Health Literacy, Self-Care Behaviors, and Biochemical Parameters Among Hypertensive Patients with Renal Complications in the Tai Lue Ethnic Community of Thailand

Purpose

Hypertension (HT) can cause renal complications or deterioration of kidney function. HT management is very important because it reduces the severity of illnesses. This study aimed to investigate the relationship between health literacy (HL), self-care behaviors (SCB), and biochemical parameters in hypertensive patients with renal complications.

Methods

A cross-sectional study of 405 hypertensive patients with renal complications among Tai Lue people living in Thailand was conducted using simple random sampling. Face-to-face interviews with questionnaires were used to collect information. Blood pressure (BP) and biochemical parameters, such as fasting blood sugar (FBS) and estimated glomerular filtration rate (eGFR), were measured.

Results

The participants' mean age was 68.3 years. A significant correlation was found between HL score, SCB score, systolic BP (SBP), diastolic BP (DBP), FBS, and eGFR (p<0.01). Multiple linear regression revealed that eating salty foods was a risk factor for SBP in males and for SBP and DBP in females. Body mass index (BMI) (B = 0.54), sweet food consumption (B = 13.90), and SCB score (B = -0.29) were significantly associated with FBS level (R2 = 17.8%, p<0.05). Employment (B = 2.55), eating bland food (B = 4.07), receiving information from family (B = 3.53), SCB (B= 0.31), and age (B = -0.51) were all significant factors for eGFR (R2 = 35.0%, p<0.05).

Conclusion

HL and SCB levels were associated with the health of hypertensive patients with renal complications in the Tai Lue ethnic community. The significance of organizing health education programs is to emphasize increasing HL to lead to self-care decisions and reduce complications in patients, resulting in improved SCB and quality of life in the future.

The Influence of Social Support on Self-Care Behavior among T2DM Patients

Introduction

T2DM is a chronic health condition that requires routine self-care. Despite T2DM patients being able to manage self-care behaviors, psychosocial factors, including social support, have been considered effective in improving diabetic self-care behaviors.

Objective

This study aimed at examining the influence of social support on self-care behavior among T2DM patients in Dr. Soliaman Fakeeh Hospital.

Methods

This was a cross-sectional study. The study was carried out at Dr. Soliaman Fakeeh Hospital using a sample size of 192 T2DM patients. Data were collected using a self-administered questionnaire comprised of a demographic section, the Scale of Perceived Social Support (MSPSS) section, and the Diabetes Self-Care Activities Questionnaire (DSCAQ) section. The data were analyzed using descriptive statistics and inferential statistics.

Results

The study analyzed data from 192 complete responses (91.86%) out of 209 respondents. Regarding gender, most of the respondents were female T2DM patients (n  =  103, 53.6%), while males (n  =  89, 46.4%) The highest level of social support was from the family (mean of 5.49). The highest performing self-care activity performed by the respondents was blood glucose monitoring (mean of 6.01). Analysis of the correlation between the Scale of Perceived Social Support (MSPSS) and the DSCAQ revealed positive and significant correlations (r  =  0.370, p  =  0.001).

Conclusions

This study showed that social support influenced self-care behaviors in patients with T2DM. Therefore, interventions should be developed focused on enhancing the levels of social support and self-care behaviors.

[Effects of a Motivational Interview Intervention on Self-Efficacy, Self-Care Behavior, and Glycemic Control in Type 2 Diabetic Patients]

BACKGROUND

Motivation is an important factor in disease management for diabetic patients. However, motivational strengthening interventions have been inadequately effective in effecting behavior change in this group.

PURPOSE

This study was designed to investigate the effect of a motivational interview intervention on self-efficacy, self-care behavior, and blood sugar control in patients with type 2 diabetes.

METHODS

The target population comprised patients with type 2 diabetes in two medical wards of a regional hospital in the southern Taiwan. The 112 participants were randomly assigned to the experimental group (n = 56) and control group (n = 56). Over a three month period, the experimental group received 6 motivational interview sessions of 50 minutes each in addition to usual diabetes care, while the control group received usual diabetes care on the ward. Both groups completed the demographic questionnaire, Chinese version of Diabetes Self-Efficacy Scale, Diabetes Self-Care Behavior Scale, glycosylated hemoglobin level pre-test, and 3 months post-test survey. The results were analyzed using SPSS 22.0 for Windows.

RESULTS

A total of 55 patients in the experimental group and 52 patients in the control group completed the study. After analysis, significant inter-group differences in self-efficacy and self-care behavior were found between the experimental group and the control group at pre-test and three-month post-test (p < .001). For the experimental group, the three-month post-test score and glycated hemoglobin value were higher than at pre-test. The three-month post-test value was significantly lower (p < .001) than the pre-test value, and the change effect in the experimental group was better than that in the control group. There was a significant difference in the stages of change between pre-test and post-test (χ2 = 43.89, p < .001), and the change effect in the experimental group was better than that in the control group.

CONCLUSIONS / IMPLICATIONS FOR PRACTICE

The proposed motivational interview intervention can help patients with type 2 diabetes admitted to medical wards improve their self-efficacy, self-care behavior, and glycated hemoglobin values. In the future, nursing education should improve the teaching of motivational interview skills to allow nurses to conduct effective interviews quickly during treatment, increase their patients' motivation to self-control blood sugar, and enable patients to learn blood sugar control skills before discharge to achieve effective blood sugar control.

Self-care behaviors, drinking, and smoking to cope with psychological distress during COVID-19 among Chinese college students: the role of resilience

OBJECTIVE

College students are vulnerable to psychological distress during COVID-19 due to pandemic-related stressors. In response to psychological distress, college students engage in various coping behaviors, such as self-care behaviors and substance use. The transactional model of stress and coping depicts a cognitive appraisal process in the stress-coping association. Psychological resilience is an essential factor for the cognitive appraisal. This study aimed to investigate the mediation effects of resilience on psycho-behavioral health in response to COVID-19 stressors.

DESIGN

Longitudinal data were collected from 1,225 Chinese college students via web-based anonymous surveys at wave 1 (T1, between Jan 31 and Feb 11, 2020) and wave 2 (T2, between Mar 20 and Apr 3, 2020).

MAIN OUTCOME MEASURES

Participants reported their COVID-19 stressors (T1), resilience (T1), psychological distress (depression and anxiety; T2), and coping behaviors (self-care behaviors, drinking, and smoking; T2). Path analysis was used for data analyses.

RESULTS

Resilience mediated the association between COVID-19 stressors and psychological distress. Resilience together with psychological distress mediated the association of COVID-19 stressors with self-care behaviors or drinking.

CONCLUSIONS

Resilience appears to offer protection that promotes psycho-behavioral health in college students in the face of COVID-19 stressors. Interventions for college students should attend to resilience.

Investigating the factors affecting the self-care behaviors of patients with type II diabetes and the role of demographic variables: A case study in Iran

BACKGROUND

Self-care practices in diabetes patients are crucial to keep the illness under control and prevent complications. Effective management of diabetes will be a difficult task without an adequate understanding of the current level of practice related to diabetes self-care. Therefore, this study aims to assess the factors affecting the self-care behaviors of patients with type II diabetes and the role of demographic variables in Iran.

MATERIALS AND METHODS

The present study is a descriptive-analytical study that was designed and conducted in 2022. This study population was type II diabetic patients at the Diabetes Research Center of Ayatollah Taleghani Hospital in Kermanshah who were selected by available sampling method of 280 samples. Data collection tools included demographic characteristics questionnaire and standard self-care questionnaire for the Glasgow and Toobert diabetic patients. Data were analyzed using SPSS-23 software, independent t-tests, one-way analysis of variance, and stepwise regression.

RESULTS

The mean of self-care scores was 2.07 ± 2.08 and indicated an unfavorable condition. The highest mean scores of self-care were in the field of regular use of medications, and the lowest scores were in the field of blood-glucose testing. The mean scores of self-care were significantly different based on marital status, occupation status, residence, type of treatment, duration of diabetes, years, smoking status (P < 0.05). Regression results showed that the variables predictors; type of treatment, smoking status, the complication of diabetes, education level status, place of residence explained 515% of the variance of self-care.

CONCLUSIONS

The study showed that the extent to which individuals adhere to type II diabetes recommended management is substantially low. Improving awareness of patients and the community at large is imperative, especially on the diet, exercise, blood-glucose testing, foot care, and no smoking.

Impact of Nursing Interventions on Hospital Readmissions in Patients With Pulmonary Tuberculosis: A Quasi-Experimental Study

PURPOSE

Our study aimed to evaluate the effectiveness of the nursing care program on the incidence and rate of 28-day hospital readmissions among pulmonary tuberculosis (TB) patients.

METHODS

We conducted a quasi-experimental study using a historical control (usual care) group. Patients diagnosed with pulmonary TB who received nursing interventions between January 28, 2021, and May 31, 2021, were categorized as an intervention group, whereas historical controls were selected from January 1, 2020, to December 31, 2020. The primary outcomes were the incidence and rates of hospital readmissions within 28 days due to TB-related complications. The secondary outcome was the change in knowledge and self-care behavior scores at discharge and 28 days postdischarge. Cox models were used to assess the intervention's impact on the incidence of hospital readmission. Rates of readmission were compared by the Poisson model. Both Cox and Poisson models were adjusted for age, sex, sputum smears at diagnosis, serum albumin level, and diabetes mellitus at baseline.

RESULTS

Among 104 pulmonary TB patients included in the analysis (68 were in a historical control group and 36 were in an intervention group), 20 patients were readmitted due to TB-related complications. We found that our nursing care program resulted in a significant reduction in the incidence (adjusted hazard ratio was 0.16 [95% CI 0.03, 0.87]) and the rate of hospital readmissions (adjusted incidence rate ratio was 0.22 [95% CI 0.06, 0.85]). Furthermore, nursing interventions significantly improved knowledge and self-care behavior scores with significant score retention at 28 days postdischarge.

CONCLUSIONS

The nursing care program can significantly decrease the incidence and rate of 28-day hospital readmission and improve knowledge and self-care behavior scores in pulmonary TB patients.

Virtual Group Appointments Improve Outcomes in Veterans with Heart Failure During a Global Pandemic: A Quality Improvement Project

This report on a quality improvement initiative describes a multi-professional approach to improving self-care behaviors and reducing hospitalizations in Veterans with heart failure (HF) by implementing virtual group appointments. Patients with HF are more susceptible to complications related to COVID-19 infection, creating the need for alternative communication methods for patient education during the social isolation and reduced health-care resources brought on by the global pandemic. From March 2020 to June 2021, 57 Veterans participated in 1 of 12 group appointments at the VA Portland Health Care System in Portland, Oregon. Each group was led by a multi-professional team who provided education on self-care behaviors, nutrition, medications, and mental health impacts of HF. Chart reviews and pre-/post-self-care behavior questionnaires showed that the virtual group HF appointments were associated with a decrease in hospitalizations, compared to previous data with the same population, and self-reported self-care behaviors improved from pre- to post-questionnaire. Group appointments offer a unique educational and motivational experience for those with HF and provide the ability to engage with each other during challenging times.

Evaluating a Telephone and Home Blood Pressure Monitoring Intervention to Improve Blood Pressure Control and Self-Care Behaviors in Adults with Low-Socioeconomic Status

Hypertension (HTN) affects nearly 75 million in the United States, and percentages increase with low socioeconomic status (SES) due to poor access to, and quality of, care, and poor self-care behaviors. Federally Qualified Health Centers (FQHCs) employ evidence-based strategies, such as telehealth interventions, to improve blood pressure (BP) control in under-resourced communities, yet a southeastern FQHC could achieve a BP control rate of only 27.6%, well below the Health People 2020 goal of 61.2%. This pilot project used a pre/post, matched-cohort design to evaluate the effect of a telehealth intervention on BP control and self-care behaviors. Secondary outcomes included self-efficacy and perceived stress. Frequency and percentage, Wilcoxon signed-rank, and McNemar tests were used for statistical analysis of results from a convenience sample of 27 participants. Baseline HTN management guidance that incorporated home blood pressure monitoring (HBPM) was reinforced through telephone counseling every two weeks. Although BP control was not achieved, average scores for systolic and diastolic blood pressures decreased significantly: 13 mm Hg (p = 0.0136) and 5 mm Hg (p = 0.0095), respectively. Statistically significant differences were also seen in select self-care behaviors. Greater BP reduction aligned with higher self-efficacy scores and call engagement. Overall, telephone counseling and HBPM were feasible and effective in reducing BP and increasing self-care behaviors. The inability to control BP may be attributable to under-recognition of stress, lack of medication adherence/reconciliation, and underutilization of guideline-based prescribing recommendations. Findings elucidate the potential effectiveness of a sustainable telehealth intervention to improve BP in low-SES populations.

Longitudinal patterns and predictors of self-care behavior trajectories among Korean patients with heart failure: A 6-month prospective study

PURPOSE

This study aimed to identify distinct trajectories of self-care behaviors over 6 months after hospital discharge in patients with heart failure, including the baseline predictors affecting these trajectories.

DESIGN

This was a prospective longitudinal observational cohort study with a 6-month follow-up.

METHODS

A total of 158 patients with heart failure (mean age = 66.75 years, 62.7% men) were included in this study. Patients' characteristics, including cognitive function, health literacy, and social support were collected as possible baseline predictors of self-care behavior trajectories using a structured questionnaire and an electronic medical record review. Self-care behaviors were evaluated using the Korean version of the nine-item European Heart Failure Self-care Behavior Scale at baseline, 1, 3, and 6 months after hospital discharge. Latent growth model analysis was conducted to identify the homogeneous subgroups with distinct trajectories of self-care behaviors. Subsequently, multinomial logistic regression was used to assess whether baseline predictors were associated with these trajectories in patients with heart failure.

RESULTS

Three distinct self-care behavior trajectory groups were identified: "low-decreased" (n = 33, 20.9%), "middle-increased" (n = 93, 58.9%), and "high-sustained" (n = 32, 20.2%). The multinomial logistic regression analysis showed that baseline adequate health literacy and positive social support significantly predicted patients' belonging to both the middle-increased and high-sustained self-care behavior trajectory groups compared to the low-decreased group. Importantly, better cognitive function at baseline was only significantly associated with the high-sustained self-care behavior trajectory compared to the low-decreased trajectory.

CONCLUSION

Our study revealed that only one-fifth of the patients belonged to the high-sustained self-care behavior group 6 months after hospital discharge. Strategies aimed at improving cognitive function, health literacy, and social support should be developed to sustain satisfactory self-care behaviors in patients with heart failure. Further studies with long-term follow-ups are required to identify other possible factors, as well as the baseline predictors of this study affecting longitudinal trajectories of self-care behaviors.

CLINICAL RELEVANCE

Healthcare providers should recognize and evaluate the distinct patterns of self-care behaviors over time in patients with heart failure. Importantly, assessing baseline cognitive function, health literacy, and social support before hospital discharge may be necessary to prevent a decline in self-care behaviors over time.

The relationship between personality profile and self-care among patients with type 2 diabetes

Background

As a chronic disease, diabetes needs special self-care behaviors until the end of life. Personality traits are considered to be effective psychological factors in controlling diabetes and self-care in patients with diabetes. The present study was conducted to determine the relationship between personality profile and self-care among people with type 2 diabetes.

Methods

In this descriptive-correlational study conducted in 2021, 160 patients with type 2 diabetes referred to the diabetes clinic of Imam Khomeini Educational and Medical Center in Ardabil were selected by convenience sampling method. The data collection tools included the Diabetes Self-Care Activities questionnaire (SDSCA) and the short form of the Millon Multi-Axis Clinical Test (MCMI-3), which were completed through interviews with patients. Data were analyzed by SPSS software using descriptive statistics (mean, SD, and frequency) and inferential statistics (Pearson correlation coefficient and linear regression).

Results

Based on the results, apart from the obsessive personality disorder, which had a positive relationship with self-care behaviors, a significant negative correlation was observed between schizoid, avoidant, depressed, dependent, antisocial, self-harming, borderline, and paranoid personality disorders with self-care behaviors (p < 0.01).

Conclusion

The results showed that there is a significant negative relationship between personality profile and self-care status of patients with type 2 diabetes. In other words, a person's personality profile can predict self-care behaviors. Accordingly, personality traits can be considered as one of the influencing factors on self-care in the educational programs of diabetic patients. Holding educational classes to empower patients using psychological interventions and teaching effective solutions can be an effective step toward increasing the level of mental-physical health and self-care of patients with type 2 diabetes.

Self-care behaviors in older adults suffering from knee osteoarthritis: Application of theory of planned behavior

Background

Osteoarthritis is one of the main reasons causing disablement. Educational intervention for self-care behaviors of patients suffering from knee osteoarthritis is important because its effect on quality of patient life decreases the economic burden of disorder on society and family. This study aimed to investigate the effect of educational intervention based on the theory of planned behavior (TPB) on promoting self-care behaviors in elderly patients suffering from knee osteoarthritis.

Methods

This quasi-experimental study was performed on 200 elderlies suffering from knee osteoarthritis in the rheumatology clinics of Shiraz, Iran, in 2019. The subjects were divided into two groups (100 experimental and 100 control). Before and after 4 months, both experimental and control groups filled a questionnaire. After administering a pre-test to both groups, only the experimental group was trained based on the TPB constructs on self-care behaviors in elderly people suffering from knee osteoarthritis in eight sessions by presenting educational films and images, power points, and group discussions for solving problems.

Results

The mean age of the experimental group was 67.25 ± 3.64, and the mean age of the control group was 66.12 ± 3.50. The average scores of attitudes, subjective norms, perceived behavioral control, intention, and behavior before the educational intervention did not have significant differences in experimental and control groups, however, 4 months after the educational intervention, the paired t-test indicated significant enhancement in every construct in the experimental group, but no significant changes in the control group.

Conclusion

According to the results, the educational intervention increased the self-care behaviors of patients suffering from knee osteoarthritis based on the theory of planned behavior. Therefore, the results of this study can be used in theory-based intervention strategies for self-care behaviors of patients suffering from knee osteoarthritis.

Implementing a novel self-care clock strategy as part of a trauma awareness intervention in a university setting

PURPOSE

This study compared post- and preintervention trauma-informed care attitudes, explored relationships among outcomes, and identified self-care behavior changes participants are willing to make.

DESIGN AND METHODS

A quasi-experimental study with content analysis was conducted with 96 adults that took part in a Trauma Awareness Intervention including a novel self-care clock.

CONCLUSIONS

Participants' trauma-informed care attitudes improved (p ≤ 0.05) compared to baseline and were positively related to their post-intervention compassion scores (p < 0.05). Qualitative analyses revealed self-awareness, self-care, empathy, applying a trauma lens, changing the narrative, and student-centeredness as the main themes in participants' responses.

PRACTICAL IMPLICATIONS

This university-based initiative had a positive impact on attitudes toward trauma and should be explored in other settings, as there is an unmet need for trauma-informed care strategies at the community level.

Undergraduate versus graduate nursing students: Differences in nutrition, physical activity, and self-reported body mass index

ObjectiveThis study compared self-reported nutrition, physical activity, and body mass index (BMI) in undergraduate versus graduate nursing students.ParticipantsRespondents included 233 undergraduate and 230 graduate nursing students in a Southeastern public university.MethodsThe study was an exploratory, descriptive, cross-sectional comparison administered via online questionnaire including self-reported demographics, nutritional intake, physical activity, and BMI.ResultsUndergraduates reported exercising more than graduate students. Graduate students reported consuming significantly more vegetables than undergraduates; however, more graduate students self-reported BMIs in overweight and obese categories than undergraduates.ConclusionsFindings provide a foundational understanding that interventions or educational programs to improve self-care behaviors of nursing students should be tailored depending on the educational level of the students. Educators must establish self-care skills within nursing students at all levels to help them preserve their health in the fast-paced, strenuous, and stressful work of all echelons of nursing upon completion of the educational program.

Self-care and quality of life among men with chronic heart failure

Introduction

Chronic Heart Failure (CHF) involves a complex regimen of daily self-care behaviors: pharmacological therapy, symptom monitoring and lifestyle modifications. Patients with CHF may have a reduced health related quality of life (HRQoL) due to various physical and emotional symptoms. HRQoL may be improved through the use of self-care interventions.

Purpose

To assess the level of self-care and quality of life among men with chronic heart failure.

Methods

The study was conducted among 80 men diagnosed with CHF (mean age 58 years). The study was cross-sectional. A self-administered questionnaire and analysis of medical records were used to collect baseline sociodemographic and clinical data. Self-care was assessed using the standardized European Heart Failure Self-care Behavior Scale- EHFScBS-9 and quality of life was assessed using the World Health Organization Quality of Life Bref.

Results

The Patients in NYHA class II constituted the vast majority (71.25%), mean LVEF in the study group was 43.5%, and mean disease duration was 3 years. The most common comorbidities were ischemic heart disease (72.5%), hypertension (70%) and diabetes mellitus (60%). The most commonly reported non-pharmacological treatments for NS were fluid restriction (45%), moderate physical activity (42.50%) and daily weight control (41.25%). The EHFSc-9 questionnaire score averaged 50.31 points out of 100 possible (SD = 26.52). The mean score regarding perception of QoL was 2.78 points (SD = 0.91), and 40% of patients indicating poor perception of QoL. The mean score for self-rated Analysis of the results of the individual domains of the WHOQoL BREF questionnaire showed that patients rated their QoL best in the environmental domain (M = 13.28; SD = 3.11), then in the social domain (M = 12.81; SD = 2.71), and in the psychological domain (M = 12.8; SD = 3.2). In contrast, QoL in the physical domain was rated the lowest (M = 10.44; SD = 2.85). There was no significant correlation between quality of life and self-care (p > 0.05).

Conclusions

Men with CHF have unsatisfactory self-care outcomes and low quality of life scores and are dissatisfied with their health. Strategies to improve selfcare and quality of life in this group are indicated.

The role of protective psychological factors, self-care behaviors, and HbA1c in young adults with type 1 diabetes

OBJECTIVE

To investigate whether protective psychological factors in young adults with type 1 diabetes are associated with more optimal self-care behaviors and HbA1c, and to explore possible mediators between protective psychological factors and HbA1c.

RESEARCH DESIGN AND METHODS

This cross-sectional study examined the associations between protective psychological factors (optimism, positive efficacy expectancies, and self-compassion), maladaptive psychological factors (depression, anxiety, and stress), self-care behaviors, and HbA1c in 113 young adults (17-25 years) with type 1 diabetes in Auckland, New Zealand. Pearson's correlations, multiple linear regressions, and multiple mediation analyses were used to examine associations and mediators.

RESULTS

Higher positive efficacy expectancies (beliefs about coping with difficulties) were associated with more optimal HbA1c (β = -0.26, 95% CI: -1.99 to -0.45) and more optimal self-care behaviors (β = 0.33, 95% CI: 0.28 to 0.92) in the adjusted models. Higher levels of self-compassion were associated with more optimal self-care behaviors (β = 0.27, 95% CI: 0.09 to 0.43). Depression was associated with less optimal self-care behaviors (β = -0.35, 95% CI: -1.33 to -0.43) and stress was associated with less optimal HbA1c (β = 0.26, 95% CI: 0.27 to 1.21). Mediation results suggested that self-care behaviors mediated the relationship between all three of the protective psychological factors and more optimal HbA1c, and that lower stress also mediated the relationship between higher self-compassion and more optimal HbA1c.

CONCLUSIONS

This study adds to the emerging literature that protective psychological factors may play an adaptive role in improving health outcomes in young adults with type 1 diabetes. Interventions targeting protective psychological factors present a promising approach to optimizing wellbeing and self-care in youth with type 1 diabetes.

Factors Associated with Quality of Life in Patients with Type 2 Diabetes of South Benin: A Cross-Sectional Study

Background: Type 2 diabetes (T2D) adversely affects health-related quality of life (QoL). However, little is known about the QoL of diabetic patients in Benin, where the disease is a growing concern. Thus, this study aims to assess the QoL and its associated factors among T2D patients in Cotonou, southern Benin. Methods: A total of 300 T2D patients (age > 18 years) were enrolled, and the diabetes-specific quality of life (DQoL) and Natividad self-care behaviors’ (SCB) instruments were used for data collection. DQoL scores were calculated, and factors associated with DQoL explored using logistic regression. Results: The mean of patients’ DQoL was 38.1 ± 4.1, with 43% having low QoL. In terms of DQoL, 56.3% reported a high diabetes impact, followed by low life satisfaction (53%) and high worry about diabetes (32.7%). In the logistic regression analysis, education, marital status, occupation, family history of diabetes, complications, and social support were associated with DQoL. SCB factors, including healthy eating, problem-solving, coping strategies, and risk reduction, were significant predictors of DQoL. Conclusions: Patients’ empowerment, starting with self-management education, is essential to improve the QoL of T2D patients in Cotonou. However, the programs need to target low education, low socioeconomic status, low social support, and overweight patients.

Heart Failure Care: Testing Dyadic Dynamics Using the Actor-Partner Interdependence Model (APIM)-A Scoping Review

Self-care behaviors are essential for the effective treatment of heart failure (HF), and poor self-care may lead to adverse clinical events in patients with HF. A growing body of literature addresses the need to analyze the characteristics of both patient and caregiver since they are in mutual, long-term interaction, and their reactions to events are dependent on each other. One of the most common approaches for analyzing data on HF self-care dyads is the Actor–Partner Interdependence Model (APIM). The purpose of this study was to conduct a scoping review to answer the following question: what did we learn from HF dyadic studies based on the APIM approach? Medline, Academic Search Ultimate, and CINAHL Complete databases were searched, using the terms “dyad,” “dyadic,” and “heart failure,” for studies published between 2009 and April 2021. Fifteen studies were reviewed from a pool of 106 papers. Studies using the APIM approach revealed interrelated patient and caregiver characteristics that influence self-care and explain many complex dyadic behaviors. Our analysis provided evidence that (1) APIM is a useful analytical approach; (2) a family-oriented approach can improve the functioning of a patient with HF; and (3) social support from caregivers significantly enhances patients’ adaptation to illness.

Self-care and type 2 diabetes mellitus (T2DM): a literature review in sex-related differences

T2DM is a multifactorial disease, and it is considered a worldwide challenge for its increasing prevalence and its negative impact on patients' wellbeing. Even if it is known that self-care is a key factor in reaching optimal outcomes, and males and females implement different self-care behaviors, sex-related differences in self-care of patients with T2DM have been poorly investigated. Especially, an overall view of the available evidence has not yet been done. Accordingly, this review aims to summarize, critically review, and interpret the available evidence related to the sex-related differences in self-care behaviors of patients with T2DM. An extensive literature review was performed with a narrative synthesis following the PRISMA statement and flowchart through four databases: PubMed, CINAHL, Scopus, and Embase. From the 5776 identified records by the queries, only 29 articles were included, having a high-quality evaluation. Both females and males with T2DM must improve their self-care: more males reported performing better behaviors aimed at maintaining health and clinical stability (i.e., self-care maintenance) than females, but mainly in relation to physical activity. On the other hand, more females reported performing adequate behaviors aimed at monitoring their signs and symptoms (i.e., self-care monitoring) but with worse glycemic control and diabetic complications (i.e., self-care management). This review firstly provides an overall view of different self-care behaviors implemented by males and females with T2DM, showing that self-care management should be improved in both sexes. Health education must include the problems related to the diabetic pathology and the patient's own characteristics, such as sex.

Congestive Heart Failure 30-Day Readmission: Descriptive Study of Demographics, Co-morbidities, Heart Failure Knowledge, and Self-Care

Background Congestive heart failure (CHF) readmissions are associated with substantial financial and medical implications. We performed a descriptive study to determine demographic, clinical, and behavioral factors associated with 30-day readmission. Materials and methods Patients hospitalized with CHF at William Beaumont Hospital in Royal Oak, MI, from March 2019-May 2019 were studied. Response to heart failure knowledge and self-care questionnaires along with the patients' demographic and clinical factors were collected. Thirty-day readmission to any of the eight hospitals in the Beaumont Health System was documented. Results One-hundred ninety-six (196) patients were included. The all-cause 30-day readmission rate was 23%. A numerical higher rate of readmissions was observed among males (23.7% vs 22.2%), current smokers (27.3% vs 22.9%), and patients with peripheral vascular disease (PVD; 28.9% vs 21.2%), diabetes mellitus (DM; 26.4% vs 18.9%), hypertension (HTN; 26.4% vs 10%), coronary artery disease (CAD; 24.6% vs 19%), and prior history of cerebrovascular accident (CVA; 28.9% vs 21.2%) (p>0.05). Reduced left ventricular ejection fraction (LVEF) was associated with higher readmissions (24.4% vs 20.5%, p=0.801). Patients with the highest reported questionnaire scores corresponding to better heart failure knowledge and self-care behaviors at home were readmitted at a similar rate compared to those scoring in the lowest interval (25%, p=0.681). Conclusion Though statistically insignificant due to the limitations of sample size, a higher percentage of readmissions was observed in male patients, current smokers, reduced LVEF, and higher comorbidity burden. Better reported patient self-care behavior, medication compliance, and heart failure knowledge did not correlate with reduced readmission rates. While the impact of medical comorbidities on 30-day readmissions is better established, the role of socioeconomic factors remains unclear and might suggest a focus for future work.

Multiple self-care behaviors and associated factors in community-dwelling patients with hypertension in Myanmar

This study aimed to identify the prevalence of self-care behaviors and the associated factors among hypertensive patients in primary care in Myanmar. This cross-sectional study was conducted from April to May 2019 among 410 hypertensive patients in Myitkyina Township, Kachin State, Myanmar. Hypertensive patients aged 30–70 years old and being registered at the community health centers in Myitkyina Township were selected using multi-stage cluster random sampling. Self-care behaviors were measured by Hypertensive Self-Care Activity Level Effect (H-SCALE). Chi-square test and multiple logistic regression analysis were used to explore the associated factors. Prevalence of adherence to multiple self-care behaviors were low: avoidance of tobacco use at 50.2%, followed by physical activity at 24.9%, medication at 24.1%, weight management at 9.5%, and healthy diet at 2.7%, while abstinence from harmful alcohol drinking was high at 97.8%. Multiple logistic regression analysis indicated that younger patients, low family income, inadequate knowledge, and no comorbidity were associated with non-adherence to medication. Living in rural area and having poor self-efficacy were associated with non-adherence to weight management, while being younger, female and having poor self-efficacy were also associated with non-adherence to physical activity. Compared with Kachin, other ethnics were more likely to be non-adherent to avoidance of tobacco use. Although a majority of respondents were not harmful drinkers, adherence to medication, healthy diet, physical activity, weight management and avoidance of tobacco use were very low. Health practitioners should provide education programs for hypertensive patients to direct them towards practical techniques in managing their blood pressure.

Scale of Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis: A Psychometric Study in Brazil

The purpose of this study was to evaluate the psychometric properties of the Brazilian Scale for the Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis. Cross-sectional validation study, followed the recommendation provided by Sousa and Rojjanasrirat. Content validity, explanatory and confirmatory factor analyses used to check validity and Cronbach's alpha was the reliability measure. Three hundred hemodialysis patients with arteriovenous fistula were included in the study. The expert committee assessed the content validity. Exploratory factor analysis confirmed the same two-factor structure found for the original scale, explaining 60.10% of the variance. Such solution was checked by confirmatory factor analysis with Cronbach's alpha equal to 0.920, 0.810, and 0.884 for the overall scale, the self-care in management of signs and symptoms and the self-care in prevention of complications subscales respectively. The scale has good psychometric properties to assess self-care behaviors and can be used with Brazilian patients on hemodialysis with arteriovenous fistula.

Factors Associated with Heart Failure Knowledge and Adherence to Self-Care Behaviors in Hospitalized Patients with Acute Decompensated Heart Failure Based on Data from "the Weak Heart" Educational Program

PURPOSE

As insufficient adherence to recommendations is a major cause of poor health outcomes in patients with heart failure (HF), it is important to identify the factors that improve disease knowledge and self-care behaviors. We aimed to identify factors associated with HF knowledge and self-care behaviors in patients hospitalized due to acute decompensated heart failure (ADHF) in Poland.

PATIENTS AND METHODS

This was a secondary analysis of data from a multi-center, prospective, non-randomized educational program named "The Weak Heart", which was conducted in 14 cardiology centers in Poland. The level of HF knowledge was assessed using a questionnaire developed by the research team, and self-care behaviors were evaluated using the European Heart Failure Self-care Behaviour Scale (9-EHFScBS) questionnaire.

RESULTS

The study included 259 patients admitted to the hospital with ADHF. The mean HF knowledge and 9-EHFScBS questionnaire scores were 8.25± 4.34 and 25.2±9.5, respectively. The patients' level of education (P = 0.002), number of prior HF hospitalizations (P = 0.008), and previous disease education (P < 0.001) were independently associated with better HF knowledge. Age (P = 0.03) and disease education (P = 0.02) were independently associated with self-care behaviors.

CONCLUSION

The adherence to self-care recommendations among patients with ADHF is insufficient. Disease education positively influenced both HF knowledge and self-care abilities. To improve patients' adherence to HF recommendations, well-designed models of education based on HF management guidelines should be implemented.

Type D Personality Is Associated with Glycemic Control and Socio-Psychological Factors on Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Purpose

Type D personality (TDP) has been recognized as a risk factor for many diseases. The aims of our study were to estimate the prevalence of TDP and glycemic control on the patients with type 2 diabetes mellitus (T2DM) and to assess their relationship between TDP and socio-psychological factors, such as perceived stress, self-efficacy, self-care behaviors, and psychological distress.

Patients and Methods

A total of 198 T2DM patients (male 62.6%, mean age 51.2±11.0, mean HbA1c 7.3±1.8%) were recruited consecutively from the Department of Endocrinology of a regional hospital in Taipei, Taiwan, from December 2017 to April 2018. They completed questionnaires that contain questions about sociodemographic characteristics, TDP, illness-related stress, self-efficacy, execution of diabetes management and emotional distress. Their medical records were reviewed for biomedical data.

Results

Of the 198 patients, 82 (41.4%) had TDP. Controlling for sociodemographic factors, patients with TDP were reported significantly poorer on glycemic control than those without TDP (mean HbA1c (%) 7.6±1.9 vs 7.1±1.8, P<0.05). Compared to those without TDP, the results showed significantly higher levels of perceived stress (P<0.001) and psychological distress (anxiety and depression) (P<0.001), as well as significantly lower levels of self-efficacy (P<0.001) and self-care behaviors (P<0.001) on patients with TDP. TDP was positively correlated with perceived stress and psychological distress and negatively correlated with self-efficacy and self-care behaviors scores.

Discussion

This study provides the evidence linking TDP with poor glycemic control, low levels of self-efficacy and self-care behaviors, as well as high levels of perceived stress and psychological distress, which highlights the screening of TDP and the tailored needs for the care among T2DM patients with TDP.

Self-compassion moderates the perceived stress and self-care behaviors link in women with breast cancer

OBJECTIVE

Women with breast cancer are exposed to various stressors, and self-care behaviors play an important role in their recovery. However, very few studies have investigated self-care behaviors specifically for women with breast cancer. The current study examined the relationship between perceived stress and self-care behaviors, and explored whether self-compassion moderated this relationship.

METHODS

A sample of 210 women with breast cancer aged 27 to 60 years old from three hospitals in Tehran, Iran completed online self-report questionnaires of self-care behaviors, self-compassion, and perceived stress.

RESULTS

Data analyses with structural equation modeling showed that perceived stress (β = -.37, P < .01) and self-compassion (β = .38, P < .01) were significant predictors of self-care behaviors. The interaction-moderation analysis showed that self-compassion acted as a moderator between perceived stress and self-care behaviors.

CONCLUSIONS

The findings enhance our understanding about the protective role of self-compassion in the relationship between perceived stress and self-care behaviors in women with breast cancer.

The Effectiveness of an Educational Intervention Based on Theories and Models on Diabetes Outcomes: A Systematic Review

Background & Introduction: Patient's self-management behaviors are essential to control diabetes. Studies have demonstrated that health educational interventions can improve some aspects of glycemic control and clinical outcomes, however, it is unclear which education theories underlying these interventions improve effectiveness. In this review of the literature, we aimed to assess the efficacy of health education and promotion theories, or models, to improve self-care and self- management behaviors among patients with type 2 diabetes (T2D). Methods & Results: Eight scientific databases (Web of Science, PubMed, Scopus, Magiran, Google Scholar, Medlib, ProQuest and Scientific Information Database) were searched to identify a published academic article from 2010 to 2019. We included quasi-experimental, clinical trial and randomized clinical trial studies. A total of 26 studies including data from 3879 patients with T2D met the inclusion criteria. We found that the PRECEDE (7/26, 26.92%) and Health Belief Models (7/26, 26.92%) were the most common models used to assess the efficacy of health education and health promotion models. Conclusion: Overall, health promotion and education theories and models have been used as a useful instrument for improving the self-care behaviors and self-management behaviors among patients with T2D.

Relationship Between Self-Care Behavior and Cognitive Function in Hospitalized Adult Patients with Type 2 Diabetes: A Cross-Sectional Study

PURPOSE

To investigate the relationship between diabetes self-care behavior and cognitive function of hospitalized young and middle-aged Chinese patients with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

In this cross-sectional study, young and middle-aged T2DM patients (age range, 35-65 years) were recruited at 4 tertiary hospitals between July 2016 and January 2017. Data pertaining to self-care behavior and cognitive function were collected using two questionnaires (the Summary of Diabetes Self-care Activities [SDSCA] and the Montreal Cognitive Assessment [MoCA], respectively). Multivariate linear regression analysis was performed to assess the correlation between cognitive function and self-care activities.

RESULTS

A total of 140 patients with diabetes were enrolled (mean age, 53.79±7.96 years). The mean duration of T2DM was 10.83±6.76 years. Regarding SDSCA performance, the mean scores for foot care and blood glucose monitoring were 2.20±2.57 and 1.98±2.45, respectively, which were the worst; scores for exercise (4.01±2.58) and diet (3.16±1.89) were better, while scores for medication administration (5.26±2.79) were the best. The prevalence of cognitive impairment was 37.9% (53 patients). After variables adjustment, delayed recall showed a significant correlation with blood sugar monitoring behavior (B =0.224, P=0.019); visual space and executive function (B=0.255, P=0.009) and abstraction (B=-0.337, P=0.001) showed a correlation with foot care behavior.

CONCLUSION

Cognitive ability affects the self-care behavior of patients with T2DM. Assessment of cognitive function may help inform patient education interventions to improve the self-care behavior of these patients.

Differential Impact of Food Insecurity, Distress, and Stress on Self-care Behaviors and Glycemic Control Using Path Analysis

BACKGROUND

The aim of this study was to investigate the direct and indirect pathways through which food insecurity influences glycemic control and self-care behaviors.

METHODS

Using data collected from 615 adults with type 2 diabetes, we investigated pathways between food insecurity and diabetes outcomes using path analysis. We included measures of perceived stress, diabetes distress, diabetes fatalism, and depression as psychosocial factors in the pathway. Self-care behaviors included general diet, specific diet, exercise, blood sugar testing, foot care, and medication adherence. Analyses were conducted using Stata v14, to include both direct and indirect effects, with standardized estimates to allow comparison of paths.

RESULTS

Food insecurity was directly associated with stress (r = 0.43, p < 0.001), depression (r = 0.34, p < 0.001), fatalism (r = 0.09, p = 0.03), and distress (r = 0.36, p < 0.001). The type of stress, however, was differentially associated with outcomes, with distress associated with HbA1c (r = 0.25, p < 0.001), general and specific diet (r = - 0.28 and - 0.17, respectively, p = 0.001), and medication adherence (r = - 0.26, p < 0.001), while stress was associated with specific diet (r = - 0.14, p = 0.005) and medication adherence (r = - 0.15, p < 0.001) and depression was associated with exercise (r = - 0.06, p = 0.007). Food insecurity was indirectly associated with HbA1c (r = 0.08, p = 0.001), and four self-care behaviors (general diet, specific diet, exercise, and medication adherence).

CONCLUSIONS

Food insecurity influences self-care behaviors indirectly via multiple psychosocial factors, and glycemic control indirectly through diabetes distress, supporting the hypothesis that stress is an important mechanism. Programs to improve access to resources and manage psychosocial concerns should be combined with food-based programs for food insecure populations with diabetes.

Gender Differences in the Association between Frailty, Cognitive Impairment, and Self-Care Behaviors Among Older Adults with Atrial Fibrillation

Atrial fibrillation (AF), common in older adults, increases the risk of heart failure, stroke, and all-cause mortality. Self-care behaviors help avoid adverse events in older patients with AF. However, while frailty and cognitive impairment can contribute to poor self-care behaviors, few studies have explored these relationships in older adults with AF. This cross-sectional study aims to determine associations between frailty, cognitive impairment, and self-care behaviors among older adults with AF by gender. A total of 298 patients with AF aged 60 and over were assessed with a self-reported questionnaire consisting of the Korean version of the FRAIL scale, modified mini-mental state examination, and self-care scale for AF. Prevalence of frailty and prefrailty in men and women was around 11% and 48.4% and 28% and 47.4%, respectively. According to the hierarchical linear regression analysis, in men, prefrailty (β = -2.874, p = 0.013) and frailty (β = -7.698, p < 0.001) were associated with self-care behaviors; in women, frailty (β = -5.476, p = 0.003), and cognitive impairment (β = -3.350, p = 0.044) were associated with self-care behaviors. Developing individualized care plans will require periodic screening of older patients with AF to determine their frailty status and cognitive function.

Influencing Pathways to Quality of Life and HbA1c in Patients With Diabetes: A Longitudinal Study That Inform Evidence-Based Practice

BACKGROUND

Determining possible associated factors and the influencing pathways to hemoglobin A1C (HbA1C) levels and quality of life (QoL) will facilitate the development of effective interventions to improve the physical and psychosocial health of patients with type 2 diabetes mellitus (T2DM).

OBJECTIVES

To test a hypothesized model that addressed the pathways among personal characteristics, social support, diabetes distress, and self-care behaviors to HbA1C and QoL.

METHODS

A total of 382 adults with T2DM were recruited. Self-reported questionnaires and medical records were used to collect data regarding personal characteristics, diabetes distress, and social support at baseline. The self-care behaviors characters were collected 6 months later, as well as QoL and HbA1C levels 1 year later.

RESULTS

The 12-month QoL directly affected 12-month HbA1C levels. The 6-month self-care behaviors directly affected 12-month QoL, and indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline diabetes distress directly affected 12-month QoL. Moreover, baseline diabetes distress indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline social support directly affected baseline diabetes distress and 6-month self-care behaviors. In addition, baseline social support indirectly affected 12-month QoL through baseline diabetes distress. Baseline social support also indirectly affected 12-month QoL through 6-month self-care behaviors.

LINKING EVIDENCE TO ACTION

Enhancing QoL is important to improve HbA1C levels. Enhancing self-care behaviors is essential to improve subsequent HbA1C control and QoL. Reducing diabetes distress is crucial to improve subsequent QoL. Improving social support is suggested a favorable strategy to reduce diabetes distress and enhance subsequent self-care behaviors in patients with T2DM.

Cognitive deficits and self-care behaviors in elderly adults with heart failure

Introduction

Elderly adults with heart failure (HF) may have problems with self-care behaviors because of cognitive deficits. Self-care deficits have been found to be significantly associated with negative health care outcomes among HF patients. The aim of this paper was to assess cognitive deficits and the level of self-care ability in elderly patients with HF, and to determine if a relationship exists between cognitive deficits and self-care.

Materials and methods

The study included 270 elderly patients (mean age: 72.5 years) with HF. We used the Mini Mental State Examination Scale (MMSE) to evaluate cognitive functioning, and the European Heart Failure Self-care Behavior Scale, revised into a nine-item scale (EHFScBS-9), to evaluate self-care behaviors. Associations between the variables were examined using multiple regression analysis.

Results

Lower scores in both MMSE and EHFScBS-9 questionnaires were correlated with older age, living alone, lower education, longer duration of illness, higher number of rehospitalizations, as well as lower left ventricular ejection fraction and higher New York Heart Association (NYHA) class. The multiple regression analysis was used for evaluation of the impact of the following predictors: MMSE score, age, duration of illness, ejection fraction, number of hospitalizations, sex, residence, education, relationship status, and NYHA class on EHFScBS-9 score.

Conclusions

Elderly patients with HF may have worse self-care behaviors because of their cognitive deficits. Age was the strongest predictor of worse MMSE scores. Multidisciplinary health teams should pay attention to the special needs of elderly patients who live with their illness for many years and have no social support because of living alone.

Self-care behavior change and depression among low-income predominantly Hispanic patients in safety-net clinics

This study examined whether changes in self-care behaviors during a 12-month period predicted the likelihood of screening positive for depression concurrently and prospectively among low-income Hispanic patients with diabetes. Secondary analyses were conducted with longitudinal data collected from a randomized controlled trial that had tested effectiveness of collaborative depression care. We examined whether changes in self-care behaviors observed during the 12 months after baseline predicted the likelihood of screening positive for depression at 12-, 18-, and 24-month follow-up. Self-care behaviors included healthy diet, exercise, self-blood glucose monitoring, and foot care, which were measured by a validated self-reported instrument. Logistic regression analyses indicated that patients with more frequent healthy diet during the 12 months after baseline had significantly lower likelihood of depression. Patients with more frequent exercise had a lower likelihood of screening for depression at 18- and 24-month follow-up. No significant association was found with self-blood glucose monitoring and foot care. These findings suggest the importance of integrated care that emphasizes healthy diet and exercise, together with traditional depression treatment, when helping low-income Hispanic patients with diabetes and comorbid depression.

Systematic review of provider involvement in heart failure self-care interventions

BACKGROUND AND PURPOSE

Heart failure is a global concern impacting patient outcomes. Self-care interventions improve self-care behaviors in heart failure patients. The impact of direct provider involvement on patient self-care outcomes is unknown in research. The purpose is to review self-care interventions for adults with heart failure and describe direct provider involvement versus no direct provider involvement on patient self-care behaviors.

METHODS

Review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were independently selected, grounded in the population, intervention, comparison, and outcome (PICO) question, and predetermined inclusion/exclusion criteria, including self-care interventions, adult heart failure patients, self-care behavior measurement, and 10-year publication. Quality assessment of studies was conducted.

CONCLUSION

There was a lack of data and quality studies to answer the PICO question. Comparison of variables that impact self-care behaviors is problematic because the interventions are heterogeneous, which limits interpretation of results. There were minimal studies with direct provider involvement. None of the studies conceptually addressed direct provider involvement.

IMPLICATIONS FOR PRACTICE

The involvement of providers, health systems, and patients in pragmatic research can impact the integration of research, policy, and practice. Strategies to decrease threats to internal validity need to be addressed as research is translated into practice.

Diabetes Self-Management Education and Self-Efficacy Among African American Women Living With Type 2 Diabetes in Rural Primary Care

African American women suffer the highest prevalence of type 2 diabetes (T2D). Self-efficacy is important for optimal diabetes self-management (DSM). Purpose: To evaluate DSM by comparing pre- and postintervention responses to a diabetes self-efficacy scale. Design: Descriptive pilot study. Sample: Participants for this study were N = 15 African American women aged 25-65 years (M = 47.4 years) and recruited from a rural health clinic in the Southeastern United States, who received a 4-hr DSM class. Method: Data were collected using the Stanford Self-Efficacy for Diabetes (SED). Results: The increase in the pre- and posttest SED scores were statistically significant, (p < .001). Implications for Nursing: Health care providers should tailor a diabetes education program for these individuals living with T2D. Through a collaborative patient-provider relationship to care, individuals may ultimately experience increased self-efficacy leading to improved DSM.

Internet-Based Resources for Disease Self-Care Among Middle-Aged and Older Women with Chronic Conditions

OBJECTIVE

This two-part study analyzed data collected from middle-aged (age 44-64) and older women (age 65+) with one or more chronic conditions who completed the National Council on Aging Chronic Care Survey.

MATERIALS AND METHODS

Part One analyzed data from 418 women to describe sociodemographics, disease types, and healthcare utilization associated with Internet use among middle-aged and older women with 1 or more chronic diseases. Part Two analyzed data from the 251 Internet-using women to identify the online self-care resources they are using (format, host organization) and for what purposes.

RESULTS

Approximately 31% of participants were age 65 years or older, 30% reported having three or more chronic condition types, and 65% reported using the Internet. A significantly larger proportion of older women reported multiple chronic conditions, and a significantly fewer number of older women reported using the Internet. A significantly smaller proportion of Internet users were non-Hispanic white, more educated, and employed. A significantly larger proportion of non-Internet users reported needing help learning what to do to manage their health conditions and needing help learning how to care for their health conditions. Among only Internet-using women, 18.7% participated in online discussions/chatrooms/listserv and 45.2% read about the experiences of others with chronic diseases. Interest in websites and online courses varied.

CONCLUSION

Understanding Internet use among women with chronic conditions can inform targeted efforts to increase Internet availability, educate potential users about the benefits of online resources, and effectively tailor Internet-based materials to self-care needs.

The changes and factors associated with post-discharge self-care behaviors among Chinese patients with heart failure

BACKGROUND

Self-care behavior is essential for achieving good outcomes among patients with heart failure. Understanding the factors associated with self-care over time is important for the provision of appropriate and targeted interventions. However, little is known regarding the changes and factors associated with post-discharge self-care behaviors among Chinese patients with heart failure.

OBJECTIVE

To investigate the changes and factors of self-care behaviors during the first 3 months following discharge among patients with heart failure in the People's Republic of China.

METHODS

A descriptive design with a convenience sample was utilized in this study. Patients (N=128) from two hospitals, West China Hospital and Angjin Hospital, in Chengdu, People's Republic of China, were recruited from June 2013 to June 2014. The instruments used in the study included the following: the Social Support Rating Scale, the Hospital Anxiety and Depression Scale, the Self-Efficacy for Managing Chronic Disease 6-Item Scale, and the European Heart Failure Self-Care Behaviour Scale. Multivariate linear regression analyses were used to identify the factors related to self-care behaviors at baseline, 1 month, and 3 months following discharge.

RESULTS

Patients' self-care behaviors were poor and decreased significantly over time (F=4.09, P<0.05). The factors associated with self-care behaviors at baseline included the following: education level, comorbidities, and social support. The factors related to self-care behaviors at 1 and 3 months following discharge included the following: education level, comorbidities, social support, and self-efficacy. The variances in self-care behaviors attributed to these factors were 43%, 46%, and 42% at baseline, 1 month, and 3 months following discharge, respectively.

CONCLUSION

Additional support should be provided to patients with heart failure with low educational levels and patients with multiple comorbidities. Follow-up, continuity of care, and family caregiver integration following discharge are necessary for the said patients to improve their self-care behaviors and obtain better outcomes.

Usability Testing of an Internet-Based e-Counseling Platform for Adults With Chronic Heart Failure

Background

Chronic heart failure (CHF) is a major cause of hospitalization and mortality. In order to maintain heart function and quality of life, patients with CHF need to follow recommended self-care guidelines (ie, eating a heart healthy diet, exercising regularly, taking medications as prescribed, monitoring their symptoms, and living a smoke-free life). Yet, adherence to self-care is poor. We have developed an Internet-based e-Counseling platform, Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT), that aims to improve self-care adherence and quality of life in people with CHF. Before assessing the efficacy of this e-platform in a multisite, double-blind, randomized controlled trial, we evaluated the usability of the prototype website.

Objective

The objective of the study was to assess the usability of the CHF-CePPORT e-Counseling platform in terms of navigation, content, and layout.

Methods

CHF patients were purposively sampled from the Heart Function Clinic at the Peter Munk Cardiac Center, University Health Network, to participate in this study. We asked the consented participants to perform specific tasks on the website. These tasks included watching self-help videos and reviewing content as directed. Their interactions with the website were captured using the “think aloud” protocol. After completing the tasks, research personnel conducted a semi-structured interview with each participant to assess their experience with the website. Content analysis of the transcripts from the “think aloud” sessions and the interviews was conducted to identify themes related to navigation, content, and layout of the website. Descriptive statistics were used to summarize the satisfaction data.

Results

A total of 7 men and women (ages 39-77) participated in 2 iterative rounds of testing. Overall, all participants were very satisfied with the content and layout of the website. They reported that the content was helpful to their management of CHF and that it reflected their experiences in coping with CHF. The layout was professional and friendly. The use of videos made the learning process entertaining. However, they experienced many navigation errors in the first round of testing. For example, some participants were not sure how to navigate across a series of Web pages. Based on the experiences that were reported in the first round, we made several changes to the navigation structure. This included using large navigation buttons to direct users to each section and providing tutorial videos to familiarize users with our website. We assessed whether these changes improved user navigation in the second round of testing. The major finding is that participants made fewer navigation errors and they did not identify any new problems.

Conclusions

We found evidence to support the usability of our CHF-CePPORT e-Counseling platform. Our findings highlight the importance of a clear and easy-to-follow navigation structure on user experience.

Effect of diabetes self-efficacy on glycemic control, medication adherence, self-care behaviors, and quality of life in a predominantly low-income, minority population

OBJECTIVE

This study examined the effect of self-efficacy on glycemic control, self-care behaviors, and quality of life in low-income, minority adults with diabetes.

METHODS

Data on 378 participants were examined. Multiple linear regression assessed associations between self-efficacy, hemoglobin A1c, medication adherence, diabetes knowledge, self-care behaviors and quality of life.

RESULTS

Self-efficacy had modest correlations with glycemic control (r = -.250, P < .001), medication adherence (r = -.352, P < .001), diabetes knowledge (r = .118, P = .039), diet (r = .420, P < .001), exercise (r = .220, P < .001), blood sugar testing (r = .213, P < .001), foot care (r = .121, P = .032), and mental health related quality of life (r = .137, P = .017). In the regression model, self-efficacy was significantly associated with glycemic control (3 = -.104, 95% CI: -.157, -.051), medication adherence (3 = -.067, 95% CI: -.090, -.044), diet (3 = .150, 95% CI: .108, .191), exercise (-3 = 113, 95% CI: .065, .161), blood sugar testing (3 = .107, 95% CI: .049, .164) and mental health related quality of life (3 = .112, 95% CI: .051, .173).

CONCLUSION

Higher self-efficacy was associated with improved glycemic control, medication adherence, self-care behavior and mental health related quality of life.

PRACTICE IMPLICATIONS

Emphasis on self-efficacy is relevant for educational interventions developed for low-income, minority populations.