Self-care Confidence Research Articles

Use of Sharesource in Remote Patient Management in Peritoneal Dialysis: A UK Nurse's Perspective.

In June 2015, Sharesource, a cloud-based, bi-directional connectivity platform, was launched by Baxter Healthcare in the UK. With this came the ability to use remote patient management (RPM) with peritoneal dialysis (PD) patients in an easy, standardized manner across dialysis units. Improved nursing efficiency and patient outcomes, achieved utilizing RPM include individualized PD patient prescriptions, early detection and prevention of potential PD complications, reduced planned and unplanned hospital attendance, reduced drop off, and increased healthcare professional and patient/carer confidence in self-care. These are illustrated with Case Studies. The potential to reduce glucose exposure is explored and for PD units yet to use RPM, lessons learned during the implementation of Sharesource are shared.

Assessing the Impact of Patient-Centered Medical Home Principles on Hypertension Outcomes Among Patients of HRSA-Funded Health Centers.

Millions of Americans have uncontrolled hypertension and are low-income or uninsured populations. Health Resources and Services Administration-funded health centers (HCs) are primary providers of care to these patients and a majority have adopted the patient-centered medical home (PCMH). PCMH includes principles of care coordination or integration and care management-support important to the treatment of hypertension. We examined whether the receipt of PCMH concordant care by HC patients improved hypertension outcomes. We used a nationally representative survey of adult HC patients with hypertension (n = 2,280) conducted between October 2014 and April 2015. We included data from the 2013 and 2014 Uniform Data System to include characteristics of the HCs where these patients received their care. Our outcome measures included flu shots, number of primary care visits, normal blood pressure at last visit, emergency department (ED) visits, confidence in self-care, and compliance with provider recommendations. The primary independent variables were (i) whether the HC coordinated and referred patients to specialists; (ii) provided counseling, health education, coaching, treatment plans, and advice on hypertension control; and (iii) helped patients to obtain government benefits, medical transportation, and basic needs such as housing and food. Logistic and negative binomial multivariate regression models were performed. Hypertension-focused coaching was associated with normal blood pressure at last visit (odds ratio (OR) = 1.47) and fewer ED visits (incidence rate ratio = 0.81). Behavioral health counseling was associated with increased self-efficacy in self-care management (OR = 3.20). Our findings suggested that increased focus on these practices may lead to better hypertension outcomes among patients who are low-income and uninsured populations.

Effects of Guided Reflection on Diabetes Self-Care: A Randomized Controlled Trial.

The purpose of this study was to evaluate the effects of guided reflection on self-care behaviors, confidence scores, and diabetes knowledge among adults with diabetes. A randomized controlled trial with a pre/posttest design was used to generate data from a convenience sample of 62 adults with diabetes recruited from a single site. After viewing a 30-minute video on how to manage diabetes, participants were randomized to a control group (CG) (usual care) or an intervention group (IG). The IG further engaged in a reflection educational session. For 8 weeks, the IG isolated diabetes-related events weekly, critically analyzed them using Gibbs's reflective questions, and recorded their analysis in a journal. They also shared their perspective relative to using the journal in an audiotaped interview. Main measures included baseline and 8-week clinical outcomes (self-care maintenance, monitoring, management, and confidence scores and diabetes knowledge scores) and intervention acceptability. Compared to the CG, the IG had no statistically significant difference in self-care measures over time, although scores trended in the anticipated direction. Importantly, both groups had statistically significant improvement in self-care scores. Furthermore, there was statistically significant improvement in diabetes knowledge among IG participants. Informatively, IG critically analyzed 147 diabetes-related events concentrating on blood glucose, diet, exercise, monitoring, medication, sleep pattern, and health care visits. Participants found the guided reflection activity highly acceptable. Combined educational and reflection interventions are effective approaches for improving self-care outcomes and diabetes knowledge among adults with diabetes. Research concentrating on purposeful patient reflection is warranted in a larger sample paying careful attention to study limitations.

Gender differences in self-care maintenance and its associations among patients with chronic heart failure

ObjectivesTo identify the gender differences in self-care maintenance and its associations among chronic heart failure patients using the Information-Motivation-Behavioral Skills model. MethodsTwo hundred and ten patients (54.0% female) with chronic heart failure participated in this cross-sectional study. Self-care, knowledge of heart failure, social support and illness perception were measured using the Self-Care of Heart Failure Index, the questionnaire of heart failure knowledge, the Perceived Social Support Scale, and the Revised Illness Perception Questionnaire, respectively. ResultsMean scores for self-care maintenance were 51.4 ± 14.8 in men and 55.6 ± 14.1 in women (t = −2.066, P < 0.05). Associated factors of self-care maintenance were social support and self-care confidence in men and the knowledge of heart failure, self-care management and self-care confidence in women. The relationship between social support and self-care maintenance was meditated by self-care confidence in men, whereas the relationship between knowledge of heart failure and self-care maintenance was meditated by self-care management and self-care confidence in women. ConclusionsSelf-care maintenance were inadequate in both genders with chronic heart failure. Interventions for enhancing social support and self-care confidence in men patients, and strengthening knowledge of heart failure, self-care management and self-care confidence in women patients, may facilitate self-care maintenance.

Clinical and socio-demographic determinants of inadequate self-care in adults with type 1 diabetes mellitus: the leading role of self-care confidence.

To describe self-care maintenance, monitoring, and management behaviors in adults with type 1 diabetes (T1DM), and to identify clinical and socio-demographic determinants of inadequate self-care. A cross-sectional study was conducted in two diabetes outpatient clinics in Italy. Clinical and socio-demographic characteristics were collected from the medical records of 181 consecutively enrolled T1DM patients. The Self-Care of Diabetes Inventory was used to measure self-care maintenance, self-care monitoring, self-care management and self-care confidence. A standardized 0-100 score was used for each self-care dimension. A score < 70 was considered inadequate self-care. Three multiple logistic regression models were run to find determinants of inadequate self-care maintenance, monitoring, and management. The majority of patients had adequate self-care maintenance (74%; n = 134), self-care monitoring (68.5%; n = 124) and self-care confidence (87.3%; n = 158), while self-care management was adequate for only a minority (34.8%; n = 63). The odds of inadequate self-care maintenance increased by 4.5 times when self-care confidence was inadequate (OR adjusted 4.589; 95% CI 1.611-13.071; p = 0.004). The odds of inadequate self-care monitoring increased four times when patients had inadequate self-care confidence (OR adjusted 4.116; 95% CI 1.457-11.628; p = 0.008). Inadequate self-care confidence increased the odds of performing inadequate self-care management more than five times (OR adjusted 5.313; 95% CI 1.143-24.686; p = 0.033). Self-care management is commonly inadequate in adults with T1DM. Self-care confidence is the most important determinant of self-care behaviors in this population. Educational interventions are recommended to improve self-care confidence in adults with T1DM.

Effect of educational interventions on health literacy in patients with heart failure

ABSTRACTThe prevalence of heart failure (HF) is a major public health concern associated with negative health outcomes and poor quality of life. HF patients with low health literacy are considered as high-risk population with poor self-care confidence and negative health outcomes. In this study, we aimed to examine the effect of educational interventions on level of health literacy, self-efficacy and self-car behavior among patients with HF. Participants included 80 patients with HF aged 30–79 years. Prior to receiving education, they completed a series of neuropsychological tests and measures of health literacy, self-efficacy, self-care and socio-demographic characteristics. Health literacy was poor for the majority of patients and it was significantly associated with assessment measures of self-efficacy and self-care (p < 0.05). The regression model showed that age, education level, place of residence and substance addiction were important potential confounders to control level of health literacy and self-efficacy while self-care behaviors were only controlled by education level. Educational interventions could be an effective way to improve health literacy skills and self-care confidence among patients with HF. HF patients with adequate health literacy were younger and had higher levels of educational attainment.

IPAD SHARED CARE INTERVENTION FOR HEART FAILURE CARE PARTNERS

AbstractHeart failure (HF) patients often experience poor self-care, inadequate support, and increased mortality risk. Patients and family caregivers (“care partners”) have primary roles in self-care, providing support, and future-care planning. Practice guidelines recommend early and active partner involvement, but few interventions exist which effectively prepare partners to engage in these activities. The iPad-enhanced Shared Care Intervention for Partners (iSCIP), improves self-care and future planning based on patient values and preferences. Care partners use the iSCIP app to access self-care materials, manipulate values and preferences, and develop a care plan. This study assessed iSCIP feasibility, acceptability, and usability, and examined its effects on outcomes using a one-group experimental design with 10 sets of care partners. All participants completed 6 sessions, supporting feasibility. Mean program satisfaction scores were 4.8 for patients and 4.9 for caregivers (5 = “very satisfied”). Mean usability scores were 3.2 for patients and 3.3 for caregivers, indicating they were “not sure” or “somewhat agreed” that the app was easy to use. The iSCIP had a strong effect on patients’ self-care management (d = 0.81), with moderate effects for self-care confidence (d = 0.68), self-care maintenance (d = 0.56), and emotional support (d = 0.30). For caregivers, the iSCIP had moderate effects on emotional (d = 0.64) and informational (d = 0.48) support, with smaller effects on self-care confidence (d = 0.21). This study adds to the growing evidence of the acceptability of partner level interventions that address self-care in chronic conditions, care values and preferences, and future-care planning.

The Influence of Mutuality on Self-Care in Heart Failure Patients and Caregivers: A Dyadic Analysis.

Mutuality in patient-caregiver dyad may improve heart failure (HF) patient self-care and caregiver contribution to self-care, but literature is scarce. We evaluated the influence of mutuality and its dimensions on patient-caregiver dyad self-care. A sample of 366 HF patient-caregiver dyads was enrolled. The Actor-Partner Interdependence Model was used to identify the influence of individual patient and caregiver mutuality on their own self-care (actor effect) and on partner self-care (partner effect). The total mutuality score had an actor effect on patient self-care maintenance (i.e., behaviors aimed at maintaining HF stability) and on patient and caregiver self-care confidence. Total score of patient mutuality also had a partner effect on caregiver self-care management (i.e., responses to symptoms of HF exacerbation). Specific mutuality dimensions had different actor and partner effects on patient and caregiver self-care. Interventions to improve mutuality in HF patient-caregiver dyads may influence patient self-care and caregiver contribution to self-care.

Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study

AimThe aim of this study was to critically analyse and describe gender differences related to self-care among patients with chronic heart failure (HF).Methods and resultsA monocentric real-world cohort of 346...

Abstract P373: Design for a Pragmatic Trial Comparing Telehealth Care and Clinic-Based Care for Uncontrolled High Blood Pressure

The 2017 ACC/AHA hypertension guideline strongly recommends systematic follow-up and monitoring of treatment using team-based care and telehealth, based on Level A evidence. However, different models for organizing team-based care and telehealth have not been compared. We describe the design of a PCORI-funded pragmatic trial with the following objectives: Aim 1) compare the effects on BP and patient-reported outcomes of two models of team-based care for uncontrolled hypertension, and Aim 2) study how the two models are carried out in the real-world setting of a large health system. The study is a 5-year cluster-randomized trial in 2000 patients age 18-85 with uncontrolled hypertension cared for in 21 primary care clinics at HealthPartners, a large integrated healthcare system in the Twin Cities area of Minnesota and western Wisconsin. Clinic-based care uses recommended best practices and face-to-face visits primarily with physicians, nurses and medical assistants. The telehealth care approach adapts a research-tested model with systematic use of home BP telemonitoring and home-based telehealth care coordinated by a clinical pharmacist or nurse practitioner. Patients in both groups are recruited directly from primary care clinics using electronic health record (EHR) prompts. Exclusions are few: pregnancy, advanced kidney disease, hospice care, and nursing home residence. The primary outcomes for Aim 1 are:1) change in BP over 12 months, and 2) change in patient-reported outcomes over six months, including treatment side effects, experiences with hypertension care, self-monitoring rates, and confidence in self-care. Secondary outcomes include other heart- and stroke-related risk factors and safety. Patients contributed extensively to the selection of the outcomes. Outcomes are collected over 24 months without reliance on research visits: patient-reported outcomes are measured by surveys and BP and other clinical outcomes are measured using routinely collected data documented in the EHR. We also use EHR data supplemented by qualitative data to assess how the two care models are carried out in practice. The results of this comparative effectiveness trial will assess pragmatic methods for implementing hypertension guideline recommendations.

Translation and Validation of the Patient Activation Measure in Portuguese People with Type 2 Diabetes Mellitus.

Management of diabetes mellitus is largely dependent on patients' active participation in care. The 'Patient Activation Measure 13' assesses patients' knowledge, skills, and confidence in self-care. We aimed to translate, culturally adapt, and validate the 'Patient Activation Measure 13' to Portuguese, in people with type 2 diabetes. The translation and cultural adaptation occurred in six phases. A convenience sample of people with type 2 diabetes was recruited from the waiting rooms of a diabetes outpatient centre in Lisbon, between March and April 2014. The questionnaire was self-administered; medical records were reviewed to obtain glycated haemoglobin levels. Main statistical analyses were based on the Rasch rating scale model. The response rate for the final questionnaire was 76%. Rasch analysis was conducted on 193 respondents. Respondents had a mean age of 67.1 (SD 10.1) years, 42.7% were women, and the mean patient activation measure score (0 - 100) in the sample was 58.5 (SD 10.1). The sample was low to moderate in terms of activation: 40.4% were low in activation (levels 1 and 2), 49.7% were in level 3, and 9.8% were in level 4, the highest level of activation. All items had good fit and the response categories functioned well. Item reliability was 0.97 and person reliability was between 0.77 (real) and 0.83 (model). The 'Patient Activation Measure 13' was translated and culturally adapted to European Portuguese and validated in people with diabetes, showing good psychometric properties. Future research should aim at evaluating test-retest reliability of the Portuguese 'Patient Activation Measure 13', and exploring its ability to measure changes in activation over time. The 'Patient Activation Measure 13' is now available in European Portuguese and has good psychometric properties.

Video Education Improves Heart Failure Knowledge and Self-Care

Background Patient education is recommended to enhance self-care in all heart failure (HF) guidelines. The optimal method of educating HF patients is not known, but video education (VE) can provide a standardized and cost-effective method to deliver HF patient education. In addition, mobile technology can be an efficient and convenient way to deliver patient education as patients transition from hospital to home. Purpose The purpose of this study was twofold: 1) Evaluate whether HF knowledge, self-efficacy, self-care skills, and readmission rates improved after adding VE to usual care, and 2) Evaluate patient satisfaction with VE. Methods A convenience sample of adult HF inpatients was recruited over 11 weeks at an academic medical center. Participants received access via tablet, smartphone, or computer to 26 videos, each between 2-4 minutes in length, and lasting a total of 1.5 hours. The first video was shown while inpatient and subsequent videos were viewed at participants’ discretion while inpatient as well as after discharge. Participants received a “Managing Your Heart Failure With Video Education” booklet to aid accessing the videos. HF knowledge and self-care were measured before and after VE using the Atlanta Heart Failure Knowledge Test and the Self-care of Heart Failure Index. A patient log and satisfaction with each video was collected. Seventy participants enrolled and 30 completed the questionnaires. All-cause 30-day readmission data were compared to a randomly selected historical group from the previous months and year. Results Participants’ mean age was 66 years, 70% (21) were female, 67% (20) were Caucasian, 63% (19) high school educated or less, 83% (25) had hypertension, 73% (22) were New York Heart Association Class III-IV, and 43% (13) had HF with reduced ejection fraction. Mean Charlson Comorbidity Index scores was 6.2 ± 2.3. HF knowledge and self-maintenance scores increased (mean 1.7, + 3.2, p =.008, mean 13.96 + 20.99, p =.001 respectively). Participants’ scores improved by at least 5% on 20 of the 30 questions on the HF knowledge test. Self-efficacy (self-care confidence) and self-care management did not significantly improve (mean 1.67, SD 26.69, p = .735; mean 9.4, SD 22.7, p =.073 respectively). All-cause 30-day hospital readmissions did not significantly decrease (9 to 7, p= .276). HF patients were satisfied with the VE information (96%) and all would recommend the videos (100%). The videos rated most helpful were: Heart Failure Medications: Diuretics (71.4%), Managing Heart Failure: Limiting Sodium (65%), and Taking Your Heart Failure Medications (61.9%). Conclusion VE was associated with improved HF knowledge and self-maintenance with high patient satisfaction. HF Knowledge scores may further be used to tailor patient education based on identified knowledge gaps. Future work is needed to investigate whether self-efficacy and self-management improves with continued follow-up.

Trajectories of Self-Care Confidence and Maintenance in Adults with Heart Failure: A Latent Class Growth Analysis.

Heart failure (HF) affects up to 14% of the elderly population and its prevalence is increasing. Self-care is fundamental to living successfully with this syndrome, but little is known about how self-care evolves over time. The present study aimed to (a) identify longitudinal trajectories of self-care confidence and maintenance among HF patients, (b) investigate whether each trajectory is characterized by specific sociodemographic and clinical patients' characteristics, and (c) assess the association between the self-care confidence and maintenance trajectories. We conducted a prospective descriptive study of 225 HF patients followed for 6months with data collected at baseline and 3 and 6months. Latent class growth analysis (LCGA) was used to identify longitudinal trajectories. ANOVA and contingency tables were used to characterize trajectories and investigate their association. Three self-care confidence (persistently poor, increasingly adequate, and increasingly optimal) and three self-care maintenance (persistently poor, borderline but improving, and increasingly good) trajectories were identified. Married individuals were less likely to be in the persistently poor trajectory of self-care confidence. Patients with persistently poor self-care maintenance took fewer medications than patients with one of the better self-care maintenance trajectories. The two sets of trajectories were significantly and meaningfully associated. Patients in a poor self-care trajectory (confidence or maintenance) are at high risk to stay there without improving over time. These results can be used to develop tailored and potentially more effective health care interventions.

Validity and reliability of the Korean version of self-care of heart failure index

Purpose: Self-care and associated decisions for therapeutic recommendations have been a focus of attention recently in Korea. The purpose of this study was to address the dimensionality and reliability of a Korean version of Self-care of Heart Failure Index (SCHFI v.6.2), a measure of self-care of patients with heart failure within a clinical context.Methods: The study sample completed 120 surveys that consisted of demographic variables and the SCHFI v.6.2, which was created to measure self-care maintenance, self-care management, and self-care confidence in HF patients. Confirmatory factor analysis using Mplus verified a robust structural fit of the three dimensionality for each subscale.Results: Self-care maintenance, CFI = .92, TLI = .88, SRMR = .06, RMSEA = .07; self-care management, CFI = .93, TLI = .78, SRMR = .05, RMSEA = .24; self-care confidence, CFI = .95, TLI = .92, SRMR = .05, RMSEA = .13. Multidimensionality yielded the self-care maintenance scale having 4-factor structures, while each self-care management and confidence scale had a unidimensionality. Reliability estimates using methods compatible with each scale’s dimensionality were adequate to high, ranging from .71 to .96.Conclusions: Psychometric testing of the SCHFI demonstrates a sound model fit, with desirable reliability estimates given each scale dimensionality, using Cronbach’s alpha coefficient and alternative options.

Cross-cultural Adaptation of the Self-care of Hypertension Inventory Into Brazilian Portuguese

Lifestyle changes and treatment adherence still constitute a challenge to healthcare providers involved in the care of persons with hypertension. The lack of validated instruments measuring the ability of hypertensive patients to manage their disease has slowed research progress in this area. The Self-care of Hypertension Inventory, originally developed in the United States, consists of 23 items divided across 3 scales: Self-care Maintenance, Self-care Management, and Self-care Confidence. These scales measure how well patients with hypertension adhere to treatment and manage elevated blood pressure, as well as their confidence in their ability to perform self-care. A rigorous cross-cultural adaptation and validation process is required before this instrument can be used in other countries. The aims of this study were to translate the Self-care of Hypertension Inventory into Brazilian Portuguese with cross-cultural adaptation and to evaluate interobserver reliability and temporal stability. This methodological study involved forward translation, synthesis of forward translations, back-translation, synthesis of back-translations, expert committee review, and pretesting. Interobserver agreement and the temporal stability of the scales were assessed. The expert committee proposed semantic and cultural modifications to some items and the addition of guidance statements to facilitate administration of the scale. Interobserver analysis demonstrated substantial agreement. Analysis of temporal stability showed near-perfect agreement. Cross-cultural adaptation of the Self-care of Hypertension Inventory successfully produced a Portuguese-language version of the instrument for further evaluation of psychometric properties. Once that step is completed, the scale can be used in Brazil.

Enhanced Patient-Centered Educational Program for HF Self-care management in Sub-acute settings

Heart Failure (HF) is a complex condition that leads to inadequate blood circulation causing shortness of breath, fatigue, and weakness. It is one of the leading causes of death in the United States. Heart failure is associated with adverse outcomes such as high rates of hospitalization, readmission, mortality, and poor quality of life. However, despite the establishment of interventions to assist with the control of HF, numerous patients are still being readmitted to the hospital. The main purpose of this evidence-based practice (EBP) project was to implement and evaluate the effectiveness of patient centered educational program on self-care management among HF patients in sub-acute settings. The EBP was implemented in two sub-acute units at Alaris Health located at Cedar Grove. A total of 20 participants completed the pretest and 14 participants completed the post test. The Expanded Chronic Care Model of 2003 (ECCM) was utilized as the theoretical framework to coordinate the health determinants which is the “self-care management.” This EBP project used a pretest and post-test using the tool Self-care of Heart Failure Index V6.2(SCHFI). The data was analyzed using the descriptive statistics using the mean and the difference between the pre- and post-test scores. Educational intervention was provided based on the survey scores. The intervention involved provision of educational program related to effective self-care management among HF patients, their families, and care providers. The results of the study demonstrated a statically significant increase in the mean score between the pre-and post-survey related to self-care maintenance, self-care management, and self-confidence. The results of the project suggested that patient-centered educational program can enhance self-care maintenance, management, and confidence among heart failure patients.

Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study.

To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population. A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension. Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10years (p = 0.008), and having at least one comorbid condition (p = 0.006). Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.

Potential mechanisms involved in the effect of cognitive behavioral therapy on fatigue severity in Type 1 diabetes.

To identify mediators of the beneficial effect of cognitive-behavioral therapy (CBT) on fatigue severity in chronically fatigued patients with Type 1 diabetes. We performed secondary analyses of a randomized controlled trial testing the efficacy of CBT. Primary outcome was fatigue severity assessed with the Checklist Individual Strength, subscale fatigue severity. We used multiple mediation analysis to determine potential mediators of the treatment effect. Proposed mediators were symptom focusing, self-efficacy concerning fatigue and pain, perceived activity, sleep disturbances, confidence in diabetes self-care, diabetes distress and discrepancy regarding social support. Actigraphy was used to assess the level of physical activity. The analysis was repeated with depressive symptoms as potential mediator to test whether this caused a change in the other fatigue-related mediators. The effect of CBT on fatigue severity was partly mediated by a change in symptom focusing (-1.39, 95% CI [-3.32, -0.19]), fear avoidance (-1.10, 95% CI [-2.49, -0.22]), self-efficacy concerning fatigue (-1.95, 95% CI [-4.51, -0.40]), and perceived physical activity (-2.44, 95% CI [-4.53, -1.07]). Depressive symptoms were also a mediator (-1.22, 95% CI [-2.56, -0.38]), but the aforementioned fatigue-perpetuating factors still explained part of the treatment effect. Changes in cognitions about fatigue and activity, and a change in depressive symptoms partly mediated the treatment effect of CBT on fatigue severity in Type 1 diabetes. The mediators found are similar to those explaining the effects of CBT in other chronic diseases. This provides knowledge for the development of more effective and efficient interventions for fatigue. (PsycINFO Database Record

Self-care confidence mediates the relationship between type D personality and self-care adherence in chinese heart failure patients

BackgroundExisting theory and evidence suggest that self-care confidence may mediate the relationship between Type D personality and self-care adherence. ObjectivesTo assess the mediating role of self-care confidence between Type D personality and self-care adherence in Chinese HF patients. MethodsThis is a secondary analysis of a cross-sectional study. Self-care confidence and self-care adherence (maintenance) were measured by the subscales of the Self-Care of Heart Failure Index (v6). The Type D Scale-14 was administered to assess negative affect (NA), social inhibition (SI), and Type D personality. Mediation analysis based on Baron and Kenny was performed. ResultsA total of 127 HF patients were included. Self-care confidence partially mediated the relationship between Type D personality and self-care adherence but completely mediated the relationship between NA/SI and self-care adherence. ConclusionsClinicians may effectively improve self-care adherence by enhancing self-care confidence in HF patients with Type D personality.

Social support predicts self-care confidence in patients with heart failure.

Self-care for patients with heart failure includes engaging in behaviours that maintain medical stability and manage problematic symptoms, as well as the confidence in one's ability to carry out such behaviours. Given the social context of self-care behaviours in heart failure, there has been increasing interest in social support as a predictor of self-care. The goal of the present study was to examine the role of social support in self-care across time for persons with heart failure. Using data from an observational study of patients with chronic heart failure ( n = 280), we examined the role of three types of support - instrumental support, emotional support and assistance with self-care - in the longitudinal course of self-care maintenance, management and confidence. Self-report questionnaire data were collected at baseline and at three and six months later. We found that instrumental and emotional support predicted better self-care confidence on average and that self-care confidence improved at a faster rate for those with less instrumental support. Emotional support was positively associated with self-care management and self-care confidence, and assistance with self-care was positively associated with self-care maintenance. These findings highlight the contribution of social support to self-care in heart failure and provide guidance for future family-based interventions to improve self-care.