Changes In Self-care Behaviors Research Articles

Social media and health promotion: evaluation of effectiveness in promoting hypertension self-care in urban contexts of social iniquities

This paper explores the role of social media in promoting self-care for Systemic Arterial Hypertension (SAH) and addressing health inequities, emphasizing its significance in the context of the COVID-19 pandemic. It calls for a focus on social determinants of health and highlights the global impact of Chronic Non-Communicable Diseases (NCDs), with a particular focus on Brazil's healthcare system. The research, a collaboration between the University of Brasília and the research initiative Escola de Pacientes DF (EP-DF), employs Participatory Community Based Research (CBPR) to evaluate the impact of social media on SAH self-care in urban areas with social inequities. The study includes a scoping review of relevant articles, document analysis of SAH patient testimonials, and knowledge translation for community understanding. Results from the scoping review show positive changes in self-care behaviors due to social media interventions, while acknowledging challenges such as low Functional Health Literacy (FHL), age, education, and internet access. In conclusion, the paper highlights social media's potential in improving healthcare accessibility and equity for SAH and NCDs in vulnerable communities.

Changes in self-care behaviors of Iranian patients with type 2 diabetes using insulin pens during COVID-19 pandemic.

AimsThe COVID-19 pandemic as a serious public health concern has been accompanied with changes and restrictions in everyday life. This can affect directly or indirectly health behaviors and disease management, particularly in developing countries with low resources. This study aimed to compare self-care behaviors of patients with type 2 diabetes using insulin pens before and after the COVID-19 pandemic.MethodsThis was a prospective cohort study involving 300 patients with type 2 diabetes who had been referred to a referral tertiary care diabetes clinic during 2018–2019. The Summary of Diabetes Self-Care Activities Assessment (SDSCA) questionnaire was used for the evaluation of 5 self-care activities.ResultsThe mean total self-care score before and one year after the onset of the COVID-19 crisis was 37.63 (SD, 10.89) and 26.14 (SD, 10.99), respectively. Before the COVID-19 crisis, 27%, 54.3%, and 18.7% of patients had poor, moderate, and good self-care, respectively. One year after the onset of the epidemic, however, these rates were 66.3%, 29%, and 4.7%, respectively. There was a significant difference between the mean score of 5 indices of self-care behaviors before and after the COVID-19 crisis (p < 0.01).ConclusionOur findings suggest the deterioration of self-care behaviors amidst the COVID-19 pandemic in an Iranian population. Continuous follow-up of patients with diabetes and the design of effective educational programs for these patient can prevent or delay the long-term consequences of diabetes, especially in the context of the COVID-19 crisis.

Child ego state and self-care behavior change in heart failure patients

BackgroundThe psychological characteristics of ego functions interfere with self-care behavior in several diseases. However, the effect of ego functions on self-care behavior after education in heart failure (HF) remains unclear. MethodsSeventy-one HF patients were enrolled. Patients’ scores on the Japanese version of the European Heart Failure Self-care Behaviour Scale (EHFScBS) were measured before and after the HF intervention, and the rate of change was used as an indicator of educational effectiveness. The Tokyo University Egogram New Ver. II was used to assess five types of ego state functions: Critical parent, Nurturing parent, Adult, Free Child, and Adapted Child (AC). ResultsA comparison of the five ego states showed that AC scores were significantly lower than those of the other ego states (p < 0.01). Total EHFScBS scores significantly decreased from 33 (26–39) to 16 (14–20) (p < 0.01) after the HF education, and the median rates of change in EHFScBS was −46.2%. Patients with a lower rate of change in EHFScBS were more likely to have low AC scores, as characterized by a lack of compliance and coordination, and were less likely to receive higher education (all p < 0.05). Even after adjustment for covariates, low AC scores were independently associated with low rate of change in EHFScBS (p < 0.01). ConclusionsEducational behavior change for self-care is less effective in HF patients with an ego state with low AC.

A qualitative study exploring the perceptions and motivations of patients with heart failure who transitioned from non-adherence to adherence

BackgroundManagement of heart failure (HF) involves complex self-care recommendations. Many patients have difficulty adhering to these recommendations, and mechanisms that support behavior change are poorly understood. ObjectiveThe objective of this study was to explore the perceptions and motivations of individuals with HF who became adherent to HF treatment recommendations after being non-adherent. MethodsThis was a qualitative descriptive study. Participants were recruited from cardiology clinics and completed a semi-structured interview on their experiences and motivations for self-care behavior change. Data was analyzed using thematic analysis. The sample size (n = 8) was sufficient to achieve saturation. ResultsFive themes were identified: experiencing mortality, optimism and hope, making connections between behavior and health, self–efficacy, and the role of the clinician. The temporal chronological sequence of these themes across participants varied. ConclusionsThis study adds to our current understanding of HF self-care by suggesting mechanisms that may enhance existing self-care interventions, and demonstrating the important role of the clinician.

Patient decision aids in clinical practice for people with diabetes: a scoping review.

People with diabetes need to make regular choices that influence their long-term morbidity and mortality. Patient decision aids are validated tools and when used collaboratively between healthcare professionals, patients and carers, can help guide value-based discussions which encourage choices that are well informed and personally relevant. To explore the use and effect of patient decision aids in the management of diabetes. A scoping review design was used. Medline, ProQuest, PsycINFO, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases were searched for peer-reviewed articles published between January 1998 and December 2018. Patient decision aids are not commonly or widely used in diabetes management. They offer a suitable adjunct to practice within the domains of healthcare knowledge, active participation, and communication, and shared decision-making between patients and healthcare professionals. Patient decision aids can offer a simple and easy-to-use method to potentially improve diabetes health literacy, through the process of shared decision-making and two-way conversations. However, there are current limitations on using them to positively influence clinical outcomes or long-term changes in self-care behaviors within the management of diabetes. Further research to explore the validity of using patient decision aids long term in these areas is required.

The Effect of Family Diabetes Self-management Education on Self-care Behaviors of Marshallese Adults with Type 2 Diabetes.

Objectives: In this study, we assessed the effect of Family Diabetes Self-Management Educa- tion (DSME) intervention on changes in self-care behaviors among Marshallese adults with type 2 diabetes. Methods: Marshallese adults (N = 211) with type 2 diabetes were randomized to a Family DSME intervention or a Standard DSME intervention. We assessed changes in diabetes- related self-care behaviors from baseline to 12 months within and between study arms using descriptive statistics and mixed effects logistic regression models adjusted for demographic characteristics and use of diabetes medication. Results: Family DSME participants had increased engagement in glucose monitoring and doctor visits, whereas Standard DSME participants had increased engagement in glucose monitoring. Family DSME participants increased engagement in glucose monitoring more than Standard DSME participants. Conclusions: DSME can improve some diabetes related self-care behaviors. Future studies on diabetes management should consider developing and testing interventions that seek to improve long-term rates of engagement in self-care behaviors.

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

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

Text Messaging in the Patient-Centered Medical Home to Improve Glucose Control and Retinopathy Screening.

Purpose: To evaluate the effectiveness of a text messaging program (TMP) to improve glucose control, retinopathy screening (RS) rates, and self-care behaviors in patients with uncontrolled type 2 diabetes.Methods: A single-group design with a quasi-systematic random sample (n=20) received educational/exhortational text messages on their cellular phones for 3 months. Subjects, 12 of whom identified as a minority ethnicity, were mostly male, aged 27–73 years.Results: Glucose control and RS rates improved significantly. Subjects (>70%) reported changes in self-care behaviors.Conclusion: Leveraging ubiquitous technology, a TMP for patients with limited access to healthcare education, holds promise.

Abstract 10283: Motivational Interviewing Decreases Readmissions in Adults With Heart Failure

Introduction: In chronic heart failure (HF), 70% of patients are readmitted to the hospital within 12 months. At least 63% of these readmissions are for a condition other than HF. Hypothesis: We hypothesized that motivational interviewing (MI) would be effective in decreasing readmissions unrelated to HF in HF patients. Methods: Hospitalized adults with HF were enrolled if they were symptomatic (NYHA class II-IV), spoke and read English, lived in a setting where they could independently engage in self-care, and were cognitively intact. We enrolled 100 HF patients (mean age 60 ± 14.3 years; 57% Black, 33% female, 85% NYHA class III/IV symptoms, 64% were educated ≤ high school level) into a randomized controlled trial, using minimization to balance group assignment on NYHA class and gender. Participants in both groups received educational materials emphasizing self-care behavior change. The intervention group received MI emphasizing self-care (e.g. adherence, symptom monitoring) and tailored to individual goals. The intervention was provided by a nurse in a single home visit with 3-4 follow-up phone calls. Participants were followed for 3 months. For the primary outcome, readmission unrelated to HF, a multiple variable regression model was constructed using a backward variable elimination approach. Results: Over 3 months, 25% of the sample had a HF-readmission and 15% had a readmission unrelated to HF. There was an absolute difference of 21% (9 vs 30) in readmissions unrelated to HF between the MI intervention and control groups (p=0.006). The MI group had 94% lower odds of having a readmission unrelated to HF (p=0.001). Each additional unit of hemoglobin was associated with 48% lower odds of having a readmission unrelated to HF (p=0.006). For each additional year of age, the odds of having a readmission unrelated to HF were 7% lower. Participants with diabetes had 6.7 times the odds (p=0.012) of having a readmission unrelated to HF. Conclusion: An MI intervention emphasizing self-care and tailored to individual goals significantly reduced readmissions unrelated to HF in adults with HF, even after accounting for the influence of anemia, age, and diabetes.

A Systematic Review of Web-Based Educational Interventions

A complement to in-hospital educational interventions is web-based patient education accessed during the home recovery period. While findings demonstrate the effectiveness of web-based patient education interventions on patient outcomes, they fall short of identifying the characteristics that are associated with desired outcomes. The purpose of this systematic review was to determine the characteristics of web-based patient education interventions that are associated with producing changes in self-care behaviors. A systematic review involving 19 studies was conducted to determine the most effective components of a web-based intervention. Findings suggest that the most effective form of web-based patient education is one that is interactive and allows patients to navigate the online system on their own. The findings from this systematic review allow for the design of a web-based educational intervention that will promote increased performance of self-care behaviors during the home recovery period.

“Sick and tired of being sick and tired”: a qualitative study of a motivational approach to self-care behavior change in persons with heart failure

Clinicians and scientists have pondered why some patients master self-care and others do not, even after extended educational interventions. The purpose of this qualitative study was to describe the characteristics of heart failure (HF) patients that make them receptive to self-care behavioral change. All patients received an enhanced educational intervention emphasizing motivation and skill building from an advanced practice nurse (APN) trained in motivational interviewing. Audiotaped intervention sessions were conducted during home visits following a HF hospitalization. Transcriptions were analyzed using Atlas software, examined for patient and situational characteristics explaining intervention effectiveness, and augmented with field notes and personal stories. Interviews from 2 to 4 sessions with 8 patients recruited from an urban medical center were analyzed for this study. The sample was 50% female, 62.5% African American with a mean age of 67.6 (±9.9) years. All were NYHA stage II-IV at enrollment; 50% were class II and 50% had systolic HF. Mean ejection fraction was 31.2±21.7%. General coding categories of “living with HF,” “self-care practices,” “supports,” and “knowledge” were derived from data and compared across time and cases to yield a rich description of the journey HF patients undergo as they commit to self-care behavioral change. Emerging themes included the interplay of identity, roles, supports, and values with realities of “living” with HF. The relationship between long standing values and roles surfaced as a critical theme in why some patients successfully adopted behavioral change and how they incorporated self-care practices into their lives. Among those who adopted self-care behavior change, identity shifted and patients began to see themselves as “someone with HF.” The likelihood of this change was influenced by values, goals, and supports. Credibility of coding categories and themes was addressed through persistent engagement with the data and discussions among research team members. An intervention approach that considers long-standing values and roles may be essential in the shift in identity from being “sick and tired of being sick and tired” to taking control of HF. This conclusion is consistent with findings from previous studies focused on other health-related behavioral change, such as smoking cessation and problem drinking.