Improvement In Self-care Research Articles

Do Medicare Inpatient Rehabilitation Facility Patients' Self-Care and Mobility Outcomes Vary by Dual Eligibility Status, Race and Ethnicity, Rural Residence, Socioeconomic Status, and Living Alone?

To examine whether inpatient rehabilitation facility (IRF) patients' risk-adjusted functional outcomes varied with five social drivers of health: Medicare-Medicaid dual eligibility status, race and ethnicity, rural residence, socioeconomic status (SES), and living alone. This cohort study examined unadjusted and adjusted mobility and self-care change scores during IRF stays for 428,710 Medicare patients with and without social drivers of health. Regression models isolated the mean marginal effect of each of the five social factors on mobility and self-care change scores after adjusting for covariates. Patients with full dual status had slightly lower risk-adjusted mobility and self-care improvement (-4.5% and -3.3%, respectively) compared to patients without dual status. Patients who identified as Black, Asian and Native Hawaiian had self-care marginal effects that were slightly lower (-4.8%, -4.1% and -3.7%, respectively) than patients who were White. Patients living in lower SES neighborhoods and patients who lived alone had slightly higher mobility and self-care improvement scores. Risk-adjusted marginal differences in improvement scores for patients with and without these social factors were small and did not meet the meaningfully different criteria. Overall, IRF patients' risk-adjusted functional outcomes did not vary meaningfully by dual eligibility status, race or ethnicity, rural residence, SES or living alone.

Investigating the health literacy of Covid-19 and its relation to self-care in health ambassadors of Urmia

Background. The coronavirus disease 19 (COVID-19) is one of the most important public health issues, and the evaluation and improvement of COVID-19 health literacy and self-care can be effective in preventing its spread. This study was conducted to investigate the health literacy of COVID-19 and its relationship with self-care among the health ambassadors of Urmia in 2021. Methods. In this descriptive-analytical study, 400 health ambassadors of Urmia were selected using the cluster random sampling method. The data-gathering tool was a questionnaire, including questions about self-care, COVID-19 health literacy, and demographic information. The data were analyzed by SPSS 19 using analysis of variance and regression tests. Results. COVID-19-related health literacy was reported to be at a good level (63.5%) in most health ambassadors. In addition, it had a statistically significant relationship with the level of education and economic status. Similarly, there was a significant relationship between self-care and demographic characteristics such as age, gender, level of education, occupation, and economic status (P>0.05). On the other hand, according to data analysis results, with an increase in health literacy related to COVID-19, regression modeling could predict 22% of self-care behaviors in the participants of the present study. Conclusion. Overall, there is a need for interventions by healthcare professionals for training to increase health literacy related to COVID-19 that results in self-care and adoption of health behaviors in health ambassadors, given the significance of COVID-19-related health literacy and its effects on self-care in these ambassadors. Practical Implications. The findings of this study can be presented to the Deputy of Health and healthcare providers so that actions can be taken to promote health literacy and self-care and prevent similar epidemics.

Speech-Language Pathology Services Associated with Improvement in Self-Care and Mobility for Post-Acute Skilled Nursing Facility Residents

Speech-Language Pathology Services Associated with Improvement in Self-Care and Mobility for Post-Acute Skilled Nursing Facility Residents

Association Between Hospital Participation in Value-Based Programs and Timely Initiation of Post-Acute Home Health Care, Functional Recovery, and Hospital Readmission After Joint Replacement.

This study examined the association between hospital participation in Bundled Payments for Care Improvement (BPCI) or Comprehensive Care for Joint Replacement (CJR) and the timely initiation of home health rehabilitation services for lower extremity joint replacements. Furthermore, this study examined the association between the timely initiation of home health rehabilitation services with improvement in self-care, mobility, and 90-day hospital readmission. This retrospective cohort study used Medicare inpatient claims and home health assessment data from 2016 to 2017 for older adults discharged to home with home health following hospitalization after joint replacement. Multilevel multivariate logistic regression was used to examine the association between hospital participation in BPCI or CJR programs and timely initiation of home health rehabilitation service. A 2-staged generalized boosted model was used to examine the association between delay in home health initiation and improvement in self-care, mobility, and 90-day risk-adjusted hospital readmission. Compared with patients discharged from hospitals that did not have BPCI or CJR, patients discharged from hospitals with these programs had a lower likelihood of delayed initiation of home health rehabilitation services for both knees and hip replacement. Using propensity scores as the inverse probability of treatment weights, delay in the initiation of home health rehabilitation services was associated with lower improvement in self-care (odds ratio [OR] = 1.23; 95% CI = 1.20-1.26), mobility (OR = 1.15; 95% CI = 1.13-1.18), and higher rate of 90-day hospital readmission (OR = 1.19; 95% CI = 1.15-1.24) for knee replacement. Likewise, delayed initiation of home health rehabilitation services was associated with lower improvement in self-care (OR = 1.16; 95% CI = 1.13-1.20) and mobility (OR = 1.26; 95% CI = 1.22-1.30) for hip replacement. Hospital participation in BPCI or comprehensive CJR was associated with early home health rehabilitation care initiation, which was further associated with significant increases in functional recovery and lower risks of hospital readmission. Policy makers may consider incentivizing health care providers to initiate early home health services and care coordination in value-based payment models.

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.

The Influence of Prior Functional Status on Self-Care Improvement During a Skilled Nursing Facility Stay

Older adults' prior health status can influence their recovery after a major illness. We investigated the association between older adults' independence in self-care tasks prior to a skilled nursing facility (SNF) stay and their self-care function at SNF admission, discharge, and the change in self-care function during an SNF stay. Retrospective study of 100% national CMS data files from October 1, 2018, to December 31,2019. The sample included 616,073 Medicare fee-for-service beneficiaries who were discharged from an SNF between October 1, 2018, and December 31,2019. The admission Minimum Data Set (MDS) was used to determine residents' prior ability (independent, some help, dependent) to complete self-care tasks before the current illness, exacerbation, or injury. Seven self-care tasks from MDS Section GG were used to calculate total scores (range 7-42 points) for self-care at admission, discharge, and the change in self-care between admission and discharge. Most residents (62.0%) were independent, 35.3% needed some help, and 2.64% were dependent in self-care prior to SNF admission. Nearly 25% of residents with urinary incontinence, 28.8% with bowel incontinence, and 31.7% with moderate-severe cognitive impairment were independent in self-care prior to SNF admission compared with approximately 70% of residents without these conditions. Compared with residents who were dependent in self-care prior to SNF admission, those who were independent or needed some help had significantly higher self-care total scores at admission (5.67 vs 4.21 points, respectively) and discharge (6.44 vs 3.82 points, respectively) and exhibited greater improvement in self-care (3.48 vs 1.62 points, respectively). Our findings are evidence that the new MDS item for a resident's independence in self-care tasks before SNF admission is a valid measure of their prior self-care function. This is clinically useful information and should be considered when developing rehabilitation goals.

Improvement of Self-care of Postpartum Minor Discomfort

Improvement of Self-care of Postpartum Minor Discomfort

The Impact of eHealth Interventions on the Improvement of Self-Care in Chronic Patients: An Overview of Systematic Reviews.

Promoting self-care is one of the most promising strategies for managing chronic conditions. This overview aimed to investigate the effectiveness of eHealth interventions at improving self-care in patients with type-2 diabetes mellitus, cardiovascular disease, and chronic obstructive pulmonary disease when compared to standard care. We carried out a review of systematic reviews on PubMed, Scopus, Cochrane, PsychInfo, and CINAHL. AMSTAR-2 was used for quality appraisal. Eight systematic reviews (six with meta-analysis) were included, involving a total of 41,579 participants. eHealth interventions were categorized into three subgroups: (i) reminders via messaging apps, emails, and apps; (ii) telemonitoring and online operator support; (iii) internet and web-based educational programs. Six systematic reviews showed an improvement in self-care measurements through eHealth interventions, which also led to a better quality of life and clinical outcomes (HbA1C, blood pressure, hospitalization, cholesterol, body weight). This overview provided some implications for practice and research: eHealth is effective in increasing self-care in chronic patients; however, it is required to designate the type of eHealth intervention based on the needed outcome (e.g., implementing telemonitoring to increase self-monitoring of blood pressure). In addition, there is a need to standardize self-care measures through increased use of validated assessment tools.

The effects of a smartphone-enhanced nurse-facilitated self-care intervention for Chinese hypertensive patients: A randomised controlled trial

BackgroundFor hypertensive patients, self-care is of the utmost importance in disease management and health maintenance. However, due to inadequate motivation and self-efficacy in performing self-care behaviours, satisfactory self-care is difficult to initiate and maintain. Smartphone-based interventions with support from nurses may be an alternative way to improve self-care behaviours and blood pressure control. Therefore, a randomised controlled trial was conducted to test the effects of a smartphone-enhanced nurse-facilitated self-care intervention for hypertensive people. ObjectiveTo examine the effects of a smartphone-enhanced nurse-facilitated self-care intervention on improving blood pressure control, anthropometric parameters, and self-care amongst Chinese hypertensive patients from two community health service centres. DesignThis study was a single-blinded, two-arm randomised controlled trial with a repeated-measures design. SettingsParticipants were recruited from two community health service centres in China from March 2018 to June 2018. ParticipantsA total of 210 patients with hypertension were randomly allocated to either the intervention or control group (n = 105 per group). MethodsParticipants in the intervention group received six individual weekly education and consultation sessions provided by a nurse in the first 6 weeks and a researcher-developed smartphone application for 12 weeks. The sessions consisted of health education, individual self-care planning, daily records of physical health status and lifestyle behaviour, and an automated weekly health report. Data on systolic blood pressure, diastolic blood pressure, body weight, waist circumference, and self-care (behaviour, motivation, and self-efficacy) were collected at baseline, the 6th week, and 12th week after joining the study. A generalised estimating equation model was used to analyse the outcome. ResultsA total of 191 patients (91%) completed outcome measurements at the three time points. Compared with the control group at the 6th and 12th week follow-ups, the intervention group exhibited significant reductions in systolic blood pressure (T1: β = −7.29, T2: β = −11.07), diastolic blood pressure (T1: β = −4.80, T2: β = −7.50), body weight, body mass index, and waist circumference, and a significant improvement in self-care (behaviour, motivation, and self-efficacy). At the 12th week follow-up, the proportion of participants with BP < 140/90 mmHg in the intervention group (31%) was significantly higher than that in the control group (9%, p = 0.003). ConclusionThe smartphone-enhanced nurse-facilitated self-care intervention could improve blood pressure, anthropometric parameters, and self-care amongst Chinese hypertensive people in two communities. Its long-term effects amongst diverse hypertensive patient populations can be examined in a future study. Tweetable abstractThe smartphone-enhanced nurse-facilitated self-care intervention improved BP control and self-care, which is an effective alternative to hypertension management. Registration numberThis study was registered at the Chinese Clinical Trial Registry (ChiCTR-IOR-17014227).

31-LB: Improvements in Glycemic Control following Use of an Established mHealth Program among Individuals with Diabetes

Background: The prevalence of diabetes continues to rise worldwide. mHealth programs with 24/7 app access and frequent interaction with remote providers ease the learning, practice, application, and daily integration of self-care skills and health improvement behaviors for people diagnosed with diabetes, especially those at high risk for cardiometabolic and mental health complications. This study aimed to evaluate the effectiveness of an established mHealth program on measures of glycemic control in a population at high risk for the development of diabetes-related complications (hemoglobin A1c (HbA1c) ≥ 8.0%) . Methods: This study protocol employed a single-arm, retrospective design. Participants were offered the app-based Vida Health Diabetes Management program as part of their medical insurance benefit. This intervention utilized one-to-one remote sessions with Registered Dietitians and Certified Diabetes Care and Education Specialists as well as structured lessons and tools related to diabetes management. Participants were included if they had a valid laboratory HbA1c completed between 365 to 21-days of enrollment and a follow-up laboratory HbA1c value within 90 to 365-days following enrollment. Two-tailed paired t-tests were used to evaluate changes in HbA1c between baseline and follow-up. Results: Participants with HbA1c ≥ 8.0% at baseline (n=1023) demonstrated a decrease in HbA1c of -1.37 points between baseline (mean: 9.84, SD: 1.64) and follow-up (mean: 8.47, SD: 1.77, p&amp;lt;0.001) . Additionally, we observed a decrease in HbA1c of -1.94 points between baseline (mean: 10.77, SD: 1.48) and follow-up (mean: 8.83, SD: 1.94, p&amp;lt;0.001) among participants with HbA1c ≥ 9.0% (n = 618) . Conclusion: This study demonstrated clinically meaningful improvements in glycemic control among participants enrolled in the Vida Health Digital Diabetes Management Program. Future work should aim to identify mechanisms of this, and other mHealth interventions, most associated with glycemic control. Disclosure G. Zimmermann: Employee; Vida Health. A. Venkatesan: Employee; Vida Health. K. Rawlings: Employee; Vida Health. R. S. Frank: Employee; Vida Health. C. Edwards: Employee; Vida Health. Funding Vida Health

Factors affecting long term outcome in acute cervical spinal cord injury

Spinal cord injuries are most commonly caused by motor vehicle accidents. The next frequent causes are falls and acts of violence, Sports-related spinal cord injuries. Drastic reduction in the mortality &amp; morbidity was noticed with the better management of pressure sores, urinary tract infections and respiratory problems with the advent of modern rehabilitative methods. To study clinical factors affecting long term outcome in acute cervical spinal cord injury patients,A 2-year study Conducted between 2015-2017, 33 patients with acute cervical SCI were included in the study, admitted in the department of Neurosurgery, Osmania General Hospital.Maximum number of patients were in ASIA grade B 11/33 (33.33%), Neurological improvement-All patients improved in ASIA grade ‘D' and none in ASIA grade 'A'. Percentage improvement in cord edema group was 52% and contusion group was 0%. Percentage of improvement in less than forty years age group was 45%: and more than forty years age group was 46.1%. Percentage of improvement in early surgery group was 60% and in the late surgery group was 33.33%.Functional improvement in transfer, self-care and mobility was seen maximum in ASIA grade C. Amongst them, the 'transfers' function scored the maximum.

Gaps in sexual health research about women who have sex with women. A scoping review

ObjectiveTo know the characteristics of the studies that have paid attention to women who have sex with women (WSW) and to identify possible gaps in the interest of comprehensive sexual health in WSW. MethodA scoping review on sexual health on WSW was conducted from 2000 to 2019. Papers with lack of focus on sexual health on WSW were excluded and a web tool was used to guarantee blindness. Information was extracted on the key characteristics of the studies and the quality of the evidence. The sexual health categories were comprehensive sexual health, specification of sexual practices in WSW, and recommendations provided. Results39 studies were included, mostly cross-sectional. The gaps identified were the lack of evidence on sexual health, confusion about sexual orientation and sexual practices, lack of specific interest in comprehensive sexual health and the life cycle approach. Recommendations focused on WSW self-care; interventions aimed at clinical practice, research, education and prevention; and contributions of a feminist approach on sexual health of WSW. ConclusionsThere are several gaps about in the knowledge about sexual health among WSW. Self-care improvement and specific strategies addressed to the unique characteristics of these women and their different and specific situation and health determinants are highlighted.

Characterizing preoperative expectations for patients undergoing reverse total shoulder arthroplasty.

There remains a paucity of information analyzing which factors most influence preoperative expectations for patients undergoing reverse total shoulder arthroplasty (RTSA). The purposes of our study were to characterize preoperative patient expectations for those scheduled to undergo RTSA and to determine the impact of demographic factors, shoulder function, and shoulder pain on these preoperative expectations. Patients were prospectively recruited into the study if they were scheduled to undergo an elective unilateral primary RTSA for a diagnosis of glenohumeral arthritis. Preoperative patient expectations were evaluated using the Hospital for Special Surgery's Shoulder Surgery Expectation Survey. Patients also completed the American Shoulder and Elbow Surgeons shoulder score, the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function-Upper Extremity computer adaptive test (version 2.0), the PROMIS Pain Interference (PI) computer adaptive test (version 1.1), the PROMIS Depression computer adaptive test (version 1.0), visual analog scores, and an itemized satisfaction questionnaire, which paralleled the Hospital for Special Surgery's Shoulder Surgery Expectation Survey. Demographic data and preoperative shoulder range of motion (ROM) were also recorded. A total of 107 patients scheduled to undergo RTSA were included in the study. Relief of daytime pain (n = 91, 85%), improvement in self-care (n = 86, 80%), and improvement in shoulder ROM (n = 85, 79%) were most commonly cited as "very important" expectations. In the item-specific analysis, lower PROMIS Upper Extremity scores were correlated with greater expectations for the ability to reach sideways (P = .015) and the ability to perform daily activities (P = .018). Patients with lower shoulder ROM had greater expectations for improved shoulder ROM (internal rotation with arm at 90°, P = .004) and an improved ability to perform daily activities (forward elevation, P = .038; abduction, P = .009). In the cumulative analysis, a greater number of very important expectations was associated with African American race (P = .013), higher PROMIS PI score (r = 0.351, P = .004), and lower overall preoperative satisfaction (r = 0.334, P < .001). Patients scheduled to undergo RTSA have the greatest expectations for relief of daytime pain, improvement in self-care, and improvement in shoulder ROM. Patients with limited preoperative ROM have greater expectations for improvement in self-care and the ability to perform daily activities in addition to expectations for improvement in shoulder ROM. Greater overall expectations for surgery were not associated with preoperative physical function but were instead associated with lower preoperative satisfaction and higher PROMIS PI scores.

Study on covert administration of medications practices among persons with severe mental illness: A cross-sectional study.

Covert administration of medication (CoAdM) by caregivers to persons with severe mental illness (SMI) is a commonly observed medication delivery practice in India. This study aims to examine different medication delivery practices adopted by caregivers to provide care to SMI at times of medication refusal. This study was conducted at the outpatient department between April 2019 and November 2019. A semi-structured questionnaire was used to interview the caregivers of persons with SMI to assess medication delivery practices. A total of 300 caregivers were interviewed. CoAdM was practiced in 96 (32.0%) persons with SMI at least once during their lifetime, and other strategies used were pleading (n = 105, 35.0%), lying (n = 10, 3.3%), and threatening (n = 154, 51.4%). Logistic regression showed that male gender (OR 4.75; CI 1.37-16.46), absent insight (OR 10.0; CI 2.01-47.56), and poor adherence to medication (OR 4.75; CI 1.31-16.92) were significantly associated with CoAdM in the last 1 year. Caregivers perceived significant improvement in self-care (Z = -4.37, p < .01), interpersonal (Z = -7.61, p < .01), work (Z = -5.9, p < .01), family functioning (Z = -7.82, p < .01) difficult behavior (Z = -8.27, p < .01), and dependency (Z = -6.34, p < .01) in persons with SMI with use of CoAdM. CoAdM was given to one in three persons with SMI at some point in their lives. Male gender, absent insight and poor adherence were predictive of CoAdM in the last 1 year. Caregiver perceived improvements in self-care, work, interpersonal, family functioning, problem behaviors, and dependency after CoAdM. Policies need to be evolved to serve all stakeholders while keeping these practices in mind.

Gender-specific differences in patients who underwent left atrial appendage closure.

Aim: We aimed to study gender-specific differences in patients who underwent left atrial appendage closure (LAAC). Materials & methods:A total of201 consecutive patients who underwent LAAC were enrolled. The EQ-5D-3L questionnaire was employed before and 3months post-LAAC to study the quality of life. Results: Women had a higher score for Anxiety/Depression before implantation. Three months after LAAC, both groups showed a significant improvement in mobility, self-careand usual activities. The female gender had a significant improvement in health state 3months after implantation than their male counterparts. Conclusion: Our data shows an improvement in mobility, self-care, usual activitiesand the overall health state in all patients after LAAC. This potential improvement, most likely caused by the discontinuation of oral anticoagulants, should be considered an indication for LAAC.

Does an empowerment-based self-care supportive intervention save cost for improving self-care and health service utilization among heart failure patients

Abstract Background Heart failure (HF) evolves as a global pandemic and strains the over-stretched hospital service. Ineffective self-care remains the key factor to explain the avoidable hospital admission. Patient empowerment is as a theory-based strategy to optimize the patients' self-care changes for disease management [1]. Its cost-effectiveness to enhance self-care and health service utilization has yet to be determined. Purpose This was a double-blind randomized controlled trial to compare the effects and cost-effectiveness of a 12-week empowerment self-care program with a didactic education program on self-care maintenance and management as well as health service utilization among the community-dwelling HF patients. Methods A total of 236 HF patients were recruited from the specialist clinics of the Department of Cardiology in two regional hospitals. They were randomized to receive either the 12-week empowerment self-care program (Figure 1) or the 12-week didactic education. Outcome evaluation using the Self-care Heart Failure Index (SCHFI) at baseline, post-intervention (T1) and three months thereafter (T2), with record on the number of emergency room (ER) attendance and hospital admission. Cost effectiveness analyses were performed on total cost (medical, intervention and societal costs) incurred in both interventions as well as incremental cost-effectiveness ratios (ICER) expressed as incremental cost per 1) a reflected clinically meaningful improvement in self-care (i.e. a half standard deviation increase in SCHFI), 2) an ER attendance reduced, 3) a day of hospital stay reduced. Results As compared with the education group, the empowerment group reported significantly greater improvement in self-care management at T1 [B=13.77 (95% CI=6.07, 21.46), p&amp;lt;0.001] and T2 [B=10.98 (95% CI=3.21, 18.75), p=0.006]. For cost-effective analysis, The ICER (empowerment-education) was −USD220/0.5 SD increase in SCHFI, indicating the mean cost saved per patient for making a clinically significant improvement in self-care was USD 220. The cost-effectiveness acceptability curve showed patients were willing to pay at USD 207- 441 for a 80–90% chance of improved self-care, indicating that the empowerment approach was a cost saving strategy. Although the empowerment approach was associated with a lower risk of ER attendance [IRR=0.55, 95% CI=0.31–0.95)] and hospital admission [IRR=0.38 (95% CI=0.31–0.95)], it is not cost saving for reducing hospital service utilization. Conclusions The empowerment-based self-care program is a cost-saving strategy to produce a clinical significant change in HF-related self-care. Although it is associated with lower risk for hospital service utilization, its effect is not significant enough to be cost-saving. Future care model may explore the need to integrate dyadic science [2] and e-health [3] to strengthen the care continuity and effects of self-care intervention. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health and Medical Research Fund, Food and Health Bureau, Hong Kong Special Administrative Region Figure 1

Predicting Improvement in Self-Care Among Medicare Beneficiaries With an Orthopedic Hip Condition Discharged to Home From Skilled-Nursing Facilities

Abstract Date Presented 04/200/21 The study examined Medicare claims data to determine the amount of rehabilitation services needed (e.g., therapy intensity and length of stay) to maximize the improvement in self-care skills for older adults with an orthopedic hip condition in skilled-nursing facilities. Findings of the study provide reference data for OTs to plan intervention and justify resources necessary to increase clients' independence. Primary Author and Speaker: Chiung-Ju Liu Additional Authors and Speakers: Loriana Harkey, Sadie Jung, and Elizabeth Newton

O impacto das aplicações móveis no autocuidado da pessoa com insuficiência cardíaca

Introduction: Heart failure is a chronic and progressive disease, with high rates of hospital readmission, mortality and morbidity. As a chronic disease, it is essential that people adopt self-care practices to manage their disease more effectively. Digital health technologies, such as mobile applications, can work as facilitators for the self-care of people with heart failure. Objective: Identify the efficacy of mobile applications in the improvement of self-care in people with heart failure. Methods: Systematic review of the literature from the electronic databases - CINAHL Complete, MEDLINE Complete and SciELO carried out in january 2021. Articles published between may 2015 and december 2020 are considered. Results: The research resulted in 67 articles, and 7 of them were included in this review. The use of mobile applications led to improvements in the self-care of the participants from the various studies analysed. Conclusion: The results suggest that the use of mobile applications is effective in improving self-care in cases of heart failure.

Designing internet-enabled patient education for self-management of T2D diabetes-The case of the Razavi-Khorasan province in Iran.

BackgroundThe number of people with diabetes is estimated to increase to 642 million by 2040, with most having type 2 diabetes. Patients with diabetes require continuous monitoring and possible treatment changes. Patient education is the process of enabling individuals to make informed decisions about their personal health-related behaviours and internet-enabled interventions have the potential to provide support and information to patients with diabetes.ObjectiveThe aim of the study was to design a portal prototype based onto two models of care and a contextualised education programme to support the self-management of diabetes patients by involving stakeholders in the Iranian province of Razavi-Khorasan.MethodsA Design-Based Research framework was adopted. A qualitative research method was used to analyse interviews with patients and care givers. Mock-ups were developed first and designed with features of user-driven and self-care models of care. The mock-ups also had adaptation features, such as for control of the disease, ability to cure self, and family support. The portal prototype was developed iteratively by building on the mock-ups and evaluated through interviews. The features and elements of the mock-ups and the portal prototype were evaluated in an outpatient diabetes clinic in Mashhad.ResultsThirty-three participants were involved in the study. The evaluation of the mock-ups resulted in two themes and seven categories: 1) self-care improvement, including self-care requirements and self-management, and 2) educational usefulness, including medical information, information mode, mobility, interaction, and efficiency. The mock-up evaluation was used as a basis for designing a portal prototype. Next, the portal prototype was evaluated, and three categories emerged from the interview data: 1) user experience, 2) functionality, and 3) interactivity. Participants were not able to prioritise between the two care models. Some functionalities of the portal could benefit from the development within a cultural context to determine differences to the best way to present material.ConclusionsA portal prototype has been designed to include two care models to support self-management and functionalities that support aspects of culture-specific diabetes self-care. This study provides guidance on developing an internet-enabled educational portal, aimed at providing support for patients in their social context.

Utility of an Internet-based Short Message Service in the Care of Children and Adolescents with Type 1 Diabetes Mellitus

Objective: To evaluate the impact of an internet-based intervention system and a short message service (SMS) using cellular phones on the diabetes care and glycemic control in children and adolescents with type 1 diabetes mellitus (DM). Materials and Methods: Observational study in children with type 1 DM on basal bolus regimen. After administering diabetes care education children were divided in 2 groups, group I received timely SMS on diabetes care and group II did not. At the end of 3 months detailed data of diabetes care was recorded. Analysis was done using Statistical Package for the Social Sciences. Results: In a total of 42 children, group I (21) who received the SMS and group II (21), completed the follow-up period of 3 months were included in the study. There was marginal improvement in glycosylated hemoglobin in group I (from 9.2 ± 1.7 to 8.8 ± 1.2); and a minimal increase observed in group II (from 8.8 ± 1.8 to 9.4 ± 1.9) (P &gt; 0.05). The percentage of capillary blood glucose (CBG) values below and above the target range, mean CBG, frequency of self-monitoring blood glucose, significantly improved compared to the control group (P &lt; 0.05). Conclusion: SMS-based education program lead to a significant improvement in self-monitoring blood glucose frequency, diabetes self-care and marginal increase in glycemic control.