Aspects Of Self-care Research Articles

IDF21-0259 Development of a self-care program for older people with type 2 diabetes attending community health centers

Background: Diabetes is a growing problem globally, with the major impact being experienced in low and middle-income countries. In South Africa, diabetes is a major cause of morbidity and mortality and a burden to the overstretched health services, community, family, and people with the disease. Self-care management is a cornerstone of diabetes care. Aim: To inform the development of a self-care management program for older people attending public sector primary health care services in Cape Town, South Africa by using the PRECEDE planning model. Method: (1) This research study is based on the theoretical framework of the PRECEDE-PROCEED model (PPM). (2) In the PPM, a complete needs assessment involving phases should be made before planning a health promotion intervention. Results: This research study incorporates five interlinked studies, The first was a systematic review of studies that assessed the prevalence of type 2 diabetes mellitus among older people in African countries conducted between 2000 and 2015 with the objective of providing data for the monitoring of future trends. the overall prevalence of diabetes was 13.7% (95% CI 11·3–16·3) and was twofold higher in studies based on the oral glucose tolerance test than in those using fasting plasma blood glucose. The second is a secondary analysis of the Study on global AGEing and adult health (SAGE) South Africa Wave 1 data that examined the prevalence of self-reported diabetes and the association between diabetes and each health-related quality of life and disability amongst South Africa’s older adults. The results were that diabetes was associated with lower quality of life and greater disability. The third, a cross-sectional survey, examines the knowledge of older people with diabetes attending primary care clinics. Its major finding is that there was a lack of knowledge about the complications of diabetes, suggesting that the available diabetes educational opportunities have not been effective. Importantly, however, social support was positively associated with both knowledge and a number of self-care aspects. The fourth is a qualitative study consisting of a documentary review. This found that generally older persons face numerous barriers in managing their condition. Further, there are multiple efforts to re-orientate the healthcare system to focus more effectively on non-communicable diseases for the population which would benefit older patients with diabetes. Finally, the study includes a systematic review of peer and non-professional health worker-led diabetes self-management programmes (COMP-DSMP) in low and middle-income country primary health care settings, and also examines the implementation strategies and associated diabetes-related health outcomes This found equivocal evidence supporting the use of COMP-DSMP for people with diabetes in these countries and suggested that the models of a peer/CHW-led programme need to be further explored, especially given the inevitability of a professional healthcare workforce shortage in LMICs Discussion: This research alerts policymakers and clinicians to some of the specific issues considered to be pertinent and important in the care and management of older persons with diabetes. Many of these would also be applicable to older individuals with other chronic conditions.

Self-care among persons with heart failure: Examining the impact of mindfulness and impulsivity using conditional process analysis.

According to the literature, self-care in persons with heart failure is inadequate. Such inadequate levels of self-care necessitate a thorough investigation of the potential predictors. To: (a) determine the level of self-care among persons with heart failure in Jordan; (b) determine the relationship between mindfulness, impulsivity, and self-care among persons with heart failure; (c) investigate the potential moderation effect of impulsivity on the relationship between mindfulness and self-care. A cross-sectional study was conducted. A convenience sample of 100 persons with heart failure in an outpatient clinic at King Abdullah University Hospital was recruited. The following tools were used to collect the data via phone survey: Self-Care of Heart Failure Index, Barratt Impulsiveness Scale, and the Mindful Attention Awareness Scale. The sample consisted of 78 male and 22 female persons with heart failure. The effect of mindfulness was statistically significant only on self-care symptom perception, and not significant on other aspects of self-care. Impulsivity moderated only the effect of mindfulness on self-care symptom perception. Correlation analysis showed a significant relationship between mindfulness and impulsivity (r = -.532, p < .01). Mindfulness is likely to improve at least one aspect of self-care (self-care symptom perception) and reduce impulsivity among heart failure persons.

The Effect of an Automated Mobile Patient Engagement Application on Emergency Department Revisits: Prospective Observational Study

BackgroundRevisits within 30 days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continue to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system’s finances in a value-based care or global budget environment. LifeBridge Health, a community health system in Maryland, United States, implemented an automated mobile patient engagement application as part of our enterprise-wide digital health strategy to improve patient engagement and reduce revisits to the ED.ObjectiveThe aim of this paper was to evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to reduce 30-day revisits after home discharge from an ED.MethodsThe LifeBridge Health Innovation Department and ED staff from 2 participating health system hospitals collaborated with GetWellNetwork to customize their patient engagement application with automated check-in questions and other on-demand resources (eg, streaming content explaining aspects of self-care during COVID-19). An application link was emailed to adult patients discharged home from the ED. A study of ED visits for patients treated for general medicine and cardiology conditions between August 1, 2018, and July 31, 2019, was conducted using CRISP (Chesapeake Regional Information System for our Patients), Maryland’s state-designated health information exchange. We also used data within GetWell Loop (GetWellNetwork) to track patient activation and engagement. The primary outcome was the number of ED patients who experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary outcomes included the overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the application. Bivariate analysis comparing outcomes among patients who activated the GetWell Loop application to patients who did not was conducted using the Fisher exact test. Multivariate logistic regression modeling with elastic net regularization was also performed to account for potential confounders and potential collinearity of covariates.ResultsDuring this 1-year study, 1062 (27.4%) of 3866 of all emergency patients treated for general medicine or cardiology conditions, who received an invite to use the digital application, activated their account. The patients discharged from the ED, who were treated for general medicine conditions (n=2087) and who activated their GetWell Loop account, experienced a 30-day revisit rate of 17.3% (n=101) compared with 24.6% (n=369) for those who did not activate their account (P<.001). Of the patients treated for cardiology conditions (n=1779), 12.8% (n=61) of those who activated their GetWell account experienced a 30-day revisit compared with 17.7% (n=231) of those who did not activate their account (P=.01). The significance of these findings persisted after adjustment for confounding variables including age, race, sex, and payor in logistic regression modeling (adjusted odds ratio 0.75, 95% CI 0.62-0.92; P=.006).ConclusionsOur results suggest that a significant percentage of patients are willing to utilize a digital application following ED discharge to better engage in their own care, and that usage of such digital applications may significantly reduce 30-day revisit rates. LifeBridge Health’s experience demonstrates that health care systems can leverage automated mobile apps to improve patient engagement and successfully impact clinical outcomes at scale.

Extent of and Factors Associated with Self-Medication among Clients Visiting Community Pharmacies in the Era of COVID-19: Does It Relieve the Possible Impact of the Pandemic on the Health-Care System?

BackgroundSelf-medication is one aspect of self-care that has been shown to benefit primary health care. When done correctly, it provides significant benefits to customers, such as self-reliance and cost savings. Inappropriate methods, on the other hand, such as incorrect self-diagnosis and therapy selection, can be disastrous. The COVID-19 pandemic context may benefit the community in easing the burden on the health system. There have been no studies conducted on this possibility in the context of COVID-19 in a selected area, hence the purpose of this study was to determine the extent of and factors associated with self-medication among clients visiting community pharmacies in west Harerghe, Ethiopia from June 1 to 30, 2020.MethodsThis institution-based cross-sectional study used a systemic random sample of 416 community-pharmacy clients. To collect data, face-to-face interviews were conducted using pretested semistructured questionnaires modified from established techniques. EpiData 3.1 was used to enter data and SPSS 24 for analysis. To determine factors associated with self-medications, bivariate and multivariate logistic regression analyses were performed. AORs with 95% CIs are used to report associations, and the level of significance was set at P<0.05.ResultsThe proportion of people self-medicating was 73.6% (95% CI 69.2%–77.9%). Self-medications were significantly associated with age 18–24 years (AOR 9.28, 95% CI 3.56–24.21) and 25–34 years (AOR 3.54, 95% CI 1.35–9.27), Amhara ethnicity (AOR 1.72, 95% CI 1.01–2.94), current single status (AOR 0.28, 95% CI 0.15–0.51), government employment (AOR 0.31, 95% CI 0.12–0.82), and limited knowledge (AOR 2.31, 95% CI 1.40–3.79).ConclusionThree in four participants practiced self-medication in the era of COVID-19. Repetition was significantly associated with age, ethnicity, current marital status, type of occupation, and knowledge about self-medications. An alternative medical care–delivery system by all health-care providers and increasing community awareness should be promoted.

FUNCTIONS AND CONCEPTS OF CASE MANAGEMENT IN THE WORK OF A PATIENT CARE SPECIALIST

The concept of case management is a method of action dedicated to the care of people in the social and health sector. Case management stands for a human service approach that provides the necessary support, treatment, promotion and care to the affected person in sensitive and critical life situations. Individual attention as a person-related service extends to a wide range of applications in the fields of care, rehabilitation, child and youth welfare, family and disability welfare and health care. At the center is "the case" as a construction that represents the affected circumstances of the person in need of help. The task of the case manager is to initiate a caring managerial process of action that corresponds to the situational context of the person seeking help in their social environment. The basic criterion here is a cooperative intersectoral and interdisciplinary, transprofessional collaboration of all human service actors, which constitutes a care network. The intention of the case management process is to effectively and efficiently deal with the problems of the person concerned. The decisive premise for the person to be cared for is the recovery or maintenance of his or her autonomy and sovereignty, which is indicated by the client-related participation and co-creation, the aspect of self-care up to a development of the self-management of the addressee. The conceptual architecture of case management is based on an interdependent double strategy, which on the one hand delineates the action-oriented methods of the person related case level and on the other hand implies a strategic process design on the organizational or system level between the human service providers. The linking of both system levels is exhausted in different case-dependent control variants and fixed process forms, which represent the core elements of methodical action at the case and system level.

Exploring equity in accessing diabetes management treatment: A healthcare gap analysis

Healthcare inequities are often investigated empirically as associations between socio-economic characteristics and differences between observed healthcare utilisation and estimates of needs-based utilisation. However, the concept of ‘need’ is tricky to operationalise and utilisation may be contingent on inequities arising at an earlier stage. In this study, we apply a unique combination of register and survey data collected in 2019 to assess equity in opportunities to access treatment for patients with recently diagnosed type 2 diabetes. In the study of this population (N = 1864) we escape the challenge of estimating needs by arguing that need can be approximated from treatment guidelines within a nationwide framework of disease management programmes. Furthermore, instead of observed utilisation we use patient reports on whether they have been offered treatment as a measure of opportunities to access multiple components of care, that is, we focus on possible inequalities arising prior to possible utilisation inequalities. ‘Healthcare gaps’ are computed as the discrepancy between an index of guideline recommended treatments and patients' perceived offers of treatments, thus providing a novel take on the ‘healthcare deprivation profiles’ approach to the study of healthcare inequalities. Using this method, we explore and document inequalities along multiple dimensions of familiar socio-economic factors (income, education, occupation) as well as self-reported barriers to access. We also provide supporting evidence that healthcare gaps, as measured in our study, are associated with poorer quality of care, and that those who experience large gaps are more likely to be disadvantaged in terms of self-reported difficulties in relation to key self-care aspects. We conclude that even in a health system with comprehensive universal coverage, healthcare inequity can arise already at the stage of offering access to preventive treatment. The results warrant further research into the causes, consequences and remedies of such inequities.

Measuring the Change in Health-Related Quality of Life in Patients Using Marijuana for Pain Relief

Introduction: Current evidence suggests that cannabinoids are safe with minimal side effects and are effective in managing chronic pain. Data also show that medical marijuana (MM) may improve quality of life (QoL) among patients. However, there are little data showing the health-related QoL (HRQoL) benefit in MM patients using it for pain. The purpose of this study was to determine if there is a relationship between HRQol and MM use in patients using it to relieve pain. Methods: All pain patients aged 18 years or older enrolled in the Pennsylvania MM program were eligible for inclusion. Recruited subjects completed 4 surveys – at enrollment (baseline) then 2, 4, and 8 weeks post-enrollment. We used the EQ-5D survey tool for measuring HRQoL. The primary outcome measure was the change in the EQ-5D Index Score from survey 2 to survey 4 (6 week difference). Secondary outcomes included self-reported pain and health scores. Data were analyzed using a paired t test and repeated-measures multivariable analysis to control for both gender and length of time between surveys. Results: 1,762 people responded to the screening request, and 1,393 (79%) met screening criteria. Of those, 353 (25.3%) agreed to participate and 51% completed all 4 surveys, for a final sample of 181 with 85 male and 95 female and one nonbinary subject. The average age was 41.21 (SD = 12.9) years, with no difference between genders. The adjusted HRQoL score improved from 0.722 to 0.747 (p = 0.011) from survey 2 to survey 4, as did the self-reported pain and health scores. The EQ-5D subscales revealed no change in mobility or usual activities, significant improvement in anxiety and pain, and a significant worsening in self-care. Conclusion: The results show a significant improvement in HRQoL among patients using MM for pain. The EQ-5D subscales validated the pain improvement and also showed an improvement in anxiety. However, the decline in the self-care subscale may have tempered the overall improvement in HRQoL, and further research into which aspects of self-care are impacted by MM use in this population is warranted. Overall, there is a positive relationship between MM use and HRQoL in patients using it for pain.

Effectiveness of A Coping Style- related Instructional program on Self - Care of Patients with Diabetes Mellitus Type II at Endocrinology and Diabetes Center in Al-Basra City

Methodology: A descriptive analytic (quasi – experimental) design. Sample composed of (60) patients were divided into two groups study and control group, (30) patients in each one. Results: The study findings Shows that participants’ age group at a level (46-65 years) were (67.7%) of the study group, and (56.7%) of the control group. (56.7%) of the study group were male, while (53.3%) of the control groups were female. The study also confirms that the effectiveness of a Coping style related instructional program on Self - Care of Patients with Diabetes Mellitus Type II at Endocrinology and Diabetes Center in Al-Basra City, Iraq.Conclusion : The study concludes that A coping style-related instructional program is effective to enhance diabetes patients’ self-care activities, knowledge, and coping style among patients with T2DM. This conclusion is based on the result of our study that reveals significant differences between pre-intervention and post-intervention. Recommendations: Improve knowledge and self-care activities of patients with T2DM, by using our study guidelines.. Encourage the health care provider to improve diabetic patients’ self-care activities and focusing on all domain aspects of self-care.

Chronic disease self-care: A concept analysis.

The purpose of this concept analysis is to clarify and analyze the concept of self-care. Self-care is vital in the prevention, control, and management of chronic disease. It is substantially important in all aspects of health and all levels of care, and it is key to chronic disease management. Walker and Avant's (2011) method for concept analysis was used. A literature search was performed using the Cumulative Index to Nursing and Allied Health Literature, Psych INFO, Cochrane Library, Embase, Medline, and Google Scholar databases for relevant articles published between 2000 and 2020 using the search terms self-care, chronic illness, and chronic disease. A total of 22 articles were found for the final analysis. The three defining attributes of self-care include readiness, ability, and activity/practice. Similarly, antecedents (illness/treatment, health systems, and environment) and consequences (health status improvement and wellbeing-related, symptom management-related, cost reduction-related, and personal development-related) of self-care were derived from literature. Constructed cases were created to illustrate these aspects of self-care. Through this concept analysis, the complexity and breadth of the self-care concept are elucidated.

Self-care and related factors in patients with type II diabetes in Iran.

To assess Self-care and related factors in patients with type II diabetes in Iran. This descriptive cross-sectional study was performed on 100 patients with type II diabetes who were referred to specialized diabetes centers related to Arak University of Medical Sciences in Iran. Data collection was done using a researcher-made questionnaire. The questionnaire consisted of three parts (the first part was demographic information, the second part was self-care behaviors such as diet, exercise, control, treatment, and prevention of complications over the past seven days, and the third part was factors influencing patients' self-care behaviors). The inclusion criteria were; patients 18-80years of age with a diagnosis of type 2 diabetes, at least one year passed of diabetes diagnosis, no chronic diseases other than those related to diabetes, had awareness of the diagnosis, had no hearing and speech impairments, and no mental illnesses. The exclusion criteria was the patient's failure to answer all questions of the questionnaire. Data analysis was performed using SPSS software version 16, and using descriptive statistics and Pearson test, independent t-test, one-way analysis of variance and Spearman test. The mean score of self-care in patients was 84.41 ± 11.75 and at the intermediate level. Spearman correlation coefficient test results showed a significant relationship between self-care behavior and gender (p = 0.001), and insurance type (p = 0.035). Also, men had higher average self-care compared to women (p = 0.001). The highest average score of self-care was in Adherence to medication and the lowest score was in exercise and physical activity. Due to the low self-care score in exercise and physical activity and the lack of periodic renal examinations, planning and educational interventions in all aspects of self-care, especially in terms of sports and physical activity, and periodic renal examinations are essential.

Cluster Identification of Diabetic Risk Factors among Saudi Population

Aims: The aim of the study was to estimate the prevalence and risk factors of diabetes mellitus among adult population of Albaha region, Saudi Arabia and to identify the diabetic risk clusters among Saudi population using various cluster analysis techniques.&#x0D; Study Design: Cross-sectional observation and Hierarchal cluster analyses.&#x0D; Place and Duration of Study: The study was conducted in three different cities of the Albaha region, Saudi Arabia including Albaha, AlAqiq and Baljurashi among Saudi adults 15 years of age or above. The study was carried out from April 2019 to May 2019.&#x0D; Methodology: The first part of the research was a random cross-sectional observational diabetic risk factors screening using a structured questionnaire among adult volunteers of the Albaha region. The second part constituted a multiple cluster analysis technique performed to identify the diabetic risk factors from 13 regions of Saudi Arabia, clustered into five main regions, using NCSS software.&#x0D; Results: In the first part, the risk factors identified among non-diabetic participants showed a significant association with the development of diabetes mellitus, particularly physical inactivity (49.12%), hypertension (41.15%), and high body mass index (19.03%). Likewise, in 11.54% of diabetic patients, elevated body mass index (30.51%), hypertension (27.12%) and physical inactivity (55.93%), which could be associated with diabetic complications. In the second part, the three forms of cluster analyses (the agglomerate hierarchical cluster, clustered heat map and K means clustering analysis) identified physical inactivity and high body mass index as key risk factors which are connected to all other risk factors among the total of 213591 volunteers.&#x0D; Conclusion: Increased prevalence of diabetes and risk of developing diabetes mellitus in the Kingdom require substantial education and training programs to counsel volunteers on all aspects of self-care. Our data provides a robust evidence to establish diabetic counseling through regular diabetes awareness program that can reduce the risk of developing diabetes mellitus.

Factors associated with the risk of diabetic foot in patients with diabetes mellitus in Primary Care.

To analyze factors associated with diabetic foot risk in patients with diabetes mellitus assisted in Primary Care. Observational, analytic, and transversal study took place in Teresina, Piauí, with diabetic patients who are assisted in Primary Care. Data collection took place through interviews, foot clinical exams, and medical record analysis. We used the Mann-Whitney, Pearson's Chi-square and multiple logistic regression statistics tests to analyze the data. The association power among categorical variables was measured by Odds Ratio . 322 patients participated. Marital status with a partner presented a protection factor (p = 0.007). Risk factors for the development of the diabetic foot are: arterial hypertension (p = 0.045), obesity (p = 0.011), smoking (p = 0.027), not being submitted to follow ups (p = 0.046), inadequate control of capillary blood glucose (p < 0.001), indisposition to the care of the foot (p=0.014), and foot self-exam less frequently (p = 0.040). Sociodemographic, clinical, and self-care aspects interfere in diabetic foot development, highlighting the necessity of effective follow up tracking and educational interventions for patients with diabetes mellitus in Primary Care.

Adherence to Secondary Prevention and Influential Factors in Individuals with Coronary Angioplasty.

Objective.To explore the relation between adherence to secondary prevention and factors that influence on said adherence in people with acute coronary syndrome, who underwent percutaneous coronary angioplasty in a clinic in Medellín.Methods.Cross-sectional study on a random sample of 128 volunteer patients. A questionnaire was used for sociodemographic variables, the “Scale to measure therapeutic adherence for patients with chronic diseases, based on explicit behaviors” by Trujano, Vega, and Nava and the “Instrument to evaluate adherence by patients according to influential cardiovascular risk factors” validated by Consuelo Ortiz.Results.Socioeconomic factors influenced in very low manner on the adherence to secondary prevention; factors related with the therapy did so moderately and patient factors influenced in low manner. No relation was found between the health provider factor and said adherence.Conclusion.Factors exist that influence in a lesser or higher measure on adherence to secondary prevention and which must be recognized in people with coronary angioplasty to design strategies to improve this aspect of self-care.

A systematic review of self-care measures for adolescents with health needs.

The current study sought to review instruments measuring self-care for adolescents with health needs to provide a summary of the tools available for conducting self-care research in this population. Studies were mainly identified through searches in three electronic bibliographic databases (i.e., PsycINFO, CINAHL, and PubMed) and additional sources to retrieve relevant articles. Studies were included if they focused on self-care measures, included samples of adolescents (ages 10-19), were published in English peer-reviewed journals, dissertations, and from the years 1980 through 2020. The COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) was used to assess the methodological quality of each study and evaluate the measurement quality based on available studies. A total of ten scales from 12 papers were identified to meet the search criteria and designed for adolescent patients with three types of health needs, including diabetes, cystic fibrosis, and others (female care and nutrition). There is a lack of a clear and comprehensive definition of self-care for different health needs. The dominant focus of the scales was the behavioral aspect of self-care (e.g., adherence to medication regimen), with only a few scales (e.g., female care) assessing the psychological aspect of self-care. The quality of the psychometric properties of the scales varied greatly. Results highlighted the need for more research on developing and validating self-care measures for adolescents with health needs. The unique developmental characteristics of adolescents should be adequately considered, and the psychological aspect of self-care should be incorporated in measurement development.

Frequency Of Neck Disability Among Patients Wearing Complete Dentures

BACKGROUND: Temporomandibular disorder (TMD) is a collective terminology embracing a number of medical issues, which involve the masticatory musculature, the temporomandibular joint or both. Complete denture wearing most often not only effects TMJ but also effects the neck and its functionality.&#x0D; OBJECTIVETo assess the frequency and level of Neck disability among patients wearing complete dentures.&#x0D; METHODSIn this study a total of 100 complete denture wearing patients participated. Patients with any previous maxillofacial injury, trauma and below the age of 40 were excluded. Simple convenient sampling was used to collect all the data. Results: A total of 100 complete denture wearing patients participated in this study. The study included 50(50%) male and 50(50%) female with and average mean age of 57.68.&#x0D; RESULTResults showed 11(11%) experienced moderate recurring pain at neck movement, 10(10%) needed help every day in most aspects of self-care, 6(6%) patients wearing full dentures suffered from moderate neck pain or disability.&#x0D; CONCLUSIONThe study concluded that frequency and level of Neck Pain was variable among patients wearing complete dentures. Many of the full denture wearing patients experienced more than one clinical symptoms of Neck Disability.

The ‘work’ of self-care for people with cardiovascular disease and prediabetes: An interpretive description

BackgroundCardiovascular disease and sustained high blood glucose (prediabetes) are established concurrent diagnoses. People with these concomitant conditions carry out self-care which is overt (e.g., daily weighing or taking a specific diet), plus there are also concealed facets of self-care (e.g., accessing information about diet or medications). Also of note is the need to 'work' to achieve a self-determined level of self-care. The 'work' put into self-care is currently under-reported when people discuss their progress with health professionals. ObjectiveOur research aimed to demonstrate that aspects of self-care are typically concealed. A further objective was to reveal the extent of 'work' dedicated to self-care. DesignInterviews were conducted with 23 participants to reveal their experiences of long-term conditions, cardiovascular disease and prediabetes. Interpretive description underpinned the development of a thematic representation of the data. Setting and participantsRecruitment was from a tertiary hospital coronary care unit in New Zealand. Included participants were those with an acute coronary event, also found to have a high blood glucose. Those people known to have diabetes prior to admission were not included. MethodParticipants were interviewed once, for approximately 60 min, nine months after discharge home. The data is analysed using thematic analysis, organising an interpretation into themes. ResultsSelf-care requires 'work', the work itself was frequently understated by participants, they trivialised their important role in their self-care. Participants often required prompting to discuss the responsibilities, choices and behaviours they participated in to support self-care to improve their health and well-being. Participant data showed how the 'work' of self-care aligned to three work themes: solo self-care, teamwork, and constant companion self-care. ConclusionNurses can improve the outcomes for people with long-term conditions by acknowledging and incorporating the often concealed 'work' of self-care when assessing, planning and implementing health care in any clinical setting. A important recommendation for nurses is to support people-as-patients, by encouraging self-determination and working with the preferences patients have for self-care, in order to enhance their quality of life while living with ill-health.

The impact of internet-based cognitive behavioral therapy and depressive symptoms on self-care behavior in patients with heart failure: A secondary analysis of a randomised controlled trial

BackgroundPatients with chronic heart failure may require treatment of depressive symptoms to improve self-care behaviour. ObjectivesTo investigate the impact of internet-based cognitive behavioral therapy (CBT) on self-care behaviour in heart failure patients, and to study the association between changes in depressive symptoms and changes in self-care behaviour. DesignA secondary analysis of data collected in a pilot randomized controlled study. Setting50 heart failure patients with depressive symptoms were recruited from four hospitals in Sweden. MethodsPatients were randomized to nine weeks of internet-based CBT (n = 25) or to an active control group participating in an online discussion forum (n = 25). In week two and three, those in the internet-based CBT group worked with psychoeducation about heart failure and depression, emphasizing heart failure self-care. During the same weeks those in the on-line discussion forum specifically discussed heart failure self-care. Patient Health Questionnaire-9 was used to measure depressive symptoms at baseline and at the nine-week follow-up. The European Heart Failure Self-care Behaviour Scale-9 was used to measure self-care behaviour (i.e., the summary score and the subscales autonomous based, provider based and consulting behaviour) at baseline, and at the three-week and nine-week follow-ups. ResultsNo significant differences were found in self-care between the patients in the internet-based CBT and the patients in the online discussion group at the three- and nine-week follow-up. Within-group analysis of the changes in the European Heart Failure Self-care Behaviour Scale showed that from baseline to week three, the summary score increased significantly for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.15). At the nine-week follow-up, these scores had decreased. Similarly, consulting behaviour improved at week three for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.22). Provider-based adherence at the nine-week follow-up had increased from baseline in the internet-based CBT group (p = 0.05) whereas it had decreased in the on-line discussion group. Improvement in symptoms of depression was significantly associated with improvement in autonomy-based self-care (r = 0.34, p = 0.03). ConclusionImprovement in depressive symptoms was associated with improved autonomous-based self-care. ICBT for depression in HF may benefit aspects of self-care that are vital to improve symptoms and prognosis.

'If I die, I die, I don't care about my health': Perspectives on self-care of people experiencing homelessness.

Self-care, which refers to what people do to prevent disease and maintain good health, can alleviate negative health consequences of people experiencing homelessness. The aim of the study was to apply a theoretically informed approach in exploring engagement of people experiencing homelessness in self-care and to identify factors that can be targeted in future health and social care interventions. Qualitative semi-structured interviews were conducted with 28 participants opportunistically recruited from a specialist homelessness healthcare centre of North East Scotland, the United Kingdom (UK). An interview schedule was developed based on the theoretical domains framework (TDF). Interviews were audio-recorded and transcribed verbatim. Six aspects of self-care were explored, including (a) self-awareness of physical and mental health, (b) health literacy, including health seeking behaviour, (c) healthy eating, (d) risk avoidance or mitigation, (v) physical activity and sleep and (e) maintaining personal hygiene. Thematic analysis was conducted by two independent researchers following the Framework Approach. Participants described low engagement in self-care. Most of the barriers to engagement in self-care by participants were related to 'environmental context and resources' domain of TDF. Participants often resorted to stealing or begging for food. Many perceived having low health literacy to interpret health-related information. Visits to churches and charities to get a shower or to obtain free meals were commonplace. Participants expressed pessimism that there was 'nothing' they could do to improve their health and described perceived barriers often too big for them to overcome. Alienation, lack of social support and the perception that they had done irreversible damage to their health prevented their involvement in self-care. The theme of 'social circle' held examples of both enabler and barriers in participants' uptake of risky behaviours. Health and social services should work with persons experiencing homelessness in designing and delivering targeted interventions that address contextual barriers, multi-morbidity, health literacy and self-efficacy.

Development and Psychometric Validation of the Novel Glucose Monitoring Experiences Questionnaire Among Adults with Type 1 Diabetes.

Background: Glucose monitoring is an essential aspect of self-care for people with type 1 diabetes. With technologies developing rapidly, valid assessment of user experiences and satisfaction is needed. Our aim was to develop a novel measure: the Glucose Monitoring Experiences Questionnaire (GME-Q). Methods: Questionnaire design was informed by exploratory and cognitive debriefing interviews. The GME-Q was included in a large online survey enabling psychometric validation. Results: The interview sample included 17 adults (aged [mean ± SD] 46 ± 11 years, 53% women) with type 1 diabetes duration of 26 ± 14 years. The proposed conceptual framework included three domains: "Effectiveness", "Intrusiveness", and "Convenience", assessed with 25 items plus a single, overview item. The validation sample included 589 adults (aged 44 ± 15 years; 64% women) with type 1 diabetes (duration: 22 ± 14 years, self-monitoring blood glucose [SMBG] using finger-prick devices: median [IQR] 6 [4-7] daily checks). Questionnaire acceptability was indicated: 98% (n = 578) completion rate. After deleting 3 redundant items, principal components analysis supported a 22-item questionnaire with 3 domains ("Effectiveness" [9 items]; "Intrusiveness" [6 items]; "Convenience" [7 items]), accounting for 55% of variance, with good internal consistency reliability (α = 0.83-0.88). Subscales correlated significantly (rs = ±0.44-0.66, P < 0.001) with the single, overview item, together explaining 51% of the total variance in the single item score. Associations with demographic and clinical characteristics supported convergent and discriminant validity. Conclusions: Overall, the 22-item GME-Q is a brief, acceptable, valid, and reliable measure of satisfaction with glucose monitoring in adults with type 1 diabetes using SMBG, and this needs to be assessed among those using continuous glucose monitoring.

Education in people with venous leg ulcers based on a brochure about compression therapy: A quasi-randomised controlled trial.

Brochures are a useful supplement to patient education. There is increasing evidence that they are an effective medium to support patient satisfaction, adherence, and empowerment. This study aims to produce reliable data on how much patients with venous leg ulcer (VLU) may profit from a brochure that focuses on VLU and on measures and aims of the related compression therapy. The evaluation took part from October 2018 until March 2019 and included 136 patients with VLU and related compression therapy. They were randomly sorted into a case group and a control group of 68 patients each. The case group received a brochure about venous disease and compression therapy and filled in a questionnaire after reading. The questions ranged from basic knowledge about VLU and compression therapy to aspects of self‐care. The control group answered the same questions without previous reading of the brochure. The results show that in almost every aspect, the patients in the case group were better informed about their diseases, the compression therapy, and how they may support the measures adequately. This study suggests that patients with VLU may profit from a brochure that explains their disease and the related compression therapy. Better knowledge and understanding may strengthen their empowerment and adherence.