Reliability, validity and factor structure of the Appraisal of Self-Care Agency Scale-Revised (ASAS-R)

Study protocol: LIAM Mc trial (Linking In with Advice and supports for Men impacted by Metastatic cancer)

BACKGROUND

The significant increase in cancer survivorship rates necessitates a comprehensive, multidisciplinary approach to supportive care services. This study seeks to assess the feasibility of introducing a Men's Health Initiative supportive care intervention program in Ireland.

METHODS

This is a single-arm feasibility study involving a 12-week men's cancer survivorship programme alongside routine follow-up care in patients with advanced genitourinary malignancies. Men with advanced/metastatic genitourinary cancer (including prostate, kidney, urothelial tract, testicular or penile cancer), are eligible to enrol, with a target of 72 participants over a 2-year period. The intervention programme entails a twice-weekly physiotherapy-led exercise programme, along with dietetics, nursing, and psychosocial components, and regular signposting to additional available services. A Pilot Phase involving analysis of data from the first group of 6 participants to complete the programme is planned, before an Expansion Phase. Assessments will occur at baseline, on completion of the 12-week intervention, and 3 months post-intervention, and will include analyses of exercise/activity levels, body composition, muscle strength, psychological wellbeing, quality of life and resources utilised. The primary endpoints are to determine the feasibility and acceptability of introducing a men's cancer survivorship intervention programme into routine follow-up care in patients with advanced genitourinary malignancies. Secondary endpoints include impact of the intervention programme on quality of life, cancer-related fatigue, maintenance of weight, changes in body composition and changes in dietary intake and diet quality over the study period, as well as self-care agency and its relationship to quality of life and symptoms experienced. A qualitative process evaluation will be undertaken to explore participants' experiences, while an economic analysis will examine the healthcare resource utilization and costs associated with the intervention. The trial was peer-reviewed by the Irish Cancer Society.

DISCUSSION

The programme described in this protocol provides a supportive and safe environment for the introduction of self-care interventions using a small group-based format supported by individualised counselling according to the participant's identified needs. The development and implementation of future supportive care programmes for men's cancer survivorship will be guided by the findings of this study.

TRIAL REGISTRARTION

ClinicalTrials.gov NCT05946993.

Self-management of everyday female health: The role of self-care agency, patient-centered communication, and technology features in the intention to adopt period-tracking apps

Despite the increasing prevalence of health-related apps, the communication-related mechanisms driving their adoption remain underexplored. Approaching health-related self-tracking from a communication perspective, this study explores how patient-centered communication (PCC), supported by active patient participation, can affect women's intentions to adopt period-tracking apps. Using a cross-sectional survey with 485 women aged 18-49 who had visited a healthcare provider in the past year, our findings showed that individual self-care agency indirectly predicted higher PCC through better patient communication competence. Both communication competence and PCC were associated with increased adoption intentions for period-tracking apps, mediated by perceived ease of app use, app usefulness, and positive attitudes towards the apps. Our findings highlight the intricate interplay between personal communication abilities, healthcare provider interactions, and technology features in shaping health technology adoption. Theoretical and practical implications are discussed, offering insights into enhancing female health self-management through improved communication strategies and supportive technological features.

Self-Care Management and Its Predictors Among Jordanian Patients with Type 1 Diabetes Mellitus: Cross-Sectional Study

Background

Self-care management (SCM) is a cornerstone in the management of diabetes mellitus (DM), as it has a positive impact on glycemic control.

Aims

To investigate the level, specific practices, correlates, and predictors of SCM practices among Jordanian adult patients with type 1 diabetes (DM1).

Methodology

Using an online self-report questionnaire, a convenience sample of 127 DM type 1 patients were recruited who agreed to complete the questionnaire. The questionnaire had four sections; demographics, the diabetes self-efficacy scale (DSES), the appraisal of self-care agency scale-revised (ASAR-R), and the Diabetes Self-Management Scale (DSMS).

Results

The mean score of the total Diabetes Self-Management Scale (DSMS) of patients was 204.16 (SD = 40.35, range = 97-299). We found that SCM practices differed between patients according to their characteristics; the SCM-Activity and SCM-Food differed according to gender, educational level, and income. Furthermore, there were significant negative relationships between the duration of being diagnosed with DM and SCM-activity, and between BMI and each of SCM-Blood glucose monitoring and SCM-adherence to the medication regimen. Lastly, sequential regression showed that income, self-efficacy (SE), and self-care agency (SCA) were significant predictors of SCM.

Conclusions

Patients with DM type 1 exhibit different levels of SCM according to their personal and clinical characteristics. Tailored health education plans should be provided to patients according to their risk factors for low SCM practices.

Determination of the Relationship Between Self-Care Agency and Death Anxiety Among Elderly Individuals

This study aimed to determine the relationship between self-care agency and death anxiety among elderly individuals. The study sample consisted of 163 elderly individuals who applied to the internal medicine and chest diseases outpatient clinic of a university hospital. Death anxiety (DAS) and Self-care agency (SCAS) scales were used for data collection. The mean DAS score of the participants was found 6.76 ± 3.25 and low. The mean SCAS scores was 94.35 ± 16.37 and moderate. A positive very weak correlation was found between self-care agency and death anxiety (p = 0.044, r = 0.158). Elderly individuals without regular income had higher levels of death anxiety compared to those with regular income (p < 0.05). A significant difference was found in death anxiety levels with respect to the sex and marital status (p < 0.05). The low-level death anxiety on elderly individuals may have a positive effect on maintaining their self-care agency. Nurses should engage in training activities and interventions to increase the levels of self-care agency and determine the death anxiety among elderly individuals.

Uncertainty affects cancer-related fatigue among breast cancer women undergoing peripherally inserted central catheter chemotherapy: the chain mediating role of psychological resilience and self-care

BACKGROUND

Breast cancer patients undergoing chemotherapy via peripherally inserted central catheter often experience serious behavioral and psychological challenges, with uncertainty and cancer-related fatigue being prevalent issues that profoundly impact prognosis. Therefore, this study aimed to investigate the relationship between uncertainty and cancer-related fatigue by employing a chain mediation model to examine the potential mediating roles of psychological resilience and self-care.

METHODS

A cross-sectional study was conducted with 223 breast cancer patients receiving peripherally inserted central catheter chemotherapy at two tertiary affiliated hospitals of China Medical University in Liaoning, China, from February 2021 to December 2022. Participants completed self-reported questionnaires to assess uncertainty, psychological resilience, self-care, and cancer-related fatigue. The collected data were subsequently analyzed using Pearson's correlation analysis, hierarchical regression analysis, and mediation analysis.

RESULTS

Uncertainty exhibited a significant positive correlation with cancer-related fatigue (p < 0.01) and a negative correlation with psychological resilience (p < 0.01) and self-care (p < 0.01). Uncertainty was found to impact cancer-related fatigue through three pathways: psychological resilience mediated the relationship between uncertainty and cancer-related fatigue (mediating effect = 0.240, 95% confidence interval: 0.188 to 0.298, effect ratio = 53.22%); self-care also mediated this relationship (mediating effect = 0.080, 95% confidence interval: 0.044 to 0.121, effect ratio = 17.74%); furthermore, there was a significant joint mediating effect of psychological resilience and self-care on the association between uncertainty and cancer-related fatigue (mediating effect = 0.042, 95% confidence interval: 0.021 to 0.068, effect ratio o = 9.31%).

CONCLUSION

The findings of this study revealed that uncertainty not only directly influenced cancer-related fatigue, but also operated through the mediating effect of psychological resilience, self-care, and sequential mediation of psychological resilience and self-care. Interventions tailored for breast cancer patients receiving peripherally inserted central catheter chemotherapy should target these factors to help alleviate uncertainty, enhance psychological resilience, and improve self-care practices, thereby ameliorating cancer-related fatigue.

Behavioral marker-based predictive modeling of functional status for older adults with subjective cognitive decline and mild cognitive impairment: Study protocol

Objective

This study describes a research protocol for a behavioral marker-based predictive model that examines the functional status of older adults with subjective cognitive decline and mild cognitive impairment.

Methods

A total of 130 older adults aged ≥65 years with subjective cognitive decline or mild cognitive impairment will be recruited from the Dementia Relief Centers or the Community Service Centers. Data on behavioral and psychosocial markers (e.g. physical activity, mobility, sleep/wake patterns, social interaction, and mild behavioral impairment) will be collected using passive wearable actigraphy, in-person questionnaires, and smartphone-based ecological momentary assessments. Two follow-up assessments will be performed at 12 and 24 months after baseline. Mixed-effect machine learning models: MErf, MEgbm, MEmod, and MEctree, and standard machine learning models without random effects [random forest, gradient boosting machine] will be employed in our analyses to predict functional status over time.

Results

The results of this study will be fundamental for developing tailored digital interventions that apply deep learning techniques to behavioral data to predict, identify, and aid in the management of functional decline in older adults with subjective cognitive decline and mild cognitive impairment. These older adults are considered the optimal target population for preventive interventions and will benefit from such tailored strategies.

Conclusions

Our study will contribute to the development of self-care interventions that utilize behavioral data and machine learning techniques to provide automated analyses of the functional decline of older adults who are at risk for dementia.

Instruments for measuring self-management and self-care in geriatric patients - a scoping review

Introduction

With demographic changes, prioritizing effective care for geriatric patients to maintain functionality, independence, and quality of life is crucial. Well-developed self-management or self-care abilities, which can be maintained and improved through interventions, are of the utmost importance. To implement these interventions tailored and effectively, a thorough assessment of the individual's self-management and self-care abilities is required.

Objective

This scoping review aimed to identify self-management and self-care instruments suitable for geriatric patients, their underlying theories and definitions of self-management and self-care, and their similarities and differences in item content.

Methods

A systematic search of the PubMed and CINAHL databases was conducted to identify retrievable full-text articles published in English in the medical and nursing fields since the 1970s, which were validated on a sample with an average age of at least 70 years, used generic rather than disease-specific items, and addressed the broad range of self-management and self-care abilities.

Results

Of the 20 included articles, six instruments were identified that were based on different theories and offered varying definitions of self-management or self-care. Despite these differences, all emphasize empowered individuals taking an active role in their care. Most address actual behavior and abilities referring to lifestyle factors and (anticipated) adjustment behavior. However, crucial aspects, such as psychological factors, (instrumental) activities of daily living, and social environment are not fully addressed in these instruments, nor are the types of execution to which the items refer, such as wants, feelings, confidence, or attitudes.

Conclusion

To fully understand how geriatric patients implement daily self-management or self-care, a combination of instruments covering the important factors of self-management and self-care and addressing multiple types of item execution, such as behaviors, abilities, wants, or attitudes, is recommended. This review provides the first comprehensive overview of self-management and self-care instruments suitable for geriatric patients.

Self-management of geriatric syndromes - an observational study

BACKGROUND

Self-management of health refers to various actions and decisions that impact health outcomes. To improve health, independence, and quality of life (QoL) while reducing healthcare utilization and costs, patients' self-management abilities can be enhanced. However, disease-specific self-management interventions may not be applicable for older adults with multiple illnesses. Instead, focusing on prevalent geriatric syndromes, such as frailty, cognitive decline, pain, incontinence, or impaired mobility, may be more beneficial. To achieve this, a detailed understanding of the specific needs of the older population is crucial.

METHODS

Patients who are 70 years old or older will be chosen from four geriatric hospitals, which include both inpatient and outpatient facilities. At baseline, each participant will undergo a comprehensive geriatric evaluation and answer various questionnaires that focus on their current self-management abilities, self-efficacy, anxiety, aging perception, and QoL. Moreover, extensive data on the presence and impact of geriatric syndromes will be gathered. Three and six months after the initial evaluation, follow-up assessments will be conducted to identify any changes in participants' health, independence in daily activities, geriatric syndromes, cognition and mood, QoL, and self-management.

DISCUSSION

The present investigation aims to assess the factors that may facilitate or impede self-management in older adults afflicted with geriatric syndromes. Instead of concentrating on particular diseases, this study will analyze the association between self-management and geriatric syndromes. The information obtained will contribute to clinical expertise on the self-management habits of older adults and their effects on their well-being, autonomy, and overall QoL, as well as provide insights into geriatric syndromes. This valuable knowledge will be crucial for developing personalised programs to enhance self-management among older adults.

TRIAL REGISTRATION

German Trial Register (Deutsches Register Klinischer Studien) DRKS00031016.

A web-based educational therapy intervention associated with physical exercise to promote health in fibromyalgia in Brazil: the Amigos De Fibro (Fibro Friends) study protocol

BACKGROUND

Health education is one of the main items to enable health promotion to patients with fibromyalgia. The objective of the study "Amigos de Fibro (Fibro Friends)" is to evaluate the impact of an educational intervention associated with physical exercise based on the web in promoting health and quality of life of patients with fibromyalgia in Brazil.

METHODS

A study with a randomized controlled trial approach will be carried out. The sample will consist of 24 participants, divided into two groups, with 12 individuals each. The experimental group will participate in meetings with lectures, debates, conversation rounds and exercises by a multidisciplinary team. Physical exercises will also be performed in an online environment. On the other hand, the control group will receive an e-book of education and self-care. Primary outcomes will be quality of life. The secondary outcomes will be sociodemographic and health profile, pain intensity, sleep quality, self-care agency, usage and costs of health and social care services, viability of the program and program participation. In addition, a qualitative evaluation process will be carried out with the participants. After the intervention, the data of both groups will be collected again, as well as after 3, 6, and 12 months to verify the effect and the maintenance of the intervention.

DISCUSSION

The results will provide data for studies to consider the use of this tool in the future by professionals working in the field of rheumatology.

TRIAL REGISTRATION

The protocol was registered in the Brazilian Registry of Clinical Trials RBR-3rh759 ( https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-3rh759 ). Date of registration: 07/02/2020].

The Effect of a Diabetes Self-Management Mobile Application on Self-Efficacy, Self-Care Agency, and Self-Care Management Among Patients With Type 1 Diabetes Mellitus

Background: Diabetes mellitus is a chronic disease that needs long-term management. Mobile health is an emerging field that is being used for diabetes self-management. Aim: Evaluate the effect of a diabetes self-management mobile application on self-efficacy, self-care agency, and self-care management among 128 Jordanian patients with Type 1 Diabetes Mellitus. Methods: The study utilized a non-equivalent controlled groups quasi-experimental design, with 64 patients in the control and in the intervention groups. Results: There was significant improvement in mean self-efficacy in the intervention group, improved self-care agency between the groups, and improved self-care management both within the intervention group and between the groups, after controlling for self-efficacy and self-care agency. Conclusion: Using a diabetes self-management mobile application may help improve patients' confidence in managing diabetes, and better commitment to and performance of self-care activities.

Measurement of Perceived Risk of Developing Diabetes Mellitus: A Systematic Literature Review

BACKGROUND

This systematic review describes approaches to measuring perceived risk of developing type 2 diabetes among individuals without diagnoses and describes the use of theories, models, and frameworks in studies assessing perceived risk. While a systematic review has synthesized perceived risk of complications among individuals with diabetes, no reviews have systematically assessed how perceived risk is measured among those without a diagnosis.

METHODS

Medline, PubMed, PsycINFO, and CINAHAL databases were searched for studies conducted through October 2022 with measures of perceived risk among adults ≥ 18 years without a diabetes diagnosis. Extracted data included study characteristics, measures, and health behavior theories, models, or frameworks used.

RESULTS

Eighty-six studies met inclusion criteria. Six examined perceived risk scales' psychometric properties. Eighty measured perceived risk using (1) a single item; (2) a composite score from multiple items or subconstructs; and (3) multiple subconstructs but no composite score. Studies used items measuring "comparative risk," "absolute or lifetime risk," and "perceived risk" without defining how each differed. Sixty-four studies used cross-sectional designs. Twenty-eight studies mentioned use of health behavior theories in study design or selection of measures.

DISCUSSION

There was heterogeneity in how studies operationalized perceived risk; only one third of studies referenced a theory, model, or framework as guiding design or scale and item selection. Use of perceived lifetime risk, absolute risk, or comparative risk limits comparisons across studies. Consideration of context, target population, and how data are utilized is important when selecting measures; we present a series of questions to ask when selecting measures for use in research and clinical settings. This review is the first to categorize how perceived risk is measured in the diabetes prevention domain; most literature focuses on perceived risk among those with diabetes diagnoses. Limitations include exclusion of non-English and gray literature and single reviewer screening and data extraction.

Self-Management of Diabetes and Associated Factors among Patients Seeking Chronic Care in Tshwane, South Africa: A Facility-Based Study

The burden of diabetes continues to increase in South Africa and a significant number of diabetes patients present at public primary healthcare facilities with uncontrolled glucose. We conducted a facility-based cross-sectional study to determine the diabetes self-management practices and associated factors among out-patients in Tshwane, South Africa. An adapted validated questionnaire was used to collect data on sociodemography, diabetes knowledge, and summaries of diabetes self-management activities measured in the previous seven days, and over the last eight weeks. Data were analysed using STATA 17. A final sample of 402 diabetes out-patients was obtained (mean age: 43 ± 12 years) and over half of them were living in poor households. The mean total diabetes self-management of score was 41.5 ± 8.2, with a range of 21 to 71. Almost two thirds of patients had average self-management of diabetes, and 55% had average diabetes knowledge. Twenty-two percent of patients had uncontrolled glucose, hypertension (24%) was the common comorbidity, and diabetic neuropathy (22%) was the most common complication. Sex [male: AOR = 0.55, 95% CI: 0.34-0.90], race [Coloured: AOR = 2.84, 95% CI: 1.69-4.77 and White: AOR = 3.84, 95% CI: 1.46-10.1], marital status [divorced: AOR = 3.41, 95% CI: 1.13-10.29], social support [average: AOR = 2.51, 95% CI: 1.05-6.00 and good: AOR = 4.49, 95% CI: 1.61-7.57], body mass index [obesity: AOR = 0.31, 95% CI: 0.10-0.95], diabetes knowledge [average: AOR = 0.58, 95% CI: 0.33-0.10 and good: AOR = 1.86, 95% CI: 0.71-4.91], and uncontrolled glucose [AOR = 2.97, 95% CI: 1.47-5.98] were factors independently predictive of diabetes self-management. This study emphasizes that the self-management of diabetes was mostly on average among patients and was associated with the aforementioned factors. Innovative approaches are perhaps needed to make diabetes education more effective. Face-to-face sessions delivered generally during clinic visits should be better tailored to the individual circumstances of diabetes patients. Considerations should be given to the options of leveraging information technology to ensure the continuity of diabetes education beyond clinic visits. Additional effort is also needed to meet the self-care needs of all patients.

Improving quality of life in patients with rare autoimmune liver diseases by structured peer-delivered support (Q.RARE.LI): study protocol for a transnational effectiveness-implementation hybrid trial

BACKGROUND

Psychosocial support is a crucial component of adequate rare disease care, but to date psychosocial support needs of this patient population are insufficiently met. Within Q.RARE.LI, we strive to evaluate the effectiveness of a structured, transdiagnostic, and location-independent psychosocial support intervention in routine care of patients with rare autoimmune liver diseases in five countries and prepare its implementation.

METHODS

Within an effectiveness-implementation hybrid trial, we aim to a) investigate the effectiveness of the intervention in routine care in five diverse healthcare systems and b) assess implementation outcomes, examine and prepare the implementation context, and develop country-specific implementation strategies. To assess effectiveness, we will include N = 240 patients with rare autoimmune liver diseases. Within a two-armed randomized controlled trial (allocation ratio 1:1), we will compare structured and peer-delivered psychosocial support in addition to care-as-usual (CAU) with CAU alone. Outcomes will be assessed via electronic database entry prior to intervention, directly after, and at a three-month follow-up. Our primary effectiveness outcome will be mental health-related quality of life at post-assessment. Secondary outcomes include depression and anxiety severity, perceived social support, helplessness, and disease acceptance. Implementation outcomes will be assessed within a mixed-methods process evaluation. In a quantitative cross-sectional survey, we will examine perceived acceptability and feasibility in patients, peer-counselors, and healthcare providers involved in delivery of the intervention. In qualitative focus groups, we will analyze the implementation context and determine barriers and facilitators for implementation with different stakeholders (patients and/or representatives, peer-counselors, healthcare providers, health insurers). Based on these results, we will derive country-specific implementation strategies and develop a concrete implementation plan for each country.

DISCUSSION

The intervention is expected to help patients adjust to their disease and improve their mental quality of life. The transdiagnostic and location-independent program has the potential to reach patients for psychosocial support who are usually hard to reach. By preparing the implementation in five countries, the project can help to make low-threshold psychosocial support available to many patients with rare diseases and improve comprehensive healthcare for an often neglected group.

TRIAL REGISTRATION

ISRCTN15030282.

Correlates of quality of life in South Korean patients undergoing hematopoietic stem cell transplantation based on the symptom management model

While hematopoietic stem cell transplantation (HSCT) has led to higher survival rates, the number of patients experiencing adverse reactions is also increasing. Based on the symptom management model, we aimed to analyze the relationships between symptom experience, symptom management strategies, self-management behavior, and quality of life among patients undergoing HSCT in South Korea and to identify the factors affecting their quality of life. The data of 67 conveniently sampled patients undergoing HSCT at a university-affiliated hospital, for the period from March 23 to June 7, 2016, were collected using a self-reported structured questionnaire. Data were analyzed using Pearson's correlations and multiple regression analysis. Quality of life showed a significant negative correlation with symptom experience and significant positive correlations with symptom management strategies. Factors influencing quality of life included symptom distress, symptom management strategies, and self-management behavior; these explained 39.4% of the variance. To improve quality of life in patients undergoing HSCT, the efficient management of multiple co-existing symptoms is important. There is a need for tailored nursing interventions based on a patient-focused and person-centered approach for patients undergoing HSCT.

The Women's Health Initiative cancer survivorship clinic incorporating electronic patient-reported outcomes: a study protocol for the Linking You to Support and Advice (LYSA) randomized controlled trial

BACKGROUND

The improved survival rate for many cancers in high-income countries demands a coordinated multidisciplinary approach to survivorship care and service provision to ensure optimal patient outcomes and quality of life. This study assesses the feasibility of introducing a Women's Health Initiative cancer survivorship clinic in Ireland.

METHODS

The trial https://spcare.bmj.com/content/9/2/209.short comprises an intervention and control arm. Two hundred participants will be recruited. Key eligibility (1) women with early-stage hormone receptor-positive breast or gynecologic cancer (cervix or endometrial), within 12 months of completion of primary curative therapy, and (2) access to the Internet. The complex intervention comprises a nurse-led clinic targeting symptom management through a trigger alert system, utilizing electronic patient-reported outcome (ePRO) assessments at baseline, and 2, 4, 6, 8, 10, and 12 months. It also includes input from a dietitian monitoring diet and nutritional status. The control group will receive their usual care pathway standard of care and attend the cancer survivorship clinic and complete ePRO assessments at the start and end of the study. The primary endpoint (feasibility) includes the proportion of enrolled participants who complete baseline and follow-up ePRO surveys and partake in health professional consultations after ePRO data triggers. Secondary endpoints include changes in cancer-related symptom scores assessed by ePROs, health-related Quality of Life Questionnaire (QLQ) scores, Appraisal Self-Care Agency-R scores, and adjuvant endocrine therapy medication adherence. A process evaluation will capture the experiences of participation in the study, and the healthcare costs will be examined as part of the economic analysis. Ethical approval was granted in December 2020, with accrual commencing in March 2021.

DISCUSSION

This protocol describes the implementation of a parallel arm randomized controlled trial (RCT) which examines the feasibility of delivering a Cancer Survivorship Clinic. The ePRO is an innovative symptom monitoring system which detects the treatment-related effects and provides individualized support for cancer survivors. The findings will provide direction for the implementation of future survivorship care.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT05035173 . Retrospectively registered on September 5, 2021.

Validation and Psychometric Analysis of the German Translation of the Appraisal of Self-Care Agency Scale-Revised

Self-care and self-management are essential for well-being, especially in advancing age or chronic illness. To assess these complex behaviors, validated questionnaires are needed. The Appraisal of Self-Care Agency Scale-Revised (ASAS-R) is a self-report questionnaire to evaluate the actions people take to manage their health. This manuscript reports the psychometric properties of the German ASAS-R translation. After standardized translation, convergent validity was assessed with the Patient Activation Measure (PAM) controlling for sociodemographic and health factors. Internal consistency, descriptive statistics, and principal component analysis (PCA) are reported. We analyzed data of 215 community-dwelling German adults aged 51.6 ± 14.7 years with at least one chronic illness. Similar to the original ASAS-R, PCA revealed three factors, although item allocation differed. The ASAS-R showed good internal consistency overall and for each factor, although ceiling effects were present for some items. Convergent validity was good, and the ASAS-R was as a predictor for the PAM irrespective of other variables. As self-care is highly complex, we conclude that factor structure should be assessed for each dataset. Overall, the German ASAS-R is a valid instrument to measure self-care and self-management of chronic diseases that may enhance research on this fundamental health behavior in German-speaking countries.

The Appraisal of Self-Care Agency Scale-Revised (ASAS-R): Reliability and Validity among Portuguese Medical Students

Self-care agency plays an important role in an individual's health. Considering the particularities of their education, it can be a protective factor for the mental health of medical students. This study aims to validate the Portuguese version of the Appraisal of Self-care Agency Scale-Revised (ASAS-R) in Portuguese medical students. A cross-sectional, quantitative, and analytical online study was conducted between 23 April 2021, and 15 July 2021. Exploratory factor analysis (EFA) was performed to test the internal structure of the ASAS-R. Correlations with the SHS (Subjective Happiness Scale), SWLS (Satisfaction with Life Scale), and MHI (Mental Health Inventory) were calculated using Pearson's coefficient so as to test convergent validity. Internal consistency was evaluated using inter-item correlation, corrected item-total correlation, and Cronbach's alpha. The total sample included 781 individuals. EFA yielded a 3-factor solution accounting for 53.9% of the explained variance. Pearson's coefficients obtained between the 3 factors of ASAS-R and the total scores of the 3 construct-related scales demonstrated adequate convergent validity. Total Cronbach's alpha value was 0.85, while the Cronbach's alpha of the three factors was 0.81, 0.55, and 0.83, respectively. This study demonstrated that ASAS-R is a valid and reliable instrument for measuring self-care agency among Portuguese medical students.

Self-Care and Sense of Coherence: A Salutogenic Model for Health and Care in Nursing Education

Background: Effective advocacy on self-care and the enhancement of a sense of coherence among nurses don’t only benefit control over one’s health and personal performance, but it may have a direct impact on clinical care and on the entire healing system. In this regard, nursing curricula grounded on a salutogenic model of health (SMH) operate with strategies to engage students in self-care and contribute to improving their mental health and wellbeing. The aim of this study was to explore the relationships between self-care agency and a sense of coherence as dependent variables and the age and self-reported academic performance as independent variables in nursing assistant students. Methods: For this cross-sectional study, data were collected from a full sample of 921 Certified Nursing Assistant (CNA) Spanish students. A self-administered questionnaire, including sociodemographic variables, the ‘appraisal of self-care agency’ (ASA), and the ‘sense of coherence’ (SOC) constructs, was administered. Results: Results: Older participants presented significantly stronger values of both constructs. Apart from a significant and positive correlation between ASAS and SOC, ANOVA analyses indicate signif-icant differences in terms of academic performance according to different ASAS and SOC de-grees. Conclusion: The findings of this study endorse the assumption that there is a consistent relationship between ASA and SOC constructs that might, indeed, have a potential effect on stu-dents’ academic performance. In practical terms, it seems relevant to try to recognise the stu-dents’ self-care agency and the sense of coherence as forceful predictive variables of mental health and wellbeing, in addition to academic success as a strength implied in the future career achievement.

Cohort profile: The Bariatric Experience Long Term (BELONG): a long-term prospective study to understand the psychosocial, environmental, health and behavioural predictors of weight loss and regain in patients who have bariatric surgery

PURPOSE

The Bariatric Experience Long Term (BELONG) prospective study cohort was created to address limitations in the literature regarding the relationship between surgical weight loss and psychosocial, health, behaviour and environmental factors. The BELONG cohort is unique because it contains 70% gastric sleeve and 64% patients with non-white race/ethnicity and was developed with strong stakeholder engagement including patients and providers.

PARTICIPANTS

The BELONG cohort study included 1975 patients preparing to have bariatric surgery who completed a baseline survey in a large integrated health system in Southern California. Patients were primarily women (84%), either black or Hispanic (59%), with a body mass index (BMI) of 45.1±7.4 kg/m², age 43.3±11.5 years old, and 32% had at least one comorbidity.

FINDINGS TO DATE

A total of 5552 patients were approached before surgery between February 2016 and May 2017, and 1975 (42%) completed a baseline survey. A total of 1203 (73%) patients completed the year 1 and 1033 (74%) patients completed the year 3 postoperative survey. Of these survey respondents, 1341 at baseline, 999 at year 1, and 951 at year 3 were included in the analyses of all survey and weight outcome data. A total of 803 (60% of eligible patients) had survey data for all time points. Data collected were self-reported constructs to support the proposed theoretical model. Height, weight and BMI were abstracted from the electronic medical record to obtain the main outcomes of the study: weight loss and regain.

FUTURE PLANS

We will collect self-reported constructs and obtain height, weight and BMI from the electronic medical record 5 years after bariatric surgery between April 2022 and January 2023. We will also collect patient experiences using focus groups of 8-12 patients each throughout 2022.

Factor analysis of the Chinese version of the Self-care Ability Scale for the Elderly: A multi-centre cross-cultural validation study

AIM

This study aimed to explore and confirm the factor structure and item distribution of the Chinese version of Self-care Ability Scale for the Elderly among older Chinese people.

METHODS

A cluster random sampling method was used to collect 2856 older people from five different cities of China from July 2018 to July 2019. A questionnaire comprised of socio-demographic information and the Chinese version of the Self-care Ability Scale for the Elderly was administered, and SPSS 21.0 and Mplus 7.4 were used for analyses.

RESULTS

Participants were aged 60 to 92 years, with a mean age of 71.52 (SD = 7.68) years. In the Exploratory Factor Analysis, the three-factor structure and item distribution of the Chinese version of the Self-care Ability Scale for the Elderly were verified to be better than other options. The factor loadings varied from 0.428 to 0.800, and the communality values ranged from 0.426 to 0.792. The modified model showed a good fit in the Confirmatory Factor Analysis.

CONCLUSION

The Chinese version of the Self-care Ability Scale for the Elderly has a clear three-factor structure and a good item distribution. It serves as a convenient and accurate assessment tool to assess the self-care ability of older Chinese people.

Evaluation of a Non-Face-to-Face Multidisciplinary Health Care Model in a Population with Rheumatoid Arthritis Vulnerable to COVID-19 in a Health Emergency Situation

This study evaluated a non-face-to-face-multidisciplinary consultation model in a population with rheumatoid arthritis (RA) during the COVID-19 pandemic. This is an analytical observational study of a prospective cohort with simple random sampling. RA patients were followed for 12 weeks (Jul-Oct 2020). Two groups were included: patients in telemedicine care (TM), and patients in the usual face-to-face care (UC). Patients could voluntarily change the care model (transition model (TR)). Activity of disease, quality of life, disability, therapeutic adherence, and self-care ability were analyzed. Bivariate analysis was performed. A qualitative descriptive exploratory study was conducted. At the beginning, 218 adults were included: (109/TM-109/UC). The groups didn't differ in general characteristics. At the end of the study, there were no differences in TM: (n = 71). A significant (p < 0.05) decrease in adherence, and increase in self-care ability were found in UC (n = 18) and TR (n = 129). Seven patients developed COVID-19. Four categories emerged from the experience of the subjects in the qualitative assessment (factors present in communication, information and communication technologies management, family support and interaction, and adherence to treatment). The telemedicine model keeps RA patients stable without major differences compared to the usual care or mixed model.

Self-care appraisal in nursing assistant students: Adaptation, validation and psychometric properties of the Spanish ASAS

The core implication of nursing professionals’ labor is promoting self-care and foster well-being among healthcare service users. The beginning of the healing process starts with the provider, and self-care habits are needed to positively impact on patients’ care outcomes at different spheres. Overall, current literature supports the idea that nurses’ personal self-care should be a necessary skill to be expected in their professional role. In this regard, the Appraisal of Self-care Agency Scale (ASAS) is a worldwide known instrument aimed at assessing the ability to engage in self-care. However, it has never been tested in the Spanish context before, and much less in nursing practitioners or apprentices. The aim of this study was to translate, adapt and validate the ASAS for Spanish nursing apprentices, assessing its dimensionality, psychometric properties and convergent validity by means of the Sense of Coherence (SOC-13) questionnaire. Methods: Data were collected from a random sample of 921 Certificated Nursing Assistant (CNA) Spanish students and was analyzed trough confirmatory factor analyses via structural equation models. The core ASAS construct and its subscales were correlated with the SOC-13 scores. Results: Fair psychometric properties for the questionnaire were set. Also, SEM models endorse the validity and reliability of the four-factor dimensionality of the Spanish adaptation of the ASAS, whose associations to SOC scores were coherent and significant. Conclusion: This study allowed to establish that the Spanish version of the ASAS might be a useful tool for addressing self-care-related issues among nursing apprentices, a key population for promoting both their own and patients’ health and welfare through healthy and care-related behaviors.

Self-care agency and associated factors in postmenopausal women

OBJECTIVE

The aging process in women is marked by several changes, including the transition to menopause. The evaluation of self-care management is essential and has great relevance for public health. The aim of the present study was to evaluate self-care management and associated factors in postmenopausal women.

METHOD

This study was a cross-sectional study performed with 260 postmenopausal women who attended routine consultations at the Menopause Outpatient Clinic of the Hospital of the State University of Campinas-SP. Women aged 50 years or older with amenorrhea for at least 12 months were included. The women were interviewed by a researcher during the routine consultation, and the self-care agency assessment was performed using the Appraisal of Self-Care Agency Scale-Revised questionnaire.

RESULTS

The average total self-care score for the women in this study was 62.27 (± 9.64). Higher Appraisal of Self-Care Agency Scale-Revised scores were associated with performing outdoor activities, better self-perceived health, and a higher score on knowledge about vitamin D. Active smoking was associated with a lower self-care score.

CONCLUSION

We observed that the self-care management of postmenopausal women was satisfactory and was associated with lifestyle, self-perceived health, and knowledge about vitamin D.

Generic Self-Reported Questionnaires Measuring Self-Management: A Scoping Review

This study aimed to (1) identify generic questionnaires that measure self-management in people with chronic conditions, (2) describe their characteristics, (3) describe their development and theoretical foundations, and (4) identify categories of self-management strategies they assessed. This scoping review was based on the methodological framework developed by Arksey and O'Malley and completed by Levac et al. A thematic analysis was used to examine self-management strategies assessed by the questionnaires published between 1976 and 2019. A total of 21 articles on 10 generic, self-reported questionnaires were identified. The questionnaires were developed using various theoretical foundations. The Patient Assessment of Self-Management Tasks and Partners in Health scale questionnaires possessed characteristics that made them suitable for use in clinical and research settings and for evaluating all categories of self-management strategies. This study provides clinicians and researchers with an overview of generic, self-reported questionnaires and highlights some of their practical characteristics.

Translation, Cross-cultural Adaptation, and Psychometric Properties of the Turkish Version of the Self-care Ability Scale for the Elderly

Purpose

The Self-care Ability Scale for the Elderly (SASE) is a frequently used scale that was created in Sweden according to Orem’s self-care deficit theory and later modified according to Pörn’s theory of environment and purpose. This study translated and cross-culturally adapted the Turkish version of the SASE (T-SASE) and demonstrated its psychometric properties, including its reliability and construct validity.

Methods

This study recruited a total of 122 participants and applied international guidelines for the translation and adaptation of the scale. The test-retest reliability of the SASE was calculated at 1-week intervals. Internal consistency was analyzed using Cronbach’s alpha. For construct validity, we compared the T-SASE to the Nottingham Extended Activities of Daily Living Scale (NEADLS) and the Exercise of Self-Care Agency Scale (ESCAS).

Results

The mean age of the participants was 68.6±5.7 years. The test-retest reliability of the T-SASE was excellent (intraclass correlation coefficient=0.914; 95% confidence interval, 0.81–0.95). The internal consistency of the total T-SASE score was also excellent (Cronbach’s α=0.912), as were the Cronbach’s alpha scores for the individual items, ranging from 0.901 to 0.915. The items were also highly consistent with each other (Cronbach’s α>0.80). The construct validity of the T-SASE was acceptable (0.35<r<0.50) in a convergent manner. The T-SASE was also strongly correlated with the NEADLS and ESCAS (r₁=0.405, r₂=0.437, p<0.01).

Conclusions

The T-SASE was a reliable and valid tool for assessing the self-care ability of community-dwelling older adults. Owing to its multidimensional structure, the T-SASE is an essential tool for evaluating self-care in older adults.

Relationship of Physical Activity to Self-Care Agency and Physical Condition Among Older Adults in a Rural Area

Background

Maintaining physical activity is important for older adults. "Self-care agency" is the ability to perform self-care, which is defined as people following their own will, managing themselves, and maintaining activities. We investigated the relationship among physical activity and self-care agency, demographic factors and physical condition in older adults.

Methods

Self-care agency was assessed by using the Self-Care Agency Questionnaire developed for Japanese patients with chronic diseases. Among 175 older adults aged 65 years or older living in a rural area, responses from 83 who performed physical activities were analyzed. Correspondence analysis was conducted to characterize demographic factors and self-care agency.

Results

A higher proportion of women than men were engaged in physical activity. Irrespective of age and sex, many of the participants performed stretching exercises, walking, radio exercises, TV exercises, and participated in community circles. Participants who engaged in physical activities had significantly higher self-care agency scores than inactive participants. Among the active participants, the self-care agency score was significantly higher for women than men (P = .04) and was also significantly higher for participants aged ≥ 75 years compared to those aged < 75 years. Individuals with a high self-care agency tended to participate in local programs and perform brief physical activities at home.

Conclusion

Physically active older adults demonstrated high self-care agency. Their activities were easily carried out in their daily lives, with activities varying by age and sex. Support from community health experts is needed to promote suitable physical activity among older adults tailored for age and sex, especially among older adults who have low self-care agency.

[Influence of Self-care on Burnout in Primary Family Caregiver of Person with Dementia]

PURPOSE

The purpose of this study was to identify the influence of self-care on burnout experienced by primary family caregivers of persons with dementia.

METHODS

The subjects of the study were 156 primary family caregivers of persons with dementia at home in Korea. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficient, and hierarchical multiple regression using IBM SPSS Statistics ver. 24.0 for Windows.

RESULTS

The mean scores for self-care and burnout were 42.35 and 61.60, respectively. Self-care, subjective health status, living with a person with dementia, and behavioral and psychological symptoms of dementia were significant factors affecting burnout in family caregivers. Self-care was identified as the strongest factor affecting burnout, explaining 13.9% of burnout with controlling factors in caregivers and care receivers.

CONCLUSION

To prevent burnout in primary family caregivers of persons with dementia, self-care of family caregivers should be emphasized. In nursing education, family caregivers should be recognized and approached as nursing clients who are responsible for taking care of their health. In nursing practice and research, digital self-care or self-care improvement intervention programs should be designed to help family caregivers, and further studies on self-care centered on health of family caregivers should be conducted.

Self-care agency and self-care practice in youth workers reduces burnout risk and improves compassion satisfaction

INTRODUCTION AND AIMS

Youth work specialises in helping vulnerable young people face life challenges during critical stages of their development. It is a complex and demanding role and factors influencing occupational stress in youth workers are rarely investigated. This study examined whether youth alcohol and other drug workers with greater compassion satisfaction, self-care practice and self-care agency experienced different rates of occupational stress including burnout and secondary traumatic stress.

DESIGN AND METHODS

A convenience sample of 258 Australian youth alcohol and other drug workers completed an online questionnaire battery. A four-stage data analysis was conducted utilising multivariate analysis of variance, bivariate correlations, linear multiple regression models and mediation modelling.

RESULTS

Burnout and secondary traumatic stress exhibited moderate negative correlations with compassion satisfaction, self-care practice and the different forms of self-care agency. Further, a decrease in lacking power for self-care, a form of self-care agency, was the strongest contributor to both burnout and secondary traumatic stress. Support was found for a mediation pathway whereby self-care agency led to greater self-care practice, which in turn increased compassion satisfaction, lowering burnout and secondary traumatic stress.

DISCUSSION AND CONCLUSIONS

The findings suggest that it would be beneficial for self-care agency to be a key focus of youth worker training and professional development programs.

Effects of a six-week mobile app versus paper book intervention on quality of life, symptoms, and self-care in patients with fibromyalgia: a randomized parallel trial

BACKGROUND

The ProFibro application (app) was developed as a Mobile Health resource to promote self-care in fibromyalgia management.

OBJECTIVE

This study aimed to assess the effects of the use of the ProFibro app for six weeks compared to the use of a traditional paper book of similar content to improve health-related quality of life, symptoms, and self-care agency in individuals with fibromyalgia.

METHODS

Forty individuals with fibromyalgia were included in this randomized, single-blind, parallel trial. One group received intervention content using the ProFibro app on a smartphone while the other received similar information using a paper book. Participants were assessed at baseline and after six weeks. The primary outcome was the Revised Fibromyalgia Impact Questionnaire. Secondary outcomes were Widespread Pain Index, Pain Visual Analog Scale, Symptom Severity Scale, and Appraisal of Self-Care Agency Scale - Revised.

RESULTS

No differences in changes were found between groups at the end of the treatment for any outcome. Both groups showed improvements in symptom severity.

CONCLUSIONS

The use of the ProFibro app for six weeks was not more effective than the use of a traditional paper book with similar content for health-related quality of life, symptoms, or self-care agency in individuals with fibromyalgia. Both groups showed improvements from baseline on severity of symptoms, suggesting that the self-care program using a mobile app or a paper book may be beneficial for individuals with fibromyalgia.

Psychometric properties of the Iranian version of self-care ability scale for the elderly

BACKGROUND

Measuring self-care ability in elderly people needs specific instruments. The Self-care Ability Scale for Elderly (SASE) is one of the common instruments used for assessing self-care ability. The aim of this study was to assess the psychometric properties of the SASE among Iranian elderly population.

METHODS

This cross-cultural adaptation study was carried out at Shahid Chamran and Shadpour Health Complex in Tabriz, Iran. The forward-backward procedure was applied to translate the SASE from English into Persian. Then, it was completed to 220 elderly people. A systematic random sampling method was used for sampling. Content validity was calculated through modified Kappa coefficient (modified CVI) based on clarity and relevance criteria. Reliability was measured by internal consistency and test-retest analysis. The construct validity also was assessed using Exploratory Factor Analysis (EFA). All the statistical analyses were performed using SPSS 21 statistical software package.

RESULTS

The mean of self-care ability was 61.14 ± 21.08. The CVI and modified kappa were 0.91 and 0.92 for relevance and clarity, respectively. The Cronbach's alpha coefficient was 0.73 and Intra-class correlation coefficient was 0.97. The results of EFA revealed a three-factor solution ('ability to take care of personal responsibility', 'ability to take care for the goals', and 'ability to take care of the health') that jointly explained for 64.61% of the total variance.

CONCLUSION

Results of the study showed that the Iranian version of the SASE has good psychometric properties and can be used in assessing the self-care ability of elderly people.

Avaliação do agenciamento de autocuidados e sua associação com sintomas e qualidade de vida em indivíduos com fibromialgia

RESUMO A fibromialgia (FM) é uma condição de alta prevalência e que causa desconforto físico, sofrimento mental e comprometimento nas relações sociais. Assim, o autocuidado pode ser um aspecto determinante para melhorar a qualidade de vida de indivíduos com FM, pois está relacionado ao ato de se investir de poder. Portanto, o objetivo deste estudo foi avaliar o agenciamento do autocuidado de indivíduos com FM e verificar a associação do autocuidado com variáveis sociodemográficas, sintomas e qualidade de vida. Participaram do estudo 40 indivíduos com FM, que preencheram os critérios diagnósticos do Colégio Americano de Reumatologia de 2010. O autocuidado foi avaliado pela Escala de Avaliação de Agenciamento de Autocuidados Revisada (EAAA-R), a intensidade da dor dos pacientes foi verificada pela Escala Visual Analógica (EVA) e pelo Índice de Dor Generalizada (IDG), enquanto a severidade dos sintomas foi avaliado pela Escala de Severidade dos Sintomas (SS) e a qualidade de vida pelo Questionário de Impacto da Fibromialgia Revisado (QIF-R). Utilizamos o coeficiente de correlação de Pearson (dados paramétricos) e coeficiente de correlação de Spearman (dados não paramétricos), com nível de significância α<0,05. Os resultados mostram valores médios para o agenciamento do autocuidado (52,75±10,25), intensidade da dor (5,84±2,16), IDG (13,32±3,78), SS (9,30±1,68), e QIF-R (63,98±17,26). Houve associação do autocuidado com a classe social (r=0,391) e associação com domínios do QIF-R: função (r=-0,338), impacto geral (r=-0,315), sintomas (r=-0,332) e escore total (r=-0,375). O estudo sugere moderado agenciamento de autocuidado e fraca associação do autocuidado com a qualidade de vida e com a classe social em indivíduos com fibromialgia.

A factor analytic evaluation of the Self-Stigma Scale-Short (SSS-S) among psychosocial clubhouse members in the United States

The main purpose of this study was to examine the factor structure, the internal consistency, and other aspects of validity of the English version of the Self-Stigma Scale-Short (SSS-S). In the present study, the SSS-S was assessed in a sample of 194 adults with psychiatric disabilities from four Psychosocial Clubhouses in the Southern and Midwestern United States. Exploratory factor analysis (EFA; n = 98) supported a one-factor structure of the SSS-S, which accounted for 59% of the variance. Confirmatory factor analysis (CFA; n = 96) demonstrated that the factor structure of the SSS-S was satisfactory. The scale was also reliable, with a Cronbach's alpha of 0.93 and 0.91 for the EFA and CFA samples, respectively. The SSS-S showed adequate convergent and criterion-related validity, as indicated by statistically significant positive correlations between internalized stigma with perceived societal stigma, symptom severity, and functional impairment, as well as negative correlations between internalized stigma with perceived social self-efficacy, social support, and resiliency. Overall, these findings support the English version of the SSS-S as a valid and reliable tool for determining the internalized stigma of adults with psychiatric disabilities in clinical settings and similar research.

Validación de escala de Valoración de Agencia de Autocuidado (ASA) en adolescentes chilenos

Resumen Objetivo Realizar validación y análisis de confiabilidad de la Escala de Valoración de Agencia de Autocuidado en adolescentes chilenos. Método Fue realizado en una muestra 199 adolescentes. La validación de contenido se hizo por revisión de expertos. Se exploró la confiabilidad y la validez de constructo por medio de análisis factorial exploratorio (AFE) y confirmatorio (AFC). Resultados Algunos términos de la escala se adaptaron culturalmente. La confiabilidad alfa de Cronbach de la escala de 24 ítems fue de 0,88. Los ítems 6, 11, 20 presentaron baja confiabilidad y correlación con la escala (<0,4). El AFE, sugirió solución factorial de cinco factores y un factor por gráfico de sedimentación. Las ecuaciones estructurales de los posibles modelos resultaron con valores de índices de ajuste, cercano a lo satisfactorio. Conclusiones e Implicaciones para la práctica Considerando la combinación de criterios: objetivos; basados en la teoría y en los análisis factoriales, la solución óptima es la de un factor con 21 ítems. La escala presenta ítems adaptados culturalmente. Se propone incorporar ítems más específicos de autocuidado en adolescentes. Investigaciones que evalúen intervenciones tendientes a mejorar la capacidad de autocuidado en adolescentes podrían utilizar la nueva versión de la escala ASA con mejores propiedades psicométricas.

Factor Analysis and Psychometric Properties Adaption of Chinese Version of the Decisional Engagement Scale (DES-10)

OBJECTIVE

To translate and validate the DES-10 into Chinese and adapt the DES-10 among Chinese prostate cancer patients. To explore the impact of demographic data on the SDM of Chinese prostate cancer patients.

METHODS

Data were collected from December 2019 to January 2020 from four hospitals among prostatic cancer patients in Henan Province, by convenience sampling method. A demographic questionnaire, DES-10, and 9-item Shared Decision Making Questionnaire (SDM-Q-9) were administered. The exploratory and confirmatory factor analysis was carried out to test the content, construct, reliability, and concurrent validity of the translated DES-10. Then, Pearson's correlation, t-test, and analysis of variance were used to test the demographic difference of DES-10.

RESULTS

A total of 380 prostatic cancer patients completed the survey (96% response rate). The total score of DES-10 was 71.16±17.14. The Cronbach's ɑ coefficient was 0.87. Single factor structure was confirmed by exploratory factor analysis (explaining 50.14% of the variance). Model fitting indexes (RMSEA=0.07, CMIN/DF=2.92) were acceptable. The DES-10 scale showed good validity with the SDM-Q-9 as the criterion. Age, marital status, homeplace, and household monthly income could affect the shared decision-making of prostatic cancer patients.

CONCLUSION

The DES-10 was demonstrated to be a valid and reliable scale to assess the prostatic cancer patient's engagement in health care decision-making. And it is culturally appropriate for use in China. The influence of age, marital status, homeplace, and household monthly income should be considered in promoting patients' participation in shared decision-making.

Factors influencing self-management in Parkinson's disease: A cross-sectional study

This study aimed to identify factors influencing self-management in patients with Parkinson's disease (PD) based on social cognitive theory. A cross-sectional design was used; data were collected at three tertiary medical centers in Korea from a convenience sample of 356 PD patients. Higher self-management scores were associated with higher education level, having a religion, and higher family income. Self-management score was positively correlated with activities of daily living, self-efficacy, and social support, and negatively correlated with non-motor symptoms. Hierarchical regression analysis revealed that demographic factors and non-motor symptoms explained 26.2% of the variance in self-management in PD. The explanatory power increased by 7.5% when self-efficacy was added, and by 6.7% when social support was added. Assessment of self-management in patients with PD should consider self-efficacy and social support, along with demographic factors and non-motor symptoms. Self-management programs that reflect these factors may be useful for improving self-management in PD patients.

Canonical Correlation Between Self-Care Agency and Health-Related Self-Efficacy with Chronic Viral Hepatitis Patients

Objectives

The purpose of this study was to examine the relationship between self-care agency and health self-efficacy measures, in patients with viral hepatitis.

Methods

Data were collected from 116 outpatients over the age of 19 years who were diagnosed with viral hepatitis between February 20, 2019 and April 30, 2019. This study used the Appraisal of Self-care Agency Scale-Revised and the Health Self-Efficacy measures. Descriptive statistics, Pearson’s correlation coefficients, and canonical correlations were used during data analysis [SPSS version 25.0 for Windows (SPSS, Chicago, IL, USA)].

Results

The first canonical correlation coefficient was 0.65 (Wilks’ λ = 0.44, F = 5.63, p < 0.001) and the second was 0.42 (Wilks’ λ = 0.76, F = 3.08, p = .001). The first variate indicated a higher perception of having power for self-care (0.85) and developing power for self-care (0.92), and this was related to exercise (0.66), illness (0.76), emotion (0.75), nutrition (0.81), stress (0.60), and health practice (0.85). The second variate indicated a higher perception of having power for self-care (0.42), whilst lacking power for self-care (−0.82), was related to illness (0.35) and stress (0.72).

Conclusion

Nursing interventions and education aimed at enhancing the self-care of viral hepatitis patients are needed to assist patients to improve their health care behaviors.

Cross-cultural validation of the Student Nurse Stress Index Scale: A descriptive survey targeting student nurses in China

BACKGROUND

Currently, relatively little is known regarding the sources and levels of stress experienced by nursing students in China. This is largely because there is no reliable and valid, culturally appropriate measure of student nurse' stress. A culturally acceptable, Chinese Version of the Student Nurse Stress Index Scale (SNSI-CHI), with established reliability and validity, is needed to identify sources of stress in Chinese nursing students.

METHODS

This validation study used a cross-sectional descriptive survey design. Stratified cluster random sampling was used to collect data from August 2017 to January, 2018 from 1100 nursing students in Henan Province, China. A demographic questionnaire, SNSI-CHI and Perceived Stress Scale (PSS-14) were administered. Exploratory and confirmatory factor analysis was carried out on two randomly selected samples (each N = 538) from the overall return. The content, construct, predictive and concurrent validity of the translated SNSI-CHI were examined.

RESULTS

1076 nursing students returned the survey (97.82% response rate). The average total score of SNSI-CHI was 58.455 ± 13.903. The internal consistency, test-retest reliability and content validity of the SNSI-CHI was excellent with a content validity index of 0.954. A four factor simple structure was revealed and confirmed using exploratory (explaining 75% of the variance) and confirmatory factor analysis (x²/df = 1.347, GFI = 0.956, AGFI = 0.945, RMR = 0.032, RMSEA = 0.025, NFI = 0.974, IFI = 0.993, TLI = 0.992, CFI = 0.993). This structure, i.e. academic load, clinical concerns, interface worries and personal problems compared well with the original SNSI. The SNSI-CHI totals and subscales showed good concurrent and predictive validity with the PSS-14 as comparator or criterion. A score of higher than 65 on the SNSI-CHI indicates high levels of perceived stress symptoms. Some 10.5% of respondents experience high levels of stressful demand. Sensitivity and specificity values of 71.7% and 75.1% respectively, demonstrated good predictive validity.

LIMITATIONS

This study sample was confined to the Henan Province, which may limit its generalizability. A larger and more diverse sample is needed in the future research.

CONCLUSIONS

The SNSI-CHI is both reliable and valid and culturally appropriate for use in China and its structure enables cross-cultural comparison.

Preventing disability in older adults with mild cognitive impairment: A Strategy Training intervention study

Non-pharmacological interventions designed to change cognitive function in older adults with Mild Cognitive Impairment have shown mixed results. Few studied interventions directly address preclinical disability. Slowing changes in disability are critical preserve independence and health related quality of life in older adults with Mild Cognitive Impairment. In this study, we discuss the design of the trial, challenges encountered, and solutions generated to guide future trials designed to prevent the onset of disability among at-risk older adults. We compared Strategy Training to enhanced-usual care in 30 older adults with Mild Cognitive Impairment. We recruited 79.7% (n = 188) of the potential participants through direct-to-consumer recruitment. We refined a three-step screening process, including a phone screen, initial in-person screening, and full in-person screening. This screening processes resulted in a high percentage of older adults completing the neuropsychological battery and adjudication of Mild Cognitive Impairment. Conducting a disability prevention among individuals without overt disability is a novel approach. Nevertheless, one of the greatest limitations to our project is the fact that follow-up is restricted to 1 year. Findings from this study can inform the design and conduct of future clinical trials that seek to slow progression of disability in older adults with Mild Cognitive Impairment.

Hypertension self-care practice and associated factors among patients in public health facilities of Dessie town, Ethiopia

Background

Hypertension self-care practice is essential for blood pressure control and reduction of hypertension complications. Nevertheless, we know little concerning hypertension self-care practice in Ethiopia. The purpose of this study was to assess hypertension self-care practice and associated factors among patients in public health facilities in Dessie town, Ethiopia.

Methods

In this cross-sectional study, 309 hypertensive patients (mean age 58.8 years, 53.4% women) completed the interviewer-administered questionnaire in Amharic language. Descriptive and logistic regression analyses were conducted using SPSS version 22.

Result

The mean score for hypertension self-care was 37.7 ± 8.2 and 51% scored below the mean. Divorced participants (AOR = 0.115, 95% CI = 0.026, 0.508, p-value < 0.01) and those who lack source of information (AOR = 0.084, 95% CI = 0.022, 0.322, p-value < 0.01) were less likely to have good self-care practice. But, participants who had convenient place for exercise (AOR = 2.968, 95% CI = 1.826, 4.825, p-value < 0.01), who had good social support (AOR = 2.204, 95% CI = 1.272, 3.821, p-value < 0.01), who had traditional clergy-based teaching (AOR = 2.209, 95% CI = 1.064, 4.584, p-value < 0.05), and who had good self-care agency (AOR = 1.222, 2.956, p-value < 0.05) were more likely to have good self-care practice.

Conclusion

Most of the study participants reported poor self-care practices. Factors associated with hypertension self-care practice are marital status, education, source of self-care information, place for exercise, social support, and self-care agency. Targeted interventions are needed to improve hypertension self-care practice.

A systematic review of outcome measures utilised to assess self-management in clinical trials in patients with chronic pain

OBJECTIVES

The aim of this review was to identify, appraise and synthesise the outcome measures used to assess self-management in patients with chronic pain.

METHODS

Medline, Embase, CINAHL, PsycINFO, the Cochrane Library and Google Scholar were searched to identify quantitative measures used within randomised or non-randomised clinical trials to assess self-management in adults (≥18 years) with chronic pain.

RESULTS

25 RCTs published between 1998 and 2016 were included in this review. Studies included patients with chronic pain, hip/knee osteoarthritis, rheumatoid arthritis, chronic low back pain, fibromyalgia and chronic fatigue syndrome. Included studies utilised 14 different measures assessing a variety of constructs including self-efficacy (n = 19), coping (n = 4), empowerment (n = 2), pain attitude and management (n = 3), self-care (n = 1), role behaviour (n = 1) and multiple constructs of self-management (n = 1). The Chronic Pain Coping Inventory (CPCI) and Health Education Impact Questionnaire (heiQ) cover different self-management related constructs across the physical, mental and social health domains.

CONCLUSION

The review identified 14 measures used as proxy measure to assess self-management in patients with chronic pain. These measures have good content and construct validity, and internal consistency. However additional research is required to develop their reliability, responsiveness and interpretability.

PRACTICE IMPLICATIONS

Multi-constructs measures (CPCI, heiQ) are suitable for assessing self-management.

Self-care among older people living with chronic conditions

PURPOSE

The aim of this study was to clarify the concept of self-care among older people living with chronic health conditions. This concept clarification will assist nurses in addressing self-care among older people through research, policy and practice in offering an expanded conceptual model.

BACKGROUND

Several policy influences over the past decade directly relate to the increased importance and economic necessity to require self-directed care for older people living with chronic health conditions to maintain their care at home in the community.

METHOD

A selective review of literature on the concept of self-care included 31 sources. The Norris Concept Clarification method (1982) was used for clarification. The phenomenon is described historically according to its antecedents, attributes and consequences.

RESULTS

A proposed definition is provided based on the clarification of this concept. A conceptual model is presented through an ecological framework. Self-care among older people living with chronic conditions is multidimensional and has multilevel influences (individual, community, system levels) and is mediated by the contexts and processes of ageing. Self-care originates along one's life course and is learned. Self-care responses are based on care needs when living with chronic health conditions.

CONCLUSION

Self-care is an individual capacity, disposition and activity older people manifest in living with multiple chronic conditions. These features (capacity, disposition, action) influence one another and are hierarchical and continuous. Research, practice and policies that promote self-care among older people can focus on these features to improve health outcomes and promote new models of care consistent with personal development and chronic care needs in older age.

IMPLICATIONS FOR PRACTICE

This concept clarification can offer a model to support self-care among older people living with chronic conditions.

The Appraisal of Self-Care Agency Scale - Revised (ASA-R): Adaptation and Validation in a Sample of Spanish Older Adults

Self-care agency is an important determinant of healthy aging. The Appraisal of Self-care Agency Scale (ASA-R) (Sousa et al., 2010) is one of the main instrument to assess self-care capacity. The objectives of the study were: 1) to adapt and validate ASA-R scale for use in Spanish population; 2) to examine the dimensionality, validity and reliability; 3) and to establish the convergent validity of ASA-R using a self-reported health measure. The ASA-R Scale and the 12-item Short Form Health Survey (SF-12) were administered to 488 Spanish seniors aged 65 and over. Confirmatory Factor Analysis (CFA) was used to analyze the dimensionality, validity and reliability. Convergent validity was tested by correlating the ASA-R factors with the SF-12 subscales; correlations were significant (p 0.05 (0.436), RMSEA closer to 0 (0.006), SRMR 0.95 (0.996 and 0.995). The results also demonstrated that ASA-R is a reliable and valid instrument. The ASA-R has demonstrated to be a reliable (CR indices > 0.7) and valid (AVE > 0.5) instrument in measuring self-care agency among Spanish older population.

Testing and comparing two self-care-related instruments among older Chinese adults

OBJECTIVES

The study aimed to test and compare the reliability and validity, including sensitivity and specificity of the two self-care-related instruments, the Self-care Ability Scale for the Elderly (SASE), and the Appraisal of Self-care Agency Scale-Revised (ASAS-R), among older adults in the Chinese context.

METHODS

A cross-sectional design was used to conduct this study. The sample consisted of 1152 older adults. Data were collected by a questionnaire including the Chinese version of SASE (SASE-CHI), the Chinese version of ASAS-R (ASAS-R-CHI) and the Exercise of Self-Care Agency scale (ESCA). Homogeneity and stability, content, construct and concurrent validity, and sensitivity and specificity were assessed.

RESULTS

The Cronbach's alpha (α) of SASE-CHI was 0.89, the item-to-total correlations ranged from r = 0.15 to r = 0.81, and the test-retest correlation coefficient (intra-class correlation coefficient, ICC) was 0.99 (95% CI, 0.99-1.00; P<0.001). The Cronbach's α of ASAS-R-CHI was 0.78, the item-to-total correlations ranged from r = 0.20 to r = 0.65, and the test-retest ICC was 0.95 (95% CI, 0.92-0.96; P<0.001). The content validity index (CVI) of SASE-CHI and ASAS-R-CHI was 0.96 and 0.97, respectively. The findings of exploratory and confirmatory factor analyses (EFA and CFA) confirmed a good construct validity of SASE-CHI and ASAS-R-CHI. The Pearson's rank correlation coefficients, as a measure of concurrent validity, between total score of SASE-CHI and ESCA and ASAS-R-CHI and ESCA were assessed to 0.65 (P<0.001) and 0.62 (P<0.001), respectively. Regarding ESCA as the criterion, the area under the receiver operator characteristic (ROC) curve for the cut-point of SASE-CHI and ASAS-R-CHI were 0.93 (95% CI, 0.91-0.94) and 0.83 (95% CI, 0.80-0.86), respectively.

CONCLUSION

There is no significant difference between the two instruments. Each has its own characteristics, but SASE-CHI is more suitable for older adults. The key point is that the users can choose the most appropriate scale according to the specific situation.