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Stangvaltaite-Mouhat L, Stankeviciene I, Martinussen SSS, Sabataitis V, Sandjord C, Toresen I, Tryggestad MS, Puriene A, Johnsen JAK. Web-Based Interventions Reduced Dental Anxiety among Adults in Lithuania and Norway: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3343. [PMID: 36834035 PMCID: PMC9966357 DOI: 10.3390/ijerph20043343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
Dental anxiety (DA) is a prevalent public health issue. However, there is a lack of self-administered DA interventions. The aim of this study was to evaluate the short-term effects of web-based interventions aiming to reduce DA in adults in two European countries. A pretest posttest design was used. Tailor-made websites were developed in Lithuania and Norway. Volunteers who self-reported DA were invited to participate. DA levels measured by the Modified Dental Anxiety Scale (MDAS) were assessed at baseline and after two weeks via online questionnaires. The interventions were completed by 34 participants in Lithuania and 35 participants in Norway. In Lithuania, the median posttest MDAS score (9.5, IQR 5.25) decreased compared to the median pretest MDAS score (14.5, IQR 8; Z value = -4.246, p < 0.001). The same was found in Norway-the median posttest MDAS score (12, IQR 9) was lower compared to the median pretest MDAS score (15, IQR 7; Z value = -3.818, p < 0.001). The present study demonstrated that two tailor-made web-based interventions had the potential to reduce dental anxiety levels when assessed in the short term in Lithuania and Norway. Studies with more controlled designs assessing long-term outcomes are needed to validate the results of this pilot study also in other cultures.
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Affiliation(s)
- Lina Stangvaltaite-Mouhat
- Oral Health Centre of Expertise in Eastern Norway, 0369 Oslo, Norway
- Institute of Dentistry, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Indre Stankeviciene
- Institute of Dentistry, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | | | - Vytautas Sabataitis
- Institute of Dentistry, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Camilla Sandjord
- Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsoe, Norway
| | - Ingrid Toresen
- Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsoe, Norway
| | | | - Alina Puriene
- Institute of Dentistry, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Jan-Are Kolset Johnsen
- Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsoe, Norway
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Salmasi S, Kapanen AI, Kwan L, Andrade JG, De Vera MA, Loewen P. Atrial fibrillation patients' experiences and perspectives of anticoagulation therapy changes. Res Social Adm Pharm 2020; 16:1409-1415. [PMID: 31983624 DOI: 10.1016/j.sapharm.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/02/2020] [Accepted: 01/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) patients' experiences with changes in their oral anticoagulant (OAC) therapy are understudied. OBJECTIVE The objective of this study was to qualitatively describe AF patients' experiences and perspectives of changes made to their OAC therapy (switches or discontinuations). METHODS A thematic analysis was performed on systematically-collected qualitative data from AF patients who experienced a therapy change (switching or discontinuing an OAC) as part of their participation in a large 2-year prospective observational study. RESULTS A total of 56 participants met the inclusion criteria. Six themes emerged from the data: 1. reasons for switch or discontinuation of therapy, 2. attitudes towards changes in therapy attributes, 3. challenges with taking medications after therapy change, 4. relief from perceived burden of medication after discontinuation, 5. patients' limited involvement in decision-making, and 6. inadequate education and follow up. Patients were found to request changes in therapy based on their subjective experience with it (rather than clinically justified reasons). They were found to have limited knowledge about their medications, differing reactions to changes in their therapy attributes after a switch, an overall negative attitude towards taking medications, adherence challenges after switching from once daily to twice daily medication, feelings of being excluded from the decision-making process about their therapy changes and feelings of being unsupported after these changes. CONCLUSIONS There are clear opportunities to improve patients' experiences with OAC therapy changes through improved shared decision-making and patient education/counselling.
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Affiliation(s)
- Shahrzad Salmasi
- Collaboration for Outcomes Research and Evaluation (CORE), University of British Columbia, Vancouver, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Anita I Kapanen
- Collaboration for Outcomes Research and Evaluation (CORE), University of British Columbia, Vancouver, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Leanne Kwan
- Atrial Fibrillation Clinic, Royal Columbian Hospital, New Westminster, Canada
| | - Jason G Andrade
- Atrial Fibrillation Clinic, Vancouver General Hospital, Vancouver, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mary A De Vera
- Collaboration for Outcomes Research and Evaluation (CORE), University of British Columbia, Vancouver, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Peter Loewen
- Collaboration for Outcomes Research and Evaluation (CORE), University of British Columbia, Vancouver, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
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Salmasi S, De Vera MA, Barry A, Bansback N, Harrison M, Lynd LD, Loewen PS. Assessment of Condition and Medication Knowledge Gaps Among Atrial Fibrillation Patients: A Systematic Review and Meta-analysis. Ann Pharmacother 2019; 53:773-785. [DOI: 10.1177/1060028019835845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Patient education facilitates construction of a correct illness representation, improves beliefs about medications, and improves knowledge, factors that have been associated with better adherence. Objective: Our objective was to characterize the published literature about atrial fibrillation (AF) patients’ disease and medication knowledge to identify knowledge gaps and misconceptions to inform AF patient education strategies. Methods: Following PRISMA guidelines, we searched PubMed, EMBASE, CINAHL, and PsychINFO from inception to May 2018 for studies that assessed AF patients’ knowledge about their condition and medications. For quantitative studies, we extracted the proportion of participants who provided correct answers to the questions asked about their condition, medications, or risk of stroke. We classified data for related questions into knowledge domains. A random-effects meta-analysis was conducted for each knowledge domain. A domain was considered a knowledge gap if the pooled mean proportion of participants who demonstrated knowledge of it was ≤50%, regardless of CI. Qualitative data were summarized narratively. Results: A total of 21 studies were included. AF- and stroke-related knowledge gaps and misconceptions included the following: AF can be asymptomatic, AF can predispose to heart failure, women are at a higher risk of stroke, the definition of ischemic stroke, and patients’ awareness of their diagnosis. Medication-related knowledge gaps were antithrombotic-drug interactions, antithrombotic-food interactions, vitamin K content of foods, the term INR (international normalized ratio) and its interpretation, and the required actions in case of a missed dose. Conclusion and Relevance: This systematic review identified several AF patient knowledge gaps about their condition and its treatment that can inform the development of AF patient education programs.
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Affiliation(s)
| | | | - Arden Barry
- University of British Columbia, Vancouver, BC, Canada
- Chilliwack General Hospital, BC, Canada
| | - Nick Bansback
- University of British Columbia, Vancouver, BC, Canada
- Providence Health Research Institute, Vancouver, BC, Canada
| | - Mark Harrison
- University of British Columbia, Vancouver, BC, Canada
- Providence Health Research Institute, Vancouver, BC, Canada
| | - Larry D. Lynd
- University of British Columbia, Vancouver, BC, Canada
- Providence Health Research Institute, Vancouver, BC, Canada
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Altiok M, Yilmaz M, Rencüsoğullari I. Living with Atrial Fibrillation: An Analysis of Patients' Perspectives. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:305-11. [PMID: 26724239 DOI: 10.1016/j.anr.2015.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 08/06/2015] [Accepted: 09/02/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of this study was to determine the perceptions of patients with atrial fibrillation regarding the disease, to reveal their feelings, thoughts and wishes, and to investigate their perspectives and coping behaviors towards their condition. METHODS Phenomenological methodology was used. The study population consisted of a total of 225 patients treated by the cardiology department of a university hospital, while the study sample consisted of 32 patients who met the inclusion criteria. A semistructured interview addressed perceptions of patients with atrial fibrillation regarding the disease. Data were collected by asking the participants the three questions on the In-depth Individual Interview Form. Data were analyzed using the continuous comparative method of Colaizzi. RESULTS In the study sample, 50.0% of participants were female, 69.0% were married, and the mean age was 66.90 years (± 7.90 years). As a result of the content analysis, four main themes and 15 subthemes were identified: patient's mental status regarding the disease, patient's social status regarding the disease, patient's physical condition regarding the disease, and disease management and coping with the disease. The study found that individuals with atrial fibrillation faced major limitations in their daily living activities and social lives due to the disease symptoms and warfarin use. CONCLUSIONS Patients need to be provided with relevant individual training and counselling so that they lead more satisfactory lives. In addition, appropriate health appointment and monitoring systems should be developed for patients to reduce the problems associated with frequent follow-up appointments.
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Affiliation(s)
- Meral Altiok
- Health High School, Mersin University, Mersin, Turkey.
| | - Mualla Yilmaz
- Health High School, Mersin University, Mersin, Turkey
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Rush KL, Hatt L, Shay M, Gorman N, Laberge CG, Reid RC, Wilson R. The Stressors and Coping Strategies of Older Adults With Persistent Atrial Fibrillation Prior to and Following Direct Current Cardioversion. J Appl Gerontol 2015; 36:1145-1165. [DOI: 10.1177/0733464815608495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective:The purpose of this study was to explore the stressors and coping strategies of older adults with persistent atrial fibrillation (AF) before and after direct current cardioversion. Method: The study used a qualitative descriptive design. Sixteen patients were recruited through an AF clinic to participate in individual interviews prior to the cardioversion and at 6 and 12 weeks post procedure. Results: Pre-cardioversion, older adults experienced symptom and health care–related stressors superimposed on existing non-AF stressors. They used a range of emotion and problem-focused coping. Non-AF stressors increased post procedure at the same time that participants perceived less need for coping strategies with a return to regular rhythm. Discussion: There was a shift from AF to non-AF related stressors following the cardioversion but a decrease in coping strategies. Older adults with AF should be encouraged to maintain use of coping strategies to manage ongoing stress and reduce the risk of AF recurrence.
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Affiliation(s)
- Kathy L. Rush
- University of British Columbia–Okanagan, Kelowna, Canada
| | - Linda Hatt
- University of British Columbia–Okanagan, Kelowna, Canada
| | - Matt Shay
- University of British Columbia–Okanagan, Kelowna, Canada
| | - Nicole Gorman
- Atrial Fibrillation Clinic, Kelowna, British Columbia, Canada
| | - Carol G. Laberge
- University of British Columbia–Okanagan, Kelowna, Canada
- Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - R. Colin Reid
- University of British Columbia–Okanagan, Kelowna, Canada
| | - Ryan Wilson
- University of British Columbia–Okanagan, Kelowna, Canada
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Nasser S, Mullan J, Bajorek B. Challenges of Older Patients’ Knowledge About Warfarin Therapy. J Prim Care Community Health 2011; 3:65-74. [DOI: 10.1177/2150131911416365] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To review the challenges of warfarin education for older patients (aged 65 years or older) in terms of knowledge, access to warfarin education, and education resources. Methods: A quasi-systematic review of the literature was performed via electronic database searches (eg, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Meditext, and Google Scholar) from 1990 to May 2011. Results: The 62 articles reviewed found that improved patient knowledge results in better anticoagulation control. The review also found that between 50% and 80% of older patients have inadequate knowledge about the basic aspects of warfarin therapy (eg, action, benefits and risks, interactions with other drugs or foods, international normalized ratio management). Demographic factors, such as advancing age, lower family income, and limited health literacy, were found to inversely affect patients’ warfarin knowledge, and access to warfarin education and information resources were often suboptimal in different practice settings. Finally, a number of educational strategies and resources that could be readily incorporated to improve the effectiveness of current warfarin education programs were extracted from the review. Conclusion: This comprehensive review highlights that education about warfarin in older patients is currently suboptimal and may in part contribute to poor therapeutic outcomes. This review article also acknowledges the need to identify, target, and develop educational strategies and resources to further improve older patients’ knowledge about their warfarin therapy.
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Burns S. Application of the theory of planned behavior to oral anticoagulant therapy. Nurs Health Sci 2009; 11:98-101. [DOI: 10.1111/j.1442-2018.2009.00426.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hardin SR, Steele JR. Atrial fibrillation among older adults: pathophysiology, symptoms, and treatment. J Gerontol Nurs 2008; 34:26-33; quiz 34-5. [PMID: 18649821 DOI: 10.3928/00989134-20080701-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Atrial fibrillation is the most common arrhythmia among older adults. Valvular heart disease, dilated cardiomyopathy, aortic stenosis, hypertension, coronary artery disease, pericarditis, thyrotoxicosis, pulmonary disease, cardiac surgery, alcohol excess, and alcohol withdrawal are associated with atrial fibrillation. Nurses caring for older adults need to understand the condition's pathophysiology, signs and symptoms, diagnostic data and treatment protocols, and adherence issues to prevent the formation of emboli in chronic atrial fibrillation and to understand treatment of this common arrhythmia. This article presents an individual example of an elderly man exhibiting a new onset of atrial fibrillation and the interventions required to manage the associated complications. Atrial fibrillation places patients at risk for stroke from a thromboembolism; thus, pharmacological and nonpharmocological care strategies for managing patients with atrial fibrillation are discussed.
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Affiliation(s)
- Sonya R Hardin
- School of Nursing, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.
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McCabe PJ, Schad S, Hampton A, Holland DE. Knowledge and self-management behaviors of patients with recently detected atrial fibrillation. Heart Lung 2008; 37:79-90. [DOI: 10.1016/j.hrtlng.2007.02.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 01/16/2007] [Accepted: 02/05/2007] [Indexed: 10/22/2022]
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Koponen L, Rekola L, Ruotsalainen T, Lehto M, Leino‐Kilpi H, Voipio‐Pulkki L. Patient knowledge of atrial fibrillation: 3‐month follow‐up after an emergency room visit. J Adv Nurs 2007; 61:51-61. [DOI: 10.1111/j.1365-2648.2007.04465.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Leena Koponen
- Leena Koponen PhD RN
Leading Nursing Director
Helsinki University Central Hospital, Helsinki, Finland
| | - Leena Rekola
- Leena Rekola PhD RN
Senior Lecturer
Helsinki Polytechnic, Helsinki, Finland
| | - Taru Ruotsalainen
- Taru Ruotsalainen PhD RN
Senior Lecturer
Helsinki Polytechnic, Helsinki, Finland
| | - Mika Lehto
- Mika Lehto MD
Resident of Cardiology
Helsinki University Hospital, Helsinki, Finland
| | - Helena Leino‐Kilpi
- Helena Leino‐Kilpi PhD RN
Professor, Head of Department of Nursing Science and Turku University Hospital, Turun yliopisto, Finland
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