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

Knowledge, attitudes and practices among patients with end-stage kidney disease towards hyperkalaemia management in Shenzhen, China: a cross-sectional study

OBJECTIVES

To investigate the knowledge, attitudes and practices (KAP) among patients with end-stage kidney disease (ESKD) towards hyperkalaemia.

DESIGN

A cross-sectional study.

SETTING

This study was conducted between September and November 2023 at the Department of Nephrology, Shenzhen Third People's Hospital and the Second Affiliated Hospital of Southern University of Science and Technology.

PARTICIPANTS

The study included 568 patients with ESKD who were undergoing haemodialysis, peritoneal dialysis or both, recruited through convenience sampling.

PRIMARY AND SECONDARY OUTCOME MEASURES

This study was conducted using a self-administered questionnaire, which assessed participants' KAP towards hyperkalaemia management. The questionnaire comprised four sections: demographic information, knowledge (13 items), attitudes (9 items) and practices (9 items), with responses evaluated using a 5-point Likert scale. A cut-off value of 70% of the total score was applied, with thresholds for sufficient knowledge, favourable attitudes and proactive practices set at 6.3, 31.5 and 31.5 points, respectively. The higher the KAP scores, the better the levels of knowledge, attitude and practice. A structural equation model (SEM) was constructed to analyse the effects of demographic characteristics on KAP dimensions. Path coefficients (standardised estimates) were used to assess the strength of relationships between variables, with coefficients>0.2 generally considered moderate effects and >0.5 strong effects.

RESULTS

A total of 568 participants were enrolled in this study, including 369 (64.69%) males, and 249 (43.84%) have been diagnosed with ESKD for more than 5 years. The median (IQR) KAP scores of the participants were 9 (3-9) (possible range: 0-9), 34 (24-45) (possible range: 9-45) and 32 (10-45) (possible range: 9-45), respectively. SEM demonstrated that the frequency of dialysis had direct effects on knowledge (coefficient=0.113, p=0.039), education had direct effects on attitudes (coefficient=0.257, p<0.001), knowledge had direct effects on practices (coefficient=-0.130, p=0.016), attitudes had direct effects on practices (coefficient=0.549, p<0.001) and education had direct effects on practices (coefficient=0.112, p=0.007).

CONCLUSION

Patients with ESKD enrolled in this study have sufficient knowledge, favourable attitudes and proactive practices towards the hyperkalaemia. Nevertheless, it is still recommended to enhance clinical practice in hyperkalaemia management among patients with ESKD by tailoring education for those with lower education levels, emphasising the importance of regular dialysis and implementing strategies to bridge the knowledge-practice gap.

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.