Self-care Behaviors Research Articles

Exploring the Relationship Between eHealth Literacy and Diabetes Knowledge, Self-Efficacy, and Self-Care Behaviors in Chinese Diabetic Patients: A Cross-Sectional Study.

The importance of online educational resources enhancing self-management among patients is underscored by the growing prevalence of diabetes. It is crucial to comprehend how patients with diabetes in China seek diabetes-related information and use mobile applications (apps) designed for diabetes management. Although the Knowledge-Attitude-Practice theory plays an integral role in diabetes management, in-depth studies on eHealth literacy (eHL) and Knowledge-Attitude-Practice in populations with diabetes remain scarce. This study was developed to provide insights into the online information-seeking behaviors of and diabetes apps used by individuals living with diabetes by exploring the relationships among eHL, diabetes knowledge, self-efficacy, and self-care behaviors. A cross-sectional survey was conducted from November 2022 to June 2023 on 380 inpatients with diabetes at the Yantai Yuhuangding Hospital in Shandong Province. The participants voluntarily completed surveys covering sociodemographic characteristics, diabetes status, diabetes app usage, online diabetes information searching, eHL, diabetes knowledge, self-efficacy, and self-care behaviors. Structural equation modeling analyses were employed to assess model fitness and the interrelationships between latent constructs and observable variables. Of the 380 participants, 57.1% (217/380) reported actively seeking diabetes information online, whereas only 3.7% (14/380) had used diabetes apps. eHL was shown to have a direct effect on diabetes knowledge (β = 0.377, p < .001) but no direct impact on self-care behaviors (β = 0.017, p = .860). However, an indirect effect on self-care behaviors was observed via diabetes knowledge and self-efficacy. The results of this study indicate that, despite widespread online information-seeking behavior, diabetes app utilization remains limited in China. Also, the findings indicate enhancing patients' eHL contributes to more comprehensive diabetes knowledge. Furthermore, eHL was shown to influence self-care behaviors via diabetes knowledge and self-efficacy. A self-managed intervention strategy should be developed to improve eHL that utilizes internet resources to improve patients' knowledge and self-efficacy and promote better self-care behaviors.

Effects of depression and stress on oral self-care among perinatal women in Appalachia: A longitudinal study.

Oral health during the perinatal period and beyond affects the health and well-being of women and their offspring. Oral self-care behaviours can maintain or improve oral health; depression or stress during the perinatal period may compromise these behaviours. The aim of the study was to investigate the independent and combined effects of depression and stress on oral self-care behaviours of perinatal women in Appalachia, given the high burden of oral disease in this region. A total of 1172 women in the first or second trimester of pregnancy were enrolled in the Center for Oral Health Research in Appalachia, cohort 2 (COHRA2) in West Virginia or Pittsburgh, Pennsylvania. Participants completed the Center for Epidemiological Studies Depression Scale, Perceived Stress Scale-10, and self-report items about oral self-care behaviours (i.e. toothbrushing and flossing) during pregnancy and five times in the 2+ years following birth. A Generalized Estimating Equation approach was used to analyse the longitudinal data. Maternal depression and stress were independently negatively related to toothbrushing and flossing frequency. These findings for toothbrushing were more pronounced in those with high levels of depression and high levels of stress, so there were both independent and combined effects. Frequency of toothbrushing and flossing stayed constant over time, so time was not associated with outcomes. About three-fourths of the sample reported toothbrushing levels that are consistent with established guidelines (i.e. two times daily), but almost half of the participants had very low levels of flossing (i.e. once or less a week). Interventions targeting stress and depression throughout the perinatal period might be helpful in improving oral self-care behaviours and oral health among women in Appalachia, in addition to the benefit of decreasing emotional distress.

Impact of WhatsApp-Based Self-Care Education on Self-Care Behaviors and Lifestyle in Overweight and Obese Pregnant Women with Diabetes: A Randomized Controlled Trial

Background: Self-care education for overweight and obese pregnant women with diabetes can empower them to make informed decisions during pregnancy. Objectives: This study aimed to evaluate the effect of WhatsApp-delivered self-care education on self-care behaviors and lifestyle in this population. Methods: This randomized controlled trial involved eighty pregnant women with diabetes in Ahvaz, Iran. Participants were randomly assigned to two groups: One receiving face-to-face education and the other receiving a combination of face-to-face and WhatsApp-delivered online education. Blood glucose levels [fasting blood sugar (FBS), 2-hour postprandial (2HPP)], oral glucose tolerance test (OGTT) results, lifestyle scores, and self-care scores were measured before and after the intervention. Data were analyzed using SPSS. Results: Post-intervention, the intervention group demonstrated significantly lower one-hour (119.32 ± 16.54 vs. 163.55 ± 27.07, P=0.007) and two-hour (106.25 ± 15.65 vs. 147.77 ± 24.73, P = 0.028) postprandial blood glucose levels compared to the control group. Furthermore, lifestyle scores improved significantly in the intervention group (154.27 ± 23.24 vs. 42.65 ± 17.58), and self-care scores were markedly higher (141.85 ± 26.64 vs. 56.02 ± 11.63), both showing strong statistical significance (P &lt; 0.001). Conclusions: WhatsApp-based self-care education is an effective intervention for reducing blood glucose levels and enhancing lifestyle and self-care behaviors in pregnant women with diabetes.

Anterior capsulotomy and accumbensotomy of obsessive-compulsive disorder with obsessional slowness: a case report

Obsessional slowness (OS) is characterized by a syndrome of extreme slowness in doing ordinary, day-to-day activities. Several scholars regarded OS as secondary to obsessive compulsive disorder (OCD). Therefore, it is commonly thought to be the consequence of extensive rituals and has been paid minimal attention in its own right. A combination of behavior therapy and aromatherapy are recommended for treatment of this condition. However, the outcome is often frustrating. Reports of surgical management for OS are limited. Patient concerns:She had symptoms characterized by repeated checking and progressive slowness in self-care behavior. Diagnosis:At the age of 19, the patient had the first presentation. The patient was diagnosed with a case of OCD with obsessional slowness according to the International Classification of Diseases and Related Health Problems (ICD-10).Interventions:Considering the lack of a response to pharmacotherapy and cognitive behavioral therapy (CBT), we treated this case with anterior capsulotomy and accumbensotomy. Outcomes: Moderate somnolence, urticaria, juvenile behavior, mild short-term memory impairment and slight nonsense were noted during the first postoperative days. At 10 months, the patient’s OCD symptoms recovered nearly to her preoperative level. The OS symptom also had an obvious rebound at 10 months. Through comprehensive judgment, we decided to choose accumbensotomy. At 9 months after the accumbensotomy, the OCD symptoms started to rebound. Soon after, the OS symptoms also recurred. At the last timepoint of 30 months, the patient’s OCD and OS symptoms had completely rebounded. This time, the patient and parents refused any treatment. Conclusion: This case suggests that OCD with OS, as a special category, might not be suitable for stereotactic neurosurgery. Furthermore, multiple surgeries in this kind of OCD patient should be considered with as much caution as much as possible.

The practice, nature, and impact of nurse-led type 2 diabetic foot prevention services and educational programs in Sub-Saharan Africa: a scoping review

ObjectiveThe objective of this study is to assess the scope of existing practice, nature, and impact of nurse-led type 2 diabetic foot prevention services and educational programmes in Sub-Saharan Africa (SSA).IntroductionType 2 diabetes mellitus (T2DM) in SSA imposes a heavy burden on current healthcare services. Complications such as foot ulcers can have a significant impact on patient care and healthcare resources. It is imperative to identify patients at risk of developing diabetic foot complications and empower them with diabetes self-management education and support from specialised foot clinics is crucial. However, the availability of such programmes and services in SSA is limited.Inclusion criteriaStudies of nurse-led diabetic foot prevention services and/or educational programmes in low- or middle-income countries in SSA for adults with T2DM, written in English, between August 2013 and March 2024 were considered.MethodsFollowing the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting and reporting scoping reviews, searches were conducted on four electronic databases (CINAHL, ProQuest, MEDLINE, and Scopus) and Google Scholar. The titles and abstracts were scrutinised. All eligible papers were retrieved and screened for full text.ResultsThe review included ten studies (across 14 papers), all of which focused on nurse-led diabetes self-management education (DSME) programmes in SSA. There are no specific educational programmes or services led by nurses that focus exclusively on diabetic foot prevention. The analysis highlighted the components of successful nurse-led DSMEs that led to positive glycaemic control and self-care behaviors, including the focus on behavior change and the DSME should be co-produced with service users. The theoretical aspects of the DSME include evidence-based, structured, interactive, culturally and linguistically appropriate group-based activities. The DSME should be delivered over a period of several weeks, and sessions should last between 1.5 and 2 h. Barriers to delivery and participation include the rainy season, stockouts, time and resources needed, and a DSME that meets diverse levels of literacy and education.ConclusionThere is a heightened need for nurse-led, co-produced, culturally congruent, frugal, and sustainable education interventions or programmes. There is also a need for diabetic foot screening and foot ulcer prevention services that can operate sustainably alongside these educational interventions through task-shifted, simple, and frugal initiatives.

Factors affecting quality of life among older adults with hypertension in Wenzhou, China: A cross-sectional study.

In China, the incidence of hypertension rises significantly with age, resulting in a markedly reduced quality of life (QoL) among older patients compared to the general population. Therefore, it is essential for healthcare providers, particularly nurses, to identify the predictive factors that influence QoL in this demographic. This study aimed to describe the QoL levels and investigate the predictive power of perceived health status, self-care behavior, and social support on QoL among older patients with hypertension in Wenzhou, China. A cross-sectional study was conducted with 131 patients with hypertension aged 60 and above, visiting the Cardiovascular Outpatient Department of The Second Affiliated Hospital of Wenzhou Medical University. Data were collected using validated instruments between November and December 2022 and analyzed using descriptive statistics and stepwise multiple regression. The overall QoL was moderate (Mean = 75.52, SD = 5.86). Self-care behavior (β = 0.421, p <0.001), social support (β = 0.416, p <0.001), and perceived health status (β = -0.170, p <0.001) were significant predictors of QoL, collectively explaining 82.7% of the variance. The findings highlight the importance of self-care behavior, social support, and perceived health status as critical factors influencing QoL among older patients with hypertension. Nurses and other healthcare providers should focus on enhancing these areas through targeted education and support initiatives to improve the overall well-being of this vulnerable population.

Determining Information Requirements for a Mobile Self-Care App for Chronic Kidney Disease Patients

Introduction: Chronic kidney disease is a common condition that affects a person's entire life after diagnosis. Self-care using a mobile phone helps to improve the management and ease the disease. This study aims to identify the educational content needed to design a self-care mobile application for chronic kidney disease patients. Methods: This applied study was conducted using a descriptive method. The tool used was a researcher-made questionnaire, which was validated for reliability and validity. The study population consisted of nephrologists and general surgeons, from which 25 participants were randomly and purposefully selected from the nephrology clinics of Tehran and Kurdistan University of Medical Sciences. Data analysis was performed using descriptive statistics with SPSS software version 19. Results: The educational content of the application was organized into three main axes, comprising 28 educational needs: Disease information, including understanding kidney function, stages of disease progression, and early and primary signs and symptoms; medications, encompassing familiarity with prescribed medications, drug interactions, and the importance of accurate and timely medication intake; and lifestyle and personal habits, covering healthy nutrition, weight management, and work-related issues. However, topics such as diagnostic methods, various tests, drug side effects, dietary regimens, nutritional energy tables, and opioid use were not deemed essential. Conclusion: The educational needs serve as the first step in designing a self-care application for chronic kidney disease education. By defining the technical capabilities and various features of the application, patient awareness and adherence to desirable self-care behaviors will improve.

Mediating Effects of Depressive Symptoms and Uncertainty on Physical Symptoms and Self-Care in Korean Older Men With Heart Failure.

Heart failure is prevalent among aging populations. Given the increasing median age in many countries, sustainably improving self-care behaviors in heart failure patients is crucial. Physical symptoms predict self-care in patients with heart failure, whereas psychological factors such as depressive symptoms and uncertainty negatively affect disease management efficacy. The mediating and indirect effects of depressive symptoms and disease uncertainty regarding the relationship between physical symptoms and self-care behaviors were examined in older South Korean men with heart failure. A descriptive correlational survey design was used to collect data from 185 older men with heart failure. Data were obtained from medical records and self-reported questionnaires addressing physical symptoms, depressive symptoms severity (Patient Health Questionnaire-9), illness uncertainty (Mishel Uncertainty in Illness Scale-Community Form), and self-care behaviors (European Heart Failure Self-care Behavior Scale). The mediating effects of depressive symptoms and disease uncertainty were assessed using a bootstrapping method via PROCESS Model 4, a parallel mediation model, in SPSS. The mean age of the participants was 77.41 (SD = 5.35) years. Half (50.8%) had a diagnosis of New York Heart Association Class II heart failure, and 21.6% had a diagnosis of New York Heart Association Class III/IV heart failure. Self-care behaviors were found to correlate negatively with physical symptoms, depressive symptoms, and uncertainty. Depressive symptoms (B = -0.10, 95% confidence interval [CI] [-0.18, -0.01]) and uncertainty (B = -0.05, 95% CI [-0.09, -0.01]) were found to mediate the relationship between physical symptoms and self-care behaviors. The findings reveal depressive symptoms and disease uncertainty significantly mediate the relationship between physical symptoms and self-care behaviors in older South Korean men with heart failure. In light of this, cardiovascular nurses should join in targeted educational initiatives tailored to address the unique needs of older men with heart failure that consider psychological factors such as depressive symptoms and uncertainty as well as physical symptom management.

Abstract 4117868: The Mediation Effect of Self-care Self-efficacy between Illness Perceptions and Self-care Behaviors among People with Heart Failure

Introduction: Heart failure (HF) self-care behaviors are related to patient outcomes. The Common-sense Model of Self-Regulation indicates that illness perceptions and self-care self-efficacy are crucial predictors of self-care behaviors. However, research evidence is limited on these relationships. Aims: To explore the associations among illness perceptions, self-care self-efficacy, and self-care behaviors in people with HF. Methods: A cross-sectional study design was adopted. People with HF were recruited from a tertiary hospital between February and April 2023 in China. All the participants were assessed for illness perceptions, self-care self-efficacy, and self-care behaviors. Data were analyzed using Pearson correlation and mediation analyses. The study was reported following the STROBE checklist. Results: A total of 164 people with HF were enrolled. Pearson analysis reported the negative correlations between the scores of illness perceptions and the scores of self-care maintenance (r=-0.344, p&lt;0.001), symptom perception (r=-0.352, p&lt;0.001), and self-care management (r=-0.519, p&lt;0.001), as well as the positive associations between the scores of self-care self-efficacy and the scores of self-care maintenance (r=0.689, p&lt;0.001), symptom perception (r=0.697, p&lt;0.001), and self-care management (r=0.771, p&lt;0.001). Moreover, a significant negative relationship between the scores of illness perceptions and the scores of self-care self-efficacy was observed (r=-0.527, p&lt;0.001). Mediation analysis reported that the scores of self-care self-efficacy completely mediated the negative relationships between the scores of illness perceptions and the scores of self-care maintenance, symptom perception, and self-care management, and the mediation effect accounted for 71.4%, 72.5%, and 88.2% of the total effect, respectively. Conclusions: Among people with HF, self-care self-efficacy completely mediated the relationships between illness perceptions and self-care behaviors. Interventions targeting improving illness perceptions and self-care self-efficacy may enhance HF self-care behaviors.

Abstract 4117856: Effects of a Nurse-led Common-sense Model of Self-regulation-Based Heart Failure Self-care Program on Patient Outcomes: A Randomized Controlled Trial

Introduction: Guidelines have recognized the critical role of self-care in heart failure (HF), but people with HF do not adequately practice self-care. The Common-Sense Model (CSM) of Self-Regulation is a widely used theoretical framework for promoting behavior change and improving disease prognosis among patients. However, studies on the effects of the application of this model among people with HF are limited and present mixed results. Aims: To examine the effects of a nurse-led CSM of Self-Regulation-based self-care intervention on illness perceptions, self-care behaviors, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, anxiety, symptom burden, sleep quality, healthcare service utilization, and mortality among people with HF. Methods: A randomized controlled trial was conducted. Participants were recruited from a university-affiliated hospital and randomized at a 1:1 ratio into the intervention or the control groups. Participants in the intervention group received a 6-week nurse-led CSM of Self-Regulation-based self-care program and usual care. Control group participants only received the usual care. Outcomes of interest were measured at baseline, 6 weeks (T1), and 3 months (T2) after enrollment. The generalized estimating equations model and Mann-Whitney U test were used to examine the intervention effects on the study outcomes. Results: 138 subjects were enrolled in the study between March and May 2023. Participants in the intervention showed statistically greater improvements in illness perceptions, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, symptom burden, and sleep quality compared with the controls at T1 and T2. We also observed a statistically significant reduction in the number of HF-related unscheduled outpatient department visits in the intervention group compared to the control group at T2. However, no significant differences were found in anxiety, number of HF-related hospital readmissions, length of HF-related hospital stays, number of HF-related emergency department visits, or HF-related mortality between the study groups at T1 and T2. Conclusion: Our program generates favorable effects on promoting behavior change and improving health outcomes among people with HF. It also fills the knowledge gaps around the application of CSM of Self-Regulation in people with HF and provides more empirical evidence supporting the effectiveness of nurse-led interventions.

Abstract 4124531: Digital Health Intervention to Enhance Optimization of Heart Failure Care: From Reciprocal Innovation using Human-Centered Design to Pilot Study

Introduction: Guideline-directed medical therapy (GDMT) for Heart Failure with reduced ejection fraction (HFrEF) reduces adverse events by 70%, but is underutilized. The Human Centered Design (HCD) methodology can be useful to build a strategy to optimize GDMT centered on patients’ demands and perspectives. We aimed to reciprocally innovate a telephone-based digital health intervention (DHI) from a Brazilian trial to an app co-developed for a US trial and iterate it again to the Brazilian context using HCD. We will evaluate the app’s usability and utility to facilitate HF GDMT optimization, considering barriers of the Brazilian public health system users, such as low literacy and socioeconomic status. Methods: Mixed methods study. Steps were carried out according to HCD method: (1) empathizing and identifying challenges, (2) suggesting solutions, (3) prototype development, (4) ranking features for feasibility and utility (5) engineering work and (6) prototype testing. In stages 1-3, semi-structured interviews were held with 10 HF patients and 2 health professionals. Steps 4 and 5 were done by the research team. In stage 6, we conducted a pilot study with 10 HFrEF patients, with at least one GDMT drug with an optimization gap. The primary outcome was the app’s usability assessed by an engagement score, and the app’s utility at 4 weeks. Secondary outcomes included change in self-care score using the European Self-Care Behavior Scale. After step 6, new interviews were carried out to capture the user experience and identify new iterations. Interviews were recorded and transcribed for content analysis. Results: The average engagement score was 80% (SD 16) and the app’s utility score was 82% (SD 8). The average self-care score increased by 32% (SD 25) at the end of the pilot. The main challenges were lack of knowledge about HF and self-care. Technical difficulties and lack of trust in the app to handle health data were mentioned. In the pilot, patients reported the app was easy to use and contributed to self-care and understanding of HF. Among the DHI components, teleconsultation was best evaluated, followed by the educational videos. The greatest challenge was connecting the blood pressure cuff and scale via Bluetooth. Conclusion: The app was well accepted and considered useful by patients. User contributions were fundamental to create tools that facilitate engagement and utility. The final product will be evaluated in a randomized, multicenter, clinical trial.

Dental Hygienists' Influence on Oral Health Knowledge, Attitudes and Behavioural of Patients and Effectiveness on Improving Patients' Periodontal Status-Evaluations of a Hospital Based Oral Hygiene Training Program in China.

To evaluate the possibility of integrating dental hygienists (DHs) into the dental field in China, and investigate its effectiveness on improving patients' knowledge, attitudes, self-care behaviours as well as their periodontal status. A hospital-based oral hygiene training program was developed at Sir Run Run Shaw Hospital's (SRRSH) Dental Clinic with the support of two registered DHs from Loma Linda University in California. A questionnaire evaluating oral health knowledge, attitudes and behaviours was conducted in patients who visited SRRSH's Dental Clinic. Scores of oral health knowledge and proportions of positive oral health attitudes and favourable self-care behaviours were estimated between patients treated and not treated by DHs (DH group and NDH group). The improvements in patients' periodontal conditions following non-surgical periodontal therapy (NSPT) administered by DHs at the Dental Clinic of SRRSH, as assessed through the measurement of periodontal pocket depths and the incidence of bleeding upon probing. Patients in DH group exhibited relatively better results in several aspects of oral health knowledge, attitudes and behaviours, compared to those in NDH group. Moreover, NPST performed by DHs significantly improved the periodontal status of the patients, with a remarkably reduction in periodontal pocket depth and bleeding on probing. Integrating DHs into SRRSH's Dental Clinic showed effectiveness in enhancing patients' oral health knowledge, attitudes, behaviours and succeeded in improving patients' periodontal status. This program demonstrated that incorporating DHs into dental care team is not only practical but also enhances the value of the dental workforce in China.

Self-care behaviours in patients with restless legs syndrome (RLS): development and psychometric testing of the RLS-Self-care Behaviour questionnaire.

Restless legs syndrome (RLS) is a highly prevalent condition that significantly disrupts sleep and causes reduced quality of life. While previous RLS research has mainly focused on the pharmacological treatment, this study presents the first instrument to measure self-care, the RLS-Self-care Behaviour questionnaire (RLS-ScBq). Self-care, defined as an active decision-making process, can empower patients to effectively participate in their own healthcare through awareness, self-control, and self-reliance to cope with their disease. Self-care can in a RLS context include actions such as physical exercise, meditation, and massage. Hence, the aim of this study is to explore the psychometric properties of the RLS-ScBq in patients with RLS. A cross-sectional design, including 788 patients with RLS (65% women, mean age 70.8 years, [standard deviation (SD) =11.4]) was used. Sociodemographics, comorbidities, and RLS-related treatment data, including insomnia symptoms (i.e., Insomnia Severity Index), daytime sleepiness (i.e., Epworth Sleepiness Scale) and RLS symptoms (i.e., RLS-6 scale) were collected. The validity and reliability of the RLS-ScBq were investigated using exploratory factor analysis and Rasch models. The two-factor solution (i.e., physical, and mental actions) showed an explained variance of 32.33% for The Self-care Behaviour Frequency part and 36.28% for The Benefit of Self-care Behaviour part. The internal consistency measured by Cronbach's α was 0.57 and 0.60, and McDonald's ω was 0.60 and 0.67, respectively. No differential item functioning was identified for gender, age, insomnia, daytime sleepiness, or RLS severity. The eight-item RLS-ScBq can serve as a tool enabling healthcare personnel to explore use and benefit of self-care activities in patients with RLS.

The Effect of Mobile Application Follow-Up on Treatment Compliance and Self-Care Management in Patients With Hypertension: Randomized Controlled Trial.

Hypertension (HT) is a global health problem. Although there are effective treatment protocols, patients have difficulty in adapting to regular use of drugs, diet, and lifestyle changes. Mobile apps can be a potential alternative for managing HT and improving self-care behavior. This study aimed to determine the effect of mobile application follow-up on treatment compliance and self-care management in patients with HT. This randomized controlled trial was conducted in November 2021 and March 2022 with 40 experimental and 40 control group patients with HT. Research data were collected using a patient information form, "Hill-Bone Hypertension Treatment Compliance Scale (HBHTTCS)," "Hypertension Self-Care Profile-Motivation Scale (HTSPMS)," a mobile application program (daily blood pressure, pulse, medication, diet, exercise tracking) uploaded to the mobile phones of the patients, and individual motivational messages. The mean total score of the HBHTTCS at Week 6 was 14.57±1.89 and the mean total score of the HTSPMS was 78.15±2.05.There was a statistically significant difference in mean total HTSPMS (p = 0.000) and HBHTTCS (p = 0.000) scores and mean scores on medical (p = 0.002) and nutrition (p = 0.002) subscales of HBHTTCS between the first interview (1st-week follow-up) and the last interview (6th-week follow-up) of patients in the intervention group. This study showed that mobile application follow-up increased motivation levels and treatment compliance in patients with HT and resulted in better self-care. These positive findings indicate importance of integrating mobile applications in the disease management of HT patients. ClinicalTrials.gov ID: NCT05334446, https://clinicaltrials.gov/ct2/show/NCT05334446.

Long-term effects of non-pharmacological interventions in adolescents and young adults with type 1 diabetes: A systematic review and meta-analysis.

Consistent diabetes control is crucial for patients with type 1 diabetes (T1D) to prevent diabetic complications. Analyzing the long-term effects of non-pharmacological interventions can improve diabetes management. To examine the long-term effects of non-pharmacological interventions in adolescents and young adults with T1D through a systematic review and meta-analysis of randomized controlled trials (RCTs). The searches, without any year limitations, were conducted in seven databases. Two reviewers independently performed data extraction and risk of bias assessments. The meta-analysis was conducted using the RevMan 5.4 program and R Studio. The study was registered with PROSPERO (CRD42024503185). A total of 40 studies were included in the systematic review, of which 28 were included in the meta-analysis. Notably, non-pharmacological interventions were effective in improving glycated hemoglobin (HbA1c) at 6 months and self-care at >12 months of follow-up. Subgroup analyses revealed that combined interventions encompassing self-care behavior management, education, and psychological interventions could enhance self-care. Additionally, a combination of face-to-face and telephonic communication was effective in improving HbA1c. Non-pharmacological interventions are effective in improving HbA1c levels and self-care in adolescents and young adults undergoing long-term treatment. However, few studies have analyzed their effects on cardiovascular disease risk factors. Future studies should investigate the long-term effects of non-pharmacological interventions.

Validity and Reliability of the Persian Version of the Scale of the Assessment of Self-Care Behaviors With Arteriovenous Fistula in Patients on Hemodialysis.

Background and Purpose: This methodological study aimed to assess the psychometric properties of the Persian version of the scale for evaluating self-care behaviors with arteriovenous fistula. Methods: This cross-sectional study with a methodological design was planned and conducted in 2022. The Scale of the Assessment of Self-Care Behaviors with Arteriovenous Fistula was translated into Persian. Subsequently, the validity (content and construct) and reliability of this scale were assessed. Results: The exploratory factor analysis revealed a two-factor structure for the scale, accounting for 60.71% of the total variance. Confirmatory factor analysis results indicated that all goodness-of-fit indices supported the model fit (χ2/df = 1.925, Goodness-of-Fit Index = .903, Normed Fit Index = 0.933, Incremental Fit Index = 0.950, Comparative of Fit Index = .950, and Root Mean Square Error of Approximation = .047). Furthermore, this study found that both factors demonstrated satisfactory levels of convergent and divergent validity (construct reliability = .934 and .885 for factors 1 and 2, respectively). After careful evaluation, all coefficients of internal consistency were deemed acceptable (α = .872 and McDonald's omega = 0.879). Conclusions: These significant findings provide compelling evidence that this scale can effectively assess patients' self-care behaviors and facilitate the provision of necessary training in this domain.

Predictors of self-care in kidney transplant patients according to preoperative dialysis: A comparative study

BackgroundPreemptive kidney transplantation (PKT) is associated with reduced dialysis-related morbidity and improved graft survival, which has led to an increase in the prevalence of PKT. The distinct clinical pathways of PKT and non-preemptive kidney transplantation (NPKT) patients may affect their ability to perform self-care, a key factor in post-transplant recovery. However, there is ongoing controversy regarding which group demonstrates better self-care abilities, highlighting the need to explore the factors influencing self-care in each group. ObjectivesThis study aims to identify and compare predictors of self-care in PKT and NPKT groups. MethodsWe collected data from 209 KT recipients, consisting of 101 PKT and 108 NPKT patients, using self-administered questionnaires. These questionnaires assessed general and disease-specific characteristics, stress, social support, and self-care behaviors. Data were analyzed using descriptive statistics, t-tests, ANOVA, and multiple regression analysis. ResultsThe study identified significant predictors of self-care among both PKT and NPKT patients. For PKT patients, marital status (β =.19, p=.033) and family support (β =.28, p=.006) are key predictors of self-care, with those having spousal support and strong family networks reporting better self-care levels. Conversely, in NPKT patients, significant predictors of self-care included marital status (β =.31, p=.001), employment status (β =.29, p=.007), post-transplantation duration (less than 36 month) (β =.-.22, p=.015), post-transplantation duration (36-72 month) (β =.-.33, p=.001), and stress levels (β =-.20, p=.028). ConclusionsThe study provides valuable insights into the predictors of self-care based on preoperative dialysis status, illustrating distinct predictors between the growing population of PKT and NPKT patients. These findings emphasize the need for personalized nursing strategies to enhance post-transplant self-care, tailored to individual patient characteristics.

The effect of caregivers’ health literacy levels on the quality of life and self-care of patients with heart failure

BackgroundThe aim of this study is to examine the effects of health literacy levels of caregivers on the self-care behaviors and quality of life of patients aged 65 years and older with heart failure. MethodsThe study was conducted in a university hospital in Erzincan, Türkiye between November 4, 2023, and February 12, 2024, on patients hospitalized in internal medicine, cardiology, and cardiovascular surgery wards and their caregivers (n = 206 pairs). ResultsAs a result of the multivariate regression analysis, it was determined that the access, appraisal, and application sub-dimensions of the health literacy of the caregivers positively affected the self-care behaviors and quality of life levels of the patients. ConclusionsThese results reveal the significant effect of the health literacy levels of the caregivers in the management process of heart failure disease. Healthcare providers -especially nurses- can improve patient outcomes of patients with heart failure by considering the health literacy level of their caregivers and using innovative educational methods that can improve the health knowledge and skills of caregivers.

The Effect of the Continuous Care Model on Oral Health, Self-Efficacy, and Self-Care in Patients With Head and Neck Cancer Undergoing Radiotherapy: A Study Protocol for a Quasi-Experimental Study.

Head and neck cancer, with its unique challenges, often involves radiotherapy as a primary treatment. This can lead to complications affecting patients' well-being. A continuous care model offers potential benefits, but its effectiveness requires validation through rigorous studies. This protocol aims to evaluate its impact on patients undergoing head and neck cancer radiotherapy, contributing to improved care strategies and well-being. The study is a double-arm and parallel-group quasi experimental study in which a 4-week intervention will be compared with usual care. A total of 70 eligible patients with head and neck cancer who are undergoing radiotherapy will be recruited to the intervention or control group. The patients in the intervention group will receive a continues care model designed for head and neck cancer patients in four phases of Orientation, Sensitization, Control, and Evaluation. The primary outcomes include dental plaque and gingival index, which will be measured by an approved dentist using The Gingival and Quigley-Hein index. The secondary outcomes are Oral hygiene self-efficacy and Dental and Oral Health Self-Care Behavior which will be assessed by the Oral and Dental Health Self-Efficacy and Dental and Oral Health Self-Care Behavior Questionnaires. Descriptive statistics will be used to describe variables. According to the types of variables, appropriate statistical tests, including two-sample t-tests, Χ 2, analysis of covariance, or linear regression will be performed. In conclusion, this study aims to evaluate the impact of a continuous care model on head and neck cancer patients undergoing radiotherapy. Findings will contribute to enhancing care strategies and well-being in this population. The trial has been approved by the Research Ethics Committees of Zahedan University Of Medical Sciences. In this study, written consent will be obtained from all participants. The results will be presented to representative groups and published in peer-reviewed journals.

Comparison of the effect of SMS-based education and face-to-face teaching on self-care behavior of type 2 diabetic patients in Khorramabad city

IntroductionConsidering that the adoption of self-care behaviors in patients with type 2 diabetes can reduce the complications caused by this disease, aim of the present study was compared the effect of SMS-based teaching and face-to-face teaching on self-care behavior of type 2 diabetic patients in Khorramabad city.MethodsThis was a pre- and post-test semi-experimental study. The research sample size was composed of 135 diabetic patients referred to the Khorramabad diabetes clinic who were selected using random sampling method and were randomly divided into face-to-face teaching group (n = 45), SMS-based teaching group (n = 45), and control (n = 45). Data collection tools were demographic information questionnaire, Tubert self-care behaviours questionnaire, and self-efficacy questionnaire. The educational intervention in the face-to-face training group included four face-to-face training sessions and in the SMS-based training group included three to four daily training SMS and without training intervention in the control group. For all analysis, SPSS software version 24 was done and at a significance level of 0.05.ResultsAt the baseline, average score of self-efficacy and self-care, and blood sugar were not significant between the face-to-face teaching, SMS-based and control groups. However, at the end of intervention, the mean score of these variables were significantly more in the face-to-face teaching and SMS-based groups compared to the control group (p-value < 0.001).DiscussionConsidering the positive effect of educational intervention in promoting self-care in patients with type 2 diabetic, it is suggested to use empowerment programs with self-care approach to improve the health of diabetic patients.