Instruments Measuring Self-Care and Self-Management of Chronic Conditions by Community-Dwelling Older Adults: A Scoping Review

Aging, longevity, and healthy aging: the public health approach

BACKGROUND

Population aging is one of the most significant global demographic changes of the 21st century, driven by increased life expectancy and declining fertility rates. This phenomenon presents both achievements and challenges for public health systems worldwide.

AIMS

On the one hand, advances in healthcare and socio-economic conditions have contributed to longer lives and improved quality of life for older adults. On the other hand, aging populations are increasingly affected by chronic diseases, greriatric syndromes, and multimorbidity, leading to greater healthcare demands and higher associated costs.

METHODS

This manuscript explores evidence on regards of the impact of aging on healthcare and economic systems, emphasizing the need for a paradigm shift toward healthy aging.

RESULTS

Healthy aging, as defined by the World Health Organization, focuses on the maintenance of intrinsic capacity, physical, mental, and social well-being throughout life. It highlights the importance of preventive healthcare, proper nutrition, and regular physical activity in delaying the onset of chronic conditions and maintaining functional independence. Furthermore, the manuscript addresses the challenges faced by healthcare infrastructures and pension systems as they adapt to aging populations, with particular attention to the strain caused by workforce shortages and the rising need for long-term care.

DISCUSSION

A coordinated public health approach is essential to promote healthy aging and mitigate the economic and societal impacts of population aging.

CONCLUSIONS

This paper underscores the need for integrated health policies and multidisciplinary care models to ensure that longer life expectancy is accompanied by better quality of life for older individuals.

Development and validation of a self-management questionnaire for people living with HIV in low- and middle-income countries (HIV-SM LMIC tool)

PURPOSE

The main objective of this research is to develop and validate a comprehensive self-management tool for PLWH (HIV-SM LMIC tool) in Ethiopia.

METHOD

Item development followed a recommended procedure. Item concepts were based on two previously published articles by the same authors, guided by the Individual Family Self-management (IFSMT) theoretical framework. The developed items were translated from English into Amharic (a local language in Ethiopia). Two rounds of face and content validation were conducted with HIV program experts, academics, people outside the health sector, and HIV patients. A total of 61 participants (52 in the first round and 9 in the second round) participated in the validation process. All participants evaluated the content and face validity of each item and provided qualitative judgments, comments, and suggestions.

RESULTS

In the first round of validation, most participants were health professionals (53.8%), followed by HIV patients (19.2%) and HIV program experts/researchers (9.6%). Nine participants took part in the second round. Initially, 117 draft items were refined into 63 for validation. I-FVI (individual face validity index) values ranged from 0.56 to 0.98, with 43 items (68%) scoring ≥ 0.80, indicating high face validity. I-CVI (individual content validity index) values ranged from 0.76 to 1.00, with 61 items (97%) scoring ≥ 0.80, demonstrating high content validity. Common qualitative feedback highlighted translation and contextualization issues in the Amharic version and overlapping concepts. Based on FVI, CVI, and qualitative feedback, particularly patient comments, 26 items were dropped or merged, resulting in a 37-item tool. In the second round, 31 items scored above 0.80 on the CVI. Three items were removed due to low CVI (< 0.70) and redundancy, while two were dropped based on participant feedback. The remaining 32 items had kappa values > 0.74, indicating excellent relevance. Both English and Amharic versions were revised.

CONCLUSION

A comprehensive 32-item HIV-SM LMIC tool tailored to HIV patients in low- and middle-income countries was developed following a rigorous psychometric evaluation process. Further research on its construct validity, criterion validity and reliability are recommended before its use. In addition, future studies should assess the cross-cultural validity of the final instrument.

Factors Influencing Daily Living and Ostomy Self-Care Management in Ostomates: A Mixed Methods Study

AIM

To examine the factors affecting the ability of ostomates to perform activities of daily living and manage ostomy self-care.

DESIGN

Mix method design.

METHOD

This study was undertaken through survey (descriptive and clinical characteristics form and Katz Activities of Daily Living (ADL)) for collecting the quantitative data (n = 60) and semi-structured interviews were conducted with patients unable to perform ostomy self-care for collecting qualitative data (n = 12) between January 2023 and December 2023.

RESULTS

Factors hindering the ability to perform ostomy self-care were physical reasons (68.3%) and psychological reasons (66.7%). Multiple linear regression analysis revealed that individuals with a chronic disease have a Katz ADL score 12.6 times higher than those without a chronic disease (p = 0.004, OR = 12.665, 95% CI: 2.304-69.614). Qualitative analysis identified three themes as challenges, taking over ostomy care and factors improving the quality of life with ostomy.

CONCLUSION

The findings indicate that having an ostomy impairs individuals' ability to perform daily activities independently and manage their ostomy. Additionally, the presence of a chronic disease in ostomates predicts greater dependence in daily activities. In this regard, support mechanisms should be identified and activated based on the needs of ostomates and chronic diseases, with nursing interventions tailored to address those needs.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

A dedicated team of specialised ostomy nurses can offer valuable support by focusing on ostomy management and assessing factors that affect both self-care and daily activities.

IMPACT

This study highlights the impact of coping with an ostomy on daily life and self-care, underscoring the need for targeted support for vulnerable groups and guiding ostomy care nurses in post-discharge follow-up and support group organisation.

REPORTING METHODS

STROBE and GRAMMS checklists.

PATIENT OR PUBLIC CONTRIBUTION

Patients contributed to the study by sharing their experiences through face-to-face interviews during data collection process.

Factor structure of the HIV-SM LMIC self-management questionnaire for people living with HIV in low- and middle-income countries

INTRODUCTION

Despite the need for reliable questionnaires to monitor self-management in chronic disease patients, such tools are lacking in developing countries. This study aims to pilot and assess the construct validity of the HIV-SM LMIC questionnaire.

METHOD

The validation of the HIV-SM LMIC questionnaire involved two cross-sectional studies in Ethiopia. The first round, for exploratory factor analysis (EFA), included 261 patients, while the second round, for confirmatory factor analysis (CFA), included 300 patients. Data was collected using the Kobo Collect electronic data entry template.

RESULT

The sample adequacy test showed a good value of 0.82. In the first round, 6 of the 32 items were not loaded, forming three factors in the EFA. Four of these items were dropped, but two (PSMB2 and PSMB12) were retained for their content. In the second round, CFA on the remaining 28 items led to dropping 8 more items due to conceptual overlap, resulting in a 20-item questionnaire. The final items were structured into three dimensions: awareness and well-being (4 items), self-regulation (6 items), and self-management practices (10 items).

CONCLUSION

The study refined the original 32-item HIV-SM LMIC questionnaire to a validated 20-item, three-dimensional tool with an acceptable goodness of fit. The authors recommend further cross-cultural and predictive validation and adaptation for newly diagnosed HIV patients, those with poor treatment outcomes.

Developing and Validating a Self-Care Self-Efficacy Scale for Oral Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Protocol for a Mixed Methods Study

BACKGROUND

Oral anticoagulation therapy (OAC) is the cornerstone treatment for preventing venous thromboembolism and stroke in patients with nonvalvular atrial fibrillation (NVAF). Despite its significance, challenges in adherence and persistence to OAC regimens have been reported, leading to severe health complications. Central to addressing these challenges is the concept of self-efficacy (SE) in medication management. Currently, there is a noticeable gap in available tools specifically designed to measure SE in OAC self-care management, while such tools are crucial for enhancing patient adherence and overall treatment outcomes.

OBJECTIVE

This study aims to develop and validate a novel scale aimed to measure self-care self-efficacy (SCSE) in patients with NVAF under OAC, which is the patients' Self-Care Self-Efficacy Index in Oral Anticoagulation Therapy Management (SCSE-OAC), for English- and Italian-speaking populations. We also seek to assess patients' SE in managing their OAC treatment effectively and to explore the relationship between SE levels and sociodemographic and clinical variables.

METHODS

Using a multiphase, mixed methods observational study design, we first conceptualize the SCSE-OAC through literature reviews, patient focus groups, and expert consensus. The scale's content validity will be evaluated through patient and expert reviews, while its construct validity is assessed using exploratory and confirmatory factor analyses, ensuring cross-cultural applicability. Criterion validity will be examined through correlations with clinical outcomes. Reliability will be tested via internal consistency and test-retest reliability measures. The study will involve adult outpatients with NVAF on OAC treatment for a minimum of 3 months, using both e-surveys and paper forms for data collection.

RESULTS

It is anticipated that the SCSE-OAC will emerge as a reliable and valid tool for measuring SE in OAC self-care management. It will enable identifying patients at risk of poor adherence due to low SE, facilitating targeted educational interventions. The scale's validation in both English and Italian-speaking populations will underscore its applicability in diverse clinical settings, contributing significantly to personalized patient-centered care in anticoagulation management.

CONCLUSIONS

The development and validation of the SCSE-OAC represent a significant advancement in the field of anticoagulation therapy. Validating the index in English- and Italian-speaking populations will enable personalized patient-centered educational interventions, ultimately improving OAC treatment outcomes. The SCSE-OAC's focus on SCSE introduces a novel approach to identifying and addressing individual patient needs, promoting adherence, and ultimately improving health outcomes. Future endeavors will seek to extend the validation of the SCSE-OAC across diverse cultural and linguistic landscapes, broadening its applicability in global clinical and research settings. This scale-up effort is crucial for establishing a universal standard for measuring SCSE in OAC management, empowering clinicians and researchers worldwide to tailor effective and culturally sensitive interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05820854; https://tinyurl.com/2mmypey7.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/51489.

A shared journey: evaluating a patient-assessed measure of self-management of chronic conditions in an Australian setting

Background Patient Assessment of Care in Chronic Conditions (PACIC+), included in some Australian guidelines, has been shown reliable for measuring patient engagement and perception of their care in primary care settings. Various studies have focussed on PACIC+ use in specific conditions. This study aims to expand PACIC+ to measure patient empowerment to self-manage their chronic condition and validate it in the broader Australian primary care population. This study aims to evaluate internal consistency and reliability of PACIC+ and six new supplementary items proposed to assess patient wellbeing and empowerment to self-manage their chronic condition. Methods A repeated-measures correlation design study assessed the expanded PACIC+ over three time-points. Particpants were patients with at least one chronic disease, referred by consultant physician, or recruited by advertisement posters in hospital clinic areas. Results PACIC+ (26-item) had acceptable internal consitency (Cronbach's alpha 0.96). Test-retest reliability (Time-1 and 2, P r (48)=0.43; and New supplementary items: Confidence r (48)=0.54; Understanding r (48)=0.62; Support r (48)=0.43; Overall Health r (48)=0.42; Overall Health Change r (48)=-0.31, P =0.03; and Acute Episodes of Care in 1-month r (48)=0.42, P Conclusions The expanded PACIC+ is an improved psychometric tool providing for the patient's voice in a shared health journey. It is a valid, reliable tool to monitor and measure self-management of chronic conditions in Australian population clinic and primary healthcare settings.

Development and validation of the Women's Self-care Knowledge and Attitude Questionnaire (WSKAQ)

BACKGROUND

Menopausal women should learn self-care practices to enjoy a healthy lifestyle, positive health behaviors, and health status. In addition, the lack of self-care knowledge can lead to unhealthy attitudes and lifestyles, resulting in many complications. Improved self-care knowledge can foster positive attitudes, leading to healthier lifestyles as a beneficial cycle. However, menopausal women have limited knowledge about self-care and evaluation tools. Therefore, this study aimed to develop and investigate the validity and reliability of the Women's Self-care Knowledge and Attitude Questionnaire (WSKAQ) in Iranian menopausal women.

METHODS

This cross-sectional study was conducted on 249 menopausal women, aged between 45 and 65 years and at least one year post-menopause, with a minimum literacy level of elementary education. Validation properties included construct validity, exploratory (EFA), and discriminant validity. Reliability was further established through Cronbach's α and McDonald's Omega. PASS 15 and SPSS 27 software were used to select centers, calculate sample size and analyze the data, respectively.

RESULTS

The initial stage of construct validity involved the Kolmogorov-Smirnov test and EFA, resulting in a 6-item self-care knowledge subscale, 47.29% of the total data variance, and 7-item self-care attitude subscale, 55.50% of the total data variance. Independent t-test indicated that menopausal women with education level equal to or higher than diploma have significantly higher self-care attitude scores than those with lower than diploma (p = 0.007). Additionally, significant correlations were observed between self-care knowledge and attitude (r:0.30). Cronbach's α and McDonald's Omega coefficients of the 13-item WSKAQ were 0.77 and 0.78, respectively.

CONCLUSIONS

Based on the results, the WSKAQ, consisting of 13 items, was validated and reliable for assessing the self-care knowledge and attitude of Iranian menopausal women.

Generic and disease-specific self-care instruments in older patients affected by multiple chronic conditions: A descriptive study

AIMS

To describe and compare generic and disease-specific self-care measures in patients with multiple chronic conditions (MCCs) in the three dimensions of self-care maintenance, monitoring, and management.

DESIGN

Multicentre cross-sectional study.

METHODS

Patients aged 65 and over with MCCs. We used Self-Care of Chronic Illness Inventory to measure generic self-care, Self-care of Diabetes Inventory to measure self-care in diabetes mellitus, Self-Care of Heart Failure (HF) Index to measure self-care in HF, and Self-Care of Chronic Obstructive Pulmonary Disease Inventory to measure self-care in chronic lung diseases.

RESULTS

We recruited 896 patients. Multimorbid patients with diabetes had lower scores on the self-care maintenance scale, and diabetic patients in insulin treatment on the generic management scale than on the disease-specific instrument. Multimorbid patients with HF or chronic lung diseases scored higher on generic self-care maintenance and monitoring scales than disease-specific ones. There was a partial consistency between the generic and disease-specific self-care maintenance and management. Inadequate behaviours were recorded in disease-specific self-care monitoring rather than generic ones.

CONCLUSIONS

Older patients affected by MCCs scored differently in the generic and disease-specific instruments, showing inadequate self-care in some of the three self-care dimensions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The choice between generic and disease-specific instruments to use in clinical practice and research should be made considering the specific aims, settings, patients characteristics, and knowledge of the different performance of the instruments by users.

IMPACT

No study has described and compared generic and specific self-care measures in patients affected by MCCs. Knowing these differences can help nurses choose the most suitable measure for their aims, context, and patients and plan generic and disease-specific self-care educational interventions for those behaviours in which MCCs patients perform poorly.

PATIENT CONTRIBUTION

Patients were informed about the study, provided informed consent, and answered questionnaires through interviews.

How and where does "care" fit within seminal life-course approaches? A narrative review and critical analysis

AIMS

To map the concepts of the caring life-course theory that are used in life-course approaches from different disciplines; establish whether there is a common recognition of, or language used, to describe care in those life-course approaches; and identify the role and contribution of care to the life-course literature.

DESIGN

This discursive paper uses a narrative review process to explore points of convergence and divergence between life-course approaches and the caring life-course theory.

METHODS

Categories for analysis were developed deductively and inductively, focusing on the constructs of fundamental care, capacity and capability, care network, care transition, care trajectory and care biography.

RESULTS

We identified four disciplinary perspectives: (1) life-course sociology; (2) life-course epidemiology; (3) lifespan developmental psychology; and (4) life-course health development. While six core constructs of the caring life-course theory were described, either explicitly or implicitly, in existing life-course approaches, no single approach fully describes the role and contribution of care across the lifespan.

CONCLUSION

Life-course approaches have largely neglected the contribution and role of care in informing the life-course discourse. This review highlights the significance of care beyond traditional healthcare settings and recognizes it as a fundamental human need for well-being and development, which can contribute to existing life-course literature.

IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE

There is a need to understand care as a complex system and embrace a whole-system, life-course approach to enable nurses and other healthcare professionals to provide high-quality, patient-centred care.

IMPACT

Incorporating care within a life-course approach provides opportunities to integrate and deliver care centred around the person, their life transitions, trajectories and care networks, including informal carers and healthcare professionals.

NO PATIENT OR PUBLIC CONTRIBUTION

Patients or members of the public were not involved in this study as it is a discursive paper based on the relevant literature.

Spanish version of the Self-Care of Chronic Illness Inventory: A validation study amongst community-dwelling older adults with chronic multimorbidity

AIM

To psychometrically assess the Spanish version of the Self-Care of Chronic Illness Inventory (SC-CII-Sp) in community-dwelling older adults with chronic multimorbidity.

DESIGN

A methodological study.

METHOD

A total of 1260 older adults participated in the study between May 2020 and February 2022. The data were analysed using SPSS Statistics® 26 and AMOS® 24. The items' content validity index and the Fleiss' kappa were calculated to assess the SC-CII-Sp's content validity. Convergent validity was assessed by calculating the Pearson correlation coefficient between the participants' scores on the SC-CII-Sp and their scores on the Spanish Chronic Disease Self-Efficacy scale (SCD-SE). Construct validity was tested by performing a confirmatory factor analysis (CFA). The SC-CII-Sp's reliability was tested by computing the Cronbach's alpha.

RESULTS

The SC-CII-Sp showed good content and convergent validity. The CFA showed that the SC-CII-Sp has three sub-scales. The 8-item Self-Care Maintenance sub-scale has good internal consistency and is comprised of two dimensions: illness-related and health-promoting behaviour. The Self-Care Monitoring sub-scale had excellent internal consistency and its five loaded items belonged to a single dimension. The 6-item Self-Care Management sub-scale has adequate internal consistency and two dimensions: autonomous and consulting behaviour.

CONCLUSION

The Spanish version of SC-CII is a valid and reliable instrument to be used in the assessment of self-care behaviours amongst Spanish-speaking, community-dwelling older adults with chronic multimorbidity.

IMPLICATIONS FOR THE PROFESSION

Nurses need valid and reliable tools to assess self-care behaviours in Spanish-speaking community-dwelling older adults with chronic multimorbidity. This study provides a 19-item tool that allows for the comprehensive evaluation of self-care behaviours in healthy and ill states.

IMPACT

Using the SC-CII-Sp in clinical or research settings could help nurses to examine the effects of different interventions on self-care behaviours amongst Spanish-speaking, community-dwelling older adults with chronic multimorbidity.

PATIENT OR PUBLIC CONTRIBUTION

None to be reported.

Self-Management Analysis in Chronic Conditions (SMACC) checklist: an international consensus-based tool to develop, compare and evaluate self-management support programmes

OBJECTIVES

The Self-Management Analysis in Chronic Conditions (SMACC) checklist was developed as a guidance tool to support the development, comparison and evaluation of self-management support programmes for persons with a chronic condition. The checklist was based on a previously performed concept analysis of self-management. The aim of this study was to validate its content using an international Delphi study and to deliver a final version.

DESIGN

A two-round Delphi study was conducted between October 2022 and January 2023. Using the researchers' networks, professionals with research or clinical expertise in self-management support and chronic conditions were recruited via online purposive snowball sampling. Participants were asked to score each item of the checklist (16 items total) on 3 content validity indicators: (1) clarity and comprehensibility, (2) relevance and importance and (3) degree of alignment with the overall goal of the checklist to promote adequate and comprehensive self-management support programmes. A consensus threshold of 75% agreement was used. The participants were also asked general questions about the checklist as a whole and were asked to provide feedback considering its refinement.

RESULTS

Fifty-four professionals with an average 14.5 years of experience participated in round 1, 48 with an average 12.5 years of experience participated in round 2. The majority of professionals were from Western Europe. For the majority of items consensus was reached after round 1. In round 2, 3 of the 4 remaining items reached consensus, 1 last item was retained based on highly recurring feedback.

CONCLUSIONS

The SMACC checklist was considered a valid and comprehensive tool to aid the development, evaluation and comparison of self-management support programmes. It was acknowledged as a useful instrument to supplement existing frameworks and was seen as feasible to implement in both research and clinical settings. Further validation in the field, with input from patients and peer experts, will be valuable.

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.

Spanish version of the self-care self-efficacy scale: A validation study in community-dwelling older adults with chronic multimorbidity

OBJECTIVE

To test the psychometric properties of the Spanish version of the Self-Care Self-Efficacy Scale (SCSES-Sp) in community-dwelling older adults with chronic multimorbidity.

METHODS

A sample of 1013 community-dwelling older adults with chronic multimorbidity participated in an observational cross-sectional study that was carried out in 3 phases.

RESULTS

Confirmatory factor analysis showed that the SCSES-Sp has 4 dimensions: "self-efficacy in self-care behaviours based on clinical knowledge", "self-efficacy in self-care maintenance", "self-efficacy in self-care monitoring", and "self-efficacy in self-care management". A panel of independent experts considered the content of the SCSES-Sp valid. Convergent validity analysis showed moderate-strong correlations between all of the SCSES-Sp's dimensions and the reference criteria chosen. Reliability was good for the SCSES-Sp and all its dimensions. Test-retest reliability analysis showed that the SCSES-Sp was temporally stable.

CONCLUSIONS

The SCSES-Sp is a valid and reliable tool to assess self-efficacy in self-care in Spanish-speaking, community-dwelling older adults with chronic multimorbidity.