Well-being mediates the effects of social support and family function on self-management in elderly patients with hypertension

Path analysis of the influence of digital health literacy on self-management behaviour among elderly patients with chronic diseases in rural China

BACKGROUND

Chronic disease self-management is very important for the progression and treatment of diseases worldwide. The management of chronic diseases among elderly individuals in rural areas is an urgent public health concern in China. The purpose of this study was to investigate the relationship between digital health literacy and chronic disease self-management behaviour in elderly Chinese patients with chronic diseases in rural areas, as well as the chain mediating effects of social support and depression. The objective was to provide a scientific basis for improving the active health behaviour of rural elderly patients with chronic diseases in China and worldwide.

METHODS

Using convenience sampling, the survey subjects were elderly patients with chronic diseases in rural areas of Anhui Province, China. A self-designed questionnaire was used to collect general survey data, digital health literacy scale scores, social support scale scores, depression scale scores, and chronic disease self-management behaviour scale scores. Common method bias tests, descriptive statistics and correlation analyses were performed via SPSS 29.0. The structural equation model was constructed and tested via AMOS 27.0. Differences for which p < 0.05 were considered statistically significant.

RESULTS

In all, 202 elderly patients with chronic diseases who resided in rural areas were enrolled. The digital health literacy score was 39.25 ± 9.00, and the chronic disease self-management behaviour score was 27.82 ± 9.56. The self-management behaviours of rural elderly patients with chronic diseases were positively correlated with digital health literacy and social support and were negatively correlated with depression (p < 0.01). After the mediating effect test, the total indirect effect value of social support and depression was 0.167, which accounted for 36.07% of the total effect. Among them, social support and depression were partial mediators of digital health literacy and chronic disease self-management behaviour, with effect values of 0.055 (95% CI: 0.012, 0.127) and 0.094 (95% CI: 0.024, 0.201), which accounted for 11.88% and 20.3% of the total effect, respectively. Social support and depression were chain mediators of digital health literacy and chronic disease self-management behaviour, with an effect value of 0.018 (95% CI: 0.004, 0.055) and an effect share of 3.89%.

CONCLUSION

The self-management level of elderly patients with chronic diseases in rural China is low. Digital health literacy not only directly affects the chronic disease self-management behaviour of elderly individuals but also indirectly predicts chronic disease self-management behaviour through the mediating effects of social support and depression.

Predictors of self-management behaviors among patients undergoing hemodialysis

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

The relationship between negative psychological state and quality of life among cardiovascular disease patients in China: the masking effect of abnormal dietary behavior

Background

It is well known that abnormal dietary behavior increases the risk for cardiovascular disease especially if the person is depressed and/or anxious. The purpose of this study was to construct a moderated mediation model to explore the roles of abnormal dietary behavior and family health in the mechanism through which depression/anxiety influences Quality of life (QoL) in patients with cardiovascular disease.

Methods

A field survey was conducted in China and ultimately included 730 patients with cardiovascular disease aged 20-60 years. Data were collected using the Europe Quality of five-dimensional five-level questionnaire, Short-Form of the Eating Behavior Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and the Chinese version of the short-form of the Family Health Scale. All data were analyzed using SPSS Statistics 23.0.

Results

(1) Depression was negatively associated with QoL (r = -0.386/-0.230, p < 0.001), and was positively correlated with abnormal dietary behavior (r = 0.377, p < 0.001). Anxiety was negatively associated with QoL (r = -0.383/-0.231, p < 0.001), and was positively correlated with abnormal dietary behavior (r = 0.333, p < 0.001). Abnormal dietary behavior was negatively correlated with QoL (r = -0.077/-0.119, p = 0.039/0.001). (2) In the mediation model, abnormal dietary behavior only had a masking effect on the relationship between depression and QoL, with a mediating effect size of 7.18%. The mediating effect of abnormal dietary behavior between anxiety and QoL was not significant. (3) The mediating effect size of abnormal dietary behavior between depression/anxiety and QoL increased to 14.77% and 13.57% in unhealthy families. The above masking mediation effect was not significant in healthy families.

Conclusions

Abnormal dietary behavior positively mediated the relationship between depression and QoL and attenuated the negative effect of depression on QoL in patients with cardiovascular disease. The masking mediating effect of abnormal dietary behavior between depression/anxiety and QoL was stronger for patients in unhealthy families.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Family Function and Self-Management of Patients With Early Chronic Kidney Disease: The Mediating Roles of Self-Perceived Burden and Ego Depletion

Background

Effective self-management in the early stage of chronic kidney disease (CKD) is key to delaying disease progression. However, no studies have confirmed that the combined support of internal individual factors and external family environmental factors may play an important role in the self-management of patients with early CKD.

Purpose

This current study aims to explore the effect of family function on the self-management of patients with early CKD and examine the mediating roles of self-perceived burden and ego depletion.

Patients and Methods

Three hundred and sixty patients with stage 1-3 CKD participated in the cross-sectional survey and completed structured questionnaires, including the family APGAR index, self-perceived burden scale, self-regulatory fatigue scale and chronic kidney disease self-management instrument. Mplus 8.3 was used to establish a structural equation model.

Results

Family function had a positive predictive effect on self-management (β = 0.231, P < 0.001). Self-perceived burden and ego depletion were not only single mediating variables between family function and self-management but also played a chain-mediating role. The total indirect effect was 0.304 (95% CI: 0.234 to 0.388, P < 0.001), accounting for 56.82% of the total effect (β = 0.535, 95% CI: 0.420 to 0.651, P < 0.001).

Conclusion

This study highlights the importance of self-management for patients and their families and provides new important theoretical guidance for multiple interventions of improving family function, reducing self-perceived burden and ego depletion to improve self-management, which is of great value in delaying the progression of renal disease.

Does social support improve self-management among rural hypertensive patients? An empirical analysis based on generalized propensity score matching

Background

This study aimed to examine the causal effect between perceived social support and self-management in rural patients with hypertension and to provide a basis for improving self-management.

Methods

A cross-sectional study of 1,091 rural hypertensive patients in Shanxi Province was conducted from March through June 2022 to analyze the factors influencing social support as well as the causal effects of social support and self-management using generalized propensity score matching.

Results

Rural hypertensive patients had a low level of social support (social support score = 0.632 ± 0.178). Social support had a significant and inverted U-shaped relationship with self-management; with increasing social support levels, the levels of self-management first rose and then declined, with an inflexion point of 0.774. Social support had significant negative correlations with sex, age, number of child, living status (i.e., living alone or living with others), disease duration, family economic status, and decision-making power, and positive correlations with having a spouse and having medical insurance.

Conclusion

Greater emphasis should be placed on the older adult, individuals living alone, those without spouses, only children, economically disadvantaged populations, and uninsured individuals to enhance the social support they received and ultimately improve their self-management of hypertension. Furthermore, establishing social support systems that are congruent with rural relational networks is crucial for promoting effective hypertension self-management.

Predictors of self-care performance in patients with unruptured intracranial aneurysms

In South Korea, there has been an increasing number of patients diagnosed with unruptured intracranial aneurysms (UIAs), requiring rigorous self-care to prevent rupture. This study aimed to identify predictors of self-care performance in patients with UIAs, focusing on illness perception and social support. A cross-sectional correlation design was employed. Data from 150 participants was analyzed. The Brief Illness Perception Questionnaire (B-IPQ), the Multidimensional Scale of Perceived Social Support (MSPSS), and a Self-Care Performance Tool were used for measurement. Pearson correlation was used to analyze the correlation among the participants' perceived illness perception, social support, and self-care performance. Differences in the level of self-care performance according to sociodemographic and clinical characteristics and correlations among continuous variables were identified using univariate statistics. Hierarchical multiple regression was used to identify predictors of self-care performance. The results showed that the self-care performance score was positively correlated with illness perception and social support. Regression analysis showed that being a non-smoker, not consuming alcohol, receiving social support from family, receiving social support from medical personnel, and strong illness perception positively affected the self-care performance score. Our findings should be considered when developing education and intervention programs to enhance self-care performance among patients with UIAs.

Social support and physical literacy in young and middle-aged patients with hypertension: the mediating effects of sense of coherence and self-efficacy

BACKGROUND

Despite the growing recognition of the importance of social support and physical literacy in managing hypertension among young and middle-aged patients, there is a lack of research exploring the mediating effects of sense of coherence and self-efficacy in this relationship. This study aims to bridge this gap by investigating the interplay between social support, physical literacy, sense of coherence, and self-efficacy, thus contributing to a deeper understanding of effective interventions for hypertension management.

METHODS

A cross-sectional study was conducted using convenience sampling to survey 280 young and middle-aged patients diagnosed with hypertension from five community settings in Zhejiang and Anhui provinces between January and February 2024. Measurement instruments included the General Information Questionnaire, Physical Literacy Scale for Young and Middle-aged Patients with Hypertension, Sense of Coherence Scale 13, General self-efficacy Scale, and Perception Social Support Scale. Data analysis was performed using SPSS 27.0 and AMOS 28.0, with reporting following the STROBE checklist.

RESULTS

A total of 270 valid questionnaires were collected. The total score of physical literacy for young and middle-aged patients with hypertension ranged from 18 to 90, with a mean score of 62.30 ± 13.92, indicating a moderate level. There was a positive correlation between the physical literacy score and the scores of social support (r = 0.557, P<0.01), sense of coherence (r = 0.392, P<0.01), and self-efficacy (r = 0.466, P<0.01) among young and middle-aged patients with hypertension. Furthermore, social support was found to have multiple mediating effects through sense of coherence and self-efficacy on physical literacy.

CONCLUSION

This study sheds light on the interconnectedness of social support, physical literacy, sense of coherence, and self-efficacy among young and middle-aged patients with hypertension. The findings underscore the importance of considering these factors holistically in hypertension management strategies.

Factors associated with the level of self-management in elderly patients with chronic diseases: a pathway analysis

BACKGROUND

To analyze the effects and pathways of factors such as psychological capital, family functioning, and sources of meaning in life on the level of self-management in elderly patients with chronic diseases and to provide a basis for the development of relevant nursing interventions in the future.

METHODS

Convenience sampling was used to select elderly patients with chronic diseases who underwent medical checkups and consultations at three community hospitals in Jinzhou city from March 2023 to October 2023, and the self-designed General Information Questionnaire (GIS), Psychological Capital of the Elderly Scale (PCE), Family Functioning Index Questionnaire (APGAR), Sources of Meaning of Life Scale for Older Adults(SMSE), and Self-Management Behavior of Chronic Patients Scale (SMCS) were used. SPSS 26.0 was used for data entry, one-way analysis, Pearson correlation analysis, and multiple linear regression were used to analyze the data, and Amos 17.0 was used to construct the structural equation model.

RESULTS

A total of 355 elderly patients with chronic diseases were included, and their self-management score was 74.75 ± 12.93, which was moderate. The results of the influencing factor analysis showed that the influencing factors of the self-management level of elderly chronic disease patients were age, years of illness, psychological capital, family functioning, and sources of meaning in life (p < 0.05). Path analysis revealed that sources of meaning in life were a partial mediator of the relationship between psychological capital and self-management, with an effect value of 0.166 (95% CI: 0.042,0.391), accounting for 37.6% of the total effect; life meaning was a partial mediator of family functioning and self-management level, with an effect value of 0.231 (95% CI: 0.040,0.452), accounting for 54.0% of the total effect. accounting for 54.0% of the total effect.

CONCLUSION

The self-management of elderly patients with chronic diseases is intermediate. Healthcare professionals should actively implement holistic healthcare management measures from the family aspect to help patients understand the meaning of life and improve the level of patients' psychological capital to improve the self-management level of elderly patients with chronic diseases.

The Mediating Role of Psychological Well-Being in the Relationship Between Self-Management and Quality of Life in Patients With Hypertension

This study applied a cross-sectional design to examine the relationship between self-management, psychological well-being, and quality of life in patients with hypertension and evaluated the mediation effect of psychological well-being on self-management and quality of life. Through purposive sampling, this study enrolled 255 patients with hypertension from the cardiology department of a teaching hospital in Taiwan. Mediation effects were estimated using linear regression and the Sobel test. Age, number of chronic diseases, waist circumference, self-management, and psychological well-being explained 18.7% of the total variance in quality of life. Psychological well-being partially mediated the effects of self-management on quality of life, with a total effect of 19.2%. Psychological well-being is an important factor correlated with self-management and quality of life in patients with hypertension.

Exploring the relationship between self-management behaviour, family function and health information adoption behaviour in Chinese diabetic foot patients: a mixed-methods study protocol

INTRODUCTION

Diabetic foot is a major burden and threat to individuals, families and society, making it imperative to promote good self-management behaviour. However, although nurses have provided these patients with excellent health knowledge, their self-management remains unsatisfactory. Although researches have shown that self-management requires family involvement, no research has been conducted in China on family function, specifically in the diabetic foot. Therefore, this study aimed to explore the relationship between self-management, family functioning, and health information adoption behaviour and explain the formation's reason.

METHOD AND ANALYSIS

We will conduct a mixed-methods study using an exploratory sequential study design in Zhejiang, China. In the first phase, cross-section research will be conducted using a convenient sampling strategy on 225 diabetic foot patients. SPSS V.26 was used for correlation and multiple stepwise regression analyses. Structural equation modelling will be performed by using AMOS V.24. The researchers will conduct a semistructured interview to collect qualitative data and use NVivo to analyse. Ultimately, we will 'triangulate' to integrate quantitative and qualitative data.

ETHICS AND DISSEMINATION

This study received ethical clearance from the Ethics Review Committee, the affiliated Sir Run Run Shaw Hospital of Medicine School, Zhejiang University (approval no: 2023-0145). All data collection processes will abide by health and safety measures required by the national government. Written informed consent will be obtained from all participants. The study will produce one paper that will be disseminated, to local stakeholders and participants, via local and international conferences and publications in peer-reviewed journals.

Factors influencing self-management among patients diagnosed with anxiety disorders in China: A cross-sectional study

WHAT IS KNOWN ON THE SUBJECT?: Self-management comprises five core skills: "Problem Solving, Decision-Making, Resource Utilization, Forming a Patient/Healthcare Provider Partnership and Taking Action." Effective self-management among patients diagnosed with anxiety can reduce the number of relapses and improve treatment outcomes. Knowledge of the impact of the family atmosphere, well-being and illness symptoms on self-management in patients diagnosed with anxiety disorders is limited. WHAT DOES THE PAPER ADD TO THE EXISTING KNOWLEDGE?: This is the first study in China to explore whether family atmosphere and well-being of patients diagnosed with anxiety disorders affects self-management. This paper adds to the list of factors influencing self-management among patients diagnosed with anxiety disorders. SAS scores are a major factor influencing self-management among patients diagnosed with anxiety disorders. The subjective well-being of patients diagnosed with anxiety disorders can influence their self-management behaviour. Patients who experienced family harmony had significantly higher self-management scores than those who experienced family disharmony. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should encourage patients diagnosed with anxiety disorders to manage their condition while receiving treatment at home. Nurses should focus on patients diagnosed with anxiety disorders who have significant anxiety symptoms and low well-being. Nurses should emphasize the importance of the home environment in family self-management and affirm that a good home environment promotes patient self-management.

ABSTRACT

INTRODUCTION: Better self-management can improve treatment outcomes and reduce the number of relapses for patients diagnosed with anxiety disorders. However, the impact of well-being and the home environment on self-management among patients diagnosed with anxiety disorders is unclear in China.

AIM

This study sought to determine the impact of the home environment, well-being and illness symptoms on self-management during home treatment for patients diagnosed with anxiety disorders.

METHOD

This cross-sectional study was conducted with patients diagnosed with anxiety disorders. Data were collected with SAS, Self-Management Scale for People with Anxiety Disorders and Index of Well-being. Frequency, percentage, analysis of variance, Kruskal-Wallis and multiple linear regression analyses were used.

RESULTS

Home environment (p < .001), self-perceived quality of life (p = .015), well-being index (p = .002) and SAS total score (p = .033) had a major impact on self-management in patients diagnosed with anxiety disorders (n = 245).

DISCUSSION

Family disharmony, poor self-perceived quality of life, high SAS scores and low levels of well-being were significant influences on self-management among people diagnosed with anxiety disorders.

IMPLICATIONS FOR PRACTICE

Nurses should focus on the self-management of patients diagnosed with significant anxiety symptoms and low well-being and value the importance of the home environment in facilitating self-management among patients diagnosed with anxiety disorders.

Network structure of family function and self-management in patients with early chronic kidney disease amid the COVID-19 pandemic

Background

Family function plays a pivotal role in self-management among patients with early chronic kidney disease (CKD), which has been especially important during the COVID-19 pandemic. Previous studies have investigated the relationships between family function and self-management using total scores through self-report questionnaires while ignoring the different components in both family function and self-management. The specific objective of this study was to explore the network structure of family function and self-management at the component level.

Methods

A total of 360 patients with early CKD from three tertiary hospitals were enrolled in our cross-sectional survey from September to December 2021 in China. Components of family function were measured by the Family Adaptation Partnership Growth and Resolve Index, and components of self-management were measured by the Chronic Kidney Disease Self-management Instrument. Network analysis was used to establish the network structure.

Results

Edges across the community of family function and self-management were mainly positive. Edges between F3 "Growth" and M1 "Self-integration", F2 "Partnership" and M3 "Seeking social support," F5 "Resolve" and M3 "Seeking social support" were the strongest. F3 "Growth" had the greatest positive bridge expected influence of family function community (0.12), and M3 "Seeking social support" had the greatest positive bridge expected influence of self-management community (0.16).

Conclusion

We explored the potential pathways between different components of family function and self-management among patients with early CKD during the COVID-19 pandemic and found fine-grained relationships between them. The two nodes F3 "Growth" and M3 "Seeking social support" may provide a new idea from the perspective of family function for interventions to improve self-management.

Association between self-efficacy and self-management behaviours among individuals at high risk for stroke: Social support acting as a mediator

AIMS AND OBJECTIVES

To explore the association between self-efficacy and self-management by modelling three types of social support as mediators among stroke high-risk populations.

BACKGROUND

Self-efficacy and social support (i.e. objective support, subjective support and support utilisation) are important for self-management among stroke high-risk populations. Self-efficacy activates three types of social support, and the effect of social support on self-management varies by types among chronic patients. Therefore, social support may act as a mediator between self-efficacy and self-management, and the mediating role may vary by types of social support. Disentangling the role of these different types of social support can guide tailored interventions.

DESIGN

A cross-sectional study.

METHODS

This study was conducted among 448 Chinese adults at high risk for stroke. Self-efficacy, self-management and social support were assessed using the Self-Efficacy Scale, the Stroke Self-management Scale and the Social Support Rating Scale respectively. The PROCESS SPSS Macro version 3.3, model 4 was used to explore the mediating role of different types of social support in the relationship between self-efficacy and self-management. This study followed STROBE checklist for cross-sectional studies (Appendix S1).

RESULTS

Self-efficacy improved three types of social support, and subjective support and support utilisation promoted self-management, but objective support hindered self-management. The specific indirect effect of objective support and subjective support was significant but not that of support utilisation. Objective support, subjective support and support utilisation attenuated the total effect of self-efficacy on self-management by -23.8%, 23.8% and 7.7% respectively.

CONCLUSIONS

Mediating effect of social support in the relationship between self-efficacy and self-management varies by type, and the positive effect of subjective support is offset by the detrimental effect of objective support.

RELEVANCE TO CLINICAL PRACTICE

Among stroke high-risk populations, interventions should target objective support and subjective support as well as self-efficacy to efficiently improve their self-management.

Self-Management and Its Influential Factors Among Individuals With Anxiety Disorders: A Cross-Sectional Study

Self-management has been proposed as a crucial pathway to recovery from mental disorders. The aim of the current study was to explore self-management and its influential factors among individuals with anxiety disorders. Data were from a cross-sectional survey of 180 individuals diagnosed with anxiety disorders. Sociodemographic characteristics, anxiety, self-management, and social support were investigated and analyzed. Participants' mean self-management score was 79.04, with a score rate of 63%. Economic burden, number of relapses, and anxiety severity significantly influenced self-management among participants. Increased social support was correlated with greater self-management. Mental health nursing services should be directed toward individuals with anxiety disorders. [Journal of Psychosocial Nursing and Mental Health Services, 61(4), 27-35.].

Evaluation of Psychological Distress, Self-Care, and Medication Adherence in Association with Hypertension Control

Background. Most of the patients with hypertension (HTN) who undergo medical therapy unaccompanied by psychological and behavioral interventions may not achieve their goal in HTN treatment. Self-care is a key factor in controlling HTN. Given that depression, stress, and anxiety are the most psychological disorders in chronic illnesses. Their impact on self-care, quality of life, and HTN control must be studied more. Methods. We analyzed the difference in medication adherence in 252 patients with low vs. high psychological distress. Also, patients with controlled and uncontrolled HTN were compared according to their psychological distress scores. We further assessed the relation of psychological distress, self-care, and medication adherence with patients’ demographic characteristics. Results. 61.3% of our participants were female with a mean age of 60.6 ± 11.35 and male participants had a mean age of 60.5 ± 11.55. The psychological distress score was significantly higher in women with uncontrolled HTN ( $p$ value = 0.044). Also, individuals with controlled HTN tend to have a higher medication adherence score ( $p$ value = 0.01) and higher self-care score ( $p$ value = 0.033). Hypertensive females had a higher psychological distress score (3.35 ± 2.05) and a lower self-care score (64.05 ± 8.16). There was a positive relationship between age and drug adherence. The self-care score was higher (65.95 ± 7.88) in patients having lower psychological distress levels. Conclusion. A lower psychological distress score can result in better self-care, enhancing the probability of better HTN control; thus, psychological interventions may be necessary for the treatment of HTN. However, more studies are needed to assess the effectiveness of this intervention.

The Mediating Role of Psychological Well-Being in the Relationship between Self-Care Knowledge and Disease Self-Management in Patients with Hypertensive Nephropathy

Objective: This study aimed to investigate the correlation between self-care knowledge, psychological well-being, and disease self-management in patients with hypertensive nephropathy, and to assess the effect of psychological well-being as a mediator of self-care knowledge and disease self-management. Methods: This is a cross-sectional study. The 220 patients with hypertensive nephropathy were recruited from a teaching hospital in Taiwan using purposive sampling. The average age was 70.14 (SD = 11.96) years old. Among them, 128 (58.2%) were male and 92 (41.8%) were female. Instruments included a hypertensive nephropathy self-care knowledge scale, the World Health Organization-5 Well-Being Index, and the chronic kidney disease self-management instrument. The mediating effect was determined with linear regression models and the Sobel test. Results: The total explanatory variation of age, systolic blood pressure, psychological well-being, and self-care knowledge on the disease self-management was 27.7%. Psychological well-being was the most important explanatory factor and alone explains 16%. Psychological well-being was a partial mediator of self-care knowledge and quality of life in patients with hypertensive nephropathy, with a total effect of 23.2%. Conclusions: This study showed that older patients with hypertensive nephropathy and those with a higher systolic blood pressure had lower levels of disease self-management. The higher the patients’ self-care knowledge and psychological well-being, the better their disease self-management.

Feasibility and Acceptability of the HOME Model to Promote Self-Management Among Ethnic Minority Elderly with Type 2 Diabetes Mellitus in Rural Thailand: A Pilot Study

Introduction:

Ethnic minority elderly (EME) people are recognized as a vulnerable group who have higher prevalence of type 2 diabetes mellitus (T2DM) than the majority of the population. The aim of this study was to explore the feasibility, acceptability, and effect of the HOME model (Home intervention; Online monitoring; Multidisciplinary approach; and Equity and education) specifically for enhancing self-management activities, glycemic control, and satisfaction of EME with T2DM in rural areas in Thailand.

Methods:

In this quasi-experimental study, a single group used a pre-test and post-test, which were conducted as a pilot study to examine the effect of the HOME model.

Results:

Overall, 23 dyads of EME with T2DM and their family caregivers completed the 12-week intervention. They reported that the HOME model was helpful and motivating, and they reported satisfaction with the service provided. EME with T2DM showed significant reduction of blood glucose level, and significant improvement in self-management activities, happiness, and satisfaction compared with baseline. Family caregivers had also significant improvements in happiness and reported satisfaction with the HOME model.

Conclusion:

The primary evidence suggested that the HOME model was acceptable and feasible for EME with T2DM and their families in rural Thailand.

Exploring perceived challenges of self-management in low-income older people with hypertension: A qualitative study

BACKGROUND

Hypertension is a public health problem globally. Understanding the perceived challenges of low-income older people populations with chronic disease is an obstacle the world is facing today.

AIM

To explore perceived challenges of self-management in low-income older people with hypertension.

METHODS

Data were collected in three communities from September 2019 to October 2019 by semi-structured interviews. Interviews were audio-taped by digital voice recorder and analysed according to Colaizzi's seven steps.

RESULTS

Participants demonstrated perceived challenges concerning hypertension self-management. Six themes were identified: hypertension belief bias, family dysfunction, deep-rooted habit, elder self-neglect, medical informatization and supportive health policy. Each theme was identified with several subthemes.

CONCLUSIONS

Findings implied that most of the low-income older people lacked self-management behaviours. Future research is needed to address perceived challenges related to self-management behaviour for patients with hypertension worldwide.

Family psychotherapy in patients with uncontrolled hypertension. Preliminary study

Antecedentes:

La psicoterapia familiar ha demostrado tener un impacto positivo en la evolución de enfermos con trastornos psicosomáticos, y en aquellos con hipertensión arterial arterial pudiera mejorar el nivel de control de la enfermedad.

Objetivo:

Evaluar el impacto de una intervención en psicoterapia familiar en pacientes con hipertensión arterial sistémica no controlada.

Método:

Estudio con grupos comparados. 15 pacientes hipertensos no controlados, asignados a dos grupos: un de intervención, con 10 pacientes que recibieron psicoterapia familiar, y otro de control con 5 pacientes. En ambos grupos se continuó con el tratamiento farmacológico indicado por expertos. Se compararon ambos grupos antes y después de la intervención respecto a calidad de vida (InCaViSa), funcionamiento familiar (Escala de Funcionamiento Familiar), presión arterial sistólica y diastólica, índice de masa corporal, glucosa, colesterol, triglicéridos, ácido úrico y creatinina.

Resultados:

Hubo una mejoría cualitativa en los dominios de la escala InCaViSa para estimar la calidad de vida en el grupo de intervención y no hubo cambios estadísticamente significativos entre los grupos en cuanto a funcionamiento familiar y peso corporal. Entre las variables bioquímicas, solo el colesterol mostró una reducción significativa (p = 0.47). Se encontró una mayor movilidad de la familia hacia comportamientos más funcionales en el grupo que recibió la intervención, y también en este grupo disminuyeron las cifras de presión sistólica y diastólica (p < 0.001), así como el uso de antihipertensivos, ansiolíticos y antidepresivos.

Conclusiones:

La intervención psicoterapéutica familiar puede favorecer el control de la presión arterial, reducir las dosis de antihipertensivos, ansiolíticos y antidepresivos, y ayudar en la transición a estados de mejor funcionalidad familiar.

Factors Associated With Informational Support in Transitional Care for Older Adults With Chronic Diseases: A Cross-Sectional Study

To evaluate the current situation and associated factors of informational support for older adults with chronic diseases in transitional care. Study was conducted in five hospitals of five different cities in Jiangsu Province, China. A random cluster sample of 800 older adults with chronic diseases responded to the informational support questionnaire of transitional care survey. Descriptive analysis, t-tests, variance analysis, and stepwise multiple linear regression were used to analyze data. The STROBE statement for observational studies was applied. Total score of ISQTC for older adults with chronic diseases was (44.05 ± 17.21). Marital status, educational level, past occupation, close friends, medical insurance, complications, and exercise habits were significantly correlated with informational support. The level of informational support in transitional care for older adults with chronic diseases was low. Clinical staff should periodically and primarily assess their informational support, help find information resources for those who have low initial informational support, and identify which information they preferred to carry out accurate transitional care.