Resilience as a Mediator of the Association between Spirituality and Self-Management among Older People with Chronic Obstructive Pulmonary Disease

Stroke survivors' patient activation and self-management: The serial mediating role of social support and resilience

Stroke is the leading cause of death and disability in Chinese adults. Self-management is closely related to stroke prognosis. This study was to investigate the relationship between patient activation and stroke survivors' self-management and the serial mediating role of social support and resilience. This cross-sectional study recruited 611 stroke survivors from tertiary public hospitals in four provinces in China. The serial mediating effect of social support and resilience was estimated by the SPSS Process 4.0 plug-in macro Model 6. Patient activation indirectly influenced self-management via social support (b = 0.109); resilience alone moderated the relationship between patient activation and self-management (b = 0.094); and both social support and resilience serially mediated the associations between patient activation and self-management (b=0.031). The results suggest that health care providers could encourage patient activation, enhance resilience, and cultivate a positive environment of social support to improve self-management among stroke survivors.

The Relationship Between Spiritual Care Needs and Death Anxiety in Turkish Patients with Chronic Obstructive Pulmonary Disease

This study aimed to determine the levels of spiritual care needs and death anxiety, as well as the relationship between them, in Turkish patients with chronic obstructive pulmonary disease (COPD). This descriptive and correlational study included 480 patients who were admitted to the pulmonology outpatient clinics of a public hospital with a diagnosis of COPD between November 1, 2023, and April 31, 2024. The study data were collected using the Patient Diagnosis Form, Dyspnea Fear Level Assessment Form, Spiritual Care Needs Inventory, and Templer Death Anxiety Scale. It was determined that 60.8% of the patients had high death anxiety and moderate spiritual care needs. A positive correlation (r = 0.327; p < 0.01) was found between the mean scores of the Spiritual Care Needs Inventory and the Templer Death Anxiety Scale. Patients with high death anxiety also had high spiritual care needs (p < 0.01). It was determined that the gender of the patients, fear of dyspnea, and death anxiety predicted 20% of the need for spiritual care (R = 0.457, R2 = 0.209, F = 17.800, p < 0.001). Considering the study findings, it can be stated that death anxiety may decrease as the spiritual needs of the patients are met. Within the framework of holistic care, it is essential for health professionals to identify patients' spiritual needs in addition to their physical and psychological needs and to implement interventions to meet these needs.

The relationship between intrinsic spirituality, resilience and hopelessness in patients with epilepsy: A PATH analysis

BACKGROUND

This study was conducted to examine the relationship between intrinsic spirituality, resilience and hopelessness in patients with epilepsy and to investigate the mediating role of resilience in the relationship between intrinsic spirituality and hopelessness.

METHODS

This study is a descriptive correlational research. The study was conducted with 120 patients who met the inclusion criteria between January 2023 and July 2023. Data were collected by using Personal Information Form, Intrinsic Spirituality Scale (ISS), Beck Hopelessness Scale (BHS) and Brief Resilience Scale (BRS).

RESULTS

According to the results of the study, it was found that the mean ISS score (β = 0.730) affected the mean BRS score positively and the mean BHS score (β = -0.497) negatively (p > 0.05). It was found that the mean BRS score affected the mean BHS score (β = -0.178) negatively (p > 0.05). The indirect effect (β = -0.129) and total effect (β = -0.626) of intrinsic spirituality on hopelessness mediated by the mean BRS score were found to be negative and significant. It was determined that the tested model provided a good fit and explained the direct and indirect effects of the study variables.

CONCLUSION

According to the results of the study, it was found that intrinsic spirituality affected resilience positively and hopelessness negatively. Resilience was found to have a negative effect on hopelessness. It was determined that resilience partially mediated the relationship between intrinsic spirituality and hopelessness and this situation reduced hopelessness more.

Financial and Treatment Compliance Challenges Among Diabetic Patients: A Cross-Sectional Study From Pakistan

Introduction Diabetes mellitus is a rapidly growing global health challenge, with significant health, economic, and social implications. This chronic condition imposes substantial financial burdens on individuals and healthcare systems, particularly in low-resource settings. This study aimed to assess the financial burden and treatment compliance among adult diabetic patients attending a tertiary care hospital in Rawalpindi, Pakistan. Methods A cross-sectional survey was conducted at the Diabetes Clinic of Alkhidmat Raazi Hospital, Rawalpindi. Data were collected using a structured questionnaire from 307 diabetic patients aged ≥20 years. The questionnaire captured demographics, socio-economic factors, direct medical costs, and treatment compliance. Data were analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). Results The mean annual direct medical cost was 55,113 PKR (USD 270), with medication expenses contributing significantly. Non-adherence to treatment was prevalent, with 129 (42%) patients citing financial constraints as the primary barrier. Productivity losses were reported by 234 (76%) participants, with an estimated 25% reduction in work output among affected individuals. Despite these challenges, 258 (84%) of participants reported moderate satisfaction with their health. Conclusion Diabetes imposes a substantial economic burden on patients in Pakistan, exacerbated by limited healthcare support and financial constraints. Addressing these challenges through policy reforms and targeted interventions is imperative to improve patient outcomes and alleviate the socio-economic impact of the disease.

Relationship between social support and self-care ability among patients with breast cancer during rehabilitation: The multiple mediating roles of resilience and depression

AIMS

To identify the multiple mediating effects of resilience and depression between social support and self-care ability among patients with breast cancer during rehabilitation to provide reference for developing and implementing targeted interventions.

DESIGN

A cross-sectional study reported according to the STROBE checklist.

METHODS

A convenience sample of 320 patients with breast cancer during rehabilitation was recruited from one hospital in China. Data were collected from April to August 2022 using a self-report questionnaire, including the demographic and clinical information, Appraisal of Self-Care Agency Scale-Revised, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale-10 item, and Patient Health Questionnaire-9. The mediation analysis was conducted using the SPSS Process macro.

RESULTS

Self-care ability was positively associated with social support (β = .229) and resilience (β = .290), and negatively associated with depression (β = -.208). The relationship between social support and self-care ability was mediated by resilience and depression, respectively, and together in serial. The multiple mediating effects accounted for 34.0% of the total effect of social support on self-care ability.

CONCLUSION

Our findings identify resilience and depression as multiple mediators between social support and self-care ability and highlight the important roles of social support, resilience and depression in improving self-care ability.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should pay great attention to the underlying mechanisms of how social support affects patients' self-care ability during breast cancer rehabilitation. Integrated intervention programmes targeted at enhancing social support, building resilience and alleviating depression might be beneficial to the improvement of self-care ability.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was applied to report the results.

The mediating effect of expectations regarding aging between psychological resilience and quality of life in rural elderly

BACKGROUND

At present, China's elderly population is facing several difficulties. The implementation of active aging is an important initiative in the face of the rapidly developing situation of population aging, among which improving elderly expectations regarding the aging level is the key link to achieving active aging. Improving the quality of life of the majority of elderly individuals is the main goal of active aging. Moreover, increasing the level of expectations regarding the aging of the elderly depends to a large extent on psychological resilience. However, most of the current research related to expectations regarding aging focuses on urban elderly individuals and pays less attention to the expectations regarding the aging level of rural elderly individuals. It is not yet known how quality of life, psychological resilience, and expectations regarding aging are related among rural elderly individuals. This study focused on the state of expectations regarding aging, psychological resilience, and quality of life among senior citizens living in rural areas, as well as the relationships among these three factors. The goal is to provide a theoretical basis for further targeted interventions and promote active aging in China.

METHODS

A cross-sectional descriptive design was conducted via convenience sampling of 320 elderly individuals living in four rural areas of Panzhihua, China, from January to May 2024. Questionnaires were used to collect data on the participants' demographic information, the aging expectancy scale (ERA-21), the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and a 12-item short-form health survey (SF-12). The data were analysed via SPSS version 26.0 software for descriptive statistics, one-way ANOVA, and Pearson's correlation coefficient. In addition, AMOS version 24.0 software was employed for path analysis.

RESULTS

The results revealed that Chinese rural elderly individuals have low expectations regarding aging, moderate levels of psychological resilience, and moderate levels of quality of life. There were positive relationships between expectations regarding aging and quality of life (r = 0.631, p < 0.01), positive relationships between expectations regarding aging and psychological resilience (r = 0.261, p < 0.01), and psychological resilience in terms of quality of life (r = 0.334, p < 0.01). Expectations regarding aging play a partial mediating role between psychological resilience and quality of life (β = 0.273, 95% CI, 0.185 ~ 0.381), with an indirect effect accounting for 45.81% of the total effect.

CONCLUSIONS

Expectations regarding aging play a partial mediating role in the relationship between psychological resilience and quality of life. These findings suggest that grassroots health workers should take an active role in providing health education and psychological counselling, as well as actively working to improve the psychological resilience and health of elderly individuals. They should also be encouraged to actively approach aging and to raise expectations regarding aging. Finally, they should help elderly people maintain a healthy lifestyle and improve their quality of life.

Factors associated with the core dimensions of spiritual health among older adults with chronic obstructive pulmonary disease: A cross-sectional study

AIMS

To investigate the level of spiritual health in older patients with chronic obstructive pulmonary disease (COPD) from the core dimensions and to explore its associated factors.

DESIGN

A cross-sectional study.

METHODS

Participants were recruited from four hospitals between September 2020 and June 2021, using a convenience sampling. Older patients with COPD (n = 162) completed the demographic and disease-related information questionnaires, Function Assessment of Chronic Illness Therapy Spiritual Scale, 10-item Connor-Davidson Resilience Scale, General Self-efficacy Scale, Social Support Rating Scale, COPD Assessment Test, 15-item Geriatric Depression Scale and modified Medical Research Council Dyspnea Scale. Descriptive statistics, Pearson and Spearman correlation analyses, t-tests, one-way ANOVA and multiple linear regression models were used.

RESULTS

Older patients with COPD have a moderate level of spiritual health. The multiple linear regression analysis showed that psychological resilience, general self-efficacy, social support, symptom burden and monthly income were associated with the core dimensions of spiritual health.

CONCLUSION

Chinese older patients with COPD have a moderate level of spiritual health. Psychological resilience, general self-efficacy, social support, monthly income and symptom burden were associated with the core dimensions of spiritual health.

IMPACT

This study is the first to investigate the level of spiritual health in older patients with COPD from the core dimensions and to explore its associated factors, providing a basis for developing spiritual intervention programs. Our findings can help us realize that intervention strategies of psychological resilience, general self-efficacy and social support can all be used to enhance spiritual health. Nurses should focus on the spiritual health of older COPD patients with high symptom burden and low monthly income.

PATIENT OR PUBLIC CONTRIBUTION

Although we did not directly involve patients and the public because of the COVID-19 pandemic, the results of the study will be disseminated to patients and the public through WeChat and seminars.

Fatalism as a Mediator of the Association Between Family Resilience and Self-Management Among Patients with Chronic Wounds in China

Purpose

The purpose of this study was to examine how fatalism acts as a mediator in the correlation between family resilience and self-management among patients with chronic wounds in China.

Participants and Methods

This study used a cross-sectional research design. A total of 269 adult patients (18-94 years old) with chronic wounds residing in Wuxi, China participated in this study. Participants completed the Chinese version of the Walsh Family Resilience Questionnaire, 16-item Chinese version of the Fatalism Scale, and Self-Management Scale of Chronic Wound Patients. We conducted correlation and mediation analyses using SPSS 27.0 and PROCESS 4.0.

Results

The results indicated family resilience was a significant positive predictor of self-management (β = 0.7101, p < 0.0001), and the pathway between family resilience and self-management was partially mediated by fatalism (Effect = 0.1432, 95% confidence interval [0.0625, 0.2341]).

Conclusion

The results indicated that incorporating spiritual interventions into future person-centered self-management programs could align with the motivation of patients with chronic wounds and their families, and reduce the negative impact of fatalism on health outcomes.

Exploratory graph analysis on the Connor-Davidson Resilience Scale (CD-RISC) among older adults in China

It is important for healthy aging to understand resilience in depth. This study aims to examine the dimensional structure underlying the Connor-Davidson Resilience Scale (CD-RISC) among Chinese older adults. Exploratory Graph Analysis (EGA) was used to evaluate the dimensional structure of CD-RISC in two large samples: training sample (n = 11,493) and cross-validation sample (n = 7662). Then, Confirmatory Factor Analysis (CFA) was used to compare the fit of the theoretical dimensions with the EGA dimensions. Finially, Generalized Linear Model was used to examine the association between resilience scores and self-rated health (SRH) after controlling other covariates in order to evaluate the predictive value of the EGA dimensions. The EGA indicated two demensions(named foresight and self-adjustment) of the 25-item CD-RISC. The CFA comparison found that the two-demension structure of CD-RISC fit significantly better than the theoretical three-demension structure. After controlling for sociodemographic characteristics, generalized linear model showed that the EGA dimensions has better protective value with SRH. Compared with older adults with lowest quartile of foresight, those with second (odds ratio, OR = 0.68, 95% CI = 0.62 ~ 0.75), third (OR = 0.50, 95% CI = 0.45 ~ 0.56) and fourth quartile (OR = 0.42, 95% CI  =  0.37 ~ 0.48) of foresight had lower odds ratio of poor SRH. Similarly, older adults with the second (OR = 1.11, 95% CI = 1.01 ~ 1.23) and fourth (OR = 0.79, 95% CI = 0.69 ~ 0.90) quartile of self-adjustment also had lower OR of poor SRH than those with lowest quartile of self-adjustment. These findings show that EGA outperforms the traditional methods, which may be helpful to understand resilience deeply. CD-RISC should be interpreted into two aspects among community-dwelling older adults in China, highlighting the significance of the practical value and cultural context of resilience.

The Spiritual Supporter Scale as a New Tool for Assessing Spiritual Care Competencies in Professionals: Design, Validation, and Psychometric Evaluation

This study aimed to design, validate and standardize the Spiritual Supporter (SpSup) Scale, a tool designed to assess competency to provide spiritual care including knowledge, sensitivity to spiritual needs and spiritual support skills. This instrument can be used by all those engaged in or training for caregiving roles. The study was conducted in Poland in the Polish language. The SpSup Scale demonstrates high overall reliability (Cronbach's α = 0.88), a satisfactory diagnostic accuracy (0.79), and a satisfactory discriminatory power of the items. Given the psychometric properties of SpSup Scale demonstrated here, the scale is recommended for the assessment of the competency to provide spiritual care in both clinical and research settings in Poland.

Associations Between Self-Management Behaviors and Psychological Resilience in Patients With COPD

BACKGROUND

COPD is a common but irreversible disease. Nevertheless, patients with COPD can maintain good quality of life through psychological resilience and effective self-management. However, limited studies have investigated the relationship between self-management behaviors and resilience in patients with COPD. Thus, the present study aimed to determine the factors associated with self-management behaviors and resilience among patients with COPD.

METHODS

A total of 100 subjects with COPD were recruited from a medical center in northern Taiwan from February 2020 to January 2021. Each subject completed a questionnaire based on the 20-item COPD Self-Management Scale and 25-item Resilience Scale through a face-to-face interview. A multiple linear regression model that controlled for sociodemographic and clinical factors was used to examine the relationship between self-management behaviors and resilience.

RESULTS

Analysis of our data indicated that differences in educational level, smoking status, religion, modified Medical Research Council dyspnea scale score, degree of COPD impacting wellbeing, number of COPD-related hospitalizations within 1 year, and self-reported comorbidities were associated with differences in self-management and resilience scores. The GOLD (Global Initiative for Chronic Obstructive Lung Disease) D group had the lowest scores for self-management and resilience among GOLD groups A, B, C, and D. Self-management and resilience were positively correlated (r = 0.703, P < .001). In the linear regression model, a better self-management value was associated with a higher resilience score (β = 0.749, P < .001), whereas an increasing resilience score was also associated with a better self-management score (β = 0.461, P < .001).

CONCLUSIONS

This study revealed that self-management and psychological resilience were positively correlated and associated in our linear regression model. Future work may focus on finding the causative relationship between self-management and resilience among patients with COPD.

Spirituality in people with advanced chronic obstructive pulmonary disease - challenge for more effective interventions, support, and healthcare education: Mini-review

More recently there has been a growing interest in spirituality in medicine, especially in the field of palliative care, oncology, intensive care, and cardiology. However, according to literature, it seems to be a limited number of researches on how healthcare professionals should provide spiritual care (SC) for people with non-malignant lung diseases and what kind of education for them enables them to do it efficiently. This mini-review aims to provide an overview of current knowledge of an area of spirituality and SC for people with advanced chronic obstructive pulmonary disease, including spiritual well-being and religious/spiritual coping, their relations with the quality of life and symptom burden, exercise capacity and daily functioning, mental health, or medication adherence. It also analyses the use of interventions to meet patients' spiritual needs and patients' expectations regarding SC provided by professional careers. Based on the literature authors try to show the fields that should be improved and proposed future research directions.

A quasi-experimental study of the effect of a comprehensive blended health educational program on self-management practices among patients with chronic obstructive pulmonary disease

BACKGROUND

The prevalence and illness burden of chronic obstructive pulmonary disease (COPD) are both high. Currently, limited guidance is available to support the establishment of effective health programs to increase self-management practices in patients with COPD.

OBJECTIVES

To explore the effect of a comprehensive blended health education program on self-management practices in patients with mild-to-moderate COPD in Jeddah City, Saudi Arabia.

METHODS

A quasi-experimental research study was carried out with a convenience sample of 60 discharged or stable patients with COPD following treatment. Participants were divided into an intervention group (n = 30) that received usual hospital care and blended health education program, and a control group (n = 30) that obtained the usual hospital care without involvement in the health education program from May 2021- to August 2021. Data were collected before and three months after the intervention using the COPD Self-Management Scale and patient socio-demographic and clinical information surveys.

RESULTS

Statistically significant differences were found between the control and intervention groups after three months of the intervention based on total COPD Self-Management Scale scores. There were no statistically significant relationships between the participants' mean COPD Self-Management Scale scores in both groups with their socio-demographic and clinical characteristics before and after the intervention.

CONCLUSIONS

A nurse-led, comprehensive blended health education program was found to be an effective method for improving COPD patients' self-management practices. COPD nurses and nurse researchers must collaborate to identify the most common interventions with the best cost/benefit ratios and greater positive effects on early COPD patients' self-management practices and general well-being.

Self-management model based on information-motivation-behavioral skills model in patients with chronic obstructive pulmonary disease

AIM

To develop and test a predictive model of self-management based on the theory of the information-motivation-behavioural skills model and previous literature on self-management for patients with chronic obstructive pulmonary disease (COPD).

DESIGN

A descriptive, correlational, cross-sectional design was used.

METHODS

A convenience sample recruited 248 patients with COPD from the pulmonary medicine clinic in South Korea between July 2020 and June 2021. We used self-administrated, structured questionnaires for dyspnoea, health status, knowledge, attitude, social support, self-efficacy and self-management. Data were analysed using path analysis to test a self-management model for patients with COPD.

RESULTS

Gender, COPD self-management knowledge, social support and COPD self-efficacy had a direct effect on COPD self-management. Dyspnoea, Global Initiative for Chronic Obstructive Lung Disease stage, health status, COPD self-management attitude and social support had an indirect effect on self-management in patients with COPD. These variables explained 43.2% of the total variance for self-management in patients with COPD.

CONCLUSIONS

When assessing self-management of COPD; demographic and clinical factors, knowledge, attitudes, social support and self-efficacy included in the information-motivation-behavioural skills model should be considered together.