Self-care Maintenance Research Articles

Impact of continued Planned Education Provided by Clinical Nurses on Patients with Chronic Heart Failure

Background Patient education is essential for all patients. Nurses should be competent in patient education. Aim This study aimed to investigate the effect of training patients on their self-care capabilities, heart failure health behaviors, and satisfaction levels. Methods This study was conducted based on a quasi-experimental research method with a pretest-posttest design. The two study groups included individuals with heart failure and their nurses and a total of eight nurses working in the cardiology clinic and 31 patients. The nurses were trained on the program “Planned patient education” in three sessions and two meetings. Following the completion of this process, the nurses started their patient education (PE) in line with their training. The data on nurses were collected in pre-and post-training processes, and patients’ data were collected in three stages, including pre-education, discharge, and three months after education. Results The mean±SD score of Heart Failure Health Behavior Scale (HFHBS) in patients in the pre-and post-education period and three months after education were obtained at 47.54±11.98, 63.12±11.12, and 66.90±10.44, respectively, indicating a statistically significant difference between the groups. The mean score of the “Self-Care Maintenance” subcategory was estimated at 32.14±15.88, 51.17±17.60, and 53.43±18.14 in pre-and post-education period, and three months after education, respectively. The mean score of the “Self-Care Management” subcategory was obtained at 44.83±21.31, 53.87±19.22, and 8.38±26.18 in pre-and post-education period, and three months after education, respectively. The mean score of the “Self-confidence in Self Care” subcategory was obtained at 32.46±22.74, 48.78±25.78, and 45.91±30.65 in pre-and post-education period and three months after education, respectively. Patients were satisfied with the efficiency of the subjects covered (75.8%), nurses making short, understandable, and explicit sentences (87.9%), the usefulness of the topics covered (93.9%), and nurses’ knowledge (84.8%). Conclusion Based on the obtained results, PE enhanced the health behavior of people with chronic heart failure and improved patients’ self-care behaviors. The PE led to an increase in patient's satisfaction.

Validity and Reliability of the Korean Version of the Self-Care of Diabetes Inventory (SCODI-K).

This was a methodological study to evaluate the validity and reliability of the Korean version of the Self-Care of Diabetes Inventory (SCODI-K). A total of 210 patients with type 2 diabetes from a university hospital were enrolled. Content validity, construct validity, and criterion-related validity were evaluated. Cronbach’s α was used to assess reliability. The SCODI-K consisted of 40 items in four dimensions (self-care maintenance, self-care monitoring, self-care management, and confidence). Four factors (activity-nutritional behavior, health-adherence behavior, health-promotion behavior, diet-restriction behavior) in the dimension of self-care maintenance, two factors (health status monitoring, symptom recognition) in the dimension of self-care monitoring, three factors (glucose self-control, problem-solving behavior, consultative self-care) in the dimension of self-care management, and one factor (self-care confidence) in the dimension of confidence were extracted. Confirmatory factor analysis supported a good fit with reliable scores for the SCODI-K model (normed chi-square(χ²/df) < 5, root mean square error of approximation (RMSEA) < 0.1, comparative fit index (CFI) ≥ 0.9, goodness-of-fit-index (GFI) ≥ 0.9). The SCODI-K showed a high positive correlation coefficient of 0.75 with the summary of diabetes self-care activities (SDSCA), confirming convergent validity. Cronbach’s α was 0.92 for the overall scale and 0.69 to 0.90 for the four dimensions. Therefore, the SCODI-K is a valid and reliable instrument for assessing self-care of patients with type 2 diabetes in Korea.

Self-Care Experiences of Empty-Nest Elderly Living With Type 2 Diabetes Mellitus: A Qualitative Study From China.

BackgroundThe number of type 2 diabetes mellitus (T2DM) cases among empty-nest elderly increases with increasing aging in China. Self-care plays an important role in preventing and reducing adverse outcomes of diabetes; however, few studies focus on self-care experiences of empty-nest elderly with T2DM.ObjectiveTo explore self-care experiences for a chronic disease among empty-nest elderly patients with T2DM in mainland China.MethodsA descriptive phenomenological design was used in this study. Semi-structured interviews were conducted for 15 empty-nesters with T2DM. Interviews were implemented in department of endocrinology at a tertiary teaching hospital located in Shandong province, east of China.ResultsThe participants were poorly adept with monitoring their blood glucose and lacked the ability to deal with abnormal blood glucose levels. Most participants had a good relationship with medication and physical activity. Living without children was perceived as a benefit that improved dietary management and is a disadvantage in terms of economic and emotional support and access to medical resources. Elderly empty-nesters also lacked knowledge about diabetes and paid little attention to potential complications.ConclusionEmpty-nest elderly patients with T2DM value medication compliance and lifestyle modification more than blood glucose monitoring, complication prevention, and coping with negative emotions. Friends and spouses play indispensable roles in patients’ self-care motivation and maintenance. Diabetes education on self-care, access to medical resources, and social support is needed for better diabetes management.

Abstract 10934: Validity and Reliability of the Korean Version of the Revised Self-Care of Heart Failure Index V7.2

Background: The psychometric properties of the Korean version of the revised Self-care of Heart Failure Index (K-SCHFI v7.2) remain undetermined. Objectives: To examine validity (construct and predictive validity) and reliability of the 29-item K-SCHFI v7.2 in Korean patients with heart failure (HF). Methods: Using a cross-sectional, descriptive design, data on self-care and depressive symptoms were obtained for this psychometric testing. Construct validity was tested with confirmatory factor analysis (CFA) and predictive validity was tested through relationships between each self-care scale and depressive symptoms. Reliability was tested with Cronbach’s alpha and McDonald’s omega coefficients. Results: Patients with HF participated from four university-affiliated hospitals in South Korea (N = 207; mean age, 59.67 ± 13.87 years; male, 63.6%). CFA supported the construct validity of the K-SCHFI v7.2 (CFI from .931 to .977; RMSEA from .033 to .065), specifically, Self-Care Maintenance (CFI = .950, TLI = .931, SRMR = .063, RMSEA = .048); Symptom Perception (CFI = .931, TLI = .908, SRMR = .047, RMSEA = .065); and Self-Care Management (CFI = .977, TLI = .966, SRMR = .040, RMSEA = .033). Validity was further supportive with the relationships between the self-care and depressive symptoms, with patients with more depressed symptoms having poorer self-maintenance (t = 2.34, p = .018) and self-management (t = 2.00, p = .048). Reliability estimates were marginally satisfactory, with Cronbach's α and McDonald’s omega coefficients of .66 and .72 (Self-Care Maintenance), .78 and .82 (Symptom Perception), and .66 and .70 (Self-Care Management), respectively. Conclusion: Validity of the revised K-SCHFI v7.2 was supportive with a sound model fit and the relations to the depressive symptoms. Reliability of each scale was marginally supportive through the alpha and McDonald’s coefficients, while validation is required using a larger sample.

Abstract 9818: Self-Care Self-Efficacy and Perception of Income Adequacy Influence Self-Care Among African Immigrants with Chronic Disease

Introduction: Self-care is vital in chronic illness management. Little is known about the self-care behaviors of African immigrants living in the US. Objectives: I) Describe the self-care behaviors of adult African immigrants in the US living with hypertension, diabetes, or other chronic illness. II) Identify significant determinants of self-care. Methods: Using a cross-sectional design and purposive sampling, 88 African immigrants to the US were enrolled if they self-identified as sub-Saharan African immigrants, were ≥35 years of age, had a symptomatic chronic illness, and could speak and understand English. Self-care was measured with the Self Care of Chronic Illness Inventory and the Self-Care Self-Efficacy scale. Scores are standardized 0-100 with scores &gt;70 considered adequate. Acculturation was measured using a modified standardized acculturation instrument and predefined acculturation proxies (e.g., duration of residency and age at immigration). General linear modeling with backward elimination was used to identify potential determinants of self-care. Results: The 88 participants were between 35 and 78 years, most were married (67%) and reported either diabetes (18%) or hypertension (50%) as their major illness. Self-care scores were adequate (mean 78.6, 77.9, 75.6 for self-care maintenance, monitoring and management). Specific self-care behaviors low in this population were eating a special diet and monitoring for medication side-effects and fatigue. In response to symptoms, few modified their diet or called a healthcare provider. Most (56.8%) were acculturated and acculturation was not associated with self-care. Self-care self-efficacy was high (81.3) and a strong determinant of self-care maintenance (p&lt;0.0001), monitoring (p&lt;0.0001) and management (p&lt;0.0001). Perceived inadequacy of income was a significant determinant of poor self-care management (p= 0.03). Conclusions: In this sample of African immigrants with primarily diabetes and hypertension, self-care was adequate. Self-care self-efficacy and perceived income adequacy were determinants of self-care. These factors can be used to inform culturally concordant interventions to promote self-care.

Abstract 10070: All Caregivers Are Not Alike: Stress, Caregiving Effort, and Self-Care in Heart Failure and Dementia Caregivers

Introduction: Caregiving for someone with a chronic condition is stressful. Deferring self-care is common among caregivers but little is known about differences among various caregiver groups. The aim of this study was to compare stress, self-care, and self-care confidence in two groups of caregivers. Methods: We compared baseline data from two groups of caregivers (HF and frontotemporal dementia [FTD]) enrolled in an on-going study of an intervention designed to decrease stress and improve self-care. Eligible participants had to report caregiving ≥8 hours/week and neglect of ≥2 self-care behaviors (e.g., adequate sleep). Stress was measured with the Perceived Stress Scale (14 items, 5-point scale, higher score means higher stress). Self-care was measured with the Self-Care Inventory with embedded scales measuring self-care maintenance, monitoring, management, and confidence (30 items, 5-point scale, higher scores mean better self-care). Each self-care scale is standardized 0-100; ≥70 reflects adequate self-care. Baseline data prior to the intervention were compared. Results: Compared to HF caregivers, the FTD caregivers were significantly more likely to be Caucasian (87.1% vs. 60.9%), male (25.8% vs. 14.3%), married to the patient (98.8% vs. 72.5%), and older (64.8±10.1 vs. 54.4±15.1) years. The FTD caregivers had been caregiving for fewer years (5.1±3.7 vs. 7.3±8.6) but their daily caregiving effort was higher (Table). Stress levels did not differ significantly and self-care was poor in both groups. Self-care confidence was higher in HF than FTD caregivers. Conclusions: Although caregiving effort was higher in FTD caregivers, stress levels were comparable and self-care was poor in both HF and FTD groups. Understanding the source of the stress, barriers to self-care, and the factors that promote self-care confidence are important for developing and testing tailored interventions to promote self-care of caregivers.

Abstract 9906: Not All Heart Failure Patients Are Men, Not All Caregivers Are Women: Comparing Differences by Gender

Background: Male patients with female caregivers are well represented in dyadic HF research. However, patient-caregiver dyads that are all male, all female, or female patients with male caregivers are not well described. Aim: Compare self-care, clinical, and psychosocial characteristics of patient-caregiver dyads based on the genders of dyad members. Methods: Secondary analysis of a cross-sectional study of patient-caregiver dyads (n=277) using the Caregiver Contribution to Self-Care of HF Index (CC-SCHFI) v2. Dyads were grouped by Patient-Caregiver gender: Male patient-Female caregiver, Female patient-Male caregiver, Female-Female, and Male-Male. Self-care was assessed using the Self-Care of Heart Failure Index and the matching CC-SCHFI. Standardized scores for both indexes range from 0-100 points; higher scores equal better self-care. Characteristics of dyad gender groups (comorbidities, HF duration, NYHA functional class, quality of life (QOL), age, marriage, habitation status, and length and type of caregiving relationship) were compared using chi-square, ANOVA and Kruskal-Wallis equality-of-populations rank tests. Results: Female caregivers of male patients were typically spouses (48%), whereas the majority of caregivers in other dyads were adult children/children-in-law (63-73%). Female patients cared for by female caregivers were older, not married and had worse physical QOL. Male and female caregivers of similar gender patients were younger (47.3±14.0 and 47.7±12.1), less likely to live with the patient and spent the fewest number of hours/day caregiving. Patients in these dyads were more likely to live alone and male patients had the lowest self-care monitoring (48.2±20.1 vs 59.2±18.3 for male patients with female caregivers, p =.06). Males caring for female patients had the lowest contribution to self-care maintenance (63.3±20.3, p =.04) and lower contributions to self-care monitoring, management, and self-efficacy. Conclusion: Patient-caregiver dyads of similar and mixed genders differ across a number of self-care, clinical, and psychosocial characteristics. Results suggest that dyad members’ genders may need to be considered in clinical and research practice.

Self-Care of African Immigrant Adults with Chronic Illness.

This cross-sectional study aims to describe the self-care of adult African immigrants in the US with chronic illness and explore the relationship between acculturation and self-care. A total of 88 African immigrants with chronic illness were enrolled. Self-care was measured with the Self Care of Chronic Illness Inventory v3 and the Self-Care Self-Efficacy scale. Scores are standardized 0 to 100 with scores >70 considered adequate. Acculturation was measured using a modified standardized acculturation instrument and predefined acculturation proxies. The self-care scores showed adequate self-care, with the mean scores of 78.6, 77.9, and 75.6 for self-care maintenance, monitoring, and management. Self-care self-efficacy mean score was 81.3. Acculturation was not significantly associated with self-care. Self-care self-efficacy was a strong determinant of self-care maintenance (p < .0001), monitoring (p < .0001), and management (p < .0001). The perception of inadequate income was a significant determinant of poor self-care management (p = .03). Self-care self-efficacy and perceived income adequacy were better determinants of self-care than acculturation.

Self-care behaviours mediate the effect of educational intervention on health-related quality of life of patients with heart failure: causal mediation analysis

Abstract Background/Introduction Educational interventions have been developed and tested in an attempt to improve health-related quality of life (HRQOL) for patients with heart failure (HF). While some have shown satisfactory results, the mechanism of the intervention effect on HRQOL remains unclear. Purpose To explore whether HF knowledge, self-care behaviours, self-care maintenance, self-care confidence, or social support mediates the effect of intervention on HRQOL of patients with HF Methods We analysed data from a randomized controlled trial testing the effect of an educational intervention for patients with HF. The intervention group (n=60) received 1-hour single session education followed by 8-week telephone follow-ups, and the control group (n=62) received care as usual. Study variables were measured at baseline and at 3 and 6 months. Using causal mediation analysis described by Valeri &amp; VanderWeele (2013), we explored the causal pathway between intervention allocation and HRQOL at 6 months with HF knowledge, self-care behaviours, self-care maintenance, self-care confidence, and social support measured at 3 months as potential mediators (Figure 1). Results Intervention allocation was significantly associated with HF knowledge, self-care behaviours, self-care maintenance, and self-care confidence at 3 months (all p&amp;lt;0.05), but not with social support at 3 months (p=0.57). In unadjusted models, none of the potential mediators had a significant indirect effect between intervention and HRQOL. When adjusting for age and gender, the indirect effect of self-care behaviours on 6-month HRQOL became significant (indirect effect −6.24, 95% CI: −12.88 to −1.18). When baseline values of the mediator and HRQOL were adjusted in addition to age and gender, the indirect effect of self-care behaviours remained significant (indirect effect −7.18, 95% CI: −13.48 to −2.35) and the indirect effect of self-care maintenance became significant (indirect effect −3.02, 95% CI: −7.94 to −0.07). Conclusion Our findings support the mediating role of self-care behaviours on the relationship between the educational intervention and HRQOL of patients with HF. In order to successfully improve HRQOL of patients with HF, educational interventions should aim to promote self-care behaviours, especially by encouraging treatment adherence and self-monitoring. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Seoul National University, College of Medicine Figure 1. Mediation model

Does an empowerment-based self-care supportive intervention save cost for improving self-care and health service utilization among heart failure patients

Abstract Background Heart failure (HF) evolves as a global pandemic and strains the over-stretched hospital service. Ineffective self-care remains the key factor to explain the avoidable hospital admission. Patient empowerment is as a theory-based strategy to optimize the patients' self-care changes for disease management [1]. Its cost-effectiveness to enhance self-care and health service utilization has yet to be determined. Purpose This was a double-blind randomized controlled trial to compare the effects and cost-effectiveness of a 12-week empowerment self-care program with a didactic education program on self-care maintenance and management as well as health service utilization among the community-dwelling HF patients. Methods A total of 236 HF patients were recruited from the specialist clinics of the Department of Cardiology in two regional hospitals. They were randomized to receive either the 12-week empowerment self-care program (Figure 1) or the 12-week didactic education. Outcome evaluation using the Self-care Heart Failure Index (SCHFI) at baseline, post-intervention (T1) and three months thereafter (T2), with record on the number of emergency room (ER) attendance and hospital admission. Cost effectiveness analyses were performed on total cost (medical, intervention and societal costs) incurred in both interventions as well as incremental cost-effectiveness ratios (ICER) expressed as incremental cost per 1) a reflected clinically meaningful improvement in self-care (i.e. a half standard deviation increase in SCHFI), 2) an ER attendance reduced, 3) a day of hospital stay reduced. Results As compared with the education group, the empowerment group reported significantly greater improvement in self-care management at T1 [B=13.77 (95% CI=6.07, 21.46), p&amp;lt;0.001] and T2 [B=10.98 (95% CI=3.21, 18.75), p=0.006]. For cost-effective analysis, The ICER (empowerment-education) was −USD220/0.5 SD increase in SCHFI, indicating the mean cost saved per patient for making a clinically significant improvement in self-care was USD 220. The cost-effectiveness acceptability curve showed patients were willing to pay at USD 207- 441 for a 80–90% chance of improved self-care, indicating that the empowerment approach was a cost saving strategy. Although the empowerment approach was associated with a lower risk of ER attendance [IRR=0.55, 95% CI=0.31–0.95)] and hospital admission [IRR=0.38 (95% CI=0.31–0.95)], it is not cost saving for reducing hospital service utilization. Conclusions The empowerment-based self-care program is a cost-saving strategy to produce a clinical significant change in HF-related self-care. Although it is associated with lower risk for hospital service utilization, its effect is not significant enough to be cost-saving. Future care model may explore the need to integrate dyadic science [2] and e-health [3] to strengthen the care continuity and effects of self-care intervention. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health and Medical Research Fund, Food and Health Bureau, Hong Kong Special Administrative Region Figure 1

Further Evidence of Psychometric Performance of the Self-care of Diabetes Inventory in Adults With Type 1 and Type 2 Diabetes.

The Self-care of Diabetes Inventory (SCODI) is a theory-based tool that measures self-care, a key strategy in the appropriate treatment of diabetes. However, despite the clinical differences between people with Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM), the psychometric properties of the SCODI were only tested in mixed samples. This study aims to test the psychometric performances of the SCODI in two separate groups of adults with T1DM and T2DM. This is a secondary analysis from two previous multicentre cross-sectional observational studies involving patients with T1DM (n = 181) and T2DM (n = 540). We tested dimensionality with confirmatory factor analysis and reliability with a multidimensional model-based coefficient for every scale of the SCODI: self-care maintenance, self-care monitoring, self-care management, and self-care self-efficacy. We found that the SCODI showed the same dimensionality, with minimal variation in factor loadings for each factor and each scale among T1DM and T2DM groups. High reliability for each scale in both groups was also found (self-care maintenance: T1DM = 0.86, T2DM = 0.83; self-care monitoring: T1DM = 0.84, T2DM = 1.00; self-care management: T1DM = 0.87, T2DM = 0.86; self-care self-efficacy: T1DM = 0.88; T2DM = 0.86). The SCODI can be used for measuring self-care in people with T1DM, T2DM, or mixed groups using identical scoring procedures. Considering the well-known differences between Type 1 and Type 2 diabetes diseases and patients' characteristics, our results support the generalizability of the self-care theory on which the instrument is based.

Abstract P126: Self-management Program And Black Women With Hypertension

Introduction: Prevalence rates of hypertension (HTN) among Black adults (males 58.3% and females 57.6%) in the United States is among the highest in the world. Black females (46%) experience a higher incidence of Stage 2 HTN than Black males (42%) contributing to a greater risk of heart failure, stroke, and kidney disease. Levels of awareness, treatment, and control of HTN among Black women are decreasing. Effective strategies to combat these trends are imperative. Lifestyle changes and medication adherence are proven strategies to facilitate blood pressure (BP) control. Getting individuals with HTN to incorporate these strategies into the context of their everyday physical and social environments where they can be performed independently requires active individual engagement in healthcare behaviors and self-care activities. Aim: This study examined the effects of the Chronic Disease Self-Management Program (CDSMP) on self-care (maintenance, management, and confidence) and BP control in Black women with HTN at baseline and then 3-, 6-, and 9-months post CDSMP. Methods: The current study used data from the Interactive Technology Enhanced Coaching Intervention RCT for Black Women with HTN study. All participants completed a 6-week CDSMP at the beginning of the study. Self-care data were collected using the Self-Care of HTN Inventory along with manual BP readings at baseline, and repeated measures at 3-, 6-, and 9-months. Results: Of the 90 community-dwelling Black women enrolled in the study, 83 completed the CDSMP and 69 completed the study. The mean age was 53.57 ( SD = 10.07) years and the average number of years diagnosed with HTN was 11.06 ( SD = 8.47). All participants had BP readings greater than 130/80 mmHg at baseline and 44.92% (31 of 69) moved to less than 130/80 mmHg at 9-months. A weak negative correlation occurred at 9-months between systolic BP and self-care management, r (67) = -.26, p = .029, and confidence, r (67) = -.25, p = .035; and diastolic BP and self-care management, r (67) = -.31, p = .009, and confidence, r (67) = -.28, p = .018. Conclusion: The CDSMP was feasible, successfully delivered, and well-received by those enrolled in the study. Future studies should evaluate effective interventions for self-care strategies to improve long-term BP control.

CN51 Self-care in patients with myeloproliferative neoplasms: Scale development and initial validation

Myeloproliferative neoplasms (MPN) are rare chronic haematological malignancies including polycythaemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF). Given the chronic nature of these neoplasms, health professionals should encourage patients living with MPN to engage in self-care behaviours, including self-care maintenance, self-care monitoring, and self-care management. This study aimed to develop a self-report questionnaire measuring self-care behaviours according to the Middle-Range Theory of Self-Care of Chronic Illness.

Cross-cultural adaptation and validation of the caregiver contribution to self-care of chronic illness inventory in China: a cross-sectional study

ObjectiveCaregiver contribution (CC) is important for the self-care behaviors of chronic disease individuals, as it could enhance patient outcomes. Therefore, it is necessary to assess this CC by using a...

Self-care in spinal cord injuries inventory (SC-SCII) and self-care self-efficacy scale in spinal cord injuries (SCSES-SCI): development and psychometric properties.

Validation cross-sectional study. To develop and assess the psychometric properties of two instruments based on the middle-range theory of self-care in chronic illness: the Self-Care in Spinal Cord Injuries Inventory (SC-SCII) and the Self-Care Self-Efficacy Scale in Spinal Cord Injuries (SCSES-SCI). Multicenter study in five spinal units across Italy and Ireland. Instrument development was based on self-care behaviours identified in the scientific literature. Behaviours were grouped into four dimensions during a consensus conference: self-care maintenance, self-care monitoring, self-care management and self-care self-efficacy. Sixty-seven items were subsequently generated based on these dimensions. A multidisciplinary group of 40 experts evaluated content validity. Dimensionality of the final items was tested by confirmatory factor analyses (CFA) with a sample of 318 participants. Internal consistency and test-retest reliability were evaluated for each dimension. Construct validity was assessed using correlations between items and scoring differences amongst participants with more severe conditions and secondary complications. Content validity of the SC-SCII and SCSES-SCI was satisfactory for thirty-five of the previously generated items, which were further refined. CFA showed comparative fit indexes ranging from 0.94 to 0.97 and root mean square errors of approximation from 0.03 to 0.07. Internal consistency ranged from 0.71 to 0.85, and intraclass correlation coefficients were higher than 0.70. Correlations among dimensions were moderate, and the theoretical hypotheses formulated when designing the instruments were largely confirmed. The SC-SCII and the SCSES-SCI represent valid and reliable theoretically-grounded instruments to assess self-care in people with spinal cord injury.

The Revised Self-Care of Heart Failure Index - a new tool for assessing the self-care of Polish patients with heart failure.

According to the European Society of Cardiology guidelines, self-care is a key part of treatment for patients with heart failure. A large evidence base has been accumulated regarding the direct impact of self-care on the outcome of patients with heart failure. In order to assess self-care in patients with heart failure and to evaluate the effectiveness of the interventions taken, a reliable and culturally acceptable instrument is required. The Revised Self-care of Heart Failure Index (SCHFI) is a new tool for assessing self-care in patients with heart failure. Our aim was to test the reliability of the Polish version of the Revised SCHFI. The standard forward-backward translation procedure was used to translate the Revised SCHFI questionnaire into Polish. The reliability of the SCHFI was assessed based on Cronbach's α, item-total correlation, exploratory factor analysis, and confirmatory factor analysis. A total of 127 patients with heart failure (mean [SD] age, 68.5 [11.2] years) completed the questionnaire. The mean (SD) total self-care score in the study group was 51.92 (22.0). Patients scored the highest in terms of self-care confidence (mean [SD] score, 65.63 [21.0] points), and the lowest in symptom perception (mean [SD] score, 54.64 [18.28] points). The Revised SCHFI had satisfactory psychometric properties in all subscales (self-care maintenance α = 0.790, symptom perception α = 0.790, self-care management α = 0.705). The Polish version of the Revised SCHFI is a reliable and valid instrument for assessing self-care level in heart failure patients.

Recognition of symptoms, mitigating mechanisms and self-care experiences of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia

Background: Compliance of patients with self-care practices is the mainstay of measures to manage diabetes. This study explored self-care practices of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia. Methods: The study employed an interpretive phenomenological approach using purposive sampling. The data were collected from 24 (11 males and 13 females) participants (July 2019 to January 2020) using in-depth interviews till theoretical saturation. The data were analyzed thematically and organized using QDA Miner Lite v2.0.8. Results: The findings were categorized into: labeling diabetes, self-care maintenance experiences, recognition of symptoms, and mitigating mechanisms of symptoms. The self-care maintenance practice of patients was linked with diet input preferences and the effectiveness level of insulin. What guides the self-care behavior was the patients’ preferentiality of strictly adhering to their preferred dietary inputs. Barley and wheat were the most common preferential and non-preferential inputs, respectively. The patients strictly adhered to insulin treatment because they found it effective. The most common hyperglycemia symptoms to be managed by taking an additional dose of insulin, were frequent urination, increased thirst, and their consequences (dehydration). Excessive sweating (initial), shivering (middle), and falling (final), respectively in severity, were the most common symptoms of hypoglycemia which were perceived to be treated with sweet snacks. Originality: To our knowledge, this is the first research in Ethiopia to investigate the self-care experiences of type 2 diabetes patients receiving insulin using an interpretive phenomenological approach.

Health literacy of Icelandic patients with coronary heart disease

Abstract Funding Acknowledgements Icelandic Nurses" Assoc., Landspitali Univ Hosp., Icelandic Reg Dev Instit, Univ of Akureyri, Akureyri Hosp, OnBehalf KRANS Background Sufficient health literacy (HL) is vital for patients to effectively manage their chronic disease. There are indications that around 50% of the public have limited HL, which can lead to difficulties in self-care, such as medication adherence and lifestyle management. In order to develop effective patient education for patients with coronary heart disease (CHD) and support their self-care, more knowledge is needed on their HL. This is one of the first studies on HL in Iceland and the first on HL in the cardiac patient population. Purpose To describe HL and related factors in patients, 6 months after hospital admission for their CHD. Methods Data was collected from patients with questionnaires (in 2018-2019), six months following an acute or elective treatment for their CHD. Patients answered the European Health Literacy Survey Questionnaire- short version (HLS-EU-Q16), a 16 items instruments with scores ranges from zero (low/no HL) to 16 (high HL). A score of 0 to 8 is considered an indicator of "insufficient" HL, a score from 9 to 12 as "limited" health literacy, and a score of 13 or more as "sufficient" HL. Data on educational needs (on 19 CHD related topics), disease-related knowledge (CADE-Q SV), general (mental and physical) health (SF-12V2) and self-care (SC-CHDI) were collected from patients as background data. Results Preliminary data analysis shows that patients (N = 376, mean age 65 (SD 8.9), 80% male, 30% with basic education only) had a mean HL score of 13.7 (SD 2.5). Sufficient HL was observed in 71.7% of patients, limited HL in 24.5% and 3.8% had insufficient HL. Health literacy was inversely associated with educational needs (odds ratio (OR) 0.58 (0.35;0.98). An increase in HL level was associated with an increase in knowledge (OR 1.13 (0.01; 1.26), self-care maintenance (OR 1.03 (1.01; 1.06), self-care confidence (OR 1.03 (1.01; 1.04) and mental health (OR 1.02 (1.01;1.04). Conclusions The health literacy of patients in this study is satisfactory. Their HL is associated with their disease-related knowledge, educational needs, confidence, mental health and self-care maintenance. HL should be assessed when planning patient education for patients with CHD and the education tailored to individual needs.

Heart failure inpatient"s self-care behaviour: mulricenter approach focousing on gender differences

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart failure is often characterized by low exercise capacity and great impairment on performance in activities of daily living. The correct management of the disease can prevent the worsening of symptoms and promote a better quality of life. Self-care behaviour plays an important role on patient"s quality of life. Aim The aims of this study are to evaluate the self-care behaviour in a sample of heart failure inpatients, using the Self-Care Heart Failure Index (SCHFI) and to understand whether gender and patophisiologic characteristics does interfere on it. Methods Cross-sectional multicenter study enrolling 225 heart failure inpatients from eight hospitals. At admission, patient’s functional capacity was evaluated as well as their self-care behaviour, using the SCHFI Portuguese v6.2. Comparison between self-care behaviour with gender was performed. Also some correaltions were perfomed with the total sample of patients, aiming to understand which were the variables that may interfere with the socre of each sub-scale of the self-care HF index. Results Patients’ mean age was 68.4 ± 10.7 years old, 68% were male and 82.3% have reduced ejection fraction. A mean value of 47.9, 35.6 and 38.8 points was found in the SCHFI score of the sections self-care maintenance (SCMt), self-care management (SCMg) and self-care confidence (SCC), respectively. Heart failure inpatients present inadequate levels of self-care behaviour. No difference was found between genders on any section of the SCHFI. Among all variables, only the number of CVRFs and the left ventricular ejection fraction had significant differences. Males had better results, but not with a statistically significant difference. Association tests (ANOVA) between different variables and the score of each section of the SCHFI were perfomred. Only in the NYHA there are variables associated with a better self-care, namely in the SCMg (p = 0.011) and in SCC (p = 0.010). Correlations were made using the numeric variables age, CVRF, BI, LCADL, SCMt, SCMg and SCC, in order to understand the influence of the variables with each other. All the three dimesnions present a positive correlation, at 99% confidence interval between them (SCMt with SCMg: r = 0.365, p &amp;lt; 0.000; SCMt with SCC: r = 0.272, p &amp;lt; 0.000 and SCMg with SCC: r = 0.670, p &amp;lt; 0.000). In addition, SCMt presents a positive correlation with age at a 95% confidence interval (r = 0.158, p = 0.018). Negative correlations were found between 1) BI and age (r=-0.151, p = 0.023), at a 95% confidence interval and 2) BI with LCALD (r=-0.407, p &amp;lt; 0.000), at a 99% confidence interval. Regarding NYHA functional class and left ventricular systolic function, only NYHA class II patients present a statistically significant difference in SCMg and SCC comparing to Class III and IV patients (who do not present differences between them). Conclusion The results do not suggest a relationship between gender and pathophysiological characteristics with self-care behaviour.

Recognition of symptoms, mitigating mechanisms and self-care experiences of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia

Background: Compliance of patients with self-care practices is the mainstay of measures to manage diabetes. This study explored self-care practices of type 2 diabetes patients receiving insulin treatment in North-East Ethiopia. Methods: The study employed an interpretive phenomenological approach using purposive sampling. The data were collected from 24 (11 males and 13 females) participants (July 2019 to January 2020) using in-depth interviews till theoretical saturation. The data were analyzed thematically and organized using QDA Miner Lite v2.0.8. Results: The findings were categorized into: labeling diabetes, self-care maintenance experiences, recognition of symptoms, and mitigating mechanisms of symptoms. The self-care maintenance practice of patients was linked with diet input preferences and the effectiveness level of insulin. What guides the self-care behavior was the patients’ preferentiality of strictly adhering to their preferred dietary inputs. Barley and wheat were the most common preferential and non-preferential inputs, respectively. The patients strictly adhered to insulin treatment because they found it effective. The most common hyperglycemia symptoms to be managed by taking an additional dose of insulin, were frequent urination, increased thirst, and their consequences (dehydration). Excessive sweating (initial), shivering (middle), and falling (final), respectively in severity, were the most common symptoms of hypoglycemia which were perceived to be treated with sweet snacks. Originality: To our knowledge, this is the first research in Ethiopia to investigate the self-care experiences of type 2 diabetes patients receiving insulin using an interpretive phenomenological approach.