Poor Self-care Behaviors Research Articles

Self-care behaviour and associated factors among chronic heart failure clients on follow up at selected hospitals of Wollega zones, Ethiopia

BackgroundEffective prevention and treatment of heart failure needs good knowledge of cardiovascular diseases (CVD) conditions and their risk factors. However, in developing countries such as Ethiopia, the levels of knowledge and awareness for CVD and risk factors were generally near to the ground. ObjectiveTo assess self-care behaviour and its associated factors among heart failure (HF) patients on follow up at Wollega zones public hospitals, Ethiopia. MethodsHospital based cross-sectional study was employed. The data was entered into Epi-data version 3.1 and analyzed using SPSS windows version 24.0. Variable with p-value<0.05 at multi variable analysis was taken as significant variable for self-care behavior. ResultsAmong 424 study participants, (57.1%) were females and the mean age (±SD) of the respondent was 46.25 ± 17.047 years. About half, 51.2 % (95% CI; 46.1–56.3) of heart failure patients reported good adherence to their self-care recommendations. Urban residence (AOR = 3.49, 95% CI: 2.044–5.7) and duration of heart failure greater than one year (AOR = 1.758, 95% CI; 1.057–2.924) were positively associated with good to self-care recommendation. Whereas, presence of co-morbidity (AOR = 0.099, 95% CI; 0.053–0.184), female sex (AOR = 0.186, 95%CI; 0.096–0.362) and side effect of the drugs (AOR = 0.118, 95% CI: 0.025–0.557) were negatively associated with good to self-care behavior up on multivariable logistic regression. ConclusionSubstantial proportion of heart failure patients had poor self-care behavior adherence. Provision of health education and counseling to clients with heart failure will play a paramount role.

Associations of Personality, Distress, Social Support With Self-Care Behaviors in Patients With Type 2 Diabetes

The findings of recent studies indicate that self-care behaviors are significantly associated with diabetes-related distress and social support in patients with type 2 diabetes. Moreover, Big-Five personality traits are also considered to be associated with self-care behaviors and should be considered. This study was designed to investigate the associations between Big-Five personality traits, diabetes-related distress, and social support and diabetes self-care behaviors in patients with type 2 diabetes. A cross-sectional study design was conducted with 200 participants recruited by convenience sampling. A self-reported questionnaire was used to collect data on demographic and disease characteristics, Big Five personality indicators, diabetes-related distress, social support, and self-care behavior. Data were analyzed using percentage, mean and standard deviation, independent t-test, one-way ANOVA, Pearson's correlation test, and enter method multiple regression analysis. Social support was found to relate positively and significantly with self-care behavior, while no significant relationship was found between diabetes-related distress and self-care behaviors. Participants with high scores for extroversion, agreeableness, and conscientiousness tended to have better self-care behavior, while those with a high score for neuroticism tended to have poor self-care behaviors. The results of the enter method multiple regression analysis showed age and social support to be significant factors associated with self-care behaviors, explaining 19.5% of the variance. Priority concern should be given to patient age and social support status when working to improve the self-care behaviors of patients with type 2 diabetes. As personality traits were found to be significantly associated with self-care behaviors, these should be included in the individual health education program.

Abstract 13344: Do Heart Failure Patients’ Personal Priorities Influence Their Self-care Maintenance Behaviors?

Introduction: The personal priorities of community dwelling patients with HF may influence their self-care behavior. However, clinicians are unsure of the personal priorities that influence self-care choices in patients with HF. Objective: To explore personal priorities ranked highest among HF patients with poor or excellent self-care behaviors. Methods: We conducted a cross sectional convergent mixed methods study of community dwelling patients with HF in the US, excluding those with significant cognitive impairment (MoCA score ≤22). All completed the Self-Care of HF Index v7.2 (scores standardized 0-100). Extreme case sampling was used to select people with poor self-care maintenance scores (≤60) or excellent self-care maintenance scores (≥80). In interviews, participants placed their personal and healthcare needs into the same imaginary bucket and then rank-order them from highest to lowest priority. Interview data was audio-recorded, transcribed verbatim and analysed using qualitative inductive analysis. Results: We enrolled 33 patients with HF (aged 42-82 years, 57% male, 45.5% black, 45.5% married, 54.6% unemployed). Sixteen patients were poor in self-care maintenance and 17 were excellent. Two themes representing HF patients’ personal priorities emerged: a) Healthcare (60.6%, N=20), and b) Family and Housing (36.4%, N=12). Patients who chose healthcare identified medications, insurance and living a longer life as important. As stated by one patient, “without your health you have nothing.” Patients who chose family and housing identified; 1) rent, mortgage, or real estate taxes and 2) food for their children and a roof over their head as most important. They explained by saying “ I have to have some place to live and the utilities ” and “ I can be in a card box, but I just wanna make sure they are fed .” Of those who chose healthcare as their priority, 12 (60%) had excellent self-care maintenance. Only 4 patients (33.3%) who chose family and housing had excellent self-care. Conclusion: HF patients who identify healthcare needs as their highest priority may be better at self-care maintenance. Identifying the priorities of patients with HF will help clinicians tailor discharge instructions.

The effects of a self-regulation programme on self-care behaviour in patients with heart failure: A randomized controlled trial

BackgroundSelf-care behaviour is important for patients with heart failure to prevent disease progression. More than half of patients have poor self-care behaviour. Self-regulation theory emphasizes that patients need to initiate monitoring of their symptoms, identify their own problems, and perform appropriate self-care behaviour. However, studies focused on interventions based on self-regulation theory for patients with heart failure are limited. ObjectivesTo investigate the effects of a self-regulation programme on self-care behaviour in patients with heart failure. DesignA randomized controlled trial. Participants and settingEighty-two patients with heart failure were recruited from a cardiovascular outpatient department at a teaching hospital in northern Taiwan. MethodsParticipants were randomly assigned to the intervention (n = 41) or control group (n = 41). The intervention group participated in a 4-week self-regulation programme, including one 20-to-30-min, face-to-face individual self-regulation education session and 15- to 20-min telephone follow-up counselling sessions twice per week for four weeks. The control group received only routine outpatient care. Self-care behaviour was measured by the Self-Care of Heart Failure Index at baseline, 4 weeks and 8 weeks after patients were enroled. ResultsThe intervention group reported improvements in self-care behaviours, including self-maintenance and self-confidence subscale scores, after four weeks of the self-regulation programme. In contrast, the control group showed no significant differences. Compared with the control group, the intervention group exhibited significantly greater improvements in self-care maintenance (B = 3.74, p = 0.01), self-care management (B = 6.33, p = 0.004), and self-care confidence (B = 5.15, p = 0.003) at four weeks but showed significantly greater improvements only in self-care management (B = 6.97, p = 0.03) and self-care confidence (B = 6.24, p = 0.001) at 8 weeks. ConclusionsThis study confirmed that a self-regulation programme could effectively improve self-care behaviour in patients with heart failure. Further studies with multicentre randomized controlled trials and larger populations of heart failure patients are necessary to evaluate the effect of this self-regulation programme in various regions and countries.Tweetable abstract: A home-based self-regulation programme could effectively improve self-care behaviour in patients with heart failure.

Frequency and factors associated with inadequate self-care behaviors in patients with type 2 diabetes mellitus in Najran, Saudi Arabia. Based on diabetes self-management questionnaire.

Objectives:To investigate the frequency and factors associated with inadequate self-care behaviors in patients with type 2 diabetes mellitus (T2DM).Methods:A cross-sectional study was conducted on a sample of 355 patients with T2DM, using multistage cluster sampling, attending the Najran University Hospital and Primary health care centres in Najran, Saudi Arabia, from January to May 2019. The assessment of self-care behaviors was conducted using the 16-item diabetes self-management questionnaire (DSMQ).Results:The majority (85.1%) of the patients with T2DM were uncontrolled, 42% were obese, and 5.9% were morbidly obese. Based on DSMQ criteria, the majority of patients (90.1%) had poor self-care behaviors. The mean sum of DSMQ was 5.04 out of 10. Among the DSMQ subscales, health care use had the highest mean score of 5.63, followed by glucose management with a score of 5.12, while dietary control had lower mean scores of 4.96 and physical activity had 4.46, all were inadequate. Being married (OR=2.178, p=0.035) and having DM for more than 5 years (OR=2.711, p<0.006) were the significant independent factors associated with poor self-care behavior.Conclusion:Inadequate self-care behavior is widely prevalent in Najran city, Saudi Arabia. All the DSMQ subscales were poorly managed by most of the diabetic patients. Furthermore, being married and having a longer DM duration are the significant independent factors associated with poor self-care behaviors.

Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis.

Poor self-care behaviors can lead to an increase in the risk of adverse health outcomes among patients with heart failure. Although a number of studies have investigated the effectiveness of nurse-led self-care education, the evidence regarding the effects of nurse-led intervention in heart failure remains uncertain. This study aimed to evaluate evidence on the effectiveness of nurse-led heart failure self-care education on health outcomes in patients with heart failure. To identify studies testing nurse-led education designed to improve self-care among heart failure patients, comprehensive search methods were used between January 2000 and October 2019 to systematically search six electronic databases: PubMed, CINAHL, Embase, Cochrane library, Web of Science, and SCOPUS. All the eligible study data elements were independently assessed and analyzed using random-effects meta-analysis methods. Of 612 studies, eight articles were eligible for this study. Nurse-led heart failure self-care education significantly reduced the risk of all-cause readmission (risk ratio (RR) = 0.75, 95% confidence interval (CI) = 0.66–0.85), heart failure specific readmission (RR = 0.60, 95% CI = 0.42–0.85), and all-cause mortality or readmission (RR = 0.71, 95% CI = 0.61–0.82). However, nurse-led heart failure self-care education was not associated with improvements in the quality of life and heart failure knowledge. Studies on the effectiveness of nurse-led heart failure self-care education mostly report only the positive effects on patients’ health outcomes, whereas evidence of the effectiveness of the nurse-led approach is still limited. Therefore, high quality randomized controlled trials with detailed and explicit descriptions on the components of the interventions are needed.

Case-Control Study of Risk Factors and Self-Care Behaviors of Foot Ulceration in Diabetic Patients Attending Primary Healthcare Services in Palestine.

The purpose of this study is to identify certain sociodemographic, lifestyle, self-care, and foot examination factors that predict the development of diabetic foot ulcers in Palestine. A case-control study was performed in Palestine in 2019. The control group consisted of diabetic patients without foot ulceration (NFU). The case group included diabetic patients who had foot ulcers (DFU) with a size not less than 0.5 cm2. The sample of patients was taken from primary healthcare diabetic clinics in Palestine. Findings of the study showed several independent risk factors for developing DFUs, which were smoking, sensory loss to vibration, sensory loss to monofilament, loss of pedal pulse, presence of calluses, nephropathy, retinopathy, and neuropathy. Also, this study has shown that illiteracy and low income were significantly associated with DFU development. Moreover, the current study demonstrated that poor self-care behaviors were associated with DFU. The information gained from the study will contribute to raising awareness and improving health education for diabetic patients and their families with the aim of reducing the complications of diabetes.

Trajectory of self-care behaviour in patients with heart failure: the impact on clinical outcomes and influencing factors.

Background:Patients’ self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied.Aims:(1) To describe the trajectory of patients’ self-care behaviour over 1 year, (2) to clarify the relationship between the trajectory of self-care and clinical outcomes, and (3) to identify factors related to changes in self-care behaviour.Methods:In this secondary analysis of the COACH-2 study, 167 HF patients (mean age 73 years) were included. Self-care behaviour was assessed at baseline and after 12 months using the European Heart Failure Self-care Behaviour scale. The threshold score of ⩾70 was used to define good self-care behaviour.Results:Of all patients, 21% had persistent poor self-care behaviour, and 27% decreased from good to poor. Self-care improved from poor to good in 10%; 41% had a good self-care during both measurements. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p < 0.05). The prevalence of depression increased at 12 months in both patients having persistent poor self-care (0% to 21%) and decreasing self-care (4.4% to 22%, both p < 0.05).Conclusion:Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour.

Determination of Knowledge and Self Care Behavior of Heart Failure Pateints According to Orem Theory

Background: Heart failure (HF) is a chronic disease that requires special lifelong self-care behaviors. These patients need having self-care behaviors to confront their disease problems. Aim of the study: To assess patient knowledge about heart failure and determine the self-care behavior of heart failure patients. Subject and methods: To conduct this study, a descriptive research design was utilized. Sample: a convenient sample of 60 patients with heart failure. The study was conducted in coronary care unit at Abou-tig central hospital. Tools: One tool was utilized to collect data for this study: Patient interviewing questionnaire sheet including three parts: Part (1) demographic characteristics of the patients, part (2): Dutch heart failure knowledge scale, part (3) Heart failure self-care behavior scale, Results: The majority of the studied patients (75%) had unsatisfactory knowledge levels, while the minority (26.7%) of them had good self-care behavior. Conclusion: The majority of the studied patients had unsatisfied level of knowledge about heart failure and had poor self-care behavior. Recommendation: patients with heart Failure are in pressing need for health education about their illness which will reflect on their self-care behavior and results in better quality of life

Adherence to diet and medication and the associated factors among patient with chronic heart failure in a multi-ethnic society

ObjectiveTo investigate diet adherence, medication adherence and self-care behaviour among patients with chronic heart failure (CHF) in a multi-ethnic society and identify the significant factors associated with their diet and medication adherence. MethodsA cross-sectional descriptive correlational study was conducted with a convenience sample of 107 patients with CHF recruited from two cardiology wards of a public tertiary hospital in Singapore. Study variables were measured using the Dietary Sodium Restriction Questionnaire, the Medication Adherence Rating Scale-5 items and the European Heart Failure Self-care Behaviour Scale-12 items. ResultsOur sample reported positive attitudes towards diet adherence, poor self-care behaviour, and good medication adherence. The multiple linear regression results indicated that lower income, Chinese ethnicity, diabetic complications, current smoking, lower New York Heart Association classification I and II, and poorer self-care behaviour predicted poorer diet adherence. In addition, absence of hypertension, having non-myocardial infarction as a cause of CHF, and moderately diminished ejection fraction were identified as significant predictors of poorer medication adherence. ConclusionThe findings from this study have established the need to improve current education and rehabilitation programmes for patients with CHF by addressing those factors significantly influencing their adherence to diet and medication.

Factors Associated with Depression among Heart Failure Patients at Cardiac Follow-Up Clinics in Northwest Ethiopia, 2017: A Cross-Sectional Study.

Background Depression is a comorbid disorder in patients with heart failure and it is a major public health problem worldwide. Little is known about the depression among heart failure patients in low-income countries, while, in Ethiopia, none was studied. Objective This study is to assess the prevalence of depression and associated factors among heart failure patients at cardiac follow-up clinics at Amhara Region Referral Hospitals, Northwest Ethiopia, 2017. Methods A hospital based cross-sectional study was conducted between March 30, 2017, and May 15, 2017, G.C., by using a systematic random sampling technique to select 422 of 1395 HF patients. Structured interviewer-administered questionnaires and patient card review with a checklist that incorporates the PHQ-9 tool for depression measurement were used. The collected data were checked, coded, and entered into Epi-info version 7 and exported to SPSS version 20. Bivariate logistic regression at p-value <0.2 was exported to multivariate logistic regressions and p-value <0.05 was considered statistically significant. Results A total of 403 were included with a response rate of 95.5%. Among the participants, 51.1% had depressive symptoms. Factors associated with depressive symptoms were poor self-care behavior 1.60 [AOR (95% CI=1.01, 2.55)], poor social support 1.90 [AOR (95% CI=1.16, 3.12)], being female 2.70 [AOR (95% CI=1.44, 5.07)], current smoking history 4.96 [AOR (95% CI=1.54, 15.98)], and duration of heart failure (>1 year) 1.64 [AOR (95% CI=1.04, 2.59)]. Conclusions Around half of the patients were depressive. The patients who had poor self-care behavior, were females, had poor social support, had a current history of smoking, and had duration of chronic heart failure >1 year need special attention. Therefore, all referral hospitals need efforts to focus on those problems and target improvements of depressive symptoms.

Gender Differences in the Association between Frailty, Cognitive Impairment, and Self-Care Behaviors Among Older Adults with Atrial Fibrillation.

Atrial fibrillation (AF), common in older adults, increases the risk of heart failure, stroke, and all-cause mortality. Self-care behaviors help avoid adverse events in older patients with AF. However, while frailty and cognitive impairment can contribute to poor self-care behaviors, few studies have explored these relationships in older adults with AF. This cross-sectional study aims to determine associations between frailty, cognitive impairment, and self-care behaviors among older adults with AF by gender. A total of 298 patients with AF aged 60 and over were assessed with a self-reported questionnaire consisting of the Korean version of the FRAIL scale, modified mini-mental state examination, and self-care scale for AF. Prevalence of frailty and prefrailty in men and women was around 11% and 48.4% and 28% and 47.4%, respectively. According to the hierarchical linear regression analysis, in men, prefrailty (β = −2.874, p = 0.013) and frailty (β = −7.698, p < 0.001) were associated with self-care behaviors; in women, frailty (β = −5.476, p = 0.003), and cognitive impairment (β = −3.350, p = 0.044) were associated with self-care behaviors. Developing individualized care plans will require periodic screening of older patients with AF to determine their frailty status and cognitive function.

Consequence of Diabetes on Psychosocial Wellbeing and Quality of Life

The persons living with Diabetes in the community does not realize their actual situation. The knowledge levels of persons with acute diabetes infuse insulin and in case of Type 2 diabetes patients is comparatively moderate in symptoms of common men and experts. Individuals with diabetes survive in a community that does not realize their ailment. The complete opinion that persons with severe diabetes infuse insulin and that Type 2 diabetes is minor persists prevalent within the common people and still with certain health care specialists. The Diabetes attitudes, wishes, and needs study, underlined that emotionalassistance in this unit of patients is lower than source and ineffective, causing in weak quality of life (QoL) and decreased common wellbeing. It is frequently tricky for much to agree that they must take medicines consistently during their life cycle, causing in weak medication adherence and diabetes personal administration. These psycho social problems can eventually develop into depressive or other psychological disorders that are associated with poor self-care behavior, poor metabolic outcomes, increased mortality, functional limitations, increased health-care cost, loss of productivity, and reduced QoL. To make the situation worse, only few people understand that diabetes is a condition that cannot be simply controlled by medications and that the existence of diabetes evidently modifies the lives of persons and their dependents. Consequently, during this article we will be reviewing the scientific evidence of the consequences of impaired psychological wellbeing and poor perception of quality of life on patients with diabetes. We will be enlightening the importance of social work and self-empowerment on this aspect of management, which is crucial for the improvement in the physical, psychological, and social wellbeing of every patient suffering from this disease. Keywords: Diabetes; psychological; wellbeing; quality of life

A study protocol on effectiveness of theory-based intervention on self-care and glycated hemoglobin among type 2 diabetes patients in National Center for Diabetes in Yemen

Background and objectives: Diabetes is a complex, chronic illness that needs unceasing medical care with multifactorial risk-reduction strategies. Adequate glycemic control is recommended to reduce diabetes complication. Adequate self-care is important to improve glycemic control. Despite the importance of glycemic control, the majority of diabetic patients in Yemen have poor glycemic control. Poor glycemic control is a sign of poor self-care behaviors. Inadequate self-care increases patient’s morbidity and mortality, costs of medication and laboratory tests and cost in time and effort of care providers. The purpose of this study was to develop, implement, and evaluate the effect of Information-Motivation-Behavioral Skills (IMB) model-based Diabetes Self-Management on diabetes self-care behaviors (diet, physical activity, and foot care) and glycated hemoglobin among patients with type 2 diabetes in the National Center for Diabetes in Yemen. Subjects and methods: This is a parallel-randomized controlled trial, which will be conducted at the National Center of Diabetes in Yemen. Eligible participants who give consent will be randomized to an intervention group and a control group (usual care) after baseline assessment. The intervention group will receive the intervention, which is a 3-hour session, based on the information motivation behavioral skills model to improve the self-care behaviors (diet, physical activity, and foot care) and glycated hemoglobin. A post-intervention assessment will be done at 6 months after the intervention. Patient recruitment began in February, 2018. Analysis of primary outcome measure will be completed in July 2019, and the study will be finished in September 2019. Study protocol: 1.0. The protocol was approved by the Ethics Committee for Research Involving Human Subjects from Universiti Putra Malaysia on February 7, 2017 (reference No. FPSK (FR16) 015) and Al Thawra Hospital Ethics Committee (reference No. 2/2018). Outcome measures: The primary outcomes of this study are the changes in diabetes self-care behaviors (diet, physical activity, foot care) and glycated hemoglobin. The secondary outcomes are the changes in information motivation and behavioral skills of diet, physical activity, and foot care. Discussion: This theory-based randomized controlled trial aims to improve the glycemic control of patients with type 2 diabetes through improving the adherence to diabetes self-care behaviors. Trial registration: This trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) (registration number: ACTRN12617001037392) on July 17, 2017. http://www.anzctr.org.au/ACTRN12617001037392.aspx

An exploration of learning needs: identifying knowledge deficits among hospitalized adults with heart failure.

The current study examined the learning needs of hospitalized patients with chronic heart failure (CHF) by identifying their current CHF self-care behaviors and knowledge levels, while identifying relationships between clinical variables, and their learning needs. A descriptive, cross-sectional design was utilized to examine a convenience sample of 42 hospitalized patients with CHF. Self-care behaviors and knowledge levels were measured using the Self Care of Heart Failure Index V. 6.2, and the Japanese Heart Failure Knowledge Scale. Descriptive statistics were used to describe the learning needs and sociodemographic data and Pearson product moment correlation examined relationships between the learning needs and clinical variables. The mean scores of self-care were 38.6% (maintenance), 41.6% (management) and 17.8% (confidence). The participant's mean knowledge level score was 74.9%. Multiple CHF hospital readmissions had a significant negative correlation with CHF knowledge scores (r = −0.358, p < 0.05), suggesting the lower the knowledge score, the higher the prevalence of CHF readmissions. There were significant positive correlations between self-care maintenance (r = 0.525, p < 0.05), management (r = 0.435, p < 0.05), confidence (r = 0.366, p < 0.05), knowledge level (r = 0.752, p < 0.05) and not living alone. Thus, indicating that living with family support is correlated with better self-care and greater knowledge. The presence of multiple comorbidities revealed significant positive correlations (p < 0.05) with self-care scores (maintenance [r = 0.391], management [r = 0.438], and confidence r = 0.504), indicating a higher number of comorbidities, yielded lower self-care behaviors. Findings revealed poor self-care behaviors in all three areas (maintenance, management, confidence). These findings suggested that patients had difficulty implementing knowledge into self-care. By identifying knowledge deficits and contributing factors to suboptimal self-care, the chronic care model can be used as a guideline for ideal CHF education and management. Improving self-care behaviors can be obtained by initiating an active engagement between health care teams and the patient.

Medication Adherence and Diabetes Self-Care Activities Among Patients With Type 2 Diabetes Mellitus

The prevalence of type 2 diabetes mellitus (T2DM) is increasing at an alarming rate in developing countries. The accompanying complications of T2DM can be reduced by maintaining a good adherence to medication and self-care activities. To evaluate medication adherence and self-care behaviors among patients with T2DM. A total of 497 subjects with T2DM were recruited from three hospitals and a government clinic in the state of Selangor, Malaysia. Previously validated scales were used to measure medication adherence (Morisky Medication Adherence Scale) and diabetes self-care activities (Summary of Diabetes Self-Care Activities). Pearson correlation coefficient was used to investigate the relationship between the risk factors and medication adherence. Pearson χ2 test of association was used to test significant association. The mean age of the subjects was 55.5 years. The mean Morisky Medication Adherence Scale score was 5.65 ± 1.97, indicating a moderate adherence level to medication. Among the subjects who had low adherence level, 50.9% were Malays, followed by 34.2% Indians. The Pearson χ2 test of association indicated a significant association (P = 0.000) between ethnicity and medication adherence. The subjects had better self-care behaviors in their general diet (mean 5.04 ± 1.88) and poor self-care behaviors in blood sugar testing (mean 2.13 ± 2.34). The Malaysians had a moderate medication adherence level, whereas they were nonadherent to blood glucose testing. Emphasis on self-care activities and medication adherence is relevant to improve outcomes in the management of T2DM.

Association between the Vicious Cycle of Diabetes-Associated Complications and Glycemic Control among the Elderly: A Systematic Review.

Background and objectives: Improved quality of life (QoL) and life expectancy of elderly diabetic patients revolves around optimal glycemic control. Inadequate glycemic control may lead to the development of diabetes-associated complications (DAC), which not only complicate the disease, but also affect morbidity and mortality. Based on the available literature, the aim was to elucidate the vicious cycle underpinning the relationship between diabetes complications and glycemic control. Materials and Methods: A comprehensive literature search was performed to find eligible studies published between 1 January 2000 and 22 September 2018 pertaining to diabetes complications and glycemic control. Results: Initially, 261 studies were retrieved. Out of these, 67 were duplicates and therefore were excluded. From the 194 remaining articles, 85 were removed based on irrelevant titles and/or abstracts. Subsequently, the texts of 109 articles were read in full and 71 studies were removed at this stage for failing to provide relevant information. Finally, 38 articles were selected for this review. Depression, impaired cognition, poor physical functioning, frailty, malnutrition, chronic pain, and poor self-care behavior were identified as the major diabetes-associated complications that were associated with poor glycemic control in elderly diabetic patients. Conclusions: This paper proposes that diabetes-associated complications are interrelated, and that impaired glycemic control aggravates diabetes complications; as a result, patient’s self-care abilities are compromised. A schema is generated to reflect a synthesis of the literature found through the systematic review process. This not only affects patients’ therapeutic goals, but may also hamper their health-related quality of life (HRQoL) and financial status.

Condom-use self-efficacy as a mediator between syndemics and condomless sex in men who have sex with men (MSM).

Among men who have sex with men (MSM), HIV sexual risk and poor self-care behavior is associated with syndemics, or co-occurring psychosocial problems. Though prior research has demonstrated an additive total effect of syndemics on HIV risk behavior and infection, mostly within cross-sectional designs, it is possible that these associations are not direct but rather that syndemics disrupt relevant individual-level mediating psychological variables. One of the more common individual-level psychological variables that predicts health behavior generally, and HIV risk behavior specifically, is self-efficacy. This study sought to examine the potential effects of syndemics on condomless sex via condom-use self-efficacy as an intermediary variable. In high-risk MSM (N = 197), across 3 time points (baseline, 3 months, and 6 months) we used latent growth curve modeling to test the degree to which self-efficacy mediated the relationship between syndemics (heavy alcohol use, substance use disorder, sexual compulsivity, depression, social anxiety, intimate partner violence, childhood sexual abuse) and condomless anal sex. The baseline analyses were consistent with an indirect effect of the association between syndemics and condomless sex through self-efficacy. Prospective longitudinal mediation was partially supported, such that baseline syndemics were associated with lower baseline self-efficacy, which in turn predicted higher increases in condomless anal sex across time. These findings provide preliminary evidence (due to the partial support for the longitudinal model) that syndemics themselves may not be directly causal in their association with condomless sex, but the association may be through modifiable social-cognitive mechanisms such as condom self-efficacy. (PsycINFO Database Record

A study on the information-motivation-behavioural skills model among Chinese adults with peritoneal dialysis.

To examine whether the information-motivation-behavioural skills model could predict self-care behaviour among Chinese peritoneal dialysis patients. Peritoneal dialysis is a treatment performed by patients or their caregivers in their own home. It is important to implement theory-based projects to increase the self-care of patients with peritoneal dialysis. The information-motivation-behavioural model has been verified in diverse populations as a comprehensive, effective model to guide the design, implementation and evaluation of self-care programmes. A cross-sectional, observational study. A total of 201 adults with peritoneal dialysis were recruited at a 3A grade hospital in China. Participant data were collected on demographics, self-care information (knowledge), social support (social motivation), self-care attitude (personal motivation), self-efficacy (behaviour skills) and self-care behaviour. We also collected data on whether the recruited patients had peritoneal dialysis-associated peritonitis from electronic medical records. Measured variable path analysis was performed using mplus 7.4 to identify the information-motivation-behavioural model. Self-efficacy, information and social motivation predict peritoneal dialysis self-care behaviour directly. Information and personal support affect self-care behaviour through self-efficacy, whereas peritoneal dialysis self-care behaviour has a direct effect on the prevention of peritoneal dialysis-associated peritonitis. The information-motivation-behavioural model is an appropriate and applicable model to explain and predict the self-care behaviour of Chinese peritoneal dialysis patients. Poor self-care behaviour among peritoneal dialysis patients results in peritoneal dialysis-associated peritonitis. The findings suggest that self-care education programmes for peritoneal dialysis patients should include strategies based on the information-motivation-behavioural model to enhance knowledge, motivation and behaviour skills to change or maintain self-care behaviour.

Relationship between self-care behaviors and health literacy among elderly women in Iran, 2015.

Background and aimSelf-care is a basic concept in health promotion, regarding the importance of health literacy as a key factor in self-care. This study aimed to identify the relationship between self-care behaviors and health literacy among elderly women in Iran.MethodsThis descriptive and analytic study was performed between October and December 2015. A total of 360 participants were selected from elderly women referred to health centers. Data was collected by test of functional health literacy in adults (S-TOFHLA) and a checklist for assessment of self-care behaviors, and health information seeking. Data were analyzed by SPSS software (version 22) with One-Way Analysis of Variance, and the Pearson correlation coefficient, t-test and regression test.ResultsThe mean score of functional health literacy was 41.30±6.29. Of the participants, 73.6% had inadequate health literacy, 20.8% borderline health literacy, and 5.6% enough health literacy. The mean score of health information seeking was 1.791. Also, 31.9% of elderly women had poor self-care behaviors, 56.9% moderate, and 11.1% high. A significant difference was observed in mean score of health literacy between different levels of self-care (F=30.087, p<0.001). Based on regression analysis, health literacy and health information seeking predicted 19.9% of the variance of self-care behaviors.ConclusionThis study highlights the necessity of promoting health literacy and attention to its influencing factors to improve self-care ability of elderly women. In conclusion, Planning interventions to improve health literacy is essential for health promotion among elderly women.