Self-care Adherence Research Articles

Correlation of Diabetes self-care adherence with glycemic measures: a cross-sectional health facility-based study in Kathmandu, Nepal

Self-care plays a key role in prevention of complications, and improvement of the quality of life of persons with diabetes (PWDs). This study has assessed adherence to self-care behavior and its correlation with glycemic measures among PWDs attending private health care facilities in Kathmandu, Nepal. A cross-sectional study was carried out using a semi-structured questionnaire. Socio-demographic information and recent fasting (FBG) and 2-hr post-prandial blood glucose (2-hr PBG) levels were recorded. Self-care inventory (SCI) 12-item version was used to assess adherence to diabetes self-care over the preceding four weeks. Self-care practice was measured in five domains: glucose monitoring; diabetes medication; diet; exercise; and preventative care. The overall adherence score was obtained by computing the average of seven items (items 1, 2, 4, 5, 6, 7, 14). Scores more than or equal to median score were considered as higher levels of self-care efficacy. Univariate linear regression analysis of the subscale scores and individual item-wise score with age, duration of diabetes (years), FBG and PPBG levels was carried out. Pearson’s coefficient (r) was reported for normally distributed variables. Among 385 PWDs, mean FBG was 146 mg/dl (±54.7), 2-hr PBG was 210 mg/dl (±82). Median score for overall adherence to diabetes self-care was 25 (IQR:21 to 29). Higher self-care efficacy was seen among 55% (n=212). Overall adherence to self-care was significantly and negatively correlated with age and glycemic measures. Self-care efficacy was mainly driven by adherence to diabetes medication. Adherence to preventative care, exercise and home monitoring of blood glucose was low. FBG was significantly and negatively correlated with glucose regulation (r=-0.16, P=0.001), diabetes medication and food regulation (r=-0.11, P=0.03), preventative care (-0.14, P=0.03) and overall adherence to treatment (-0.15, P=0.004). 2-hr PBG was significantly and negatively associated with all domains of self-care (r -0.14, P=0.04 to -0.21, P<0.0001). Elderly persons, may face difficulty with regular physical exercise, dietary recommendations and overall adherence to self-care. Continuing diabetes education is imperative to motivate PWDs and caregivers regarding importance of self-care efficacy in glycemic regulation and diabetes care.

Self-care adherence and associated factors among hypertensive patients at Guraghe Zone, 2023

BackgroundHypertension is the primary cause of cardiovascular disease and early mortality. Self-care is important for the prevention of hypertensive-related complications, and it was found to be necessary to determine the self-care adherence of hypertensive patients in Guraghe Zone, as there are limited findings in this area. The other reason for conducting this study was that there are certain variables related to self-care that have not been well studied, such as BMI, the number of antihypertensive medications, and the duration of antihypertensive drugs the patients are taking. ObjectiveTo assess self-care adherence and associated factors among hypertensive patients at Guraghe zone public hospitals. Methods and materialsA multi-center institution-based cross-sectional study was conducted at selected Guraghe zone hospitals from May 20 to June 20, 2023. A systematic random sampling method was employed to select 370 participants. Hypertension self-care Activity Level Scale Effects (H-SCALE) was used to measure the self-care status. A binary logistic regression model was applied, and variables with a p-value <0.05 with a 95 % CI in the multivariable analysis were considered significant. ResultsThe study evaluated the self-care adherence of 370 patients, and 50.8 % of patients had good self-care adherence. Normal BMI (AOR = 2.049, 95 % CI: 1.041, 4.033), starting antihypertensive in <5 years (AOR = 2.530, 95 % CI: 1.462, 4.381), patients taking three or more antihypertensive (AOR = 4.534, 95 % CI: 2.005, 10.252), absence of comorbidity (AOR = 1.758, 95 % CI: 1.030, 3.003), and strong social support (AOR = 3.842, 95 % CI: 1.994, 7.402) were significantly associated with good self-care. Conclusionand recommendation: Nearly half of patients with hypertension had good self-care adherence. BMI, antihypertensive duration, number of antihypertensive, comorbidity, and social support were variables that showed significant association with self-care adherence. Patients need to implement the lifestyle recommendations in addition to regular follow-up to prevent complications. Health-care facilities need to provide health education on the proper implementation of self-care recommendations.

The feasibility of a social media-based foot self-management education and support program for adults with diabetes: A partially randomized preference trial

AimTo assess the feasibility of Diabetic Foot Care Group (DFCG), a social media-based self-management education and support intervention, for people with diabetes (PWD) empowerment in diabetes-related foot ulceration prevention. MethodsA partially randomized preference trial was conducted among 32 PWD. DFCG was implemented through Facebook. Participants in the intervention group joined the DFCG in addition to their usual care, while the control group received usual care. Data were collected online using questionnaires on participants' DFCG acceptance, engagement and preliminary efficacy on nine diabetes foot care-related outcomes at baseline, one, and three months post-intervention. ResultsThe participants' study intervention acceptability and engagement rates were 84.2% and 55.2%, respectively. DFCG efficacy rate compared to usual care was 88.9% to 22.2%. Three diabetes foot care-related outcomes increased significantly in the intervention group three-month post-intervention: foot self-care adherence (p = 0.001, ηp2 = 0.35), preventive foot self-care practice (p = 0.002, ηp2 = 0.33), and physical health status (p < 0.02, ηp2 = 0.23). ConclusionDFCG is feasible and could effectively improve diabetes foot care-related outcomes. InnovationSocial media is an innovative approach healthcare professionals could utilize to virtually support PWD in ongoing learning and engagement in optimal foot self-care activities. Trial registrationClinicalTrials.gov, Identifier: NCT04395521

Targeting self-care adherence for glycaemic control in multimorbid type 2 diabetes mellitus with depression using bupropion: a protocol for cross-over randomised controlled trial

IntroductionDiabetes and depression are among the 10 biggest health burdens globally. They often coexist and exhibit a strong bidirectional relationship. Depression leads to decreased adherence to self-care activities. This impacts...

Illness Perception, Coping, and Self-Care Adherence Among Adults With Type 2 Diabetes

Understanding the key factors in managing type 2 diabetes over the long term has become necessary. This study aims to explore the association between illness perception, coping, and self-care adherence among adults with type 2 diabetes and find the influence of illness perception and coping on self-care adherence. A cross-sectional survey design was used to collect data from 123 adults with type 2 diabetes aged between 30 and 55 years. The questionnaires included the Brief Illness Perception Questionnaire (BIPQ), Brief COPE, Self-Care Inventory-Revised (SCI-R), and a personal information sheet. A significant correlation was found between illness perception, maladaptive and adaptive coping strategies, and self-care adherence. Adaptive coping, illness perception, and maladaptive coping strategies together explained a 59.9% variance in self-care adherence (F(3, 119) = 59.29, p &lt; .001). The study highlights the importance of developing a less threatening perception of the illness and enhancing the practice of adaptive coping strategies for achieving better self-care adherence among people with type 2 diabetes. This study signifies the need for a collaborative approach by healthcare professionals, mental health providers, and policymakers to provide accurate diabetes self-management knowledge and develop interventions tailored to individuals’ needs.

Differences in patient-reported and clinical characteristics by age group in adults with type 2 diabetes.

The global burden of type 2 diabetes (T2D) is growing, and the age of onset is widening, resulting in increasing numbers of young adults and elderly patients with T2D. Age-specific diabetes care needs have yet to be fully explored. This study examined (1) differences in patient-reported and clinical characteristics by age group and (2) the effect of age on two proxy measures assessing psychological health and self-care adherence after adjusting for potential mediators. A cross-sectional, correlational design was used. Adults with type 2 diabetes (T2D) were recruited from a university hospital in Korea between 2019 and 2020. Participants were divided into four groups based on years of age (40s and younger group [n = 27]; 50s group [n = 47]; 60s group [n = 54]; and 70s and older group [n = 48]) to compare patient-reported and clinical characteristics. Chi-square tests, ANOVA, Kruskal-Wallis tests, and logistic regression analysis were performed to assess group differences and effect of age on psychological health and self-care adherence. Of 178 participants, two-thirds were men (n = 114; 64.41%). The mean ages in the 40s and younger, 50s, 60s, and 70s and older groups were 39.4, 54.7, 63.9, and 76.0 years, respectively. There were significant differences in patient-reported and clinical characteristics by age group. The youngest group reported the poorest psychological health and self-care behaviors. Although the oldest group showed the poorest physical functioning, this group also showed the highest self-care adherence and the best psychological health. Regarding clinical characteristics, traditional diabetes-related blood test results showed no significant group differences. Age-specific diabetes care needs were identified in adults with T2D. Interventions to improve psychological health and priming effects of behavioral adherence need to be developed. Furthermore, meticulous investigation to detect potential complications early is essential in adults with T2D.

Health-seeking behaviors and determinants among herpes zoster patients in South Wollo public hospitals, Ethiopia, 2022

BackgroundHealth-seeking behavior towards herpes zoster is vital to find an appropriate remedy for patients and utilization of timely healthcare services can have an impact on good health outcomes. The study aimed to assess the health-seeking behavior and determinants among Herpes Zoster patients in public hospitals, South Wollo, Ethiopia. MethodA hospital-based cross-sectional study was conducted from September 1, 2022, to November 30, 2022. The simple random sampling technique was used to select 419 participants. Pretested, structured questionnaires and patient interviews were used to collect the data. The bivariable analysis was done and variables with p-value <0.25 were further examined using a multivariable logistic regression model. AOR with a 95 % CI and a P-value <0.05 at a 5 % level of significance were considered. ResultsAbout 55.6 % of patients had poor health-seeking behavior towards herpes zoster, with a response rate of 99.1 %. Distance from health facilities (AOR = 4.9; 95 % CI: 1.33–10.35), being rural residence (AOR = 0.3; 95 % CI: 0.17–0.40), being illiterate (AOR = 5.9; 95 % CI: 3.40–10.32), poor self-care adherence (AOR = 1.8; 95 % CI = 1.14–3.07), moderate depression (AOR = 7.3; 95 % CI: 4.10–11.50), moderate (AOR = 0.3; 95 % CI: 0.10–0.70) and severe anxiety (AOR = 0.1; 95 % CI: 0.01–0.63), and duration more than seven days of herpes zoster (AOR = 3.1; 95 % CI = 1.42–6.97) were statistically significant. ConclusionNearly half of the study participants had poor health-seeking behavior. Being a rural resident and illiterate, poor self-care adherence, moderate and severe anxiety, moderate depression, and duration of more than 7 days were significantly associated. with health-seeking behavior towards Herpes Zoster. Proper guidance, psychological support, and awareness creation about Herpes Zoster severity and complications.

What frail, older patients talk about when they talk about self-care—a qualitative study in heart failure care

BackgroundSelf-care plays a crucial role in the management of heart failure (HF) and is especially important for older patients who are frail. However, there is limited knowledge about how frail, older patients with HF perceive and experience self-care. Therefore, the aim of this study was to describe the experiences of self-care among frail, older patients with HF.MethodsA qualitative descriptive design with semi-structured interviews with frail, older patients diagnosed with HF (n = 19; median age 82 years). Thematic analysis, guided by Braun and Clarke, was used to analyse the data.ResultsTwo main themes emerged from the analysis: 1) “To maintain my health,” encompassing various aspects such as hygiene practices, engaging in physical activity, medication adherence, following a healthy diet, and ensuring adequate rest; and 2) “To maintain my well-being and happiness,” highlighting the importance of hobbies, maintaining independence, participating in social activities, and creating a supportive environment.ConclusionThis study provides valuable insights into the perspectives of frail, older patients with HF regarding self-care. It was observed that older patients often associate self-care with general well-being, hygiene, and happiness. Clear communication between healthcare providers and patients is essential to align different perspectives on self-care and ensure that self-care plans are tailored to individual needs. Moreover, addressing the emotional well-being and happiness of patients should be prioritized, as these factors play a significant role in promoting self-care adherence.

Health Education-Based Group on Self-care Adherence among Patients with Diabetes Mellitus in Cendrawasih Public Health Center, Makassar City

Background: Self-care is crucial strategy to improve and maintain health condition among diabetes patients. However, most type 2 DM patients are disobedient in carrying out self-care. Objective: The study aimed to examine the effect of health education on self-care adherence among patients with diabetes mellitus in Cendrawasih Public Health Center, Makassar city. Method: A quantitative study with pre-experimental approach, two group, pretest and posttest design were applied in this study. Thirty-six diabetes mellitus patients were involved in this study using the total sampling technique since limited number of patients in this Public Health Center. We divided into the experimental group (n=18) and the control group (n=18). The Wilcoxon test was used to analyzed the data. Result: The results found that there are significantly difference on self-care adherence among type 2 diabetes mellitus before and after receiving the health education with p-value &lt;.05. Conclusion: The health education was effective to improve the understanding of diabetes patients who carry out the self-care in maintaining the self-care. Recommendation: Further study need to apply the wide of study using the Randomized Control Trial (RCT) to ensure the effectiveness of health education using varied of strategy on health outcomes

Medication Adherence in Elderly Diabetic Patients: A Cross-Sectional Study From Dakshina Kannada, India.

Diabetes Mellitus (DM) has emerged as a major global healthcare problem. The risk of diabetes can be reduced by maintaining blood glycaemic levels, which can be achieved by stringent adherence to the treatment regime. Therefore, there is a continuing need to assess the level of adherence to medication/self-care activities and the factors that are related to non-adherence to medication and self-care. This would facilitate healthcare professionals to identify subjects with low medication adherence and thereby aid them in planning interventions to improve medication and self-care adherence. In this study, we aimed to estimate the proportion of medication adherence among diabetic patients above 60 years of age attending a tertiary care hospital in Southern India. We found that 72% of type 2 diabetes patients were adherent to the medications prescribed to them and there was a discernible effect of gender and literacy on medication adherence. However, more such regional studies need to be conducted with a larger sample size from diverse hospital setups to obtain a clear and unbiased picture of the drug adherence scenario in India.

SELFCARE IN RELATION TO DIETARY COMPLIANCE FOR NUTRITION AND FLUID AMONG PATIENTS UNDERGOING HEMODIALYSIS

The dietary intake of nutrients and fluids holds paramount importance for patients afflicted with chronic kidney disease undergoing hemodialysis, as it significantly influences their overall well-being and quality of life. Mismanaged nutritional and fluid intake may lead to adverse clinical consequences, including the development of ascites and edema. Furthermore, inadequate implementation of a well-balanced nutritional and fluid regimen can result in the depletion of muscle and fat mass, thereby impacting the daily functioning of individuals grappling with chronic kidney disease. The correlation between patients' adherence to such dietary protocols and their ability to autonomously manage self-care further underscores the significance of this study. This quantitative research was conducted using a descriptive approach and a cross-sectional design to examine patient self-care and its alignment with nutritional and fluid diet adherence among chronic kidney disease patients undergoing hemodialysis. The study was conducted at Bakti Timah Hospital and Depati Hamzah General Hospital in Pangkalpinang. This research primarily measured the degree of Self Care exhibited by Patients with Chronic Kidney Disease Undergoing Hemodialysis in adherence to a prescribed Nutritional and Fluid Diet. The findings unveiled a majority of patients (82.2%) adhering to dietary intake of essential nutrients, particularly staple foods. Conversely, the assessment of side dish consumption revealed a considerable proportion (62.7%) in the non-adherent category. Similarly, the description of mineral and water intake highlighted a majority (50.8%) falling into the non-compliant segment. Conversely, vegetable and fruit intake garnered adherence from a substantial number of patients (68.6%). Moreover, the assessment of self-care adherence in relation to vitamin consumption displayed a significant level of compliance (64.4%). In general, the self-care adherence to diet, nutrition, and fluids in hemodialysis (68.6%) was within the non-adherent category.

Exploring facilitators and barriers to patient-provider communication regarding diabetes self-management

ObjectiveLong-term type 2 diabetes management requires open communication between a patient and their provider for self-care adherence. This study explored facilitators and barriers to diabetes-specific communication in West Virginia, a medically underserved state with the highest prevalence of diabetes (16.2%) in the U.S. MethodsA secondary qualitative analysis was conducted using data from semi-structured interviews (n = 34) and 4 focus groups (n = 23) with participants of a diabetes education program. Transcripts were analyzed using thematic analysis. ResultsThree facilitators to patient-provider communication emerged: “Patient-Provider Partnership”, “Provider Accessibility”, and “Empowerment Through Education”. Partnership with providers, especially those who were accessible outside of scheduled appointments, and empowerment obtained through diabetes education facilitated diabetes-specific patient-provider communication. However, barriers included “Providers' Focus on ‘Numbers' Rather than Patient Concerns”, “Patient Lack of Preparation for Appointments”, and “Providers ‘Talking Down to’ Patients”. ConclusionThe findings highlight patient- and provider-related factors that impact diabetes-specific communication. InnovationPrevious interventions have trained providers in communication skills. Despite some success, challenges in implementation remain considering providers' limited time and overwhelming demands. This study suggests that diabetes education programs incorporating communication and self-advocacy skills could be a promising alternative as they can empower patients to communicate their diabetes-specific needs/preferences with providers.

Self Efficacy of Self-Care Adherence in People with Hypertension

This study aims to investigate the relationship between self-efficacy and self-care adherence in patients with hypertension. Self-care adherence refers to an individual's compliance with medical recommendations and behaviors supporting hypertension control. The research method employed is an observational study involving participants with hypertension. Data were obtained through questionnaires measuring the level of self-efficacy and self-care adherence. Statistical analysis was conducted to identify the relationship between self-efficacy and self-care adherence. The findings of the study indicate a positive relationship between self-efficacy and self-care adherence in patients with hypertension. Individuals with strong self-efficacy are more likely to be compliant in their self-care practices, including regularly taking medication, following a healthy diet, engaging in regular exercise, and monitoring their blood pressure. These findings highlight the importance of strengthening self-efficacy in individuals with hypertension to enhance their self-care adherence. In conclusion, self-efficacy plays a significant role in self-care adherence among patients with hypertension. Enhancing self-efficacy can be an effective strategy for improving self-care adherence and controlling blood pressure in patients with hypertension

Motivational Interviewing for Enhancing Self-care in Patients With Heart Failure: Protocol for a Randomized Controlled Trial.

Heart failure (HF) is characterized by an increasing prevalence, representing a public health problem and a significant cause of morbidity and mortality. Self-care is a cornerstone approach for optimizing therapy for patients with HF. Patients play a crucial role in managing their condition, given that several adverse health outcomes might be avoided with adequate self-care. In this regard, the literature describes motivational interviewing (MI) as highly favorable for treating chronic diseases, with promising results supporting its efficacy in enhancing self-care. Moreover, caregivers' availability constitutes a fundamental supporting factor among the strategies to improve self-care behaviors in people with HF. The primary study aim is to test the efficacy of a structured program, including scheduled MI interventions, in improving self-care maintenance in the 3-month follow-up from the enrollment. Secondary aims comprehend the assessment of the effectiveness of the above intervention on secondary outcomes (eg, self-care monitoring, quality of life, sleep disturbance) and the corroboration of the superiority of caregivers' participation to the intervention over the program administrated only to individual patients in enhancing self-care behaviors and other outcomes at 3, 6, 9, and 12 months from the enrollment. This study protocol designed a prospective, parallel-arm, open-label, 3-arm, controlled trial. The MI intervention will be administered by nurses trained in HF self-care and MI; the education program will be provided to nurses by an expert psychologist. Analyses will be performed within the framework of intention-to-treat analysis. Comparisons between groups will be based on an alpha of 5% and 2-tailed null hypotheses. In the case of missingness, analyzing the extent of the missingness and identifying underlying mechanisms and patterns will guide imputation methods. The data collection was started in May 2017. We completed the data collection with the last follow-up in May 2021. We plan to perform data analysis by December 2022. We plan to publish the study results within March 2023. MI enhances potential self-care practices in patients with HF and their caregivers. Although MI is effectively largely employed either alone or combined with other treatments and is administered in different settings and ways, face-to-face interventions seem to be more effective. Dyads with higher shared HF knowledge are more efficient in promoting self-care adherence behaviors. Moreover, patients and caregivers may perceive proximity with health care professionals, resulting in a better ability to follow the received health professionals' directions. The scheduled in-person meetings with patients and caregivers will be exploited to administer MI, respecting all the safety regulations for infection containment. The conduction of this study may support changes in clinical practice to include MI to improve self-care for patients with HF. ClinicalTrials.gov NCT05595655; https://clinicaltrials.gov/ct2/show/NCT05595655. DERR1-10.2196/44629.

Relationship between Disease Knowledge and Self-care Adherence among Heart Failure Patients at King Abdulaziz University Hospital

Backgrounds: Heart failure (HF) is a progressive syndrome characterized bycomplicated therapeutic regimens and repeated hospitalizations. HF has turnedinto a global epidemic demonstrating serious mortality and morbidity. This studyaimed to assess the relationship between disease knowledge and self-careadherence among adult HF patients at King Abdulaziz University Hospital (KAUH).Methods: A cross-sectional descriptive correlational design was utilized. Patientswere recruited from outpatient clinic at KAUH in Jeddah, Saudi Arabia. Aconvenience sample of 208 HF patients. The Dutch Heart Failure Knowledge Scale(DHFS) and the European Heart Failure Self-Care Behavior Scale (EHFSCBs) wereused to measure the main study outcomes. Participants were recruited from heartfailure outpatient clinics at KAUH from January 31 – May 17, 2021. Results: 63.9%of participants were male, 49% were over 61 years old, and 30.8% of theparticipants were not educated. 55.8% of the participants had an adequate level ofknowledge about HF disease and 57.2% had a good level of self-care adherence. Themean total HF knowledge score DHFS was 8.58±3.08 out of 15 and the self-careadherence score EHFSCBs was 28.97 ±5.61out of 60. A significant positive moderatecorrelation existed between disease knowledge and self-care adherence.Conclusion: Disease knowledge was adequate in more than half of the participants,and self-care adherence was good. This study has shown a relationship betweendisease knowledge and self-care adherence, which means that a high level of HFknowledge was associated with improved self-care adherence.

Amazon Amandaba-Sociodemographic Factors, Health Literacy, Biochemical Parameters and Self-Care as Predictors in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study.

Health literacy (HL) and its domains (functional, critical, and communicative) appear to be related to self-care adherence in people with type 2 diabetes mellitus (DM2). This study aimed to verify if sociodemographic variables are predictors of HL, if HL and the sociodemographic factors affect biochemical parameters together, and if HL domains are predictors of self-care in DM2. We used the baseline assessment data from 199 participants ≥ 30 years in the project, "Amandaba na Amazônia: Culture Circles as a Strategy to Encourage Self-care for DM in Primary Health Care," which took place in November and December 2021. In the HL predictor analysis, women (p = 0.024) and higher education (p = 0.005) were predictors of better functional HL. The predictors of biochemical parameters were: glycated hemoglobin control with low critical HL (p = 0.008); total cholesterol control with female sex (p = 0.004), and low critical HL (p = 0.024); low-density lipoprotein control with female sex (p = 0.027), and low critical HL (p = 0.007); high-density lipoprotein control with female sex (p = 0.001); triglyceride control with low Functional HL (p = 0.039); high levels of microalbuminuria with female sex (p = 0.014). A low critical HL was a predictor of a lower specific diet (p = 0.002) and a low total HL of low medication care (p = 0.027) in analyses of HL domains as predictors of self-care. Sociodemographic factors can be used to predict HL, and HL can predict biochemical parameters and self-care.

The Relationships Among Health Literacy, Patient Activation, and Self-Care Behaviors in Adults With Heart Failure: A Cross Sectional Study

Despite current efforts, adherence to heart failure (HF) selfcare remains suboptimal. There is a need to identify modifiable factors that promote self-care adherence. Evidence suggests that patient activation and health literacy (HL) are modifiable and may be useful for improving HF self-care. However, more research is needed to understand the influences of these variables on HF self-care. The aim of this study was to examine the relationships between patient activation, health literacy, and self-care adherence in a diverse group of adults with HF. This study used a correlational, cross-sectional design. Correlation and regression tests were used to analyze associations among variables. Stratified random sampling was applied to attain a study sample that was 50% persons of color (POC). Of the 174 participants, 51% were female and 48.5% were POC with a mean age of 62 years. There was no significant relationship between HL and HF self-care adherence. There was a small, positive correlation between HL and dichotomized high/low activation levels ( r = .163; p &lt; .05). There was a small, positive correlation between patient activation and HF self-care behaviors ( r = .151; p &lt; .05). However, regression tests showed patient activation was not a predictor of selfcare ( B = 0.173, p = .064). Persons with HF may perform self-care activities when highly activated, regardless of HL status. Patient activation was not a reliable predictor of self-care adherence. More research is needed to elucidate the influence of patient activation and HL on HF self-care behaviors.

Self-Efficacy and Adherence to Self-Care Among Patients With Type 2 Diabetes: A Systematic Review

Highly prevalent chronic illnesses such as type 2 diabetes can be effectively managed by adhering to certain health behaviors. As such, self-efficacy is a vital factor in this adherence process. This systematic review of cross-sectional studies aims to outline and evaluate the characteristics of the literature investigating self-efficacy and adherence to self-care in the type 2 diabetes population. Eleven eligible studies were identified based on the inclusion criteria after conducting a primary and secondary screening of three major databases (ProQuest, Scopus, and EBSCOhost) from inception to April 2022, along with manual searching from other sources. A narrative synthesis was used to analyze this review. The findings indicated that self-efficacy is significantly correlated with self-care adherence in persons with type 2 diabetes and that higher self-efficacy leads to better self-care behaviors. The selected studies failed to fulfill the quality criteria for identifying and measuring the confounding variables; therefore, future studies should focus on rigorous research design. A more sophisticated approach to elucidate phase-specific self-efficacy and its influence on health behavior among the type 2 diabetic population may be required in the future to design and test theoretical frameworks and intervention studies.

Abstract 11819: Self-Care Adherence and Related Factors in Koreans With Heart Failure

Introduction: Self-care is pivotal in managing heart failure (HF). However, patients’ adherence to self-care and associated factors are not fully understood in Koreans with HF. The aim of this secondary analysis was to assess the level of adherence to self-care and to identify associated factors in patients with HF. Methods: We analyzed baseline data from 122 HF patients (mean age 66.22 [SD 13.58] years; 50.8% female) enrolled in a randomized controlled trial. To determine adherence to self-care behaviors, the proportion of patients answering “completely agree” or “agree” to each item in the European self-care behavior scale (EHFScBS) was calculated. Based on the situation-specific theory of HF self-care, we investigated the effects of person-related factors (i.e., age, sex, socioeconomic status, health literacy, and self-efficacy), problem factors (i.e., multimorbidity, physical functioning, and depression), environmental factor (i.e., social support), and knowledge on adequate self-care (EHFScBS score &amp;ge; 70) using logistic regression analyses. Results: The mean EHFScBS score was 58.29 (SD 19.23), and 34 patients (27.9%) reported adequate self-care. The adherence rate was lowest for fluid restriction (25.4%) and low salt diet (36.1%). Self-care confidence, depressive symptoms, and social support were significantly associated with adequate self-care in univariate analyses (Table 1). After adjusting for other factors, higher levels of self-care confidence (adjusted odds ratio 1.03, p =.004) and lower levels of depressive symptoms (adjusted odds ratio 0.89, p =.03) were significant factors for adequate self-care. Conclusions: Efforts are needed to help patients with HF to engage in self-care practice. Self-care interventions should focus on promoting self-care confidence and reducing depressive symptoms in patients with HF. Routine assessment of self-care confidence and depressive symptoms may help clinicians to identify high-risk patients.

Prognostic efficacy of a post-discharge visiting program for patients with heart failure.

We aimed to investigate the impact of post-discharge scheduled hospital visits on readmission due to heart failure (HF). In this retrospective study, a total of 245 patients (N = 101 in the scheduled hospital visit group, N = 144 in the non-scheduled hospital visit group) who were alive with free from readmission due to HF for 90 days after discharge were enrolled. The patients had been hospitalized with acute decompensated HF between August 2018 and July 2019. Scheduled hospital visits were recommended 90 days after the patients had been discharged. After checking their self-care adherence, nurse-led self-care maintenance and monitoring were provided. To determine the effectiveness of the scheduled hospital visits, we conducted landmark analyses divided into two periods: Scheduled visits within 180 days, and after 180 days. The readmission rate due to HF within 180 days was lower in the scheduled visit group. In the landmark analysis, the 1-year incidence rate of readmission was significantly lower in patients with a scheduled hospital visit than in those without, in the period within 180 days (2.0% vs 9.0%, P = 0.029) but not after 180 days. After adjusting for age and estimated glomerular filtration rate as confounders, scheduled hospital visits tended to reduce readmission due to HF (P = 0.060); however, readmission was significantly reduced in the period within 180 days (P = 0.007). In conclusion, scheduled hospital visits at 90 days after discharge may be beneficial in delaying readmission due to HF by reducing risk of readmission during the early post-visit period.