Self-care Education Research Articles

A Health Mobile Application for Self-Care of Colostomy Patients

Abstract Introduction and Objective In most cases, due to the failure of nonsurgical methods in the treatment of diseases related to the colon, it is necessary to perform colostomy as the main treatment method. However, this surgery can cause a wide range of physical, social, and psychological problems in patients. Therefore, in order to prevent and treat the complications of colostomy, it is necessary to adopt measures in the field of self-care and continuous education for patients to control the complications of the disease, seek treatment, and experience improvements in their quality of life . Additionally, considering the role of mobile health (mHealth) applications in facilitating continuous and effective training, and improving self-care for these patients, the aim of the present study was to design and evaluate an mHealth application for self-care of colostomy patients. Materials and Methods In the present applied research, first the functional requirements of the software were determined considering the self-care requirements of colostomy patients. Then, the software was designed based on object-oriented analysis, and according to it, the application was coded in Java and developed in the Android Studio environment. Finally, to evaluate the software, the opinions and comments of 5 gastroenterologists and 10 adult colostomy patients in the age range between 27 and 64 years who had at least a high school diploma were used as the basis of judgment at this stage. The instruments used in the evaluation included a checklist, derived from three standard questionnaires (the System Usability Scale [SUS], the mHealth App Usability Questionnaire [MAUQ], and the User Version of the Mobile Application Rating Scale [uMARS]) to measure the user-friendliness indicator, and a researcher-made checklist to measure the performance indicator of the various services provided. Results The services of the software developed include the provision of medical information and self-care instructions regarding colostomy surgery, as well as alerts for the user to schedule an appointment with a doctor and the time to take medications. Based on the results of the evaluation stage, the users were generally satisfied with the interface, services, and general features of the software. In general, the software was evaluated at the “acceptable” level, with a rate of 85%. Discussion and Conclusion Based on the findings of the current research, the software developed can be significantly effective in facilitating the education of colostomy patients and improving their self-care. Proper and continuous self-care and education for colostomy patients is necessary to prevent and control complications resulting from surgery and to improve their quality of life. Therefore, in addition to patients, all health care staff, organizations, and associations which support colostomy patients can also use this software to educate patients and improve the care provided to them.

Effect of Psychological/Spiritual Self-care Education Through Telenursing on Death Anxiety of the Elderly During the COVID-19 Pandemic in Gonabad, Iran: A Randomized Controlled Clinical Trial

Effect of Psychological/Spiritual Self-care Education Through Telenursing on Death Anxiety of the Elderly During the COVID-19 Pandemic in Gonabad, Iran: A Randomized Controlled Clinical Trial

Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education [Response to Letter

Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education [Response to Letter

A TELENURSING SERVICE'S IMPACT ON COVID-19 PATIENTS: LITERATURE REVIEW

Background: Pandemic Corona Virus Disease 2019 (COVID-19) is an infectious disease caused by SARS-COV2. COVID-19 has become a world pandemic that poses various risks throughout the world such as an increase in the number of patients and the risk of disease development in the world health system, especially nursing. The WHO reports that technology has a growing role in education and good work practice. Telenursing is well defined as the application of telecommunications and information technology to provide remote nursing practice. Purpose: This study aimed to examine the process of establishing a telenursing service for COVID-19. Methods: Three databases—PubMed, Google Scholar, and Research Gate—were used to find research publications. English-language keywords included in the literature search are telenursing OR tele-nursing and Covid-19, with the inclusion of works from 2019 to 2021. Results: Five studies that matched the inclusion criteria and the goals of this literature review were examined from a total of 936 research articles. Following the critical evaluation of five articles, a simplified thematic analysis was performed. This research review's main finding was that non-contact counseling services, instruction, and nursing care are important. Conclusion: Application of the telenursing program improved information technology and enabled the delivery of nursing care remotely. As an additional treatment option for patients with COVID-19, other remote self-care instruction techniques may be applied.

Teaching self-care: understanding the learned and lived self-care experiences of social work students

ABSTRACT Professional self-care in social work is regarded as paramount to ethical and competent practice. However, the absence of an agreed upon operationalization of self-care leaves social work educators directionless on the teaching and modeling of self-care. This study investigated the learned and lived self-care experiences of BSW and MSW students (n = 80) in their final field education experience. Data collection included an anonymous online survey, focus groups, and a follow-up online survey. Broadly, students were asked to consider three aspects of self-care: 1) their understanding of self-care, including the sources of that understanding; 2) their experienced internal and external barriers to self-care; and 3) the interface between self and systems when practicing self-care. Utilizing a general inductive approach to data analysis, several evocative themes emerged suggesting gaps between the learned experience and the lived experience of self-care including the conflict between familial or cultural values and formal self-care education, a divide between their positive experiences with self-care and their actual performance of self-care, and inhibitory components of professional systems to the personal practice of self-care. Students exhorted their social work educators to model self-care, teach it explicitly, provide in-vivo practice opportunities, and to understand the student experience.

Individual and systems-related factors associated with heart failure self-care: a systematic review

BackgroundHeart failure (HF) is a prevalent condition worldwide. HF self-care is a set of behaviors necessary for improving patient outcomes. This study aims to review and summarize the individual and system-related factors associated with HF self-care published in the last seven years (Jan 2015 – Dec 2021) using the Socioecological Model as a review framework.MethodsAn experienced nursing librarian assisted authors in literature searches of CINAHL Plus with Full Text, Ovid Nursing, PsychINFO, and PubMed databases for peer-reviewed descriptive studies. Inclusion criteria were HF sample with self-care as the outcome variable, and a quantitative descriptive design describing individual and/or system-level factors associated with self-care. Exclusion criteria were interventional or qualitative studies, reviews, published before 2015, non-English, and only one self-care behavior as the outcome variable. The search yielded 1,649 articles. Duplicates were removed, 710 articles were screened, and 90 were included in the full-text review.ResultsA subset of 52 articles met inclusion and exclusion criteria. Study quality was evaluated using modified STROBE criteria. Study findings were quantitated and displayed based on socioecological levels. Self-care confidence, HF knowledge, education level, health literacy, social support, age, depressive symptoms, and cognitive dysfunction were the most frequently cited variables associated with self-care. Most factors measured were at the individual level of the Socioecological Model. There were some factors measured at the microsystem level and none measured at the exosystem or macrosystem level.ConclusionResearchers need to balance the investigation of individual behaviors that are associated with HF self-care with system-level factors that may be associated with self-care to better address health disparities and inequity.

The use of a multi-disciplinary geriatric telemedicine service (TELEG) and its acceptance at a tertiary care centre in Malaysia.

The COVID-19 pandemic has fueled the widespread adoption of telemedicine in healthcare, particularly in Sarawak, Malaysia. This study investigates the use and acceptance of Sarawak's inaugural multidisciplinary geriatric telemedicine service, TELEG. This cross-sectional study took place at the Sarawak Heart Centre's geriatric department from July 1, 2021, to April 30, 2022. Convenient sampling included all TELEG-enrolled patients during this period, to achieve minimum sample size of 148. TELEG's utilization was assessed in terms of medication therapy and treatment plan optimization, as well as enhanced healthcare accessibility. Participants' acceptance of TELEG was measured using the Service User Technology Acceptability Questionnaire (SUTAQ) administered through Google Forms. Descriptive statistics percentages illustrated the proportion of participants who found TELEG moderately to highly acceptable. Associations between baseline characteristics and overall acceptance were explored through bivariate analyses, including Pearson's correlation test, independent t-test, and ANOVA. The influence of six SUTAQ dimensions on overall acceptance, multivariable linear regression using enter method was employed. Statistical significance was determined by p-values less than 0.5. Among 180 geriatric patients enrolled in TELEG during the study period, 149 agreed to participate. TELEG led to medication therapy optimization for 88.6% of participants, primarily involving dose adjustment (44.7%), de-prescribing (31.8%), and prescribing (15.9%). Additionally, 53.8% received treatment plan optimization, predominantly in the form of self-care education (56.3%), referrals for further treatment (33.8%), additional laboratory investigations (29.6%), and increased monitoring (26.8%). Among those educated in self-care (n = 40), dietary intake (27.5%), lower limb exercise (25.0%), and COVID-19 vaccination (12.5%) were the most common topics. All participants expressed moderate to high acceptance of TELEG (mean = 4.9, SD = 0.65, on a scale of 1 to 6). Notably, care personnel concern (B = 0.256; p < 0.001) had the most significant impact on overall acceptance. This pioneering study evaluates the utilization and user acceptance of a geriatric telemedicine service in the region, providing valuable insights to support its expansion. Follow-up surveys or interviews to gain insights into users' experiences are crucial to further enhance acceptance.

Self-Care Education on the Pain, Quality of Life, and Consequences of Disease in Patients with Knee Osteoarthritis.

Knee osteoarthritis (KOA) is one of the most common and prevalent debilitating chronic diseases across the world with various adverse effects such as pain and movement limitations which impact the health status and quality of life of the patients in the long run. This study aimed to investigate the effects of self-care education on pain, quality of life, and consequences of disease in patients with KOA in Southern Iran. This is a randomized controlled clinical trial using a pretest-posttest design. Eighty patients with KOA were enrolled in this study and randomly allocated to a control and an intervention group. The data collection instruments included VAS: Visual Analog Scale, the SF-36 quality of life scale, and the Knee Injury and Osteoarthritis Outcome Score. The collected data were analyzed through SPSS v. 22, using descriptive tests, paired t-tests, independent t-tests, Chi-square, and ANOVA. A P level of <.05 was considered as the significant level. Before the self-care educational intervention, no statistically significant difference was found between the control and intervention groups in pain intensity, quality of life, and consequences of osteoarthritis. After the self-care educational intervention, the findings revealed a significant difference between the intervention group's mean ± standard deviation for pain intensity (41.25 ± 21.74), quality of life (49.87 ± 14.74), and consequences of KOA (39.06 ± 12.15), respectively (P < .05). However, in the control group, there was no significant difference. Based on the results of this study, the positive effect of self-care education on patients with osteoarthritis was shown as to their pain intensity, quality of their lives, and reduction of the disease consequences. Thus, healthcare managers are recommended to apply this type of intervention for patients with osteoarthritis.

Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education.

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers. This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven tools and technology, on the performance of clinical and patient experience measures. A virtual care model, applied using a systems approach offered by the Value Transformation Framework (VTF), was combined with self-care tools and technology in twenty health centers across 17 states to drive improvement efforts. Changes in clinical measures and patient experience were compared. A total of 385 patients were enrolled and 270 (70.1%) completed a baseline visit and at least four virtual visits during the six-month intervention period. Statistically significant improvements were seen in measures for HbA1c, systolic and diastolic blood pressure, and bodyweight. Among the 270 who completed the baseline and at least 4 virtual visits, the percentage up-to-date for colorectal cancer screening increased from 113/270 (41.9%) to 169/270 (62.6%) after six months, p<0.001, a 20.7% increase. Patients completing the baseline visit and at least 4 virtual visits reported a 10.7% decrease in depression and increased satisfaction with virtual care visits compared to in-person visits (p<0.001). Health centers applying the Value Transformation Framework's organizing framework to the use of virtual care models together with patient self-care tools, technology, and education, had improvements in measures for chronic and preventive conditions and patient experience.

Caregivers' Contributions to Heart Failure Self-care: An Updated Systematic Review.

A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy. The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science? This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness. Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities. Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.

Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education [Letter

Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education [Letter

Assessment of diabetes self-care behaviors and knowledge among Marshallese adults with type 2 diabetes in the Republic of the Marshall Islands

AimsThe aim of this study is to assess and document engagement in type 2 diabetes mellitus (T2DM) self-care behaviors and self-reported diabetes knowledge among Marshallese adults living in the Republic of the Marshall Islands (RMI). MethodsThe study uses data from a T2DM health screening study completed in the RMI; survey and biometric data were captured as part of the health screenings. Study objectives were examined using descriptive statistics to describe the characteristics of the participants, their diabetes self-care behaviors, and their levels of self-reported diabetes knowledge. ResultsResults indicate many Marshallese diagnosed with T2DM did not engage in adequate self-care behaviors, including blood sugar checks and foot examinations. Participants reported having forgone needed medical care and medication due to issues with cost and/or access, and participants reported low levels of diabetes knowledge. ConclusionsThe results demonstrate the need for further work in improving engagement in diabetes self-care by Marshallese living in the RMI. Increased engagement in self-care and diabetes education programs may help Marshallese with T2DM to improve control of their glucose and avoid long-term health complications, as well as reduce costs to the healthcare system.

Effect of Self-Care Teaching Module on Radiation- Induced Acute Side Effects and Clinical Outcomes for Head and Neck Cancer Patient

Effect of Self-Care Teaching Module on Radiation- Induced Acute Side Effects and Clinical Outcomes for Head and Neck Cancer Patient

The Effect of Rosa Foetida Extract along with Self-Care Education on Primary Dysmenorrhea: A Prospective Randomized Clinical Trial

The Effect of Rosa Foetida Extract along with Self-Care Education on Primary Dysmenorrhea: A Prospective Randomized Clinical Trial

Enhancing self-care education amongst medical students: a systematic scoping review

BackgroundReports of emotional, existential and moral distress amongst medical students witnessing death and suffering of patients during their clinical postings have raised awareness on the need for better psycho-emotional support during medical school. Furthermore, the stress experienced by medical students stemming from the rigours of their academic curriculum underlines the need for greater awareness on mental health issues and better self-care practices across medical training. With such programmes lacking in most medical schools, we propose a systematic scoping review (SSR) to map and address our research question, “what is known about self-care education interventions amongst medical students?”.MethodsWe adopted the Systematic Evidence-Based Approach to guide a systematic scoping review (SSR in SEBA) of relevant articles published between 1st January 2000 and 30th June 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles were independently and concurrently thematically and content analysed, with complementary categories and themes combined using the Jigsaw Approach. The domains created from the Funnelling Process framed the discussion.ResultsA total of 6128 abstracts were identified, 429 full-text articles evaluated, and 147 articles included. The 6 domains identified were definition, topics, pedagogy, influences, outcomes and assessment. Most interventions were promising, though peer-led mindfulness-based interventions showed most promise in enhancing engagement, positively impacting personal wellbeing, and improving patient care. Overall, however, self-care education was poorly recognized, adopted and integrated into curricula.ConclusionGreater dedicated time and conducive practice environments within medical school curricula is required to enhance medical student wellbeing. Host organizations must ensure faculty are appropriately selected to instil the importance of self-care, be trained to assess and personalize self-care interventions and provide longitudinal assessment and support. Further study into assessing self-care capabilities is required.

Nurses' perspectives on the provision of self-care management education to patients with heart failure: A qualitative study at Cardiac Hospital, Dar es Salaam Tanzania.

Patients' education along with a motivation for developing self-care management skills is an essential component in the management of heart failure(HF). Self-care management education has been practiced by nurses in many hospitals. However, there is inadequate evidence for the provision of self-care management education in low-income countries including Tanzania. Lack of self-care management education to patients with HF during discharge is the most common reason for re-admission to hospitals. This study aimed to explore nurses' perspectives focusing on facilitators and barriers to the provision of self-care management education to patients with heart failure at Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania. This study used a qualitative descriptive design. Purposive sampling was used to recruit 12 study participants. In-depth interviews were used to collect the data. We used thematic analysis to come up with the themes and sub-themes. The two major themes emerged from this study; The first theme is "Improved patient quality of life and health outcome" which describes factors that motivate nurses to continue giving self-care management education to heart failure patients. The second theme is "Reduced effective uptake of self-care management education" which describes nurses'perspectives on barriers for providing self-care management education to heart falure patients. Nurses highlight some barriers while providing self-care management education to patients with heart failure including;inadequate knowledge of self-care management among nurses, lack of privacy during the provision of self-care education, poor communication skills among nurses, and lack of learning materials. Also, nurses pointed out facilitators that influence the provision of self-care management education such as increased involvement of family members and the use of peer educators. Poor self-care management for patients with heart failure results in readmission and prolonged hospital stay. Family involvement and the use of peer educators are the key steps in the improvement of self-care management for patients with HF. However, patient cognitive impairment and poverty which contribute to poor health outcomes, should be taken into consideration when planning for discharge for patients with HF. Self-care management education should be part of routine health care.

Adherence to Self-care Practices among Type 2 Diabetes Mellitus Patients in Rural Area of Tamil Nadu, India: A Cross-sectional Study

Introduction: Developing countries like India are facing an increased threat from both non communicable and communicable diseases. The prevalence of Type 2 Diabetes Mellitus (DM) among non communicable diseases has been rapidly increasing in India. The complications of diabetes, including both acute and chronic effects, impact the physical, mental, and social well being of patients. The effectiveness of diabetes management solely depends on the self-care practices adopted by individuals and their family members. Aim: To evaluate the patterns of self-care practices among diabetic patients and the factors associated with them. Materials and Methods: A community-based cross-sectional study was carried out among 206 diabetic patients in and around the rural field practice area of ACS Medical College and Hospital in Thiruvallur district, Chennai, Tamil Nadu, India, from June 2022 to November 2022. Type 2 DM patients aged ≥18 years were included in the study. The participants were interviewed about their diabetic status and various parameters of self-care practices, using the Summary of Diabetes Self-care Activities (SDSCA) score. The Chi-square test was applied to assess the relationship between self-care practices and factors such as age and gender. Results: The mean age of the participants was 47±10 years. The present study observed that the overall prevalence of poor selfcare practices was low, with 92 participants (44.7%) exhibiting poor practices and 114 participants (55.3%) demonstrating good self-care practices. In the current study, the association between self-care activities and education level, as well as the clinical profile of the patients, was statistically significant. A negative linear correlation was found between self-care practice scores and blood glucose levels. Conclusion: Self-care behaviours among diabetes patients were found to be good in more than half of the study population. These behaviours were significantly associated with age, education level, and complications of diabetes. The results emphasise the complex nature of self-care behaviours among individuals with DM and highlight the necessity for customised therapies that target individual challenges and foster supportive environments.

Caregivers’ mental health in cancer journey: A Review

Caregiving in the context of cancer involves intricate psychological dimensions that profoundly impact caregivers' well-being and the quality of care provided. This research delves into the overlooked realm of caregiver mental health within the cancer journey, illuminating the emotional complexities. Examining caregiver roles and stressors, the study reveals the responsibilities caregivers shoulder, encompassing emotional support, daily tasks and advocacy within the healthcare system. Emotional distress, physical strain, financial burdens and social isolation characterize their experiences, influencing both caregivers and care recipients. Exploration into coping strategies and resilience highlights the significance of emotional expression, social support, self-care and proactive education. Resilient caregivers exhibit adaptability, positivity and effective communication, crucial for navigating the challenges of caregiving. Acknowledging the need for comprehensive support, the study advocates for tailored programs to alleviate caregiver stress. Challenges in accessing support programs due to awareness gaps and financial constraints emphasize the necessity for inclusive, accessible support systems. This research sets the stage for future investigations into cultural, socioeconomic influences and longitudinal studies to develop targeted interventions. Practical implications underscore the integration of technology, caregiver-inclusive healthcare policies and robust support networks, aiming for a more empathetic and supportive landscape. In conclusion, understanding and addressing caregiver mental health stand as pivotal components of holistic cancer care. The study calls for a cultural shift, prioritizing comprehensive support for those navigating the intricate path of cancer care. Its findings advocate action across healthcare, societal attitudes and support initiatives, emphasizing the significance of caregiver well-being in the broader context of cancer care.

The effects of the use of customized silicone digital orthoses on pre-ulcerative lesions and plantar pressure during walking in people with diabetic neuropathy: A study protocol for a randomized controlled trial

BackgroundPeople with diabetes and diabetic peripheral neuropathy (DPN) often develop calluses due to toe misalignment and increased plantar pressure. Untreated, these issues can progress into ulcers, making early intervention crucial. This trial protocol aims to evaluate the efficacy and safety of customized silicone digital orthoses in preventing ulcers, pre-ulcerative lesions, and peak pressure during gait in people with DPN. MethodsIn this superiority randomized controlled parallel trial with single-blind assessment, 60 participants will be allocated to the control group (CG) or the intervention group (IG). The CG will receive specialized nurse-administered foot care, including callus removal, nail care guidance, and self-care education. The IG will receive the same care plus a customized silicone orthosis for toe realignment for 6 months. Assessments will occur at baseline and 3 and 6 months for the primary outcomes (pre-ulcerative lesions and ulcer incidence) and secondary outcomes (pressure distribution, foot function and health, quality of life, safety, and comfort). Two-way ANOVAs (p < .05) will assess group, time, and group by time effects following an intention-to-treat approach. ConclusionAlthough recommended for foot ulcer prevention, custom silicone orthosis adoption remains limited due to the low certainty of evidence. This trial seeks to provide more consistent evidence for the use of toe orthoses in preventing callus and ulcer formation for individuals with DPN. Trial registryClinicalTrials.gov (NCT 05683106) “Effects of Customized Silicone Digital Orthoses in People with Diabetic Neuropathy” (registered on December 20, 2022).

LIVING WITH DEMENTIA: COMMUNITY-BASED CARE PARTNER EDUCATION EVALUATION RESULTS

Abstract A mixed methods overall series evaluation was administered at session four in each location to assess preparedness, perceived increase in caregiver self-efficacy and wellness, development and implementation of skills, and overall program value. Fifty-five participants (73% response rate) completed the evaluation; 44 (80%) were care partners of a person living with dementia (PLWD). Twenty-four (44%) participants attended all four sessions, 9 (16%) attended three, 8 (15%) attended two, and 11 (20%) attended one. Those who attended all four sessions were more likely to strongly endorse that they felt better prepared (96% vs. 75%; X2 = 3.7, p = 0.05). On a 5-point scale (1 = Strongly disagree, 2 = Disagree, 3 = Neither agree/disagree, 4 = Agree, 5= Strongly agree), 38 (85%) reported agree or strongly agree to improved preparedness to meet the needs of their PLWD, and 41 (93%) reported improved confidence as a care-partner. The top 5 communication skills learned: Using fewer words (89%); Slowing down speech (89%); Focusing on the relationship (86%); Ending an encounter with thank you (86%); and Going with the flow (84%). Content analysis of qualitative data suggest care-partners’ new understanding and improved communication skills were having a positive influence on the pace and quality of daily life and reported less conflict and improved mood; challenges persisted with activities of daily living, such as showering and toileting. Programs like LWD that provide care partners education, skill development and support for self-care can improve daily life for care-dyads living with dementia.