We aimed to develop the Self-Care for a Heart-Healthy Lifestyle (SC-HeartLife) scale among community-dwelling adults without a history of cardiovascular disease and evaluate its psychometric properties. The 'SC-HeartLife' scale was developed in three phases-initial item pool generation, content and face validity, and psychometric testing-guided by the Middle-Range Theory of Self-Care of Chronic Illness. A total of 946 community-dwelling adults in South Korea were recruited through an online survey. From an initial 83 items, 43 were retained following content and face validity evaluations. Using two split random samples, exploratory factor analysis and the first confirmatory factor analysis (CFA) were performed with Subsample 1 (n = 473) to develop a seven-factor hierarchical model. The second CFA with Subsample 2 (n = 473) was then conducted for cross-validation. Structural validity was supported by a 38-item, seven-factor hierarchical model demonstrating good fit (CMIN/DF = 2.07, CFI = 0.91, TLI = 0.91, RMSEA = 0.05, SRMR = 0.06). The model comprises three scales: self-care maintenance (five factors), self-care monitoring (one factor), and self-care management (one factor). It was also evidenced by significant correlations of the 'SC-HeartLife' with health-promoting behaviours and health-related quality of life. Reliability was acceptable, with strong internal consistency (global reliability = 0.94) and test-retest stability (intraclass correlation coefficient = 0.89). The 38-item 'SC-HeartLife' scale, on a 5-point Likert scale, is a valid and reliable tool. It is applicable across both clinical and research settings, supporting the identification of individuals and communities vulnerable to inadequate 'SC-HeartLife' and the evaluation of tailored interventions designed to promote self-care in the context of cardiovascular disease prevention.

To advance the understanding of chronic illness self-management among Chinese immigrants in Western countries by synthesising evidence and through the lens of the Middle Range Theory of Self- and Family Management of Chronic Illness. Integrative review following Whittemore and Knafl. Two reviewers used Covidence software to screen potential articles. After identifying the sample, reviewers extracted data into a matrix and appraised study quality using Critical Appraisal Skills Programme checklists. Reviewers used the constant comparative method to categorise data into categories: (1) facilitators/barriers, (2) processes and (3) outcomes. Findings were then synthesised and mapped to the theory domains. MEDLINE, CINAHL, Web of Science, Embase, PsycINFO and ProQuest Central (database inception-August 2025). Of 3205 records screened, 20 studies met the inclusion criteria with acceptable quality. Personal characteristics/health status, resources/environment, Chinese-Western cross-cultural experiences, family and healthcare systems, and linguistic barriers shaped the processes of Focusing on Illness Needs (developing illness insights, taking ownership of health needs, and health promotion); Activating Resources (Western health care, traditional Chinese practices, community and family support, and blended spiritual resources); and Living with a Chronic Illness (processing emotions, adjusting, integrating, and meaning-making). These processes lead to outcomes including improved disease control, psychological/cognitive well-being, and healthcare utilisation and unintended negative consequences such as emotional burden and delayed care-seeking. While Chinese immigrants share certain aspects of self-management with Western populations, their approaches are shaped by culturally grounded, family-centred values, traditional health practices, and immigrant experiences, which underscore the need for culturally and contextually sensitive self-management support. The findings also expand the applicability of the guiding theory by identifying new cultural elements. Nurses can support self-management among Chinese immigrants by developing culturally and linguistically tailored interventions, engaging family members in health education and treatment planning, enhancing accessible digital, community and navigational resources, providing language assistance and strengthening staff training. We used the PRISMA 2020 checklist for adherence to review protocols. This study did not include patient or public involvement in its design, conduct or reporting.

Research Aims: This study examines the ability of firm size to moderate capital structure on profitability at the Healthcare companies listed on the Indonesia Stock Exchange 2020-2024. The health industry is seen as a sector that is very crucial in maintaining the quality of life and productivity of the community, so it is important to know the factors that can influence its profitability, as a variable that reflects the company's success in a given period. Design/methodology/approach: The study was carried out using a quantitative-causality approach. The analytical method used to test the hypotheses is moderated regression analysis. Research Findings: This study indicate that firm size is able to moderate capital structure on profitability, although capital structure is proven to have no effect on profitability. Theoretical Contribution/Originality: The theoretical contribution is the development of a middle-range theory regarding the ability of company size to moderate capital structure on profitability, which is based on a trade-off theoretical framework. This paper offers useful insights for the owners, investor, managers, and lending institutions based on empirical evidence. Research limitation and implication: This study only uses one component of capital structure, namely debt, in its measurement. Capital structure is measured using the debt to asset ratio indicator. This may have implications for results that are unable to support the trade-off theory, that capital structure is not an explanatory factor for profitability.

To describe management of life with a left ventricular assist device (LVAD) by patients and caregivers and to determine the fit of self- and family management as a guiding concept in LVAD research. We applied dimensional analysis techniques to this concept analysis, beginning with a literature search (2010-25) of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Two reviewers screened and analysed 28 articles capturing perspectives on daily LVAD management among patients, caregivers, and healthcare professionals. Fourteen studies were qualitative, 12 were quantitative, and 2 were mixed methods. We identified five dimensions of patient and family management of LVAD therapy: patient facilitators and barriers; caregiver facilitators and barriers; processes of self- and family management; clinician facilitators and barriers/processes; and outcomes. These dimensions align with the concept of self- and family management and with core components of the Middle Range Theory of Self- and Family Management of Chronic Illness. This dimensional concept analysis advances understanding of managing life with an LVAD by clarifying the collaborative roles of patients, caregivers, LVAD coordinators, and other healthcare professionals. Our analysis supports the use of self- and family management as a guiding concept and the application of the Middle Range Theory of Self- and Family Management of Chronic Illness in LVAD research. A new conceptual definition of LVAD self- and family management reflects this theoretical grounding. Our work offers direction for future research, clinical practice, and education aimed at improving outcomes for patients and caregivers managing life with an LVAD.

Background: Self-care is essential in the management of chronic illness. In 2012, we published a middle-range theory addressing self-care as a process of maintaining health through health-promoting practices and managing chronic illness. Three key concepts in the theory were self-care maintenance, self-care monitoring, and self-care management. Self-care maintenance refers to those behaviors performed to improve well-being, preserve health, or maintain physical and emotional stability. Self-care monitoring is the process of routine vigilant surveillance, self-awareness, and body monitoring or body listening. Self-care management involves the response to signs and symptoms when they occur. In 2019, we updated the theory, specifying the important contribution of symptoms to self-care. Assumptions and propositions of the theory were specified in the original publication; both are expanded in this update.Purpose: Here, we update the theory to reflect changes in our thinking and what has been learned from published literature and discussions with others. An important addition is a detailed discussion of 6 essential intrapersonal requirements for self-care: experience, knowledge, skills, reflection, decision-making, and motivation. These requirements interact dynamically; the order in which they are presented is not meant to reflect the order in which they are developed.Implications for Practice and Research: These factors are particularly important in guiding the development of self-care interventions. Readers can now refer to this version instead of the 2012 publication.

IntroductionGlobally, up to 15% of children and adolescents experience a mental health (MH) condition. In the UK, an increasing number of children and young people (CYP) are presenting to acute paediatric settings (paediatric emergency departments and paediatric medical wards) with MH issues. However, the literature suggests that the MH support available in acute paediatric settings is insufficient and unsafe in England. A key principle in NHS England’s plan for joint working to support CYP with MH needs in acute paediatric settings is for care to be personalised to the needs of CYP. However, there is a paucity of research that explores the needs of ethnic minority CYP with MH issues in acute paediatric settings, and recent research has highlighted racial disparities in the accessibility and outcomes of MH services for CYP. This is significant as MH issues in childhood are associated with lifelong inequalities in health, employment, education and mortality outcomes in later life. We aim to explore how, why and under what circumstances acute paediatric settings support (or do not support) ethnic minority CYP to access appropriate MH support, and to develop a refined programme theory for the important contextual factors and mechanisms that can influence whether acute paediatric settings support ethnic minority CYP in accessing appropriate MH support.Methods and analysisThis review will use the realist approach developed by Pawson and Tilly which involves six steps: (1) Clarifying the scope of the review, (2) Searching for evidence, (3) Selecting and appraising the primary studies, (4) Extracting and organising the data, (5) Analysing and synthesising the findings and (6) Disseminating the findings. We will search OVID Medline, PsycINFO, CINAHL and SCOPUS. Relevant data will also be sought through snowballing and backward citation searching on included studies, seeking document recommendations from relevant professionals, and grey literature searches on Grey Matters, Health Management Information Centre and Google Scholar. The search will cover documents published from database inception. Documents featuring Black and/or Mixed-Black CYP with MH issues in acute paediatric settings will be included. Documents that do not separately report the results of CYP (<18 years old) from Black ethnic groups, or are unavailable in English will be excluded. An advisory group of key stakeholders will be recruited and involved throughout all stages of the review to promote the design and outputs of the realist review reflecting the experiences of (a) Ethnic minority CYP with MH issues and (b) The professionals involved in their care and the acute paediatric setting. The output of this process will be a refined middle-range theory that will provide a detailed understanding and explanation of the key contextual factors and mechanisms involved in ethnic minority CYP accessing MH support.Ethics and disseminationThis realist review will only involve secondary data, so ethical approval will not be required. The developed programme theory will be disseminated through the advisory group, peer-reviewed publications, discussions with relevant stakeholders and presentations at relevant research conferences and community events. Additionally, the theory will inform a primary realist evaluation study where the theory will be tested and refined further.PROSPERO registration numberPROSPERO, CRD420251009912.

Transit-Oriented Development (TOD) is widely promoted and implemented as a strategy for urban and transport sustainability, yet its theoretical account of how it intersects with placemaking and value distribution, remain underdeveloped. This paper proposes a middle-range theoritical framework for TOD that systematically links urban design choices, stakeholder interests, the generation and the distribution of value realisation. Drawing on anthropological and economic theories, the middle-range theoritical framework distinguishes between Value in Exchange, Value in Use, and Shared Value, and maps value accruing to diverse stakeholder groups. The framework integrates welfare economics through Pigouvian, Coasean, and Tieboutian perspectives to address externalities, property rights, and resident mobility, and is operationalised through a results chain that connects interventions to outcomes. The framework is evaluated against Merton's criteria for middle-range theory characteristics: abstraction, logical derivation, and adaptive explanation and offers guidance for empirical research, policy design and intervention. By making value distribution explicit, the framework aims to support effective TOD outcomes across varied land tenure regimes.

Nurse-endorsed strategies to repair nurse-employer relationships, alleviate burnout, boost retention, and rebuild trust in the post-pandemic era.

Intersectoral Collaboration (ISC) involves multiple sectors working together to tackle complex challenges that no single sector can address alone. In global health, where interconnected issues demand holistic approaches, ISC aligns goals and resources to enhance effectiveness and equity. However, power dynamics within and between sectors can either foster synergy or create tensions, shaping ISC outcomes. This study explores how, why, for whom, in what contexts, and to what extent power dynamics influence ISC in a northeastern state of India. A realist evaluation was conducted in Assam, India. Six Programme Theories (PTs) from a prior realist review were tested and refined through theory-driven realist interviews with 18 stakeholders across different sectors. Data were analysed using Context-Mechanism-Outcome Configurations (CMOCs) to refine PTs, offering a nuanced understanding of how individual, institutional, and contextual factors influence ISC outcomes. A total of 62 CMOCs, grouped into 17 demi-regularities, refined six PTs on power dynamics in ISC. Fair participation fostered empowerment, while proactive leadership enhances motivation, though resource gaps may weaken these effects. Fair resource allocation reduced power imbalances, improving collaboration, whereas hierarchy and unclear roles breed distrust. Personal relationships helped build trust and overcome hierarchy. Findings emphasise that improving ISC requires attention to both structural and relational mechanisms through designing programs that leverage both of these. Given this single-district, qualitative case study, the findings are context-specific to Dibrugarh, Assam, and should be transferred cautiously to comparable settings. Future research could refine programme theories into a middle-range theory, enhancing their transferability to other settings.

Supportive self-management in postural orthostatic tachycardia syndrome (POTS): A systematic review.

Fathers' involvement in breastfeeding has a positive effect on breastfeeding, but fathers can feel uncertain about how to provide support. An intervention was implemented to improve breastfeeding rates by tailoring support to each family, actively involving both parents, and strengthening communication during home visits as part of the Danish universal health visiting program. A key element of the intervention was engaging both parents in breastfeeding as a "shared parental task". The aim of this study was to investigate how fathers responded to the intervention and to identify the contextual factors necessary to activate paternal engagement. Using a realist evaluation approach, our study was integrated into a cluster randomized trial implemented in 20 municipalities. In the intervention arm, we observed six home visits delivered by health visitors and conducted nine interviews with fathers. A theoretical perspective applying Standpoint Theory and Gender Schema Theory as middle-range theories was used to grasp the diversity of fatherhood and to understand how contextual circumstances shape it. The intervention could activate a central mechanism of change by making fathers realize their important role in breastfeeding success, leading them to engage in both the breastfeeding support and practice. Our analysis revealed three patterns in how fathers responded to the intervention: the mechanism was either not activated, partly activated, or strongly activated. Positions shaped by educational level, occupation, rootedness to rural community, ethnicity, and age, as well as perceptions of gender roles and family dynamics influenced whether, and to what degree, the mechanism was activated. Rather than being rigid categories, thesepatterns should be understood as shifting positions along a continuum that reflects a complex and evolving reality. The fathers' dispositions as well as perceptions of gender roles and family dynamics influenced how the fathers responded to the intervention. These findings highlight the importance of recognizing contextual influences on fathers' engagement in breastfeeding and tailoring breastfeeding support to better address fathers' diverse backgrounds and perspectives. Clinical Trials: NCT05311631. First posted April 5, 2022.

Humans are unique in their ability to build complex social networks that foster cooperation, knowledge sharing and innovation. Evidence from the African Middle Stone Age provides some of the earliest signs of these connections, alongside increasingly sophisticated behaviours. Archaeologists study past social interactions through various proxies, with stone tools playing a central role. Yet the extent to which stone tools reliably reflect cultural transmission and connectivity remains debated. Similarities in toolmaking can indicate knowledge exchange and social ties, but they may also result from convergent evolution, whereby different groups independently arrive at comparable solutions to similar challenges. Recent research from southern Africa and beyond shows that applying middle-range theories and integrating contextual data help distinguish cultural transmission from convergence. This approach sheds new light on how knowledge and practices spread in early human societies, revealing the deep roots of cooperation and collaboration that continue to shape human societies today.

Background: Chronic non-communicable diseases—chiefly chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus (T2DM), and cardiovascular diseases (CVDs)—remain the leading causes of morbidity and mortality worldwide. Despite the proliferation of telehealth programs, few longitudinal studies have rigorously evaluated theory-based, nurse-led digital education across multiple chronic conditions within a unified self-care framework. PROSELF (Promotion of Self-Care through Educational Interventions in Chronic Patients) addresses this gap. Methods: Promotion of Self-Care (PROSELF) is a prospective, longitudinal, multicenter, non-interventional study in community and primary-care settings in Southern Italy. A 12-month nurse-led digital educational intervention—grounded in the Middle-Range Theory of Self-Care of Chronic Illness—targets the three core self-care dimensions (maintenance, monitoring, and management) through individualized tele-education, asynchronous reinforcement, and structured follow-up at baseline, 3, 6, and 12 months. Validated self-care, quality-of-life, and social-support measures will be used. Data will be analyzed using repeated-measures and multivariate models to evaluate longitudinal changes in self-care, adherence, and related outcomes. Participation requires digitally informed consent. Results: The PROSELF study is expected to demonstrate the effectiveness of a 12-month, nurse-led digital educational program in improving adherence and self-care behaviors among patients with chronic diseases (COPD, diabetes, and cardiovascular disease). The intervention will leverage validated self-care assessment tools and tele-educational follow-up sessions. Conclusions: Findings from this study will inform the design of scalable, evidence-based, behaviorally informed models for digital chronic care delivery and nursing education.

Abstract Whether environmental sustainability is possible under capitalism is a highly divisive question for environmental scholars and advocates. Within sociology, this divide is reflected in an enduring debate between a Treadmill of Production (TOP) theory predicting worsening environmental problems under capitalism, and an Ecological Modernization (EM) perspective which provides reasons to expect improvements. Empirical support exists for both perspectives, and a synthesis remains elusive, with the only serious attempt at reconciliation a paper by Shwom (2011), which specified conditions favorable to either outcome. We assess Shwom’s model through a case study of the Swedish pulp and paper industry’s successful reduction of dioxin emissions, and chlorinated waste in general. Though we argue that the case largely supports the model’s expectations, it also suggests a need for one modification. Specifically, in the case we examine, industry unity facilitated rather than obstructed environmental improvement, with the corporatism of Swedish capitalism playing a constructive role. This modest critique aside, we endorse Shwom’s model, and recommend it as a useful way of understanding variable environmental outcomes, including in diverse national contexts. We argue for more such nuanced, middle-range analyses.

Abstract Rice-based production systems in coastal Bangladesh face increasing challenges, which influence farmers' decision-making and adoption of intensification practices. Farmers’ aspirations (desire for change) and adaptive capacity (ability to change) shape the adoption of agronomic practices and rice system performance (manifestation of change). Using diachronic household survey data from 2011 and 2021, we analyzed land system transitions, assessing changes in farmers’ perceptions, adoption of agronomic practices, and rice performance (yields and variability) in two districts with contrasting conditions: favorable (Barishal) and marginal (Patuakhali). We developed a conceptual framework highlighting three key performance dimensions: yield increase, hardship reduction, and risk alleviation, to understand the interplay between aspirations, technology adoption, and land use outcomes. This framework offers a systematic lens to understanding the factors shaping land system transitions. Aspirations for higher yields, reduced labor, and risk mitigation drove the adoption of innovations. Farmers invested in modern rice genotypes, mineral N fertilizers, and irrigation to increase yields, while mechanization and herbicides reduced labor hardships. Diversification, improved fertilizer strategies, and pesticide use helped mitigate risks of crop failure. Rice yields increased with lower production risks in dry vs. wet seasons and at favorable vs. marginal sites. The relationships between constraints, adoption rates, and technology choices are highly site-specific, aligning with the “middle-range theory of land systems change”. These findings underscore the need for context-specific strategies for sustainable agricultural intensification that enhance resilience, reduce risks, and contribute to achieving Sustainable Development Goal 2 (Zero Hunger).

Objective. To analyze the coping strategies for the adaptation of the migrant during pregnancy described in the literature. Methods. Integrative review using the method approached by Whittemore and Knafl. MeSH terms Pregnancy, Migrants and immigrants, and Psychological adaptation, were incorporated in addition to their variants in the databases of Pubmed, Scopus, EBSCO, Science Direct, and Web of Science. Articles that examined the coping strategies used by pregnant migrants to adapt during pregnancy were included. Only the articles published from 2003 to 2023 was considered. After applying the inclusion and exclusion criteria, the articles were analyzed with the CASPe critical reading tool in which quality and consistency were reviewed. Using the software, Atlas.ti, version 23.2.1, content analysis for the categorical construction of data was performed. These strategies were analyzed with the middle-range theory adaptation to life events by Callista Roy. Results.. A total of 416 articles were considered. The reviewed articles show 14 coping strategies used by the pregnant migrant, which were grouped into 5 strategies called social support, emotional regulation and transfer, positive attitude strategy, cultural adaptation strategy, and comprehensible language strategy.Conclusion. It was found that the strategy most used by the migrant pregnant woman is social support, followed by positive attitude strategies and comprehensible language; when using these strategies, the results show migrant pregnant women with a decrease in anxiety, fear and a positive attitude towards life and health.

Purpose This paper examines the impact of circular economy (CE) adoption on power and dependence dynamics in buyer-supplier relationships. It challenges the shared assumption that dependence among buyer and suppliers should be reduced by illuminating the mutually beneficial outcomes derived from CE adoption, which are captured through applying embeddedness theory. Design/methodology/approach Through a longitudinal case study and abductive reasoning, we examine a manufacturing firm's first CE initiative involving its suppliers across two material streams: steel and plastic. This research develops middle-range theory by introducing embeddedness theory as opposed to resource dependence theory in the CE context. Findings Results show that buyer-supplier relationships in the CE context are characterised by high mutual dependence. While this condition has been viewed as detrimental for the actors involved, it allows for governance mechanisms based on trust, information exchange, and joint action in which actors refrain from exercising power and shift towards non-mediated power types. Originality/value This study advances CE research by introducing embeddedness theory to investigate the less studied power and dependence dynamics through a longitudinal perspective. Additionally, this scholarship highlights the need for a comprehensive evaluation of mutual dependence, as traditional metrics may overlook key nuances in the CE context.

This paper presents the theory of asthma self-management, a middle-range theory that focuses on the personal, socioeconomic, environmental, and healthcare-related factors that affect asthma self-management behaviors and asthma control in adults. The theory of asthma self-management was deduced from Orem's self-care theory, one of the three subtheories of the self-care deficit theory of nursing. A substruction model is included and illustrates the linkages between the concepts of Orem's self-care theory and the novel middle-range theory. The development of this theory expands the body of nursing science by bridging an existing theory with current asthma knowledge.

PurposeThis study aimed to develop and validate a scale to assess self-care practices in women with polycystic ovary syndrome (PCOS), guided by the middle-range theory of self-care for chronic illness.MethodsA methodological design was used. Items were generated through literature review and expert input. Content validity was evaluated by experts, and construct validity was tested using exploratory and confirmatory factor analyses (EFA and CFA). Internal consistency was assessed using Cronbach’s alpha. Data were collected from 453 women with PCOS in South Korea.ResultsThe final scale consisted of 18 items across five factors, explaining 59.3% of the total variance. Content validity was confirmed, and CFA indicated acceptable model fit. The scale demonstrated high internal consistency (Cronbach’s alpha = 0.90).ConclusionThis validated scale provides a reliable tool to measure self-care practices in women with PCOS, a common but often overlooked chronic condition. It can be used in clinical and public health settings to promote effective self-management, guide individualized care, and support the development of evidence-based interventions aimed at improving women’s health outcomes.

Middle range nursing theory for impaired health literacy.