Development of self-management education for elderly heart patients

Self-management education for children with epilepsy and their caregivers. A scoping review

Self-management education programs have been highly successful in preparing people to manage medical conditions with recurring events. A detailed curriculum for epilepsy patients, and their caretakers, is lacking. Here we assess what is available for patients who have disorders with recurring events and offer an approach to developing a potential self-care curriculum for patients with seizures and their caregivers. Among the anticipated components are a baseline efficacy assessment and training tailored to increasing self-efficacy, medication compliance, and stress management. Those at risk of status epilepticus will also need guidance in preparing a personalized seizure action plan and training in how to decide when rescue medication is appropriate and how to administer the therapy. Peers, as well as professionals, could teach and provide support. To our knowledge, no such programs are currently available in English. We encourage their creation, dissemination, and widespread use.

Self-Management of Heart Disease by Older Adults

A randomized, controlled trial involving 636 older individuals was conducted to evaluate an intervention to enhance self-management of heart disease. Program participants experienced less impact of illness on their psychosocial functioning (p <.05), especially their emotional behavior (p < .05) and alertness (p < .01). Compared to controls, male program participants experienced improvements in their physical functioning, specifically their ability to ambulate (p < .05) and the frequency and severity of their symptoms. Female program participants did not experience gains in physical functioning. Most group differences emerged by 12 months and decayed by the 18-month final evaluation. To accurately assess the pattern of change associated with a program of this type, evaluation over at least 18 months following program completion may be needed. Separate interventions for older men and women with heart disease appear warranted, as do follow-up activities at strategic points in time to sustain program effects.

The Evolution of an Innovative Heart Disease Management Program for Older Women: Integrating Quantitative and Qualitative Methods in Practice

Few studies in the literature describe how to combine quantitative and qualitative methods to enhance the development of health education interventions. This article describes the evolution and refinement of an innovative disease management program “take PRIDE” for older adults with heart disease. Over 15 years, information obtained from data collection methods including telephone interviews, focus groups, face-to-face interviews, and program process data illuminated and guided subsequent refinement of the program and led to new iterations for different participants. Qualitative and quantitative data were incorporated into the two key areas of program development (theoretical framework, objectives, format, and content) and evaluation (evaluation design, sampling, and measurement). Combining both types of data enhanced the opportunity to detect needed program changes, to increase understanding of the mechanisms by which the program effects were produced, and to enhance the relevance of the program to different groups of program participants.

Self-Management of Chronic Disease by Older Adults

This article summarizes the literature describing the at-home management of and psychosocial coping with five chronic diseases (heart disease, asthma, chronic obstructive pulmonary disease, arthritis, and diabetes) by the general population of adults. It also reviews the literature describing self-management of these chronic diseases by older adults. Conclusions drawn subsequent to the review are (a) that there are strong commonalities in the essential nature of tasks that exist across disease entities, (b) that the context for self-management of disease by the ill elderly is likely to differ somewhat from the context for other age groups. Questions for future research are posed.

Ophthalmologist-patient communication, self-efficacy, and glaucoma medication adherence

OBJECTIVE

To examine the associations of provider-patient communication, glaucoma medication adherence self-efficacy, and outcome expectations with glaucoma medication adherence.

DESIGN

Prospective, observational cohort study.

PARTICIPANTS

Two hundred seventy-nine patients with glaucoma who were newly prescribed or taking glaucoma medications were recruited at 6 ophthalmology clinics.

METHODS

Patients' visits were video recorded and communication variables were coded using a detailed coding tool developed by the authors. Adherence was measured using Medication Event Monitoring Systems for 60 days after their visits.

MAIN OUTCOME MEASURES

The following adherence variables were measured for the 60-day period after their visits: whether the patient took 80% or more of the prescribed doses, percentage of the correct number of prescribed doses taken each day, and percentage of the prescribed doses taken on time.

RESULTS

Higher glaucoma medication adherence self-efficacy was associated positively with better adherence with all 3 measures. Black race was associated negatively with percentage of the correct number of doses taken each day (β = -0.16; P < 0.05) and whether the patient took 80% or more of the prescribed doses (odds ratio, 0.37; 95% confidence interval, 0.16-0.86). Physician education about how to administer drops was associated positively with percentage of the correct number of doses taken each day (β = 0.18; P < 0.01) and percentage of the prescribed doses taken on time (β = 0.15; P < 0.05).

CONCLUSIONS

These findings indicate that provider education about how to administer glaucoma drops and patient glaucoma medication adherence self-efficacy are associated positively with adherence.

Determinants of Self-Reported Barriers to Glaucoma Medicine Administration and Adherence: A Multisite Study

BACKGROUND

Many factors influence glaucoma medication adherence. A better understanding of the relationships between health literacy, depressive symptoms, and patient-reported problems in using glaucoma medications may reveal opportunities for intervention that could improve patients' clinical outcomes.

OBJECTIVE

To examine the relationship between patient characteristics (demographics, health literacy, and depressive symptoms) and patient-reported problems in using glaucoma medications and to assess factors related to patients' self-reported adherence to glaucoma medications.

METHODS

Patients diagnosed with primary open-angle glaucoma (n = 228) currently taking intraocular pressure-lowering medications were recruited at 6 ophthalmology clinics. Patients were interviewed to identify problems using glaucoma medications, and self-reported medication adherence was determined using a Visual Analog Scale. Questionnaires were administered to assess health literacy, depressive symptoms, outcome expectations, and medication self-efficacy.

RESULTS

Younger patients (P = 0.03), patients with depressive symptoms (P = 0.02), and patients who reported more medication problems (P = 0.005) were significantly less adherent to their glaucoma medications. Patients with higher glaucoma medication self-efficacy adherence scores (P = 0.003) and higher outcome expectations (P = 0.03) were significantly more adherent.

CONCLUSIONS

Providers should consider using tools to screen glaucoma patients for depressive symptoms and for problems in using medications to identify patients who are at higher risk of nonadherence to treatment and who might benefit from follow-up with primary care providers.

Self-Care Among Older Adults

Cette synthèse de la documentation sur les soins personnels chez les personnes ^gées définit le concept en termes des comportements préventifs et des réponses à la maladie adoptés par les profanes à leur propre bénéfice. Après avoir placé les soins personnels dans leur contexte historique, l'auteur examine les perspectives théoriques et les principales constatations sur son incidence ainsi que les corrélats et les barrières. Cet examen est suivi d'une revue du processus et des résultats des interventions destinées à promouvoir les soins personnels. L'auteur termine en présentant des recommandations en vue du développement de la recherche, des politiques et de la pratique.

The influence of social support on chronic illness self-management: a review and directions for research

A review of the empirical literature examining the relationship between social support and chronic illness self-management identified 29 articles, of which 22 were quantitative and 7 were qualitative. The majority of research in this area concerns diabetes self-management, with a few studies examining asthma, heart disease, and epilepsy management. Taken together, these studies provide evidence for a modest positive relationship between social support and chronic illness self-management, especially for diabetes. Dietary behavior appears to be particularly susceptible to social influences. In addition, social network members have potentially important negative influences on self-management There is a need to elucidate the underlying mechanisms by which support influences self-management and to examine whether this relationship varies by illness, type of support, and behavior. There is also a need to understand how the social environment may influence self-management in ways other than the provision of social support

Development of a health education programme for elderly with age-related macular degeneration: a focus group study

Age-related macular degeneration is a serious public health problem, and in most cases no cure exists. One available intervention is low vision rehabilitation, and there is a lack of programmes for the elderly. The purpose of this paper is to present the results of an evaluation of a group-based health education programme. This programme comprised six to eight 2-3 hour meetings, once a week, for persons with age-related macular degeneration. Each group consisted of four to six participants. The goal of the programme, which has its roots in the health belief model, was to sustain and restore the participants' performance of their daily activities. The tool used for process evaluation was focus group methodology, and eight focus groups were involved. Forty five persons, whose average age was 80 years, took part in the evaluation. The results indicated that the participants were, on the whole, pleased with the content of the programme. There were, however, some indications that they did not understand all the information provided. Social support, regained hope and meeting others with the same disease were reported as positive aspects of the health education programme. The importance of the group leader's role in guiding this health education programme was emphasised. Furthermore, with regard to the composition of the groups, the participants pointed out that it was important to consider variation in visual acuity, so as to provide different models for comparison, and whether both sexes should participate in all groups. Finally, several suggestions for improving the programme are put forward.

A research agenda for health education among underserved populations

This article summarizes the outcome of health education efforts among populations that, due to their cultural heritage, have received limited services. The literature reviewed shows that programs found to be effective in one population cannot be assumed to be equally effective with a different population. An argument is made for the design of culturally appropriate and group-specific interventions which would properly serve the various underserved populations. Research needs to be conducted to identify appropriate approaches and intervention strategies, as well as the group-specific sociopsychological characteristics (attitudes, norms, values, expectancies) that are related to health-damaging and protective behaviors.

The role of social relations in health promotion

In considering new paradigms for the prevention and treatment of disease and disability, we need to incorporate ways to promote social support and develop family and community strengths and abilities into our interventions. There is now a substantial body of evidence that indicates that the extent to which social relationships are strong and supportive is related to the health of individuals who live within such social contexts. A review of population-based research on mortality risk over the last 20 years indicates that people who are isolated are at increased mortality risk from a number of causes. More recent studies indicate that social support is particularly related to survival postmyocardial infarction. The pathways that lead from such socioenvironmental exposures to poor health outcomes are likely to be multiple and include behavioral mechanisms and more direct physiologic pathways related to neuroendocrine or immunologic function. For social support to be health promoting, it must provide both a sense of belonging and intimacy and must help people to be more competent and self-efficacious. Acknowledging that health promotion rests on the shoulders not only of individuals but also of their families and communities means that we must commit resources over the next decade to designing, testing, and implementing interventions in this area.

Self-regulation of health behavior: the "take PRIDE" program

Social cognitive theory, in particular, the construct of self-regulation was the basis for developing an educational program for older adults with heart disease. This paper discusses the theoretical principles utilized and describes the program activities based on them. Data from an evaluation conducted with 246 older heart patients who took part in the education are used to illustrate how social cognitive theory constructs operated empirically.

Information-seeking about health in a community sample of adults: correlates and associations with other health-related practices

Action by individuals to acquire information about their health has been an element incorporated throughout theory, research, and programs related to health promotion. This report describes an attempt to determine if an information-seeking dimension could be empirically identified in a general community-resident sample, and if so, to examine some of its characteristics. A total of 281 adults aged 18-75 were contacted by telephone using random digit dialing and were interviewed about a variety of personal health practices. Factor analysis identified a five-item cluster representing a tendency to seek out information about health. Women were more likely than men to report seeking information. In addition, more frequent information-seeking was associated with favorable responses to several other health-related practices. Formal health service use was the only type of health practice not associated with information-seeking, perhaps because regularity of contact is influenced strongly by health professionals (e.g., reminder cards and having staff call to schedule annual exams). Overall, results of the investigation support the importance of information-seeking as a component of a personal health practice repertoire. Additional attention might be directed toward elaborating its role as a "process" variable in health education programs and social marketing efforts, particularly in areas such as response to recruitment messages, dropout vs. maintenance, and differential gains on outcome measures of program effectiveness.

Principles of teaching for individual learning of older adults

Improved self-care and functioning are the ultimate goals of work with the elderly client. An essential component of rehabilitation nursing is teaching the client how to achieve these goals. Gradual changes in function occur with age; in addition, vision, hearing, and memory deficits are inevitable in the aging adult. But individualized assessment and select approaches can overcome these barriers to learning.