Aspects Of Self-care Research Articles

Clinical and Sociodemographic Profile, Self-Care, Adherence and Motivation for Treatment, and Satisfaction with Social Support in Portuguese Patients with Type 2 Diabetes

Objective: This study aimed to characterize the sociodemographic and clinical profiles of Portuguese patients with type 2 diabetes mellitus (T2DM) and to assess their self-care practices, treatment adherence, motivation, and satisfaction with social support. Methods: A cross-sectional observational study was conducted at an endocrinology unit in northern Portugal from January 2021 to December 2022. The sample included 303 adult patients with T2DM who provided informed consent. Data were collected using a structured questionnaire addressing sociodemographic, clinical, and self-care aspects. Validated scales were used to assess diabetes knowledge, self-care activities, treatment adherence, motivation, and social support. Results: Of the 303 patients enrolled, with a median age of 67 years, 51.2% were female and 68.2% retired. Clinical measures showed a median systolic blood pressure of 135 mmHg, abdominal circumference of 104.6 cm, and BMI of 29.3 kg/m2. Self-care practices were suboptimal, with only 25.1% of patients consistently following a healthy diet, and 31% engaged in weekly physical activity. Although treatment adherence was generally high, issues like forgetfulness were reported. Satisfaction with social support varied, with 30% of patients feeling isolated. Conclusions: The study identifies significant gaps in diet and physical activity adherence among T2DM patients. There is a need for targeted educational interventions and enhanced support systems to improve self-care and treatment outcomes. Personalized care strategies addressing educational, motivational, and social support factors are crucial to better managing T2DM and improving patient well-being.

Applying health promotion knowledge to self-care: healthy eating and weight management for nurses.

Promoting health in the workplace is a national and international public health priority, and health promotion is a central aspect of the nursing role. However, nurses' knowledge of health promotion does not always translate to self-care and there are barriers to some aspects of self-care at work, such as healthy eating. Evidence suggests that rates of overweight and obesity in nurses are relatively high and commensurate with the general population, which has implications for their health and well-being and their delivery of health promotion to patients. This article discusses health in the workplace and some of the evidence on overweight and obesity among nurses, including how this may influence their health promotion practice. The author also considers barriers and enablers to nurses' healthy eating at work and suggests some approaches that individual nurses and healthcare organisations can take to improve healthy eating.

Cognitive Behavioral Therapy: A Quasi-Experimental Study of Self Care Activity with Type 2 Diabetes Mellitus Patients

Individuals diagnosed with diabetes mellitus require a multi-faceted approach to treatment. Key aspects of self-care for these patients include maintaining a proper diet, engaging in regular physical activity, adhering to prescribed medications, consistently monitoring blood glucose levels, caring for the legs, and managing smoking habits. Among the therapeutic interventions used in nursing, Cognitive Behavioral Therapy (CBT) is noteworthy. The purpose of this study was to examine the impact of CBT on self-care behaviors in patients with Type 2 diabetes mellitus. Utilizing a quasi-experimental design, this study implemented a pre and post-test control group methodology. A total of 32 participants were selected based on specific criteria and probability sampling methods were employed to determine the sample. Data was gathered using the Summary of Self-Care Diabetic Activity questionnaire. Findings from the study indicate that CBT significantly enhanced dietary compliance (p-value = 0.02), increased physical activity (p-value = 0.001), and improved independent blood glucose monitoring (p-value = 0.003). Additionally, CBT enhanced adherence to medication (p-value = 0.004), leg care (p-value = 0.004), and reduced smoking behaviors (p-value = 0.021). CBT effective in enhancing various self-care activities among diabetic patients by fostering changes in mindset and encouraging positive behavioral shifts

Research on Color Design of Elderly Apartments

Aiming at the phenomenon of aging of the population and the change in family structure, we study the problems related to the independent living of the self-care elderly in apartments and the color design of the space. The article explains the definition of color psychology and analyzes the influence of color on the psychological and physiological aspects of self-care for elderly people in residential spaces. The article applies the principles of color psychology to the design of elderly apartments and explores the role of color in creating the atmosphere of the interior space. It is proposed to use color aesthetics and design rules to create a pleasant color space atmosphere, that and convenient for the elderly to live in the space color design scheme. This study can provide a theoretical reference for the design of living spaces for the elderly.

Exploring the Link Between Personality Traits and Self-Care Dimensions in Individuals Affected by Type 2 Diabetes Mellitus: A Comprehensive Systematic Review and Meta-Analysis

IntroductionType 2 diabetes mellitus (T2DM) is a prevalent, chronic metabolic disorder that exerts diverse effects on individuals’ physical and psychological well-being.ObjectivesOur aim was to investigate the potential correlation between personality traits and self-care aspects among individuals living with T2DM.MethodsWe conducted a thorough search in PsycINFO, CINAHL, and PubMed/Medline for peer-reviewed articles from inception to January 9, 2023. Following PRISMA guidelines, two reviewers independently screened, extracted data, and assessed bias. We used random-effects meta-analysis for pooling estimatesResultsWe identified 23 studies meeting our inclusion criteria. Openness, conscientiousness, and agreeableness were linked to better foot care compliance (OR = 2.53, 95% CI = 1.49-4.28; OR = 1.84, 95% CI = 1.10-3.08; and OR = 2.07, 95% CI = 1.23-3.48, respectively). Openness was also associated with improved overall self-care behaviors (OR = 2.00, 95% CI = 1.17-3.41), while conscientiousness reduced smoking likelihood (OR = 0.96, 95% CI = 0.93-0.99), and agreeableness enhanced medication adherence (OR = 1.68, 95% CI = 1.34-2.31). However, extraversion and neuroticism were linked to lower medication adherence (OR = 0.77, 95% CI = 0.61-0.96 and OR = 0.51, 95% CI = 0.40-0.65, respectively). Neuroticism also negatively affected overall self-care behaviors (OR = 0.67, 95% CI: 0.55-0.81).Image:ConclusionsPersonality traits should be considered when addressing self-care in T2DM patients.Disclosure of InterestNone Declared

A Pilot Feasibility Evaluation of a Heart Rate Variability Biofeedback App to Improve Self-Care in COVID-19 Healthcare Workers.

COVID-19 exacerbated burnout and mental health concerns among the healthcare workforce. Due to high work stress, demanding schedules made attuned eating behaviors a particularly challenging aspect of self-care for healthcare workers. This study aimed to examine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) mobile app for improving well-being among healthcare workers reporting elevated disordered eating during COVID-19. We conducted a mixed methods pre-mid-post single-arm pilot feasibility trial (ClinicalTrials.gov NCT04921228). Deductive content analysis of participants' commentary generated qualitative themes. Linear mixed models were used to examine changes in pre- mid- to post-assessment scores on well-being outcomes. We consented 28 healthcare workers (25/89% female; 23/82% Non-Hispanic White; 22/79% nurses) to use and evaluate an HRVB mobile app. Of these, 25/89% fully enrolled by attending the app and device training; 23/82% were engaged in all elements of the protocol. Thirteen (52%) completed at least 10 min of HRVB on two-thirds or more study days. Most participants (18/75%) reported being likely or extremely likely to continue HRVB. Common barriers to engagement were busy schedules, fatigue, and technology difficulties. However, participants felt that HRVB helped them relax and connect better to their body's signals and experiences. Results suggested preliminary evidence of efficacy for improving interoceptive sensibility, mindful self-care, body appreciation, intuitive eating, stress, resilience, and disordered eating. HRVB has potential as a low-cost adjunct tool for enhancing well-being in healthcare workers through positively connecting to the body, especially during times of increased stress when attuned eating behavior becomes difficult to uphold.

Social Support and Adherence to Self-Care Behavior Among Patients With Coronary Heart Disease and Heart Failure: A Systematic Review.

Cardiovascular diseases stand out as the foremost cause of mortality on a global scale and encompass conditions that require long term self-care. Coronary heart disease and heart failure are two cardiovascular conditions that require significant lifestyle modifications. Adherence to self-care is a multifaceted phenomenon, and is influenced by various factors that include social, economic, disease-related and healthcare system-related factors. A key factor in adherence to self-care in chronic illnesses is social support. To explore this relationship between social support and adherence to self-care, a systematic review was carried out across Scopus, EBSCO host and ProQuest from October 2022 to February 2023 using predefined search criteria. Studies from inception to February 2023 were considered for the review, ultimately incorporating a total of 11 studies. Six studies had an adult population with coronary heart disease while the remaining five had adults with heart failure. All the studies reported a significant positive correlation between social support and adherence to self-care. Our findings revealed that social support plays a significant role in promoting self-care, emphasizing the need for a holistic understanding of self-care to develop effective interventions. Along with self-report measures, objective measures should be used to assess adherence accurately. There is a need for scales that assess all aspects of self-care, as well as the development of new interventions and teaching strategies to facilitate the individual's self-care journey. In addition, family members and trusted resources should be involved in encouraging self-care, and interventions should target both patients and their family members.

N06 Self-care in patients affected by inflammatory bowel disease: SELF-IBD observational study in a single center

Abstract Background Self-care is an active process to maintain and promote health in chronic disease situations, and is effective in the results of many chronic diseases. So far, few studies have been conducted on the self-care of IBD. The study of self-care in IBD is also motivate, by the increase in prevalence in the coming years and the impact on health resources it could have. In addition, the study of self-care in relation to socio-sanitary features and habits within the population affected by IBD may be the beginning to identify areas for educational interventions by health care personnel. The primary objective of this study is to describe the levels of self-care maintenance, monitoring and management in patients with IBD. Methods Cross-sectional observational study to evaluate self-care in IBD patient. The questionnaire used was the Self-Care of Chronic Disease Index (SCCII). The SCCII investigates three aspects of self-care, maintenance, monitoring and management and the self-efficacy. The sociodemographic characteristics and some patient habits such as smoking habit, fatigue, exercise, sleep, nutrition and supplement use, were investigated. Ethics Committee approved Results We enrolled 85 patients with an average age of 44.8±16.8, of which 51.8% (female) and 50.6% (CD), 48.4% (UC). The level of self-care (SCCII) areas investigated ranged from score levels of 71.30 (Self-maintenance), 79.52 (self-monitoring), 68.94 (self-management) and 75.70 (self-efficacy). In the area of self-care maintenance the aspects that seem least considered by patients (never or rarely) are stress management (44.1%) and exercise (40%). Only 57.6% of patients often or always get enough sleep and only 22.3% of patients follow a healthy diet. The presence of fatigue seems to affect 68% of patients in the self-monitoring phase. In the area of self-management, only 41.2% of patients (often or always) try to rest during the day and only 52% of the sample succeeds continuously with the appearance of symptoms. In self-efficacy, it seems that 85.8% of the patients interviewed persist in following the treatment even when it is difficult. It seems that men have more significant levels of self-maintenance score 74. vs 68.8 (p>0.01) than women. Table 1 shows the average self-care scores in relation to the habits investigated. Conclusion From the results of our study it seems that patients with IBD have adequate levels of self-care (score ≥70), although sleep/rest, diet and exercise seem not to be highly considered by patients. Future studies may investigate which specific sociodemographic and clinical characteristics can be identified as predictors of maintaining self-care, self-care management and self-confidence, to improve areas of nurse educational intervention.

Unveiling the Nexus: Depressive Symptoms and Medication Adherence in Hypertensive Patients' Self-care: A Systematic Review.

Hypertension, a significant public health concern, is frequently linked to emotional disorders like depression. Research shows a reciprocal link between depression and hypertension, potentially influencing patients' adherence to self-care routines. This systematic review aimed to examine the association between depressive symptoms and aspects of self-care, with a focus on medication adherence in individuals diagnosed with hypertension. Following PRISMA guidelines, a systematic review was conducted by searching PubMed, PsycINFO and Scopus until March 17, 2023. The included studies involved quantitative primary research conducted in English, focusing on adults (≥18 years) diagnosed with hypertension and experiencing depressive symptoms. Observational studies were assessed using the Newcastle-Ottawa Scale, and randomized controlled trials were evaluated using the revised Cochrane Risk of Bias Tool (RoB 2.0). Due to the great diversity of these studies, a narrative synthesis of the results was undertaken. Results: A total of 18 studies involving 6,131 people with hypertension, that met our eligibility criteria were ultimately included. The reported rates of depressive symptoms ranged from 4% to 43%. Of these studies, nine reported a statistically significant association, showcasing an adverse impact of depressive symptoms on medication adherence. The remaining nine did not confirm the above. This systematic review highlights the diverse body of research exploring depressive symptoms and medication adherence among individuals with hypertension. The review suggests a need for increased attention to self-care practices, particularly in relation to adherence to antihypertensive medication. However, it recommends the conduction of more robust longitudinal studies to comprehensively explore this relationship.

Association of Personality Traits and Self-Care Behaviors in People With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Diabetes self-care is critical for individuals with type 2 diabetes mellitus (T2DM), and exploring the impact of personality traits on this domain remains pivotal. This study aimed to investigate the association between personality traits and various dimensions of self-care in people with T2DM. A Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA)-guided systematic review with meta-analysis was conducted. Two reviewers independently screened articles, extracted data, and assessed the risk of bias. Estimates were pooled using random-effects meta-analysis. Twenty-three studies, that met our inclusion criteria, revealed distinct associations between certain personality traits and various aspects of self-care. Notably, traits such as openness, conscientiousness, and agreeableness showed associations with improved foot care compliance (odds ratio (OR) = 2.53, 95% CI = 1.49-4.28; OR = 1.84, 95% CI = 1.10-3.08; and OR = 2.07, 95% CI = 1.23-3.48, respectively). Openness was also linked to better overall self-care behaviors (OR = 2.00, 95% CI = 1.17-3.41), while conscientiousness correlated with reduced smoking (OR = 0.96, 95% CI = 0.93-0.99), and agreeableness was associated with improved medication adherence (OR = 1.68, 95% CI = 1.34-2.31). Conversely, traits like extraversion and neuroticism showed associations with decreased medication adherence (OR = 0.77, 95% CI = 0.61-0.96 and OR = 0.51, 95% CI = 0.40-0.65, respectively), with neuroticism additionally linked to lower overall self-care behaviors (OR = 0.67, 95% CI: 0.55-0.81). This study emphasizes the intricate role of personality traits in shaping self-care practices in individuals with T2DM, underscoring the significance of factoring these traits into tailoring and improving diabetes self-care strategies. Nevertheless, establishing definitive causal relationships mandates further in-depth longitudinal investigations and broader meta-analyses to achieve a more conclusive understanding.

Self-care behaviours and practices of professional nurses working in primary health care clinics.

Historically, the nursing profession focused on caring for patients, families and communities but neglected aspects of self-care. Self-care is essential for nurses, as it could impact the quality of care nurses render to patients. This article investigated professional nurses' self-care behaviours and practices in primary health care clinics. The study was conducted at selected primary health care facilities (clinics) in regions C and D of the city of Johannesburg, Gauteng. A cross-sectional descriptive research survey. Stratified random sampling was used to select respondents. A demographic questionnaire, Self-Care Activities Screening Scale (SASS-14), Nature of Supportive Work Environment questionnaire and Self-Care Work and Home Environmental Factors (SWHEF) questionnaire were combined as the data collection instrument for this study. Descriptive and inferential statistics were used to analyse the collected data. The finding revealed health consciousness: 86.6% of professional nurses were alert to changes in their health, and 75.2% constantly examined their health. The average professional nurse slept only 7-8 h every day. While 59.4% of professional nurses who participated in the study seldom ate healthy foods (i.e. foods with less sugar, salt, fried snacks or pre-cooked food), 71.7% rarely ate three fruits and two portions of vegetables daily. Only 57.4% of professional nurses regularly drank eight recommended glasses of water daily. According to the findings, primary health care nurses must prioritise self-care and work in supportive environments.Contribution:The study acknowledged the need to promote self-care and supportive work environments for professional nurses in primary health care setting.

Assessing Self-Care Practises of People Living With HIV/AIDS Attending the Antiretroviral Clinic of the University of Abuja Teaching Hospital, Nigeria

In pursuance of the Global and National Goals of achieving HIV-AIDS epidemic control, it’s imperative to explore the Promotion of self-care management among people living with HIV/AIDS. Self-care management involves adhering to treatment regimens, good dietary patterns, increased physical exercise, social support, and health-seeking behaviours. The study reviewed five core pillars of self-care management: physical, psychological, emotional, spiritual, and workplace/professional. A cross-sectional descriptive, analytical study with a quantitative approach was conducted at the Antiretroviral Clinic of the University of Abuja Teaching Hospital from October to December 2020. Using random sampling, 372 people living with AIDS participated in the study. Trained research assistants collected data through a structured questionnaire administered at the antiretroviral clinic. The data was analysed using SPSS version 25.0, employing frequencies, computations, percentages, averages, means, standard deviation, and correlations, with a confidence interval of 95%. The study’s findings indicate that the weighted matrix scores (WMS) for various aspects of self-care were significantly above average, suggesting that PLHIV attending the antiretroviral clinic at the University of Abuja Teaching Hospital exhibit good self-care practices. However, psychological and workplace self-care requires some strengthening. The study revealed differences between self-reported appointment adherence and the calculated average appointment gap (3 visits). Associations were found between the average appointment gap and viral load among participants. The study did not establish any significant association between Total Matrixed self-care scores, adherence (appointment gap), or viral load suppression. The COVID epidemic and the nationwide ENDSARS protest in Nigeria during the study period were significant confounders and limitations. Keywords: Antiretroviral drugs, appointment adherence, HIV/AIDS, psychological health, self-care management.

Validity and reliability of the Korean caregiver contribution to self-care chronic illness inventory

The contribution of caregivers to self-care for chronically ill patients is important for improving patient outcomes. The Caregiver Contribution to Self-Care Chronic Illness Inventory (CC-SC-CII) has been used to assess caregivers’ contributions to three distinct aspects of self-care (maintenance, monitoring, and management) globally. This study aimed to examine the psychometrics of the Korean version of the CC-SC-CII with 230 family caregivers (mean age = 49.8 years, 70% women) of patients with chronic illness. We demonstrated that the CC-SC-CII-Korean has good reliability with acceptable internal consistency and construct validity for all three factors using confirmatory factor analysis. The CC-SC-CII-Korean is a reliable and valid instrument to measure the contributions of Korean caregivers to the self-care of patients with chronic illnesses.

Children and adolescents with physical disabilities: describing characteristics and disability-related needs in the Kilimanjaro region, north-eastern Tanzania – a cross-sectional survey

ObjectivesTo describe the characteristics and disability-related needs of children and adolescents with physical disabilities in the Kilimanjaro region, North-Eastern Tanzania.DesignA cross-sectional community survey was conducted from November 2020 to June...

Self-care Practices of Patients With Heart Failure Using Wearable Electronic Devices: A Systematic Review.

Heart failure (HF) is the fastest growing cardiovascular condition globally; associated management costs and hospitalizations place an immense burden on healthcare systems. Wearable electronic devices (WEDs) may be useful tools to enhance HF management and mitigate negative health outcomes. We aimed to perform a systematic review to examine the potential of WEDs to support HF self-care in ambulatory patients at home. Five databases were searched for studies published between 2007 and May 2022, including OVID MEDLINE, EMBASE (OVID), APA PsycINFO (OVID), Cochrane Central Register of Controlled Trials (OVID), and CINAHL Plus with Full Text (Ebsco). After 6210 duplicates were removed, 4045 records were screened and 6 were included for review (2 conference abstracts and 4 full-text citations). All studies used WEDs as 1 component of a larger intervention. Outcome measures included quality of life, physical activity, self-efficacy, self-care, functional status, time to readmission, social isolation, and mood. Studies were of moderate to high quality and mixed findings were reported. Enhanced exercise habits and motivational behavior to exercise, as well as decreased adverse symptoms of fatigue and dyspnea, were identified in 2 studies. However, improvements in exercise capacity and increased motivational behavior did not lead to exercise adherence in another 2 studies. The findings from this review suggest that WEDs may be a viable health behavior improvement strategy for patients with HF. However, studies of higher quality, with the primary intervention being a WED, and consistent outcome measures are needed to replicate the positive findings of studies identified in this review.

A psycho-educational intervention for the prevention of foot lesions in people with diabetes: Report of a clinical audit

Background and aimsMotivational approaches may help target the psychological aspects of self-care, improving adherence to good practices in individuals with diabetes. The present study was designed to test the feasibility and effectiveness of a psychoeducational program for diabetic foot prevention or disease progression. Methods and resultsEighty-one subjects with or at high risk of foot ulcer development entered a program consisting of six 120-min group sessions, conducted by a podiatrist and an expert in psycho-education. Occurrence/recurrence of lesions in a 3-year follow-up was compared with 172 cases with similar risk score (IWGDF score 2019), receiving education at any 6-month podiatric visit (standard-of-care). Motivation to self-care and competence were assessed by specific questionnaires. The experimental program increased adherence to follow-up. The prevalence of foot lesions was higher at baseline and was remarkably reduced at any time-point in patients attending the psychoeducational program, whereas it remained relatively stable in standard care (around 10% of cases). The cumulative incidence was lower in the psychoeducational program (13.2, 95% CI 9.2–18.0 per 100 patient-year vs. 26.1; 95% CI 22.1–30.2); time to new lesions was increased (P = 0.022). Cox proportional hazard analysis confirmed an overall reduction of lesions in the psychoeducational program (HR 0.34; 95% CI 0.18–0.66; P < 0.001), after adjustment for confounders. The program was associated with significant changes in competence and motivation to self-care. ConclusionA psychoeducational approach is both feasible and effective to support patients with diabetes at high risk of first or recurrent foot lesions, increasing their adherence to self-care practices.

Knowledge, Attitude, and Practice towards Over-the-Counter Drugs (OTC) use among adult population in Jeddah, Saudi Arabia

Background: Despite all their benefits, improper use of medicines can bring potential health hazards. Though it was previously considered unnecessary, responsible self-medication is regarded as an essential aspect of self-care. Objectives: To explore the Knowledge, Attitude, and Practice on Over-the-Counter Drugs (OTC) use, and its determinants among the adult population in Jeddah, Saudi Arabia Method: It was a cross sectional study, where data were collected through online Google form to collect information on 503 subjects; where the sample type was a convenient one. A predesigned questionnaire was used to collect information on personal, sociodemographic and clinical information, as well as on the knowledge, attitude and practice on use of OTC drugs. Statistical analysis: SPSS version 24 was used, and the Subroutine Chi square test of significance was used. The level of significance was 0.05. Results: The majority of the enrolled subjects (83.3%) used OTC drugs (419/503). About 60% were under the age of 40 years old. Lower educational level, and increased salary over 10,000 SR were significantly associated with the use of OTC drugs (p &lt; 0.05). About 80% were advised on the use of the OTC drugs by pharmacists; and 53.7% read about indications, side effects and contraindications of the OTC drugs before their use. About 80% used them for emergency; and 71% used them for treatment of mild illnesses. About 90% used them because of their past experience with their use, and 30% used them to avoid consultation fees. Painkillers were used by 97.4% of the subjects; in addition, cough suppressants (71.8%), dietary supplements (69.2%), antihistamine (40.3%) and digestive and laxative drugs (48.9%) were used. About 30%, considered that OTC drugs were cheaper and convenient. About 45% of the subjects considered that OTC drugs were safe and effective. About 80% considered it was wrong. to use the OTC drugs with other medications Conclusion: In Saudi Arabia, OTC medications can easily be obtained at pharmacies for the purpose of self-treatment. Approximately 83% of Jeddah survey respondents reported that they had used OTC drugs. The most commonly used OTC medications were antipyretics, analgesics and anti-inflammatory drugs, and these drugs were more commonly used by respondents aged &lt;40 years than those aged 40 years. The awareness level of the survey respondents on the side effects resulting from the use of OTC medications was relatively low. Keywords: OTC drugs, KAP, Saudi Arabia, mild illnesses

IDF21-0662 Diabetes CarePak: Creating & testing a bundling solution to improve access to safe insulin administration in Kenya

Background: The discovery of insulin in 1921 changed the lives of people living with diabetes (PLWD). Yet, millions still lack access to insulin. Additionally, an unrecognized number of PLWD cannot access or afford the commodities needed to measure their blood glucose (BG) or safely administer insulin itself. This inconsistent access (further exacerbated by COVID) forces PLWD to ration insulin, test strips, and ration or reuse needles/syringes, leading to increased rates of severe complications, including death. This represents a huge unmet need and a call-to-action for service delivery innovation. Aim: Diabetes CarePak project aims to:•develop a human-centered “co-packaging” solution that increases access to the combination of medication and associated supplies needed for safe administration of insulin and self-care to improve quality of life and health outcomes•demonstrate health system benefits and preliminary cost savings to the Kenyan government to advocate for broader uptake. Method: We partnered with > 100 individuals, in Kenya, with lived, clinical, or work expertise in diabetes, to actualize the “care package” included in the Kenya Ministry of Health (MOH) 2018 clinical management guidelines. Utilizing human-centered design (HCD), we conducted interviews and focus groups across three counties with PLWD, health care workers (HCW), and MOH officials to co-create the CarePak prototype, and the educational and training materials for PLWD and HCWs. The CarePak prototype, which included items such as a glucometer, test strips, lancets, needles/syringes (if applicable), and educational materials was given to 23 users with Type 1 (T1D) or Type 2 (T2D) diabetes, across five facilities within the three counties, to be used daily, at home, for two months. Nine users had T1D, eight users had T2D and used insulin, and 6 users had T2D and used oral medication. Fourteen users were female and eight were from a rural area. Users completed baseline and end-line questionnaires and pre-/post-HbA1c values were documented. Usability feedback was gathered through home, clinic, and virtual visits. Results: Emerging themes included limited diabetes management/self-care knowledge (PLWD were unaware of what type of diabetes they had, incorrect insulin injection techniques were observed), limited access to personal BG monitoring (>70% of the PLWD did not own monitoring equipment), frequent reuse of needles/syringes due to cost or unreliable availability, and frequent visits to multiple facilities to get all supplies due to stockouts. Following use of the CarePak, users reported changes in individual lifestyle management (e.g. increased self-monitoring of BG, changes in diet), clinical management changes (e.g. changes in insulin regimens using BG data over time), and improved clinical outcomes (e.g. fewer sores from needle reuse, an average HbA1C improvement of 2.8% over two months). Discussion: The HCD methodology, with PLWD at the center of the co-creation process, captured key diabetes management challenges, the need for a bundle of commodities, and ensured the CarePak was usable, feasible, and valuable. CarePak iterations continue in Kenya and work is expanding to additional countries in 2022. As COVID-19 continues to stress supply chains and PLWD, we have an obligation to address all aspects of self-care, otherwise we will continue to fail PLWD globally.

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.