

The aim of this study was to compare the effectiveness of different interventions to improve medication adherence in patients with hypertension.

METHODS

We searched PubMed, Cochrane Library, Web of Science, EMBASE, Wan Fang, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Biology Medicine disc databases for eligible studies. Medication adherence rate and medication adherence difference were assessed as outcomes. Sensitivity analysis and inconsistency detection were performed to evaluate whether the exclusion of high-risk studies affected the validity. The risk of bias was assessed using the risk of bias table in Review Manager 5.4. The surface under the cumulative ranking curve was used to estimate the rankings among different interventions.

RESULTS

Twenty-seven randomized controlled trials were included, and the interventions involved were categorized into 8 different categories. The network meta-analysis showed that the health intervention was the best to promote medication compliance in patients with hypertension.

CONCLUSIONS

Health intervention is recommended to improve medication adherence in patients with hypertension.

CLINICAL IMPLICATIONS

Health managers are recommended to provide health intervention to patients with hypertension to improve their medication adherence. This approach reduces morbidity, mortality, and healthcare costs for patients with cardiovascular disease.

Experiences of patient education among people affected by cardiovascular disease: a qualitative study based on Andragogy model

BACKGROUND

Patient education is a key component of patient care, positively affecting health promotion and self-care ability. In this regard, an extensive body of research supports the use of the andragogy model in patient education. The study aimed to explore the experiences of people with cardiovascular disease in patient education.

METHODS

This qualitative study involved 30 adult patients with cardiovascular disease who were hospitalized or had a history of hospitalization. They were purposively recruited with maximum variation from two large hospitals in Tehran, Iran. Data were gathered by conducting semi-structured interviews. Data collection was done by conducting semi-structured interviews. Then, the data were analyzed using directed content analysis and a preliminary framework based on six constructs of the andragogy model.

RESULTS

Data analysis resulted in the development of 850 primary codes, which were reduced to 660 during data reduction. These codes were grouped into nineteen subcategories under the six primary constructs of the andragogy model, i.e., need-to-know, self-concept, prior experience, readiness for learning, orientation to learning, and motivation for learning. The most common problems in patient education were associated with self-concept, previous experience, and readiness for learning components.

CONCLUSION

This study provides valuable information about the problems of patient education for adults with cardiovascular disease. Correction of the issues identified can improve care quality and patient outcomes.

Health education interventions for individuals with hearing impairment: A systematic review

OBJECTIVES

This study aims to systematically review health education interventions targeting individuals with hearing impairment.

METHODS

A total of 18 studies were selected based on search results from five databases, and quality appraisal was conducted using an appropriate tool based on the study design. The extracted results were described using qualitative analysis.

RESULTS

Among the selected studies, most interventions focused on specific cancers, and video materials were the most common delivery method. Various strategies were applied depending on the type of materials provided, in addition to sign language interpretation and the involvement of hearing-impaired related personnel. The interventions primarily resulted in a significant increase in knowledge.

CONCLUSION

This study suggests several recommendations, including expanding the scope of interventions to cover various chronic diseases, actively utilizing the features of video materials, considering health literacy, using peer support groups, and measuring behavior-related factors alongside knowledge levels.

PRACTICE IMPLICATIONS

This study makes a significant contribution to understanding the unique characteristics of the population with hearing impairment. Furthermore, it has the potential to facilitate the development of high-quality health education interventions for individuals with hearing impairment by providing insights into future research directions based on existing health education interventions.

Estimation of health literacy levels in patients with cardiovascular diseases in a Gulf country

INTRODUCTION

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. In the United Arab Emirates (UAE), the prevalence of deaths associated with CVD is higher than the global average, and the incidence of premature coronary heart disease is 10-15 years earlier than in Western nations. In patients with CVD, inadequate health literacy (HL) is significantly associated with poor health outcomes. The goal of this study is to assess HL levels among patients with CVD in the UAE to develop effective health system strategies for disease prevention and management.

METHODS

A nationwide cross-sectional survey to assess HL levels in patients with CVD was conducted between January 2019 and May 2020 in the UAE. The association between health literacy level with patient age, gender, nationality, and education was determined using the Chi-Square test. The significant variables were further analyzed by ordinal regression.

RESULTS

Of 336 participants (86.5% response rate), approximately half 51.5% (173/336) of the respondents were women, and 46% (146/336) of them attained high school level of education. More than 75% (268/336) of the participants were above the age of 50 years. Overall, 39.3% (132/336) of respondents possessed inadequate HL, and 46.4% (156/336) and 14.3% (48/336) demonstrated marginal and adequate HL, respectively. Inadequate health literacy was more prevalent among women, as compared to men. Age was significantly associated with HL levels. Participants under age 50 had higher adequate HL levels 45.6% (31/68), (95% CI (3.8-57.4), P < 0.001). There was no correlation between education and health literacy levels.

CONCLUSION

The inadequate HL levels found in outpatients with CVD is a major health concern in the UAE. To improve population health outcomes, health system interventions, including targeted educational and behavioral programs for the older population are necessary.

Assessment of knowledge, cultural beliefs, and behavior regarding medication safety among residents in Harbin, China

BACKGROUND

Medication misuse or overuse is significantly associated with poor health outcomes. Information regarding the knowledge, cultural beliefs, and behavior about medication safety in the general population is important.

AIM

To conduct a survey on medication habits and explored the potential factors impacting medication safety.

METHODS

The current survey included adults from 18 districts and counties in Harbin, China. A questionnaire on medication safety was designed based on knowledge, cultural beliefs, and behavior. Both univariate and multivariate analyses were used to explore the factors that impacted medication safety.

RESULTS

A total of 394 respondents completed the questionnaires on medication safety. The mean scores for knowledge, cultural beliefs, and behavior about medication safety were 59.41 ± 19.33, 40.66 ± 9.24, and 60.97 ± 13.69, respectively. The medication knowledge score was affected by age (P = 0.044), education (P < 0.001), and working status (P = 0.015). Moreover, the cultural beliefs score was significantly affected by education (P < 0.001). Finally, education (P = 0.003) and working status (P = 0.011) significantly affected the behavior score.

CONCLUSION

The knowledge, cultural beliefs, and behavior about medication safety among the general population was moderate. Health education should be provisioned for the elderly, individuals with a low education level, and the unemployed to improve medication safety in Harbin, China.

"I Prefer to Stay Away": A Qualitative Study of Patients in an Opioid-Sparing Pain Management Protocol

OBJECTIVE

The aim of this study was to explore beliefs and behaviors of opioid pain medications among patients undergoing elective surgery.

BACKGROUND

Opioid dependence after surgery is a major contributor to the ongoing opioid epidemic. Recent efforts by surgeons and health systems have sought to improve the education patients receive regarding safe opioid use after surgery; however, little is known about patients' pre-existing beliefs surrounding opioids.

METHODS

Semistructured interviews were conducted with patients who underwent 1 of 4 common elective surgical procedures at 1 institution. Patients were specifically asked about their knowledge and beliefs about opioids before surgery and their opinions of opioid-sparing recovery after surgery. Coding was conducted through iterative steps, beginning with an initial cycle of rapid analysis, followed by focused coding, and thematic analysis.

RESULTS

Twenty-one patients were interviewed. Three major themes emerged regarding patient opinions about using opioids after surgery. First, there was widespread awareness among patients about opioid medications, and preoperatively, patients had specific intentions about using opioids, often informed by this awareness. Second, patients described a spectrum of opioid related behavior which both aligned and conflicted with preoperative intentions. Third, there was tension among patients about opioid-free postoperative recovery, with patients expressing support, opposition, and emphasis on tailoring recovery to patient needs.

CONCLUSIONS

Patients undergoing common surgical procedures often arrive at their surgical encounter with strong, pre-formed opinions about opioids. Eliciting these preexisting opinions may help surgeons better counsel patients about safe opioid use after surgery.

Supporting Reproductive Care for Patients Requiring Solid Organ Transplant

After a solid organ transplant, individuals have the capability to maintain a successful pregnancy. However, many posttransplant pregnancies are unintended, thereby posing risks to health. There is a critical need to strengthen patient education regarding safe approaches to conception, general reproductive health, and childbearing capabilities. The complex needs of patients after transplant, including management of graft health and medication regimens, may distract from the usual reproductive care offered to other individuals of childbearing potential. Thorough education about immunosuppressant medications, contraceptive methods, and expected waiting periods before conceiving are essential. Nurses can work with each individual and direct the interprofessional health care team to provide effective, safe, comprehensive, and inclusive reproductive care to patients posttransplant.

The Multidimensionality of Low Health Literacy in Older Adults: A Scoping Review of International Studies

This scoping review aims to map the dimensions encompassing the low health literacy (HL) of older adults, describing their respective causes and consequences. A three-step search strategy was conducted using 16 databases from nine portals and reference lists. Of the 4,259 identified studies, 2,845 were screened and 29 (1%) were included. Studies were published between 1999 and 2021, most of them in English (86.2%), from the American continent (48.3%) and with observational design (86.2%). Four dimensions encompassing the low HL of older adults were mapped: (1) patient dimension, (2) healthcare system dimension, (3) social/economic dimension, and (4) health condition dimension. This review highlights specific dimensions encompassing the low literacy in older adults with evidence about its causes and consequences. These results can guide future research and evidence-based practice involving HL of older adults.

The effects of self-care education based on the health literacy index on self-care and quality of life among menopausal women: a randomized clinical trial

Purpose

Aging is associated with many different health-related challenges for women such as menopause and its associated problems. Self-care (SC) is a factor with potential effects on menopause and its consequences. SC education based on health literacy has the potential to improve menopausal women’s SC. The aim of this study was to evaluate the effects of SC education based on the health literacy index (HLI) on SC and quality of life (QOL) among menopausal women.

Methods

This randomized clinical trial was conducted in Iran. Participants were 100 menopausal women purposively recruited from five comprehensive healthcare centers in the south of Tehran. They were randomly allocated to a control and an intervention group through block randomization. Intervention was an HLI-based SC education program implemented in four 1.5–hour weekly sessions through the lecture, group discussion, and question and answer methods. Data were collected before and eight weeks after the intervention using a demographic questionnaire, the Health Literacy for Iranian Adults scale, the Menopause-Specific Quality of Life Questionnaire, and the Menopausal Self-Care Questionnaire. The SPSS software (v. 22.0) was used to analyze the data through the Chi-square, Fisher’s exact, paired-sample t, and the independent-sample t tests as well as the analysis of covariance at a significance level of less than 0.05.

Findings

There were no significant differences between the intervention and the control groups respecting the pretest mean scores of QOL (88.15 ± 32.36 vs. 79.6 ± 36.99) and SC (104.75 ± 12.31 vs. 103.32 ± 13.8) (P > 0.05). However, the posttest mean scores of QOL and SC in the intervention group significantly differed from the control group (66.44 ± 28.41vs. 81.3 ± 38.04 and 125.6 ± 11.23 vs. 102.6 ± 14.34) (P < 0.05).

Conclusion

HLI-based SC education is effective in significantly improving menopausal women’s QOL and SC and can be used to improve health-related outcomes among menopausal women.

Clinical trial registration This research was registered (24/03/2020) in the www.thaiclinicaltrials.org with registration number: TCTR20200324002.

Clinical Effects of Outpatient Health Education on Fall Prevention and Self-health Management of Elderly Patients with Chronic Diseases

Background

Elderly patients with chronic diseases (CDs) have a higher predilection for falls, with more severe consequences once they fall. Therefore, it is necessary to explore an effective way to prevent falls in elderly patients with CDs.

Objective

To clarify the clinical effects of outpatient health education on fall prevention and self-health management in elderly patients with CDs.

Methods

This retrospective study enrolled 102 elderly patients with CDs who received treatment in the School of Medicine, Sir Run Run Shaw Hospital of Zhejiang University, between January 2019 and December 2020. Patients intervened by routine nursing were assigned to the regular group (n = 48), and those additionally treated with outpatient health education were included in the research group (n = 54). Assessment of patients' negative emotions (NEs) adopted the Self-Rating Anxiety/Depression Scale (SAS/SDS), determination of their sense of self-efficacy employed the Falls Efficacy Scale International (FES-I), and their self-care capacity evaluation used the Exercise of Self-Care Agency (ESCA). Patients' falls, hospitalization time, fall prevention knowledge, fall prevention-related health behavior, and nursing satisfaction were recorded.

Results

After the nursing intervention, lower SAS, SDS, and FES-I scores were determined in the research group versus the regular group; the total ESCA score assessed from various dimensions was higher in the research group; the research group also exhibited a markedly lower incidence of falls, and shorter hospitalization time than the regular group, with better mastery of fall prevention knowledge, fall prevention-related health behavior and nursing satisfaction.

Conclusions

Outpatient health education intervention can prevent senile patients with CDs from falling, promote their rehabilitation, and enhance their mastery of fall prevention knowledge; moreover, it can improve patients' healthy behaviors to prevent falls, mitigate their NEs, and improve their sense of self-efficacy and self-care ability, which has high clinical application value.

Assessing descriptions of scalability for hypertension control interventions implemented in low-and middle-income countries: A systematic review

Background

The prevalence of hypertension continues to rise in low- and middle-income- countries (LMICs) where scalable, evidence-based interventions (EBIs) that are designed to reduce morbidity and mortality attributed to hypertension have yet to be fully adopted or disseminated. We sought to evaluate evidence from published randomized controlled trials using EBIs for hypertension control implemented in LMICs, and identify the WHO/ExpandNet scale-up components that are relevant for consideration during “scale-up” implementation planning.

Methods

Systematic review of RCTs reporting EBIs for hypertension control implemented in LMICs that stated “scale-up” or a variation of scale-up; using the following data sources PubMed/Medline, Web of Science Biosis Citation Index (BCI), CINAHL, EMBASE, Global Health, Google Scholar, PsycINFO; the grey literature and clinicaltrials.gov from inception through June 2021 without any restrictions on publication date. Two reviewers independently assessed studies for inclusion, conducted data extraction using the WHO/ExpandNet Scale-up components as a guide and assessed the risk of bias using the Cochrane risk-of-bias tool. We provide intervention characteristics for each EBI, BP results, and other relevant scale-up descriptions.

Main results

Thirty-one RCTs were identified and reviewed. Studies reported clinically significant differences in BP, with 23 studies reporting statistically significant mean differences in BP (p < .05) following implementation. Only six studies provided descriptions that captured all of the nine WHO/ExpandNet components. Multi-component interventions, including drug therapy and health education, provided the most benefit to participants. The studies were yet to be scaled and we observed limited reporting on translation of the interventions into existing institutional policy (n = 11), cost-effectiveness analyses (n = 2), and sustainability measurements (n = 3).

Conclusion

This study highlights the limited data on intervention scalability for hypertension control in LMICs and demonstrates the need for better scale-up metrics and processes for this setting.

Trial registration

Registration PROSPERO (CRD42019117750).

Non-pharmacological interventions for older patients with hypertension: A systematic review and network meta-analysis

OBJECTIVE

To determine the most effective non-pharmacological interventions to control the blood pressure variation in older hypertensive patients.

METHODS

Primary endpoints were office systolic blood pressure (SBP) and diastolic blood pressure (DBP). The quality of evidence was assessed using the "risk of bias 2″ tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. We performed a Bayesian network meta-analysis using R-4.0.2 software to compare the efficacy of interventions.

RESULTS

36 eligible studies (3,531 patients) with a median follow-up of 12 weeks, assessing 18 non-pharmacological interventions, were included. The percentages of high, moderate, low, and very low certainty evidence were 16.7%, 38.9%, 33.3%, and 11.1%, respectively.

CONCLUSION

High certainty evidence suggests that self-management education is most effective in lowering SBP and DBP in older patients with hypertension, followed by moderate-intensity aerobic exercise. Moderate-intensity resistance training is the most effective exercise for lowering SBP.

REGISTRATION

PROSPERO, #CRD42020209850.

Health knowledge and self-efficacy to make health behaviour changes: a survey of older adults living in Ontario social housing

BACKGROUND

Older adults living in social housing are a vulnerable population facing unique challenges with health literacy and chronic disease self-management. We investigated this population's knowledge of cardiovascular disease and diabetes mellitus, and self-efficacy to make health behaviour changes (for example, physical activity). This study characterized the relationship between knowledge of health risk factors and self-efficacy to improve health behaviours, in order to determine the potential for future interventions to improve these traits.

METHODS

A cross-sectional study (health behaviour survey) with adults ages 55+ (n = 599) from 16 social housing buildings across five Ontario communities. Descriptive analyses conducted for demographics, cardiovascular disease and diabetes knowledge, and self-efficacy. Subgroup analyses for high-risk groups were performed. Multivariate logistic regressions models were used to evaluate associations of self-efficacy outcomes with multiple factors.

RESULTS

Majority were female (75.6%), white (89.4%), and completed high school or less (68.7%). Some chronic disease subgroups had higher knowledge for those conditions. Significant (p < 0.05) associations were observed between self-efficacy to increase physical activity and knowledge, intent to change, and being currently active; self-efficacy to increase fruit/vegetable intake and younger age, knowledge, and intent to change; self-efficacy to reduce alcohol and older age; self-efficacy to reduce smoking and intent to change, ability to handle crises, lower average number of cigarettes smoked daily, and less frequent problems with usual activities; self-efficacy to reduce stress and ability to handle crises.

CONCLUSIONS

Those with chronic diseases had greater knowledge about chronic disease. Those with greater ability to handle personal crises and intention to make change had greater self-efficacy to change health behaviours. Development of stress management skills may improve self-efficacy, and proactive health education may foster knowledge before chronic disease develops.

Virtual management of hypertension: lessons from the COVID-19 pandemic-International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension

The coronavirus disease 2019 pandemic caused an unprecedented shift from in person care to delivering healthcare remotely. To limit infectious spread, patients and providers rapidly adopted distant evaluation with online or telephone-based diagnosis and management of hypertension. It is likely that virtual care of chronic diseases including hypertension will continue in some form into the future. The purpose of the International Society of Hypertension's (ISH) position paper is to provide practical guidance on the virtual management of hypertension to improve its diagnosis and blood pressure control based on the currently available evidence and international experts' opinion for nonpregnant adults. Virtual care represents the provision of healthcare services at a distance with communication conducted between healthcare providers, healthcare users and their circle of care. This statement provides consensus guidance on: selecting blood pressure monitoring devices, accurate home blood pressure assessments, delivering patient education virtually, health behavior modification, medication adjustment and long-term virtual monitoring. We further provide recommendations on modalities for the virtual assessment and management of hypertension across the spectrum of resource availability and patient ability.

Association Between Hypertension Management Education and Multiple Healthy Behaviors: A Cross-Sectional Study

PURPOSE

This study aimed to evaluate the association between hypertension management education and the adoption of multiple healthy behaviors.

DESIGN

Cross-sectional study.

SETTING

Data from the 2019 Community Health Survey in Korea.

SUBJECTS

Of the 213,900 participants in the 2019 database, 89,773 (42.0%) were hypertensive and 124,127 (58.0%) were normotensive.

MEASURES

Secondary data analysis included a 1:1 computer-assisted personal interview. "Multiple healthy behaviors" included not smoking, not drinking excessively, and walking briskly. "Hypertension management education" referred to information on hypertension management that participants received from clinics, hospitals, and public health centers, outside consultation with a doctor.

ANALYSIS

The association between hypertension management education and the adoption of multiple healthy behaviors was evaluated using multiple logistic regression.

RESULTS

In total, 89,773 (42.0%) participants were hypertensive. Among 61,589 patients with diagnosed hypertension, only 7,719 (12.5%) received hypertension management education. Participants who received such education were more likely to adopt multiple healthy behaviors (odds ratio [OR] = 1.27, 95% confidence interval [CI]: 1.21-1.34) than their counterparts (OR = 0.91, 95% CI: 0.89-0.93). Participants with undiagnosed hypertension were least likely to adopt multiple healthy behaviors (OR = 0.89, 95% CI: 0.86-0.92). No causal relationships were ascertained because of the cross-sectional study design.

CONCLUSIONS

Education can improve the adoption of multiple healthy lifestyles among hypertensive patients. Patients should be encouraged to participate in hypertension management education.

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

AIM

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

DESIGN

A cross-sectional questionnaire survey.

METHODS

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

RESULTS

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

The Effectiveness of Interactive Patient Education on Adherence to Leprosy Medications in an Ambulatory Care Setting Indonesia: A Randomized Control Trial

BACKGROUND: Poor treatment adherence has been linked to recurrence and the development of antibiotic resistance in leprosy patients. Previous research has shown that structured health education programs improve treatment adherence in other patients, but similar research in leprosy patients is lacking. AIM: This study aimed to assess the effect of interactive patient education on adherence to leprosy medications in an ambulatory care setting in Indonesia. METHODS: A randomized controlled trial (RCT) was conducted between January and April 2021. The research was conducted at a public health center in West Papua, Indonesia. This RCT employed 1:1 randomization to allocate participants to one of two groups. Eligibility criteria included those aged over 18 years old and diagnosed with leprosy at least 6 months. An interactive patient education program included four intervention steps that lasted 1 month, with four sessions lasting 60–90 min each week. The Morisky Medication Adherence Scale was used to assess medication adherence. The difference-in-differences technique was used to evaluate the variances between T0 and T1 and T0 for the intervention versus control groups (DID). RESULTS: Approximately, 200 participants agreed to join in this study (response rate = 72.5%). An interactive patient education program improved outcomes relative to the control at T1; medication adherence increased 0.11 (95% CI 0.01–0.25). At T2, improved outcomes relative to the control were observed in medication adherence (DID coefficient 0.31 (95% CI 0.10–0.59). CONCLUSIONS: This study demonstrates that an interactive patient education program could effectively enhance medication adherence. Therefore, it is advised that health care professionals working with leprosy patients participate in the development of patient education programs and establish therapeutic partnerships with their patients.

Concordance of the cardiovascular patient education with the principles of Andragogy model

Background

Patient education is a critical aspect of patient care and is considered a vital part of self-care (especially in patients with cardiovascular disease (CVD)) and health promotion. The literature supports incorporating the principles of the andragogy model (adult learning) into patient education. This study aimed to determine the concordance of the CVD patient education with the principles of the andragogy model.

Methods

This cross-sectional survey was conducted on 384 adult CVD patients from 2 selected hospitals of Tehran. The sampling method was convenient, and the data collection tool was a researcher-made questionnaire based on the principles of the andragogy model. Data were analyzed using SPSS16 statistical software.

Results

The mean age of the patients was 55.69 ± 13.01 years old. Frequency of distribution of the patients who, in total, selected the items of 4 or 5 for respecting the principles of andragogy model was as follows: 68.16% for the motivation, 66.29% for the need, 66.03% for the orientation, 54.16% for the experiences, 51.55% for the self-concept, and 44.65% for the readiness principle.

Also, three principles of motivation (77.37) need (74.97), and orientation (74.78) had the highest mean, respectively, in terms of adhering to this model. But the most common problems in patient education were related to the principles of readiness (64.35), self-concept (68.19), and experiences (77.71) with the lowest mean.

Conclusions

The findings of this study provided valuable information on the flaws in patient education, including ignoring and disrespecting the principles of adult education. Correcting these detected defects and providing feedback to health professionals can improve the quality of patient education programs and patient satisfaction. Also, it empowers healthcare providers, patients, and families through effective education strategies.

Associations of Health Literacy with Blood Pressure and Dietary Salt Intake among Adults: A Systematic Review

Health literacy has been recognized as a significant social determinant of health, defined as the ability to access, understand, appraise, and apply health-related information across healthcare, disease prevention, and health promotion. This systematic review aims to understand the relationship between health literacy, blood pressure, and dietary salt intake. A web-based search of PubMed, Web of Science, CINAHL, ProQuest, Scopus, Cochrane Library, and Prospero was performed using specified search/MESH terms and keywords. Two reviewers independently performed the data extraction and analysis, cross-checked, reviewed, and resolved any discrepancies by the third reviewer. Twenty out of twenty-two studies met the inclusion criteria and were rated as good quality papers and used in the final analysis. Higher health literacy had shown to have better blood pressure or hypertension knowledge. However, the relationship between health literacy with dietary salt intake has shown mixed and inconsistent findings. Studies looking into the main four domains of health literacy are still limited. More research exploring the links between health literacy, blood pressure, and dietary salt intake in the community is warranted. Using appropriate and consistent health literacy tools to evaluate the effectiveness of salt reduction as health promotion programs is required.

Health education interventions to promote health literacy in adults with selected non-communicable diseases living in low-to-middle income countries: A systematic review and meta-analysis

RATIONALE, AIMS AND OBJECTIVES

Health illiteracy is an important contributor to the burden of non-communicable diseases (NCDs); in particular in settings where health illiteracy is part of a perpetuating system of risk factors. Interventions that promote health literacy may provide an important tool in the primary and secondary prevention of NCDs. The objective of this systematic review was to evaluate the effectiveness of health literacy interventions on health literacy in the management of patients with selected NCDs living in low-to-middle income countries (LMIC).

METHODS

Seven electronic databases were searched (October 29, 2020) for RCTs aimed at improving health literacy in adults with NCDs in LMICs. Eligible NCDs included those pertaining to cancer, cardiovascular disease (CVD), chronic respiratory disease (CRD) or Diabetes. Studies were included that explicitly focussed on improving health literacy, and reported comprehensive measures of health literacy, or components thereof (ie, knowledge, attitude or behaviour). Random-effect meta-analyses were conducted for continuous outcome measures (Hedges-g).

RESULTS

The completed search yielded 2573 unique results of which 53 unique studies met the inclusion criteria. Studies included patients with cancer (n = 1, 2%), CRD (n = 8, 15%), CVD (n = 11, 21%) or Diabetes (n = 33, 62%). A significant (P < .01) summary effect was found for disease knowledge (SES = 1.27 [n = 23, 95%CI = 1.05-1.49]), attitude (SES = 1.17 [n = 20, 95%CI = 0.88-1.47]), and behaviour (SES = 1.20 [n = 31, 95%CI = 0.94-1.46]).

CONCLUSIONS

These results support the conclusion that there is compelling evidence, in particular, for patients with Diabetes, that health-literacy interventions are effective in promoting disease knowledge, attitude and behaviour across four chronic conditions that drive the burden of NCDs.

A Knowledge, Attitude, and Practice Survey on Medication Safety in Korean Older Adults: An Analysis of an Ageing Society

Background: Older adults have certain limitations in acquiring and understanding information regarding medication safety. This study surveyed their medication habits and analysed the importance of relevant education to improve knowledge, attitudes, and practice (KAP). Methods: Our survey included adults aged 65 years or older. We developed a questionnaire on medication safety based on the KAP model. To identify the interrelationships among KAP, we calculated the correlation coefficients using Pearson’s correlation analysis. A t-test was performed to verify the differences in KAP associated with the respondents’ medication safety education experience. Results: We found that 79.4% of respondents self-administered their medications. Of the respondents, 28.2% had received medication safety education. Overall, the respondents had typical levels of knowledge, attitude responses, and behavioural practices associated with medication safety. The results showed significant differences between knowledge and practice; those who were educated on medication safety performed higher levels of safe practice than those who were not (p < 0.05). Conclusion: The KAP survey confirmed that knowledge about the safe use of medication positively affected older adults’ attitudes and practices. To improve their medication usage habits, older adults should receive well-organised medication safety education.

Intervention Based on Integration of Health Literacy and Health Outcomes in Hypertension “A Systematic Review”

BACKGROUND: Hypertensive patients with low health literacy rarely visit health services, therefore, they have more chances of being hospitalized in comparison with those having a more adequate health literacy. AIM: This article aims to identify intervention based on integration of health literacy and its outcome in hypertensive patients. METHODS: Articles were searched using four bibliographic databases, namely, ProQuest, Science Direct, PubMed, and Google Scholar. PRISMA 2015 is used as a guideline for determining which articles are selected, one of the criteria being published on 2011–2021. RESULTS: A total of 25,264 articles were obtained from the four databases. Seven articles were selected after the extraction and incorporation of the inclusion criteria. The health outcomes of hypertension sufferers after receiving intervention based on integration of health literacy were divided into three groups; medical health outcomes, health literacy skills, and hypertension self-management behavioral. CONCLUSION: An intervention integrated with health literacy and considering the hypertensive patient health literacy in its own will increase the health outcomes of hypertensive patient.

Precision health care strategies for older adults with diabetes in Indonesia: a Delphi consensus study

BACKGROUND Studies on precision health care for older adults with diabetes in Indonesia are still limited. This study was aimed to reach the experts consensus on the suitable precision health care strategies for older adults with diabetes. METHODS A total of 10 experts (4 physicians, 4 nurses, and 2 dietitians) agreed to participate in the 3-round interview using Delphi technique. The experts should have at least 5 years of experience in teaching or working as health professionals in a hospital. RESULTS Consensus was reached that precision health care consisted of eight elements: self-management, interdisciplinary collaborative practice, personalized genetic or lifestyle factors, glycemic target, patient preferences, glycemic control, patient priority-directed care, and biodata- or evidence-based practice. The strategies of precision health care for diabetes were divided into seven steps: conducting brief deducting teaching; assessing self-management level and risk of cardiovascular disease; organizing a brainstorming session among patients to exchange experiences on glycemic target and specific target behavior; making a list of patients’ needs and ranking the priorities; setting a goal and writing action; doing follow-up; and reporting the goal attempts. CONCLUSIONS The eight elements of precision health care provided the basis of precision health care strategies for diabetic older adults, which are the real and measurable strategies for precision health care implementation in clinical settings.

Atrial fibrillation self-management: a mobile telephone app scoping review and content analysis

Atrial fibrillation (AF) affects over 1.4 million people in the UK, resulting in a five-fold increased stroke risk and a three to four times greater risk of severe, disabling stroke. Atrial fibrillation, a chronic disease, requires monitoring, medication, and lifestyle measures. A self-management approach supported by mobile health (mHealth) may empower AF self-care. To assess the need to develop new mHealth self-management interventions for those with AF this review aimed to identify commercially available AF self-management apps, analyse, and synthesize (i) characteristics, (ii) functions, (iii) privacy/security, (iv) incorporated behaviour change techniques (BCTs), and (v) quality and usability. We searched app stores for 'atrial fibrillation' and 'anticoagulation', and included apps focused on AF self-management in the review. We examined app functions, privacy statements against best practice recommendations, the inclusion of BCTs using the App Behaviour Change Scale, and app quality/usability using the Mobile App Rating Scale. From an initial search of 555 apps, five apps were included in the review. Common functions were educational content, medication trackers, and communication with healthcare professionals. Apps contained limited BCTs, lacked intuitive functions and were difficult to use. Privacy policies were difficult to read. App quality rated from poor to acceptable and no app had been evaluated in a clinical trial. The review reports a lack of commercially available AF self-management apps of sufficient standard for use in healthcare settings. This highlights the need for clinically validated mHealth interventions incorporating evidence-based BCTs to support AF self-management.

Effects of self-management programs on blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension: Meta-analysis of randomized controlled trials

AIM

To assess the effects of self-management interventions on systolic blood pressure, diastolic blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension.

BACKGROUND

Effective treatment of hypertension may require the practice of self-management behaviours. However, evidence on effects of self-management interventions on blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension is lacking.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science and other sources were searched to October 2020.

REVIEW METHODS

Data were analysed using Comprehensive Meta-Analysis 2.0 and quality assessment was done using ROB 2.0. The pooled effect sizes were reported as Hedges' g values with corresponding 95% confidence intervals using a random-effects model.

RESULTS

Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly decreased blood pressure and increased self-efficacy and medication adherence in older adult patients with hypertension, with no significant effect on body mass index.

CONCLUSIONS

Self-management interventions have considerable beneficial effects in older adults with hypertension. Health care providers should implement self-management interventions to strengthen the patient's role in managing their health.

Home Care Patients' Experiences with Home Care Nurses' Support in Medication Adherence

PURPOSE

To describe nurses' support interventions for medication adherence, and patients' experiences and desired improvements with this care.

PATIENTS AND METHODS

A two-phase study was performed, including an analysis of questionnaire data and conducted interviews with members of the care panel of the Netherlands Patients Federation. The questionnaire assessed 14 types of interventions, satisfaction (score 0-10) with received interventions, needs, experiences, and desired improvements in nurses' support. Interviews further explored experiences and improvements. Data were analyzed using descriptive statistics and a thematic analysis approach.

RESULTS

Fifty-nine participants completed the questionnaire, and 14 of the 59 participants were interviewed. The satisfaction score for interventions was 7.9 (IQR 7-9). The most common interventions were: "noticing when I don't take medication as prescribed" (n = 35), "helping me to find solutions to overcome problems with using medications" (n = 32), "helping me with taking medication" (n = 32), and "explaining the importance of taking medication at the right moment" (n = 32). Fifteen participants missed ≥1 of the 14 interventions. Most mentioned the following: "regularly asking about potential problems with medication use" (33%), "regularly discussing whether using medication is going well" (29%), and "explaining the importance of taking medication at the right moment" (27%). Twenty-two participants experienced the following as positive: improved self-management of adequate medication taking, a professional patient-nurse relationship to discuss adherence problems, and nurses' proactive attitude to arrange practical support for medication use. Thirteen patients experienced the following as negative: insufficient timing of home visits, rushed appearance of nurses, and insufficient expertise about side effects and taking medication. Suggested improvements included performing home visits on time, more time for providing support in medication use, and more expertise about side effects and administering medication.

CONCLUSION

Overall, participants were satisfied, and few participants wanted more interventions. Nurses' support improved participants' self-management of medication taking and enabled patients to discuss their adherence problems. Adequately timed home visits, more time for support, and accurate medication-related knowledge are desired.

Strategies to Improve Adherence to Anti-Hypertensive Medications: a Narrative Review

PURPOSE OF REVIEW

Medication adherence is critical for effective management of hypertension, yet half of patients with hypertension are non-adherent to medications. In this review, we describe and critically evaluate medication adherence interventions published in the past 3 years for patients with hypertension.

RECENT FINDINGS

We identified 1593 articles and 163 underwent full review, of which 42 studies met the inclusion criteria. Studies were classified into eight categories: simplification of medication regimen (e.g., fixed dose combination pills); electronic Health (eHealth) tools (e.g., text messaging reminders); behavioral counseling (e.g., motivational interviewing); healthcare system changes (e.g., patient-centered medical home); patient education; multicomponent chronic disease management program; home blood pressure monitoring; and financial incentives. Studies utilizing strategies to simplify medication regimens, eHealth tools, patient education, and behavioral counseling were most likely to report positive findings. Interventions targeting patient behavior were more likely to be associated with improvements in medication adherence compared to those targeting providers or the healthcare system. eHealth tools show promise for augmenting behavioral interventions. A major limitation of included trials was short study duration and use of self-report measures of medication adherence. Future research should explore how complex interventions that utilize a combination of evidence-based strategies and target multiple adherence behaviors (e.g., both day-to-day medication taking and long-term persistence) may be efficacious in improving medication adherence.