Psychometric analysis of the cross-cultural Spanish version of the diabetes management questionnaire

Evaluation of the degree of adherence to self-care among Spanish type 1 diabetes (T1DM) pediatric population lacks of a validated tool.

PURPOSE

To cross-culturally adapt and determine the psychometric properties of the Spanish version of the Diabetes Management Questionnaire to assess the degree of adherence to self-care among children with T1DM.

METHODS

Translation, back-translation, and patient suggestions, were considered to obtain the Spanish version (DMQ-Sp). A cross-sectional study was conducted with 323 children (aged 8-18 years) with T1DM and their parents to determine internal reliability, structural validity, and external validity. Responsiveness to change was analyzed through a prospective longitudinal study involving 102 newly diagnosed T1DM patients. Psychometrics were evaluated for the entire sample and stratified by age (8-12 and 13-18 years).

RESULTS

A total of 323 children with T1DM [49.8% female; age 13.3 ± 2.8 years; 155 aged 8-12; glycated hemoglobin (HbA1c) value 7.7 ± 1.0%] answered the Spanish final version. The internal consistency Cronbach's alpha was 0.76 and intraclass correlation coefficient 0.84. Test-retest reliability was r = 0.84 (p < 0.001). Fit index of structural validity was >0.7. External validity correlated inversely with HbA1c (r = -0.39; p < 0.001). The DMQ-Sp score increased significantly after 6 months of receiving the full therapeutic education program (TEP) (baseline 57.07 ± 10.81 vs. 6 months 78.80 ± 10.31; p < 0.001).

CONCLUSION

The DMQ-Sp is reliable, valid, and sensitive to change in a large sample of children (aged 8-18 years) with T1DM and their parents.

PRACTICE IMPLICATIONS

DMQ-Sp can be a useful tool for diabetes teams to identify adherence to different tasks and to evaluate TEPs.

The use of technology to improve medication adherence in heart failure patients: a systematic review of randomised controlled trials

BACKGROUND

Heart failure is an ever-growing contributor to morbidity and mortality in the ageing population. Medication adherence rates among the HF population vary widely in the literature, with a reported range of 10-98%. Technologies have been developed to improve adherence to therapies and other clinical outcomes.

AIMS

This systematic review aims to investigate the effect of different technologies on medication adherence in patients with heart failure. It also aims to determine their impact on other clinical outcomes and examine the potential of these technologies in clinical practice.

METHODS

This systematic review was conducted using the following databases: PubMed Central UK, Embase, MEDLINE, CINAHL Plus, PsycINFO and Cochrane Library until October 2022. Studies were included if they were randomised controlled trials that used technology to improve medication adherence as an outcome in heart failure patients. The Cochrane Collaboration's Risk of Bias tool was used to assess individual studies. This review was registered with PROSPERO (ID: CRD42022371865).

RESULTS

A total of nine studies met the inclusion criteria. Two studies showed statistically significant improvement in medication adherence following their respective interventions. Eight studies had at least one statistically significant result in the other clinical outcomes it measured, including self-care, quality of life and hospitalisations. All studies that evaluated self-care management showed statistically significant improvement. Improvements in other outcomes, such as quality of life and hospitalisations, were inconsistent.

CONCLUSION

It is observable that there is limited evidence for using technology to improve medication adherence in heart failure patients. Further studies with larger study populations and validated self-reporting methods for medication adherence are required.

Potential influences of religiosity and religious coping strategies on people with diabetes

Diabetes is a significant health issue that threatens patients’ overall wellbeing and quality of life. Critical public health concerns center on creating the best approach for diabetes management. Patients and caregivers have different approaches to diabetes management; however, this and the associated physiological, physical and mental health issues remain challenging. This review explores the potential influences of religiosity and religious coping strategies on people with diabetes. This study used a literature review approach to investigate how religiosity and religious coping strategies can influence the effective management of diabetes among patients. Based on the literature search, the researchers were able to identify and cite published papers that were analyzed using the descriptive-narrative analysis. An important goal of the descriptive-narrative analysis was to provide descriptions of the selected literature and take implications from the literature. The results of studies reviewed show some religious coping strategies for managing chronic diseases such as diabetes. The studies did establish a relationship between religiosity and diabetes management and suggest that religious coping strategies could positively impact the management of diabetes; however, they reported some adverse effects. Hence, we propose a pathway for the development of religion-oriented interventions and support framework for the management of diabetes.

Self-care management of bothersome symptoms as recommended by clinicians for patients with a chronic condition: A Delphi study

BACKGROUND

Chronically medically ill patients often need clinical assistance with symptom management, as well as self-care interventions that can help to reduce the impact of bothersome symptoms. Experienced clinicians can help to guide the development of more effective self-care interventions.

OBJECTIVE

To create a consensus-based list of common bothersome symptoms of chronic conditions and of self-care management behaviors recommended to patients by clinicians to reduce the impact of these symptoms.

METHODS

A two-round Delphi study was performed among an international panel of 47 clinicians using online surveys to identify common and bothersome symptoms and related self-care management behaviors recommended to patients with heart failure, chronic obstructive pulmonary disease, asthma, type 2 diabetes, or arthritis.

RESULTS

A total of 30 common bothersome symptoms and 158 self-care management behaviors across the five conditions were listed. Each chronic condition has its own bothersome symptoms and self-care management behaviors. Consensus was reached on the vast majority of recommended behaviors.

CONCLUSIONS

The list of common bothersome symptoms and self-care management behaviors reflect consensus across four countries on many points but also disagreement on others, and a few recommendations are inconsistent with current guidelines. Efforts to encourage clinicians to recommend effective self-care management behaviors may reduce symptom impact in chronically ill patient populations.

SELF-CARE AND QUALITY OF LIFE PEOPLE WITH TYPE 2 DIABETES DURING THE COVID-19: CROSS-SECTIONAL STUDY

Background

. Social distancing and emotional stress during the COVID-19 pandemic have affected the self-care management of type 2 diabetes mellitus patients. There was a shift in self-care management during the COVID-19 that will impact the quality of life of type 2 diabetes mellitus (T2DM) patients. This study aims to determine the relationship between self-care management and quality of life of T2DM patients in the community health center during the lockdown.

Methods

. This research was a quantitative study with a cross-sectional study approach. The sampling technique used a non-probability sampling with total sampling of 89 respondents. The instruments used in this study were WHO Quality of Life-BREF and Summary of Diabetes Self Care Activities.

Findings

The results showed a significant relationship between self-care management and the quality of life of people with type 2 diabetes (p = 0.000) with moderate strength and a positive direction.

Conclusions

People with diabetes coped well with their disease management which was supported by family and health professionals. Sustainable health education and motivation for patients and families are important so that the patients always carry out self-care management to improve the quality of life of type 2 diabetes mellitus patients.

Association between induction of the self-management system for preventing readmission and disease severity and length of readmission in patients with heart failure

Objective

We recently developed the self-management system using the HF points and instructions to visit hospitals or clinics when the points exceed the pre-specified levels. We found that the self-management system decreased the hospitalization for HF with an increase in unplanned visits and early intervention in the outpatient department. However, it is unclear whether we managed severe HF outpatients who should have been hospitalized. In this study, we aimed to compare HF severity in rehospitalized patients with regard to self-management system use.

Results

We retrospectively enrolled 306 patients (153 patients each in the system user and non-user groups) using propensity scores (PS). We compared HF severity and length of readmission in rehospitalized patients in both groups. During the 1-year follow-up period, 24 system users and 43 non-system users in the PS-matched cohort were hospitalized. There were no significant differences between the groups in terms of brain natriuretic peptide levels at readmission, maximum daily intravenous furosemide dose, percentage of patients requiring intravenous inotropes, duration of hospital stay and in-hospital mortality. These results suggest that the HF severity in rehospitalized patients was not different between the two groups.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05864-6.

Association between self-care management practices and glycemic control of patients with type 2 diabetes mellitus in Saud Arabia: A cross -sectional study

Objective

In this cross-sectional study, we aimed to determine the association of self-care management practices and glycemic control of type 2 diabetes mellitus in Saudi Arabia.

Methods

A total of 352 type 2 diabetes mellitus (T2DM) patients from two public tertiary hospitals in Saudi Arabia participated in this study. All T2DM patients were recruited and interviewed by a researcher between January to April 2018 from the outpatient diabetes clinics. All respondents answered a four-part questionnaire which includes demographics data, Diabetes Self-Management Questionnaire (DSMQ). Linear Regression was performed to assess the significance of predictors and compute the coefficient of determination.

Results

The mean age of the participants was 51.89 ± 10.94. Of the 352 participants, 52% were obese (BMI: ≥30 kgm²) and 77% of the participants had glycated haemoglobin (HbA1c) over 7%. The analysis showed that subscale of Glucose management was the strongest predictor of Hba1c levels of participants’ followed by physical activity. Gender and marital status emerged as significant predictors for their self-care management practices. Female patients had more self-care management practices than male patients (B 0.20; 95CI 0.10– 0.96 (p = 0.015).

Conclusion

This study provides an evidence on the self-care management of T2DM patients in Saudi Arabia. The high self-care management found in the study highlights that the patients are aware of the severity of and possible complications associated with T2DM.

Association of the induction of a self-care management system with 1-year outcomes in patients hospitalized for heart failure

BACKGROUND

To perform self-care in patients with heart failure (HF), we developed and implemented a new HF point self-care system, which was characterized by 1) the way weight and HF symptoms were scored ("Heart Failure Points") and 2) the timing of consultations defined for both patients and health care providers. We examined the association between the induction of the new system and 1-year outcomes in patients hospitalized for HF.

METHODS

We retrospectively enrolled 569 consecutive patients into our study who were admitted for HF treatment at our hospital: 275 patients between November 2011 and October 2013 (before the induction of the self-management system) and 294 patients between November 2015 and October 2017 (after the induction). We sought to compare the clinical outcomes between patients using the self-management system and those not using the system after propensity-score (PS) matching. The primary outcome measure was a composite of all-cause death or HF rehospitalization.

RESULTS

The cumulative 1-year incidence of the primary outcome measure in the use group (n = 153) was significantly lower than that in the non-use group (n = 153) (24.5% vs. 34.9%, respectively; p = 0.031; hazard ratio: 0.62; 95% confidence interval: 0.40-0.96), mainly due to a reduction in HF hospitalization.

CONCLUSIONS

The induction of the new self-care system was associated with better 1-year outcomes in patients hospitalized for HF. This system may help patients with HF to achieve more efficient self-care.

Self-care confidence mediates self-care maintenance and management in patients with heart failure

BACKGROUND

Literature highlights the influence of self-care confidence on self-care in patients with heart failure (HF), but little is known whether it explains the influence of other determinants of self-care.

OBJECTIVES

To examine whether confidence explained the associations of social support and HF-knowledge with self-care.

METHODS

In a descriptive, correlational study, 100 patients with HF completed questionnaires on self-care, social support, and HF-specific knowledge. Regression analyses were used to examine associations between perceived support and HF-knowledge and self-care.

RESULTS

Self-care confidence mediated the association between social support and self-care maintenance (path reduced from Beta = 0.713 to 0.395) and HF-knowledge and maintenance (path reduced from Beta = 2.569 to 1.798) and management (path reduced from Beta = -0.272 to -0.144).

CONCLUSION

Self-care confidence explains the influence of social support and knowledge on self-care. Supporting self-care confidence may be a key target for interventions to improve disease management and behaviors in patients with HF.

How Do Youth with Cystic Fibrosis Perceive Their Readiness to Transition to Adult Healthcare Compared to Their Caregivers' Views?

PURPOSE

To describe how perceived stages of change for self-care management skills varies by age in youth with cystic fibrosis in preparation for transition to adult healthcare, to compare caregiver perception of youth readiness for self-care, and age/frequency of transition discussion with provider.

DESIGN AND METHODS

The Transition Readiness Assessment Questionnaire and a modified version (TRAQ-C) for caregivers were used for data collection. Descriptive statistics, simple linear regression, and t-tests were employed.

RESULTS

Regression equations suggest that age predicts youth perception of self-care management skill in all five domains on the TRAQ (p ≤ .009). A paired t-test compared the overall TRAQ and TRAQ-C mean scores between dyads. Youth rated themselves significantly higher in perception of self-care skill management (m = 3.187, sd = 0.769) than caregivers (m = 2.490, sd = 0.788; t = 7.408, df = 51, p < .001). Sixteen was the average age of transition discussion for both youth and caregiver. Reported frequency of discussion varied considerably.

CONCLUSIONS

Although increasing age predicts perception of self-care management, many youth age 18-22 were still only contemplating or starting to learn skills. Skill level perceptions between youth and caregiver differed, but scores from all self-care management domains followed a similar trend. Discussions with providers began later than guidelines recommend and were often not recognized as such by youth.

PRACTICE IMPLICATIONS

Results underscore the importance of beginning transition discussion and skill evaluation in youth with cystic fibrosis at an early age, incorporating caregivers' perception in the process.

Enhanced Patient-Centered Educational Program for HF Self-care management in Sub-acute settings

Heart Failure (HF) is a complex condition that leads to inadequate blood circulation causing shortness of breath, fatigue, and weakness. It is one of the leading causes of death in the United States. Heart failure is associated with adverse outcomes such as high rates of hospitalization, readmission, mortality, and poor quality of life. However, despite the establishment of interventions to assist with the control of HF, numerous patients are still being readmitted to the hospital. The main purpose of this evidence-based practice (EBP) project was to implement and evaluate the effectiveness of patient centered educational program on self-care management among HF patients in sub-acute settings. The EBP was implemented in two sub-acute units at Alaris Health located at Cedar Grove. A total of 20 participants completed the pretest and 14 participants completed the post test. The Expanded Chronic Care Model of 2003 (ECCM) was utilized as the theoretical framework to coordinate the health determinants which is the "self-care management." This EBP project used a pretest and post-test using the tool Self-care of Heart Failure Index V6.2(SCHFI). The data was analyzed using the descriptive statistics using the mean and the difference between the pre- and post-test scores. Educational intervention was provided based on the survey scores. The intervention involved provision of educational program related to effective self-care management among HF patients, their families, and care providers. The results of the study demonstrated a statically significant increase in the mean score between the pre-and post-survey related to self-care maintenance, self-care management, and self-confidence. The results of the project suggested that patient-centered educational program can enhance self-care maintenance, management, and confidence among heart failure patients.

Factors Related to Self-Care in Heart Failure Patients According to the Middle-Range Theory of Self-Care of Chronic Illness: a Literature Update

Purpose of the Review

As described in the theory of self-care in chronic illness, there is a wide range of factors that can influence self-care behavior. The purpose of this paper is to summarize the recent heart failure literature on these related factors in order to provide an overview on which factors might be suitable to be considered to make self-care interventions more successful.

Recent Findings

Recent studies in heart failure patients confirm that factors described in the theory of self-care of chronic illness are relevant for heart failure patients.

Summary

Experiences and skills, motivation, habits, cultural beliefs and values, functional and cognitive abilities, confidence, and support and access to care are all important to consider when developing or improving interventions for patients with heart failure and their families. Additional personal and contextual factors that might influence self-care need to be explored and included in future studies and theory development efforts.

The Use of Phone Technology in Outpatient Populations: A Systematic Review

Objective:

A systematic review was conducted to identify the types of phone technology used in the adult outpatient population with a focus on Hispanic patients and psychiatric populations.

Methods:

A search for articles was conducted on the EMBASE, PubMed and PsycINFO databases. Articles reviewed were peer-reviewed, full-text, English language and published through mid-November 2014.

Results:

Twenty-one articles were included in this review and grouped according to combinations of phone technology, medical specialty area and population. For all articles, phone technology was defined as telephone, cell, or smart phone. Technology was used in psychiatry with Hispanic population in four articles, in psychiatry with non-Hispanic population in seven articles and in other specialties with Hispanic population in ten articles. Articles were evaluated for quality. Six articles were assessed as strong, eight were moderate and seven were weak in global quality. Interventions included direct communication, text messaging, interactive voice response, camera and smart phone app. Studies with Hispanic populations used more text messaging, while studies in psychiatry favored direct communication. The majority of articles in all groups yielded improvements in health outcomes.

Conclusion:

Few studies have been conducted using phone technology in Hispanic and psychiatric populations. Various phone technologies can be helpful to patients in diverse populations and have demonstrated success in improving a variety of specific and overall healthcare outcomes. Phone technologies are easily adapted to numerous settings and populations and are valuable tools in efforts to increase access to care.

Cognitive function and self-care management in older patients with heart failure

AIMS

People with heart failure have difficulty with self-care management. We do not know if patients with heart failure have difficulty with self-care management due to underlying, mild cognitive impairment (MCI). The purpose of this study was to determine whether MCI, as identified on a simple screening tool, is significantly associated with self-care management in a sample of community dwelling older patients with heart failure.

METHODS AND RESULTS

Using a cross-sectional design, heart failure patients (n=100, mean age 72 SD 10 years) attending an outpatient heart failure clinic completed the Montreal Cognitive Assessment tool (MoCA), Self-Care in Heart Failure Index (SCHFI) and Geriatric Depression Scale. The presence of MCI, as defined by a MoCA score <26, was present in 73% patients; 21% had an adequate self-care management SCHFI score; and 12% reported symptoms of depression. Participants with a MoCA score <26 vs. ≥ 26 scored significantly lower on the self-care management subscale of the SCHFI (48.1 SD 24 vs. 59.3 SD 22 respectively, p=0.035). Using backward regression, the final model was fitted to self-care management while controlling for age and sex and was significant, with (F= 7.04 df (3, 96), and p<0.001), accounting for 18% of the total variance in self-care management (R (2) = 18.03%). The MoCA score was the only variable which remained in the model significantly with p= 0.001.

CONCLUSION

Findings from this study highlight the difficulty older heart failure patients have with self-care management and the need to include formal screening for MCI when exploring variables contributing to self-care management in heart failure patients.