Using self-care strategies to make lifestyle changes

Effectiveness of a comprehensive tele-empowerment programme on self-care behaviours, uncertainty and readmission of patients with heart failure: protocol for a randomised controlled trial

INTRODUCTION

Heart failure (HF) as a long-term clinical syndrome is associated with inadequate self-care behaviours, a feeling of uncertainty and frequent hospitalisation. In recent years, empowerment has evolved for improving chronic disease management. Nevertheless, there is a lack of studies investigating remote care interventions such as a tele-empowerment programme in patients with HF. Therefore, this protocol proposes a randomised controlled trial which aims to evaluate the effectiveness of a comprehensive tele-empowerment programme on self-care behaviours, uncertainty and readmission in patients with HF.

METHODS AND ANALYSIS

The study is a double-arm and parallel-group randomised controlled trial in which a 10-week intervention, including 6 weeks of a comprehensive tele-empowerment programme and 4 weeks of follow-up, will be compared with usual care. A total of 96 eligible patients with HF will be recruited and randomly assigned to the intervention or control group. The patients in the intervention group will join virtual groups and receive the five-step tele-empowerment programme through the internet. The primary outcomes include self-care behaviours and uncertainty which will be measured with valid instruments at baseline and 10th week. The secondary outcome is the number of patients' hospital readmissions and will be assessed at the end of the study. Descriptive statistics will be used to describe variables. According to the types of variables, appropriate statistical tests including two-sample t-tests, Χ2, analysis of covariance or linear regression will be performed. In addition, standardised intervention effect sizes will be calculated for each outcome.

ETHICS AND DISSEMINATION

The trial has been approved by the Research Ethics Committee of School of Nursing and Midwifery & Rehabilitation at Tehran University of Medical Sciences. In this study, written consent will be obtained from all participants. The results will be presented to representative groups and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

Iranian Registry of Clinical Trials (IRCT20100725004443N30).

Effects of self-care programs on the incidence of diabetes among adults with prediabetes: A systematic review and meta-analysis of randomised controlled trials

OBJECTIVES

To verify the effects of self-care programs among adults with prediabetes, to identify the preferable structure components and to summarise the core content components of self-care programs.

DESIGN

A systematic review and meta-analysis of randomised controlled trials.

METHODS

PubMed, Embase, Cochrane, CINAHL, PsycINFO, Wanfang, CNKI, Chinese Biomedical Database and Open Grey were searched for studies published from January 2002 to December, 2021. Meta-analysis was conducted to verify the effects of self-care programs on diabetes incidence. Subgroup analyses based on structure components were performed to contrast the effects. We made a critical analysis to generalise the core elements of content components. The study was reported according to PRISMA statement.

RESULTS

Totally, 15 studies were included in systematic review, of which 14 studies were eligible for meta-analysis. The results of meta-analysis showed the incidence of diabetes for prediabetic adults receiving self-care programs was significantly lower than those who received usual care (OR 0.58; 95% CI 0.46 to 0.73). The results of subgroup analyses based on delivery mode, intervention implementer, health education brochures provided, and follow-up duration showed statistically significant reduction in incidence compared with control group (p < .05). However, the differences of these pair-wise comparisons (face-to-face or remote, individual or interdisciplinary team, with or without brochures provided, ≤1 year or >1 year) were not statistically significant (p > .05). Three core content elements were generalised: cognitive education, behaviour guidance and psychological support.

CONCLUSIONS

Self-care programs can effectively delay the progression of prediabetes to diabetes. Regardless of the diversified structure components, self-care programs can achieve better effects on the diabetes incidence than usual care, while the optimal structure components still remain unknown. Cognitive education, behaviour guidance and psychological support are core elements for these programs.

RELEVANCE TO CLINICAL PRACTICE

More clinical trials with rigorous study design are needed to provide further evidence.

Are formal self-care interventions for healthy people effective? A systematic review of the evidence

Introduction

Preventative interventions are shown to be effective in reducing 40% of the mortality due to unhealthy behaviours and lifestyles. Health-promoting self-care has been recognised as a promising strategy in preventative health. However, self-care research is being done around the self-management of chronic illnesses and the promotion of self-care practices among healthy populations has been overlooked by many healthcare systems.

Method

The study methodology was a systematic review with a narrative synthesis. The search was done through seven academic databases, reference tracking of selected articles and grey literature. The scoping, selection, screening and quality assessments of the articles were reviewed independently by two reviewers.

Results

Sixteen studies met the inclusion criteria. Self-care behaviour, health-promotive lifestyle changes and medical care utilisation were some of the main outcomes evaluated in the studies. Positive effects were seen in increasing self-care and health-promotive behaviours in most interventions although limited or mixed impact was seen in health attitudes, beliefs and utilisation of medical services. Most studies were from high income settings with low-quality study designs. The complexity of the word ‘self-care’ and inconsistencies in the terminology used in health-promotive self-care were significant highlights of the study.

Conclusion

Health-promoting preventative self-care interventions show promise in increasing the well-being of healthy people. However, the methodological drawbacks limit the generalisability of the findings. As the demand for self-care interventions increases, the lack of a formal globally accepted definition and framework and complexity of behaviour change are key limitations to consider moving forward.

Uptake of a Consumer-Focused mHealth Application for the Assessment and Prevention of Heart Disease: The <30 Days Study

Background

Lifestyle behavior modification can reduce the risk of cardiovascular disease, one of the leading causes of death worldwide, by up to 80%. We hypothesized that a dynamic risk assessment and behavior change tool delivered as a mobile app, hosted by a reputable nonprofit organization, would promote uptake among community members. We also predicted that the uptake would be influenced by incentives offered for downloading the mobile app.

Objective

The primary objective of our study was to evaluate the engagement levels of participants using the novel risk management app. The secondary aim was to assess the effect of incentives on the overall uptake and usage behaviors.

Methods

We publicly launched the app through the iTunes App Store and collected usage data over 5 months. Aggregate information included population-level data on download rates, use, risk factors, and user demographics. We used descriptive statistics to identify usage patterns, t tests, and analysis of variance to compare group means. Correlation and regression analyses determined the relationship between usage and demographic variables.

Results

We captured detailed mobile usage data from 69,952 users over a 5-month period, of whom 23,727 (33.92%) were registered during a 1-month AIR MILES promotion. Of those who completed the risk assessment, 73.92% (42,380/57,330) were female, and 59.38% (34,042/57,330) were <30 years old. While the older demographic had significantly lower uptake than the younger demographic, with only 8.97% of users aged ≥51 years old downloading the app, the older demographic completed more challenges than their younger counterparts (F_{8, 52,422} = 55.10, P<.001). In terms of engagement levels, 84.94% (44,537/52,431) of users completed 1–14 challenges over a 30-day period, and 10.03% (5,259/52,431) of users completed >22 challenges. On average, users in the incentives group completed slightly more challenges during the first 30 days of the intervention (mean 7.9, SD 0.13) than those in the nonincentives group (mean 6.1, SD 0.06, t₂₈₈₇₀=–12.293, P<.001, d=0.12, 95% CI –2.02 to –1.47). The regression analysis suggested that sex, age group, ethnicity, having 5 of the risk factors (all but alcohol), incentives, and the number of family histories were predictors of the number of challenges completed by a user (F_{14, 56,538} = 86.644, P<.001, adjusted R² = .021).

Conclusion

While the younger population downloaded the app the most, the older population demonstrated greater sustained engagement. Behavior change apps have the potential to reach a targeted population previously thought to be uninterested in or unable to use mobile apps. The development of such apps should assume that older adults will in fact engage if the behavior change elements are suitably designed, integrated into daily routines, and tailored. Incentives may be the stepping-stone that is needed to guide the general population toward preventative tools and promote sustained behavior change.

A meta-analysis of self-care behavior research on elders in Thailand: an update

Self-care is essential for elderly individuals to maintain their optimal level of health. This meta-analysis was conducted to summarize research findings relating to self-care among the elderly in Thailand. Twenty studies undertaken from 1990 to 2008 were used and 328 effect sizes were computed. Most studies were unpublished master's theses guided by Orem's self-care deficit theory. Data were collected in these studies by face-to-face interviews. Variables with the largest effect sizes encompassed self-concept, social support, and self-efficacy. Those with medium effect sizes entailed family relationships, overall health beliefs, internal locus of control, health status, and external locus of control. Results from this meta-analysis is useful information for nursing.

Self-Renewal in Nursing Leadership

Nurse leaders are often vulnerable to stress as experienced in the workenvironment, including long hours, patient overloads, and challenging work settings. If ignored, these stressors may lead to physical, emotional and behavioral symptoms with possible resulting medical errors, absenteeism, health challenges, and job burnout. Purpose: This study was designed to assess the meaning of caring for self by registered nurse leaders who had participated in a holistic caring-for-self project. Design/Setting: Hermeneutic phenomenology was the research method used in this study to explore the lived experience of caring for self from the perspective of 10 nursing leaders. Individual taped interviews were conducted with the participants in a private room in their work setting, a 185-bed community hospital. Findings: The nursing leaders communicated four common themes: Reflections on the Journey of Life, Why to Care for Self on the Journey, How to Care for Self on the Journey, and the Wisdom Learned Along the Path. Conclusions: Based on the reflections of the nursing leaders, recommendations include implementing creative, holistic methods to encourage self-renewal in the work environment.

Health goals among primary care patients

PURPOSE

To identify individuals' health goals and describe their preferences in attaining those goals and to explore associations of type of goals with individual characteristics.

DATA SOURCES

In a descriptive study, 60 adult patients from primary care clinics completed written questionnaires anonymously. Content analyses and frequencies were used to summarize data.

CONCLUSIONS

Health promotion interventions could be more effective if they were customized, in part, to individuals' health goals. There are few evidence-based descriptions of individuals' own health goals and their preferences in how to pursue them. Participants in this study shared common goals to get in shape, lose weight, and change consumption. Participants preferred to meet initially with practitioners to obtain advice and to connect subsequently by telephone for monitoring.

IMPLICATIONS

Participants did want to improve their health. More specific understanding of such goals and preferences is needed to guide future interventions. Findings can inform clinicians and guide researchers in how to design health behavior interventions.

Addressing barriers to health promotion in underserved women

Underserved women face numerous barriers to adopting healthy eating behaviors. To develop effective health-promotion interventions for underserved women, barriers specific to the individual need should be addressed. Influenced by individual characteristics, experiences, and culture, different types of barriers (internal, interpersonal, and environmental) can overlap to impede healthy eating in underserved women. On the basis of literature review and qualitative research experiences with underserved women, 4 potential approaches for addressing barriers to health promotion were identified: (1) individualizing interventions; (2) developing collaborative partnerships within the community; (3) using positive deviance inquiry to build on community assets; and (4) changing public policy.

Situations influencing habits in diet and exercise among nurses working night shift

OBJECTIVES

The aim of the investigation was to describe situations with a significant influence on healthy diet and exercise habits among nurses working night shift.

METHODS

A qualitative descriptive design with a Critical Incident Technique approach was used. Situations were collected by means of interviews with 27 registered/enrolled community nurses.

RESULTS

A total of 143 situations were identified comprising two main areas: coping ability at work and coping ability during leisure hours. Coping ability at work included 81 critical incidents grouped into two categories: the nurses' diet and exercise habits were influenced by social interaction with colleagues at work and by the disruption to their circadian rhythm. Coping ability during leisure hours included 62 critical incidents grouped into two categories: the diet and exercise habits were influenced when the nurses recovered from the disruption to their circadian rhythm and when they took advantage of the freedom of action offered by night work.

CONCLUSIONS

By identifying the factors that influence diet and exercise habits among nurses working night shift, strategies can be developed in order to strengthen the factors with a positive influence.

Caring for Self While Learning to Care for Others: A Challenge for Nursing Students

While learning to care for others, undergraduate nursing students often fail to care for themselves. This study examined the effect of a self-care intervention on undergraduate nursing students. Self-care is the practice of health-related activities in which individuals engage to adopt a healthier lifestyle. A pretest-posttest, single group design was used to test whether students increased their self-care activities after completing a course requiring self-care. Full-time junior nursing students (N = 67) were required to complete a lifestyle self-care plan and use 2 hours of practice time per week to engage in self-care behaviors. A measure of components of a healthy lifestyle, the Health-Promoting Lifestyle Profile-II, showed an increase on six of the seven scales. These findings suggest that nursing students may increase self-care when given time to develop self-care strategies as part of a nursing course.

Concepts in health promotion. Perceived self-efficacy and barriers in older adults

Many older adults have reached later life in apparent good health while others' lack of self-care activities has greatly accelerated the process of aging. In this article, self-efficacy and perceived barriers are explored as significant concepts that influence the self-care activities of elderly individuals. A conceptual model is presented depicting perceived self-efficacy and barriers as determinants of self-care activities. This conceptual model differs from earlier health promotion models because it is specific for older adults. Based on empirical studies, this conceptual model demonstrates that the variables of perceived self-efficacy and barriers have a profound effect on an older adult's participation in self-care activities. Testing of this model is needed to provide a knowledge base for designing health promotion strategies, maximizing cost containment strategies, and contributing to Healthy People 2010 objectives of increasing quality of life for all older adults.

e-Community health nursing

Dissolving boundaries of space and time, the Internet creates another dimension in which to practice community health nursing. Addressing the challenges of health issues in the virtual environment affords new opportunities for holistic nursing practice. Grounded in holistic nursing theory and practice and built on a feminist foundation, this article explores the process of community health nursing within an Internet-based community. A brief review of the literature identifies relevant research findings. Barriers to communication are identified. These include perceived ease of use of computer technology and gendered patterns of communication. Lessons learned in an actual Internet community are discussed.