Level Of Self-management Behavior Research Articles

Which factors enable older adults with multimorbidity to adapt and self-manage to increase health? A narrative literature review

Background: As ageing is accompanied by chronic illnesses, and chronic diseases account for most of the expenditures of the healthcare system, older people constitute an increasingly important population that is characterized by multiple medical conditions, cognitive and functional impairment and social problems. Multimorbidity leads to complex care through the use of different treatment strategies and the involvement of various health care professionals, which may lead to opposing advices or medications. Therefore patients with multimorbidity are at risk for suboptimal treatment, unsafe care, inefficient use of health care services, unnecessary costs and consequently higher risk for adverse events (van Oostrom, 2012). Challenges for current and future healthcare delivery are the growing group of older adults, the heterogeneity of this group, and the increasing healthcare costs for people with chronic conditions. As these people have to cope with physical, emotional, and social challenges of their chronic diseases and disabilities the question is which factors enable older adults with multimorbidity to adapt and self-manage.In this context the WHO definition formulated in 1948 can no longer be used. This definition describes health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 2003). Therefore in this research the new proposed concept of health as “the ability to adapt and to self-manage” is used (Huber, 2011).Method: In this research the effect of multimorbidity on self-management and adaptation is explored by conducting a narrative literature review over the last fifteen years in English, German or Dutch on the key words older adults, coping, self-management, self-related health and multimorbidity. References lists from selected studies were evaluated to identify any additional relevant articles. Articles were excluded if they addressed one specific disease or health topic or if they did not address coping with multimorbidity in older adults.Literature review: The literature shows several factors that influence health and the perception of health of older people with multimorbidity: social network, socio-economic status, cultural and personal attitudes to health and disease, prior experiences with the health care system, , living alone status, education level and patient’s coping strategies (Ament, 2012). Patients with multimorbidity and chronic diseases perceive their health differently, depending on somatic, social, mental and cognitive variables and patients adapt in multiple different ways(Strumberg, 2014 B).There is a strong association between increasing medical comorbidity with reported worse self-related health (Perruccio, 2012; Berglund, 2014; Nützel, 2014). Self-rated health correlates with more urgent service use, hospitalization and mortality and reflects an individual’s health trajectory, and is predictive for the need for support for self-management activities (Martin, 2014; van Houtum, 2013). Medically complex patients and patients with increasing age tend to think their circumstances are controlled by outside factors (external locus of control). This highlights the importance of attending to psychological needs of individuals with multimorbidity, particularly as providers engage patients in decision-making processes and care plans (Henninger, 2012; Schnee, 2013).Patients with multimorbidity want convenient access to health care, individualised care plans, support from one coordinator of care, and continuity of relationship with health professionals (Bayliss, 2008; Shadmi, 2006; McCormack, 2008). People with multimorbidity experience a poorer quality of life, yet they try to preserve their autonomy to the most possible extent and hold positive attitudes towards life (Loffler, 2012). They hope to find meaning and purpose, and desire to regain identity and sense of self-worth (Fortin, 2004; Duggleby, 2011;Holm, 2013). Therefore health care delivery systems should take patients potential for pro-active cooperation into account as they uniquely possess knowledge of their condition and circumstances (Edgren, 2012). Aim should be integrating patients’ needs and expectations in their care in order to result in higher self-related health (Strumberg, 2014A; Loffler, 2012).Many current programs mention self-management interventions, but rarely define self-management and describe how the intervention is supposed to work (Ouwens, 2005; Boult, 2009; Wolff, 2009; de Bruin, 2012; Spoorenberg, 2013). This is relevant because there is often little association between disease complexity and level of self-management behaviors (Battersby, 2003).Discussion: As health is the ability to adapt and self-manage health systems need to adopt these perspectives into in the development and evaluation of care trajectories for older adults with multimorbidity. The process of irreversible decline and the coping style of patients should also be addressed as well as the fact that many older adults with multimorbidity cope, not on their own, but with assistance from informal caregivers (Lanoix, 2013). To empower older adults in daily practice in maintaining balance, stability and adjusting a framework, like for instance the Neuman Systems Model, should be adopted by healthcare providers that takes physiological, psychological, sociocultural, developmental, and spiritual factors into account (Merks, 2012).

A cross-sectional study on self-management of pressure ulcer prevention in paraplegic patients

IntroductionLittle is known about health activation and self-management behavior in preventing pressure ulcers (PU) in paraplegic patients. Therefore this study aimed to describe the extent of health activation and self-management behavior in paraplegics to prevent PU's and associations between this behavior and patient characteristics.Furthermore, we aimed to find differences in health activation in paraplegics who never had a PU compared to paraplegics with a previous history of PU's or a new-onset PU's. MethodsA cross-sectional survey on health activation and self-management behavior was conducted among adult paraplegics recruited from two rehabilitation centers in the Netherlands. The Patient Activation Measure (PAM-score) was used to measure the extent of health activation. Patient statements on their level of self management behavior to prevent PU were evaluated. ResultsThe mean PAM-score (0–100) was 54 (±8.1; n = 162) indicating a low level of health activation. Two indicators turned out to be statistically significant associated with health activation: level of education (OR = 2.2, p = 0.017) and degree of paraplegia (OR = 2.8, p = 0.036). Evaluation of health activation levels amongst paraplegics with or without a PU- history showed no significant difference. Analysis of patients statements demonstrated a large discrepancy between intended and actual behavior to prevent pressure ulcers. ConclusionLevel of education and level of paraplegia are significantly associated with health activation. A positive PU-history is not associated with future responsible behavior nor for compliant behavior in terms of health management.

Effects of discharge planning model on self-management behaviors of patients with coronary stent implantation

Objective To investigate the effects of discharge planning model on self-management behaviors of patients with coronary stent implantation (CASI). Methods Using random control study,106 patients with CASI were divided into intervention group and control group by random digits table method with 53 cases each. The intervention group was received discharge planning services. The control group was received routine nursing and follow-up of department of cardiology. In the process of study due to lost to fall off in 5 cases, including 2 cases of intervention group and 3 cases of control group. The level of self-management behaviors of patients was evaluated before intervention, after 1 month and 6 months of intervention. Results The total scores of self-management behaviors of patients after 1 month of intervention was (94.59±8.43) scores in intervention group,which was higher than that in control group (83.41±7.91) scores,and there was significant difference, P<0.01. The total scores of self-management behaviors of patients after 6 months of intervention was (91.68±9.01) scores in intervention group,which was higher than that in control group (78.32±8.52) scores,and there was significant difference, P<0.01. Conclusion Discharge planning model can effectively improve the level of self-management behaviors of patients with CASI, improve the quality of life, ensure the implementation effect of continuing nursing care service. Key words: Patient discharge; Coronary artery disease; Stent implantation; Self-management behaviors

Research on correlation of the self-management level and the quality of life in elderly patients with gastro esophageal reflux disease

Objective To investigate the level of self-management behaviors and the quality of life with gastro esophageal reflux disease(GERD) patients, and analyze the correlation between self-management level and quality of life. Methods A total of 372 GERD patients were investigated by using Self-management Behavior Scale and Mos 36-item Short Form(SF-36) Health Survey. Results The level of self-management behaviors in GERD patients was relatively low. The total score of quality of life was (48.75±7.59) and the scores of the level of self-management behaviors was (5.13±0.59). Correlation analysis showed that there was positive correlation between quality of life and self-management behaviors(r=0.423, P<0.01). Conclusion To promote the patients’ health status, nursing staff should take measures to strengthen patient health education on the level of self-management behaviors for GERD patients. Key words: Gastro esophageal reflux disease; Self-management; The elderly; Quality of life

The Association Between Patient-Reported Self-management Behavior, Intermediate Clinical Outcomes, and Mortality in Patients With Type 2 Diabetes: Results From the KORA-A Study

Little is known about the impact of diabetes self-management behavior (SMB) on long-term outcomes. We aimed to examine the association among patient-reported SMB, intermediate clinical outcomes, and mortality in patients with type 2 diabetes. Data were collected from 340 patients with type 2 diabetes of the KORA-A study (1997/1998) who were recruited from two previous population-based surveys (n = 161) and a myocardial infarction registry (n = 179) in southern Germany. Based on previous methodological work, a high level of SMB was defined as being compliant with at least four of six different self-care dimensions, comprising physical exercise, foot care, blood glucose self-monitoring, weight monitoring, having a diet plan, and keeping a diabetes diary. The vital status of the participants was observed until 2009. Multivariable linear, logistic, and Cox regression models were applied to assess the association with intermediate clinical outcomes at baseline and to predict mortality over the follow-up period, adjusted for sociodemographic, behavioral, and disease-related factors. In the cross-sectional perspective, a high level of SMB was weakly associated with a lower glycated hemoglobin A1c level (-0.44% [-4.8 mmol/mol] [95% CI -0.88 to 0.00]), but not with low-density lipoprotein cholesterol, systolic blood pressure, or the presence of microalbuminuria, peripheral arterial disease, or polyneuropathy. During a mean follow-up time of 11.6 years, 189 patients died. SMB was a preventive factor for all-cause (hazard ratio 0.61 [95% CI 0.40-0.91]) and cardiovascular mortality (0.65 [95% CI 0.41-1.03]). Although measuring SMB is difficult and the used operationalization might be limited, our results give some indication that a high level of SMB is associated with prolonged life expectancy in patients with type 2 diabetes and highlight the potential impact of the patients' active contribution on the long-term trajectory of the disease. We assume that the used proxy for SMB is associated with unmeasured, but important, dimensions of health behavior.

제2형 당뇨병 환자의 자기관리행위 예측 요인: 노인과 성인의 비교

Purpose: The purpose of this study was to investigate the level of self management behavior of patients with type 2 diabetes and to compare the factors influencing self management behavior between the elderly and adults. Methods: The participants consisted of 105 adults and 100 elderly who visited the outpatient department of a hospital from August to December 2011. Data was collected by questionnaires and analyzed using the SPSS/WIN 18.0. Results: The elderly showed higher mean scores of subcategory of self management behavior than adults. In stepwise multiple regression analysis, a total of 42% (adults), 52% (elderly) respectively of variance in self management behavior were accounted for by self-efficacy, perceived barriers, perceived benefits, yes or no smoking and regular exercise in adults and readiness, self efficacy, perceived benefits in the elderly. Conclusion: Therefore, a diabetics intervention program should be designed and provided as a tailored one for adults and elderly separately in Korea. In the strategy for adults with type 2 diabetes in the promotion of self efficacy, perceived benefits and reduction of perceived barriers, and correction of life habits such as smoking and exercise are needed, whereas in the elderly promotion of readiness, self efficacy, perceived benefits are required.

Analysis on self-management behaviors of peritoneal dialysis patients and associated factors

Objective To find out the status of self-management behaviors of peritoneal dialysis(PD)patients,to explore factors that influencing these behaviors and provide basis for improving self-management behaviors in PD patients. Methods 151 patients were involved in this research. A questionnaire was used to investigate the current state of self-management behaviors,PD related knowledge,self-efficacy and social support among PD patients. Correlative and regression analysis were used to study the factors that influenced patients'self-management behaviors. Results In general,the score of self-management behaviors of PD patients was(6.51 ± 1.12),which was on the moderate level. Score of 9. 9% PD patients' self-management behavior was good and 57.0% was moderate while 33.1% was worst. Correlative analysis showed that age,time,PD-related knowledge,self-efficacy and social support were positively correlated with self-management behavior. Multiple regression results showed factors influencing seff-management behavior,including demographic sociology factors such as age and time of PD,PD related knowledge,self-efficacy,social support et al. Conclusions The level of self-management behavior of PD patients is generally low. Factors associated with self-management behavior include demographic sociology factor such as age and time,PD related-knowledge,self-efficacy,social support and so on. Key words: Peritoneal dialysis; Self-management behavior; Self-efficacy; Social support

The study of self-management behaviors and quality of life of kidney transplantation recipients after discharge

Objective To explore the self-management behaviors and quality of life of kidney transplantation recipients when they were post-discharge.Methods Self-management behaviors Measuring Scale and SF-36 were used to investigate self-management behaviors and quality of life of 203 kidney transplantation recipients. Results In self-management behaviors of kidney transplantation recipients,the time spent on aerobic exercise was 117.86±98.29 minutes per week,and 27.41±47.61 minutes per week on strengthening exercises.The score of cognitive symptoms management practice was 1.37±0.84,and communication with physicians was 1.96±0.93.The level of self-management behaviors of patients with postoperative time 6 to 12 months was better than others ( P <0.05). The quality of life of the patients with postoperative time less than 6 months was lower than others ( P <0.05). There were positive correlation between self-management behaviors of kidney transplantation recipients and total level of their quality of life and it,s subscales ( r =0.164'0.853,P <0.05). Conclusion Self-management behaviors need to be improved and self-management behaviors was related with quality of life of kidney transplantation recipients. Key words: Kidney transplantation; Self-management; Quality of life