Self-care Management Behaviors Research Articles

Exploring patients with COPD self-care behaviours and self-efficacy and their interconnections: A network analysis.

The aim of this study was to investigate self-care behaviours of patients with chronic obstructive pulmonary disease (COPD), understand their complex interconnections and identify key behaviours influencing self-care and self-efficacy. An observational, cross-sectional study design. The outpatient department of two tertiary hospital. A convenience sample of patients with a diagnosis of COPD were included (n = 222). Self-care behaviours were assessed using the Chinese version of self-care of chronic obstructive pulmonary disease inventory based on the Middle-Range Theory of Self-Care of Chronic Illness. Patient self-care efficacy was evaluated using Chinese version of Self-Care Self-Efficacy Scale in Chronic Obstructive Pulmonary Disease. Employing network analysis, associations between behaviours (nodes) and their interrelationships (edges) were deciphered. The study was reported following the STROBE checklist. Among the spectrum of self-care behaviours, patients exhibited the most pronounced deficiencies in behaviours directed to enhancing breathing, monitoring extra-respiratory symptoms and problem-solving. Within the network, the most central emerging behaviour was the modification of prescribed therapy at the worsening of symptoms, as suggested by healthcare providers, which drives all self-care behaviours. The confidence in being able to do something to relieve symptoms, despite difficulties, was a bridging activator of self-care. The network structure underscored the prominence of self-care self-efficacy in driving self-care maintenance, monitoring, and management behaviours. Education programs for COPD should prioritise enhancing breathing, symptom monitoring and problem-solving skills. The crucial self-care behaviour in COPD involves adjusting treatments in response to symptom changes. Patient confidence in symptom alleviation acts as a catalyst for self-care engagement. Targeted assessments addressing these aspects could enhance educational interventions, ultimately improving COPD patient outcomes. This study has been registered in the Chinese Clinical Trials Registry (registration number: ChiCTR2200059764; registration date: 11 May 2022).

Secure Messaging Use Among Patients with Depression: An Analysis Using Real-World Data.

Background: Although depression is one of the most common mental health disorders outpacing other diseases and conditions, poor access to care and limited resources leave many untreated. Secure messaging (SM) offers patients an online means to bridge this gap by communicating nonurgent medical questions. We focused on self-care health management behaviors and delved into SM initiation as the initial act of engagement and SM exchanges as continuous engagement patterns. This study examined whether those with depression might be using SM more than those without depression. Methods: Patient portal data were obtained from a large academic medical center's electronic health records spanning 5 years, from January 2018 to December 2022. We organized and analyzed SM initiations and exchanges using the linear mixed-effects modeling technique. Results: Our predictors correlated with SM initiations, accounting for 25.1% of variance explained. In parallel, 24.9% of SM exchanges were attributable to these predictors. Overall, our predictors demonstrate stronger associations with SM exchanges. Discussion: We examined patients with and without depression across 2,629 zip codes over five years. Our findings reveal that the predictors affecting SM initiations and exchanges are multifaceted, with certain predictors enhancing its utilization and others impeding it. Conclusions: SM telehealth service provided support to patients with mental health needs to a greater extent than those without. By increasing access, fostering better communication, and efficiently allocating resources, telehealth services not only encourage patients to begin using SM but also promote sustained interaction through ongoing SM exchanges.

Disease Management Experiences among College Students with Type 1 Diabetes: A Qualitative Study

ABSTRACT Background Type 1 Diabetes (T1D) requires consistent disease management for blood sugar regulation. A theoretical framework can assist with interpreting behavioral processes needed for disease management. However, limited qualitative studies have explored disease management practices among college students with T1D using a theoretical framework. Purpose To theoretically explore college students’ engagement in T1D self-care behaviors to further understand disease management experiences. Methods One-on-one interviews with 31 full-time college students attending universities in the Southeastern United States. A thematic analysis was conducted to generate subthemes. Results Subthemes explained self-care maintenance behaviors performed daily (i.e. carry supplies, administer insulin), self-care monitoring behaviors (e.g. analyzing blood sugar trends), and how self-care behaviors were adjusted when previous behaviors were no longer effective for blood sugar regulation. Discussion Although participants routinely performed T1D self-care behaviors, additional information is needed on how technology is used for self-care monitoring. Future studies should explore college students’ T1D self-care management behaviors to determine strategies that are used to improve their blood sugar. Translation to Health Education Practice Findings from this study can assist health education specialists and healthcare professionals with creating interventions to support disease management among college students living with T1D.

Body listening in the link between symptoms and self-care management in cardiovascular disease: A cross-sectional correlational descriptive study

ObjectiveThe aim of this study was to quantify relationships among symptoms, interoceptive sensibility (i.e. the conscious level of sensing, interpreting and integrating signals from the body), and self-care management behaviors (i.e. the response to symptoms when they occur) among adults with cardiovascular disease. We hypothesized that better interoceptive sensibility would increase the positive behavior-driving effects of symptoms on self-care management. MethodsAdult patients with cardiovascular disease who experienced recent symptoms were recruited to participate in this cross-sectional correlational descriptive study. Patient-Reported Outcomes Measurement Information System measures were used to capture dyspnea, pain interference, fatigue, sleep disturbances, nausea and vomiting, anxiety and depressive symptoms. Interoceptive sensibility was measured using the Multidimensional Assessment of Interoceptive Awareness Version 2. The Self-Care of Chronic Illness Inventory was used to measure self-care management. Network analysis was used to identify domains of interoceptive sensibility that were most central. Linear regression with interaction terms was used to test the moderating effect of interoceptive sensibility on the relationship between symptoms and self-care management. ResultsThe age of participants in the sample (n = 387) ranged from 18 to 88 years, a slight majority (53.5 %) were female, and a majority were Caucasian (66.4 %) or African American (32.0 %). Hypertension was the most common disorder (n = 238 (61.5 %)), followed by rhythm disorders (n = 124 (32.0 %)), coronary artery disease (n = 94 (24.3 %)), heart failure (n = 89 (23.0 %)), valve disease (n = 69 (17.8 %)), stroke (n = 62 (16.0 %)) and peripheral vascular disease (n = 49 (12.7 %)). Based on network analysis, body listening (i.e. active listening to the body for insights) was the most central interoceptive domain, and distracting (i.e. tendency to ignore or distract oneself from sensations of discomfort) was the least central. Noticing (i.e. greater awareness of body sensations), distracting, and body listening were significant in moderating relationships between dyspnea, sleep disturbances and anxiety and the outcome of self-care management behaviors (all p < 0.001). Better noticing and body listening were associated with better self-care management across symptoms, whereas ignoring or distracting oneself from discomfort was associated with worse self-care management behaviors. ConclusionAmong adults with cardiovascular disease, interventions designed to augment the identified interoceptive sensibility domains like body listening, and mitigate the tendency to ignore or distract oneself from discomfort may support adults with cardiovascular disease through the development of future interventions that optimize patient behaviors in response to symptoms when they occur.

The role of nurse-patient mutuality on self-care behaviours in patients with chronic illness.

To examine the role of nurse-patient mutuality on three self-care behaviours in chronic illness patients. A cross-sectional multi-centre study was conducted. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale which has the dimensions of developing and going beyond, being a point of reference and deciding and sharing care, and self-care was measured with the Self-care of Chronic Illness Inventory (SC-CII). Multivariable linear regression analyses were used to assess the contribution of three dimensions of mutuality on self-care maintenance, monitoring and management behaviours controlling for patient gender, age, education, number of medications, and presence of a family caregiver. The sample included 465 inpatients and outpatients with at least one chronic illness. The three dimensions of mutuality had different roles in their influence on the three dimensions of self-care. Developing and going beyond was significantly associated with self-care maintenance and self-care monitoring behaviours. Point of reference was significantly associated with self-care maintenance behaviour. Deciding and sharing care was significantly associated with self-care monitoring and self-care management behaviours. The mutuality between nurse and patient may be a novel area of research to support and improve patient self-care behaviours with implications for clinical practice and education. Mutuality between nurse and patient increases patient engagement, symptom recognition, decision-making process and patient-centred approach favouring the development of self-care behaviours. Mutuality between nurse and patient is a new concept and its association with the patient outcomes could bring relevance to the nursing profession. Self-care behaviours are important in the management of chronic diseases, but are difficult to perform. Mutuality between nurse and patient influences the three different behaviours of self-care in chronic illness, for this reason it is important to increase the level of mutuality in this dyad. STROBE checklist for cross-sectional studies was followed in this study. Patients were involved in the sample of the study.

Self-care of chronic illness prevents the risk of diabetic foot ulcers in patients with diabetes: a cross-sectional study

Introduction: Diabetic foot ulcer (DFU) is a serious and chronic complication of diabetes mellitus (DM). This study aims to explain a model of self-care of chronic illness on the prevention of DFU risk in patients with DM, including foot self-care of maintenance, monitoring, and management. Methods: This study was an analytical study with a cross-sectional approach, with 300 patients randomly selected from six Public Health Centers in Surabaya, Indonesia, from June to August 2022. The inclusion criteria were individuals with DM and aged more than 26 years. Exclusion criteria were reading disabilities or having cognitive impairments Data were collected using a questionnaire. The correlation between variables was analyzed using the statistical method of Partial Least Squares. Results: The risk of DFU in patients with DM was 40% with low risk, 38% with moderate risk, 8% with high risk, 5% remission, and 10% with DFU. This research shows that there is a significant correlation between foot self-care management and the risk of DFU, where the p-value = 0.000, while the indicators of foot self-care maintenance and self-care monitoring do not have a significant correlation with the risk of DFU, where the p-value is respectively equal to 0.350 and 0.844. Conclusions: Foot self-care management was a factor that directly correlates with the risk of DFU. Autonomous self-care management behaviors still needed to be improved, because most patients still had these inadequate behaviors. Further research is needed to improve the behavior quality of patients with DM in managing foot care independently.

Mediators of the Association Between Cognitive Function and Self-care Behaviors in Patients Hospitalized With an Exacerbation of Heart Failure.

Patients with heart failure (HF) must engage in self-care, yet their self-care is often poor. Cognitive function commonly is impaired in HF and is associated with poor self-care. Heart failure knowledge and self-care confidence also are needed to preform self-care. Few investigators have examined mediators of the association of cognitive function with self-care. The aim of this study was to determine whether HF knowledge and self-care confidence mediated the association of cognitive function with self-care maintenance and management among patients with HF. This was a cross-sectional observational study of 164 patients with HF. Cognitive function was assessed using the Montreal Cognitive Assessment. Self-care maintenance and self-care management behaviors and self-care confidence were measured using the Self-care of Heart Failure Index. Heart failure knowledge was measured using the Dutch Heart Failure Knowledge Scale. We conducted 2 parallel mediation analyses using the PROCESS macro in SPSS, one for self-care maintenance and one for self-care management. Cognitive function was indirectly associated with self-care maintenance through HF knowledge (indirect effect, 0.54; 95% confidence interval, 0.10-1.02) and self-care confidence (indirect effect, 0.26; 95% confidence interval, 0.04-0.54). Those with better cognitive function had more HF knowledge and self-care confidence. Better cognitive function was not directly associated with self-care management but indirectly associated with better self-care management through higher self-care confidence (indirect effect, 0.50; 95% confidence interval, 0.04-1.05). Both HF knowledge and self-care confidence mediated the association of cognitive function with self-care maintenance, and only self-care confidence mediated the association between cognitive function and self-care management. Interventions targeting HF knowledge and self-care confidence may improve self-care even for those with lower cognitive function and need to be developed and tested.

A health-social service partnership programme for improving the health self-management of community-dwelling older adults: a hybrid effectiveness-implementation pilot study protocol

BackgroundThe ageing population requires seamless, integrated health and social care services in the community to promote the health of older adults. However, inadequate financial resources, a lack of clear operational guidelines, and various organisational work cultures may affect the implementation quality and sustainability of these services. As a unique approach, this study seeks to examine the preliminary effects of a health-social partnership programme on the health self-management of community-dwelling older adults in Hong Kong. Additionally, the study seeks to ascertain key insights into the mechanisms and processes required to implement and sustain a self-care management programme in broader practice in community settings.MethodsThis study will use a hybrid effectiveness-implementation design. During the 3-month programme, subjects in the intervention group will receive four Zoom video conference sessions and four telephone calls conducted by a health-social service team that will include a nurse case manager, community workers, general practitioners, a Chinese medicine practitioner, and social workers. Subjects in the control group will receive a monthly social telephone call from a trained research assistant to rule out the possible social effect of the intervention. The reach, effectiveness, adoption, implementation, and maintenance framework (i.e. RE-AIM framework) will be used to evaluate the implementation and effectiveness outcomes. Of the five dimensions included in the RE-AIM framework, only effectiveness and maintenance outcomes will be collected from both the intervention and control groups. The outcomes of the other three dimensions—reach, adoption, and implementation—will only be collected from subjects in the intervention group. Data will be collected pre-intervention, immediately post-intervention, and 3 months after the intervention is completed to evaluate the maintenance effect of the programme.DiscussionThis programme will aim to enhance health-promoting self-care management behaviours in older adults dwelling in the community. This will be the first study in Hong Kong to use the hybrid effectiveness-implementation design and involve key stakeholders in the evaluation and implementation of a health self-management programme using a health-social service partnership approach. The programme, which will be rooted in the community, may be used as a model, if proven successful, for similar types of services.Trial registrationClinicaltrials.gov, NCT04442867. Submitted 19 June 2020

The moderating effect of self-care self-efficacy and self-care behaviors on the relationship between symptom burden and frailty among heart failure inpatients

Abstract Funding Acknowledgements Type of funding sources: None. Background The trajectory of heart failure is punctuated by episodes of repeated hospitalization due to heart failure exacerbation. Heart failure inpatients bear a heavy symptom burden, which acts as a strong stimulus to decrease patients' physiological reserve and lead to the development of frailty. Frailty has been shown to be a powerful predictor of heart failure inpatients' poor prognosis. Based on the theory of the Transactional Model of Stress, self-care behavior was suggested to be a cognitive-behavioral coping method to mitigate the detrimental effect elicited by symptom stimulus and improve patients' prognoses. Purpose This study was conducted to examine whether self-efficacy, self-care behaviors including self-care maintenance, symptom perception, and self-care management moderate the relationship between symptom burden and frailty. Methods This was a cross-sectional study with 207 participants recruited from June to December 2022. The Chinese versions of Memorial Symptom Assessment Scale-Heart Failure, Self-care self-efficacy scale, Self-care index of heart failure 7.2 and Edmonton frailty scale were adopted to capture corresponding variables. The moderation effects of self-care self-efficacy and three specific self-care behaviors were explored using the PROCESS macro for SPSS. Results Among recruited patients, most patients were male (61.8%), with the mean age of 71.23. As for the moderating effects analyses, self-care efficacy (P&amp;lt;0.001, ΔR2=0.032), self-care maintenance (P&amp;lt;0.001, ΔR2=0.039) and symptom perception (P&amp;lt;0.001, ΔR2=0.031) rather than self-care management (P=0.06) moderated the detrimental effect of symptom burden on frailty. The results of further analysis showed that providers recommended (P&amp;lt;0.001, ΔR2=0.036) rather than self-initiated (P=0.81) self-care management behaviors moderated the relationship between symptom burden and frailty. Conclusions This study identified the moderating effects of self-care self-efficacy, self-care behaviors in mitigating detrimental effect of symptom burden on frailty. Our study suggested one potential pathway to improve patients' prognoses by decreasing the deleterious effects of symptoms and highlighted the necessity of incorporating self-care into heart failure management.

The association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours: a cross-sectional study

BackgroundPatients with heart failure frequently report inadequate self-care behaviours. Physical symptoms can impact patients’ ability to perform self-care behaviours. However, studies investigating the association between physical symptoms and heart failure self-care behaviours have produced inconsistent findings, potentially due to variations in the determinants of self-care behaviours among patients with differing levels of self-care proficiency. Understanding the association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours could improve care for this subpopulation. The study aimed to explore the association between physical symptoms and self-care behaviours in Chinese heart failure patients with inadequate self-care behaviours.MethodsThis analysis was based on primary data from a cross-sectional study that aimed to investigate factors associated with self-care in heart failure patients. Physical symptoms were measured using the Heart Failure Somatic Perception Scale. Self-care behaviours (i.e., self-care maintenance and management) of heart failure were measured using the Self-Care of Heart Failure Index (version 6.2). Patients who reported scores < 70 on both self-care maintenance and management behaviours were eligible and included in the analysis. Hierarchical regression analysis was performed to explore the association between physical symptoms and self-care behaviours.ResultsA total of 189 patients were included in the analysis, with a mean age of 65 years and a median duration of living with heart failure of 24 months. Most participants were classified as New York Heart Association class III or IV. Dyspnoea symptoms were the most frequently reported physical symptoms. The results of the hierarchical regression analysis showed that the severity of physical symptoms was positively associated with self-care management behaviours (β = 0.157, 95% CI: 0.010, 0.368, p = 0.039) but not significantly associated with self-care maintenance behaviours (β = -0.133, 95% CI: -0.316, 0.026, p = 0.097).ConclusionsBased on the data collected in Changsha, China, we found that patients with HF with poor self-care experienced more dyspnoea symptoms. Severe HF physical symptoms might serve as drivers for better self-care management in patients with inadequate self-care behaviours. Effective care and support should be provided when physical symptoms worsen to facilitate patients’ engagement in self-care behaviour in this subpopulation.

Barriers related to self-care management among people with diabetes mellitus- A narrative review

Diabetes is a challenging disease that is considered to be hard to live with as it encompasses a lot of restrictions, lifestyle and behavioural modifications. Self-care management behaviors are very much essential to control glycaemic values and future complications. Although an import aspect leading to positive health outcomes among diabetic patients, diabetes self-care management is usually is a complex process. This narrative review summates barriers related to self-care management among people with diabetes. The literature was searched through databases like PubMed and google scholar with help of keywords and MeSH terminologies. Furthermore, selected articles reference list was also screened. It is concluded that self-care management in diabetes mellitus is often surrounded by many barriers. Deficiency of environmental resources and assisted strategies, poor awareness regarding self-care skills, lack of motivation and financial constraints are the major barriers faced by people with diabetes mellitus. Endeavour to withdraw barriers are prime in aiding people living with diabetes which will help to improve their quality of life and to attain positive results.

Effects of an mHealth Intervention for Pulmonary Tuberculosis Self-management Based on the Integrated Theory of Health Behavior Change: Randomized Controlled Trial

BackgroundImproving the health self-management level of patients with tuberculosis (TB) is significant for reducing drug resistance, improving the cure rate, and controlling the prevalence of TB. Mobile health (mHealth) interventions based on behavioral science theories may be promising to achieve this goal.ObjectiveThis study aims to explore and conduct an mHealth intervention based on the Integrated Theory of Health Behavior Change (ITHBC) in patients with pulmonary TB to increase their ability of self-care management.MethodsA prospective randomized controlled study was conducted from May to November 2020. A total of 114 patients who were admitted consecutively to the TB clinic of Harbin Chest Hospital, China from May 2020 to August 2020 were recruited by convenience sampling. Patients were divided into the control group and intervention group, and all received a 3-month intervention. Patients in the intervention group and the control group received routine medical and nursing care in the TB clinic, including the supervision of their medications. In addition, pharmacist-assisted mHealth (WeChat) intervention based on the ITHBC theory about TB management was provided to the intervention group. The primary outcome was self-management behavior, while the secondary outcomes were TB awareness, self-efficacy, social support, and degree of satisfaction with health education. The outcomes were measured using web-based self-designed and standard questionnaires administered at baseline and at the end point of the study. Intergroup data were assessed using the Mann-Whitney U test, whereas intragroup data were assessed with the Wilcoxon test (for paired samples).ResultsA total of 112 patients (59 in intervention group and 53 in control group) completed the study. After the intervention, a statistically significant increase was noted in the scores of each item of self-care management behaviors compared with the scores at the baseline (P<.001) in the intervention group. The scores of all self-care management behaviors of the control group were lower than those of all self-care management behaviors in the intervention group (all P<.05), except for the item “cover your mouth and nose when coughing or sneezing” (P=.23) and item “wash hands properly” (P=.60), which had no statistically significant difference from those in the intervention group. Compared with those at baseline, TB knowledge awareness, self-efficacy, social support, and degree of satisfaction with health education in the intervention group increased significantly (P<.001), and the intervention group had significantly higher scores than the control group (P<.001).ConclusionsmHealth intervention for TB self-management based on ITHBC could deepen the understanding of patients with TB about their disease and improve their objective initiative and self-care management behaviors, which were beneficial for promoting compliance behavior and quality of prevention and control for pulmonary TB.Trial RegistrationChinese Clinical Trial Registry ChiCTR2200055557; https://tinyurl.com/4ray3xnw

Self-care recommended by clinicians in patients with heart failure or type 2 diabetes: a Delphi study

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Australian Catholic University, Australia Background Patients with heart failure or type 2 diabetes often experience bothersome symptoms (e.g., swelling, dizziness) and need clinical support with symptom management to reduce the impact of these symptoms. Knowledge about recommended self-care management behaviors by experienced clinicians can help to guide the development of more effective self-care interventions. Purpose To develop a list of common bothersome symptoms of heart failure and type 2 diabetes and of self-care management behaviors that clinicians recommend to patients to reduce the impact of these symptoms. Methods A two-round Delphi study among a panel of 37 nurses and physicians (heart failure only n=14; type 2 diabetes only n=11 and both heart failure and type 2 diabetes n=12) from Italy, the Netherlands, Sweden and the US was performed. Online surveys were used to identify common and bothersome symptoms and related self-care management behaviors that they recommend to patients with heart failure or type 2 diabetes. Self-care management behaviors that received at least 75% agreement were retained and similar self-care management behaviors were discussed and merged to reduce redundancy. Results For heart failure, the final list included 12 common bothersome symptoms (e.g., fatigue/tiredness, shortness of breath) and 51 related self-care management behaviors (e.g., balance rest &amp; activity, check body weight &amp; swelling). For type 2 diabetes, 11 common bothersome symptoms (e.g., hypo- and hyperglycemia symptom clusters, foot wounds) and 25 related self-care management behaviors (e.g., check blood sugar, take insulin, contact podiatrist) were included in the final list. Consensus was reached on the vast majority (70%) of recommended behaviors. Conclusion The lists of common bothersome symptoms and self-care management behaviors reflect consensus but also discrepancies between clinicians’ recommendations and current guidelines. Efforts to enhance and align the use of proven effective self-care management behaviors to reduce symptom impact in routine care by clinicians should be considered.

A mobile phone app for obtaining daily reports of symptoms, self-care, and decision making

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Australian Catholic University Background/Introduction The number of individuals suffering from cardiovascular disease (CVD) is increasing worldwide. One approach to controlling the prevalence of CVD is the aggressive control of risk factors like hypertension and diabetes. Adults with these conditions may experience symptoms (e.g. high blood sugar) that need to be addressed. However, decision-making that occurs between recognizing a symptom and implementing a self-care management behavior is poorly understood. Ecological daily assessment (EDA) is a data collection method for evaluating self-reported states (i.e., experience of symptoms) and processes (i.e., decision making) in the natural environment. Purpose The purpose of this pilot study was to evaluate the feasibility of using a mobile phone EDA app for collecting data about self-reported symptoms, self-care management behaviors, and the factors that influence decisions to engage in self-care. Methods In this feasibility study, we recruited adult volunteers from ResearchMatch.org with a chronic illness, who experience symptoms at least three times per week. Participants used the mobile app for two weeks to complete twice-daily questions about a selected symptom, their responses to this symptom, and the factors that influenced their decisions about what to do when the symptom occurred. Results Eighteen adults (9 male; ages = 33-73) completed an average of 83% of prompts over the 14-day period. Diabetes was one of the most commonly reported conditions (n =11) and four participants reported on high blood sugar as their selected symptom. Among these four participants, there were 49 reports of high blood sugar and it was severe or somewhat severe 41% of the time. Respondents attributed the symptom to their behavior (49% of the time), a change in mood (41%), and stress (35%), but 20% of the time they did not know what caused the symptom. The most common self-care management behaviors included modifying the diet (57%), taking insulin (49%) and checking blood glucose (43%). In 8% of reports, no action was taken. When asked about decision making, most of the time (59%) participants did what usually works for the symptom. Decisions were also influenced by advice from others (29% of the time), uncertainty about the meaning of the symptom (18%), feeling too unwell to decide (18%), rapid worsening of the symptom (16%) and believing they could tolerate the symptom (10%). The underlying theme about decision making was trying to balance the unpleasantness of a symptom vs. taking action. Conclusions &amp; Implications Controlling major risk factors like diabetes can strongly influence the development of CVD. A mobile phone EDA app is feasible for gathering data about symptoms, self-care, and decision making in adults with chronic illness. The next step is to refine the mobile app and use it in an international study on the relationship between symptoms, self-care management, and decision making in adults with chronic illness.

Self-care management of bothersome symptoms as recommended by clinicians for patients with a chronic condition: A Delphi study

BackgroundChronically medically ill patients often need clinical assistance with symptom management, as well as self-care interventions that can help to reduce the impact of bothersome symptoms. Experienced clinicians can help to guide the development of more effective self-care interventions. ObjectiveTo create a consensus-based list of common bothersome symptoms of chronic conditions and of self-care management behaviors recommended to patients by clinicians to reduce the impact of these symptoms. MethodsA two-round Delphi study was performed among an international panel of 47 clinicians using online surveys to identify common and bothersome symptoms and related self-care management behaviors recommended to patients with heart failure, chronic obstructive pulmonary disease, asthma, type 2 diabetes, or arthritis. ResultsA total of 30 common bothersome symptoms and 158 self-care management behaviors across the five conditions were listed. Each chronic condition has its own bothersome symptoms and self-care management behaviors. Consensus was reached on the vast majority of recommended behaviors. ConclusionsThe list of common bothersome symptoms and self-care management behaviors reflect consensus across four countries on many points but also disagreement on others, and a few recommendations are inconsistent with current guidelines. Efforts to encourage clinicians to recommend effective self-care management behaviors may reduce symptom impact in chronically ill patient populations.

Self-care behaviors in patients with cancer treated with oral anticancer agents: a systematic review.

Continuous progress in cancer care has led to its increased use in oral anticancer agents that are easily managed by patients at home with fewer costs and hospitalizations. However, correct self-care behaviors are needed for the safe use of these medications. This review aimed to synthesize studies on self-care behaviors in patients treated with oral anticancer agents. This systematic review used a convergent qualitative synthesis design for mixed studies. Studies on adult patients with cancer using any kind of oral anticancer agent and describing self-care maintenance, self-care monitoring, and/or self-care management behaviors were searched on PubMed, EMBASE, and CINAHL. After data extraction, the findings were retained for qualitative synthesis. Of3419 records, 19 studies were included in this review. From the qualitative synthesis, all the retrieved behaviors were synthesized in the three self-care dimensions. Five themes and 18 subthemes were identified. Self-care maintenance included "adherence to the medications" and "prevention." Self-care monitoring consisted of "health surveillance and recognition of illness changes." Self-care management included "seeking help" and "autonomous management of side effects." Overall, most of the behaviors described focused only on adherence. The findings of this systematic review could guide future studies on self-care and drive future interventions aimed at improving self-care in this vulnerable population. Nurses and other healthcare professionals should provide self-care support to patients taking oral anticancer agents. In particular, they should promote behaviors aimed at improving well-being, preserving health, or managing side effects.

Symptom Recognition as a Mediator in the Self-Care of Chronic Illness.

BackgroundThe recognition of a symptom is needed to initiate a decision to engage in a behavior to ameliorate the symptom. Yet, a surprising number of individuals fail to detect symptoms and delay in addressing early warnings of a health problem.PurposeThe aim of this study was to test the hypothesis that symptom recognition mediates the relationship between monitoring for and management of symptoms of a chronic illness.MethodsA secondary analysis of existing cross-sectional data. A sample of 1,629 patients diagnosed with one or more chronic conditions was enrolled in the United States (US) (n = 407), Italy (n = 784) and Sweden (n = 438) between March 2015 and May 2019. Data on self-care monitoring, symptom recognition, and self-care management was assessed using the Self-Care of Chronic Illness Inventory. After confirming metric invariance in cultural assessment, we used structural equation modeling to test a mediation model where symptom recognition was conceptualized as the mediator linking self-care monitoring and self-care management with autonomous (e.g., Change your activity level) and consulting behaviors (e.g., Call your healthcare provider for guidance).ResultsSymptom recognition mediated the relation between self-care monitoring and autonomous self-care management behaviors (β = 0.098, β = 0.122, β = 0.081, p < 0.001 for US, Italy, and Sweden, respectively). No mediation effect was found for consulting self-care management behaviors.ConclusionOur findings suggests that symptom recognition promotes autonomous self-care behaviors in people with a chronic condition. Self-care monitoring directly affects consulting self-care management behaviors but not through symptom recognition. Further research is needed to fully understand the role of symptom recognition in the self-care process.

Perceived Participation in Decision-Making on Primary Surgery and Associated Factors Among Early Breast Cancer Patients: A Cross-sectional Study.

Breast cancer patients wish to participate in the treatment decision-making, but the perceived participation was inconsistent with the willingness, leading to poor patient outcomes. The aims of this study were to explore the perceived participation in the primary surgery decision-making among Chinese patients with early-stage breast cancer (BCa) and to analyze the relationships of demographic and clinical factors, participation competence, self-efficacy, social support, and doctors' promotion of participation with the guidance of the capability, opportunity, motivation-behavior system (the COM-B system). Paper surveys were used to collect data from 218 participants. The participation competence, self-efficacy, social support, and the doctor facilitation of involvement were evaluated to measure factors related to perceived participation among early-stage BCa. Perceived participation was low, and participants with a high level of participation competence, self-efficacy, and social support and who were employed and had a higher education level and higher family income perceived higher participation in primary surgery decision-making. Perceived participation was low and may be facilitated by patients' internal and external factors during the decision-making process. Health professionals should be aware that patient participation in decision-making is a type of self-care health behavior, and targeted decision support interventions should be provided to facilitate participation. Patient-perceived participation may be evaluated from the perspective of self-care management behaviors among BCa patients. Nurse practitioners should emphasize their important roles in providing information, patient education, and psychological support to better contribute to the course of the treatment decision-making process for BCa patients who faced primary surgery.

AACE2021-A-1029: Identifying and Addressing the Determinants That Affect Successful Control of Diabetes Mellitus Type II

Various life variables are known not essential to the advancement of type 2 diabetes including weight, absence of adequate physical action, terrible eating routine, anxiety, and urbanization. A number of dietary factors such as consumption of sugar-sweetened drinks in excess and the type of fats in the diet also appear to play a role. Objectives: Estimating the prevalence of successful control of type 2 diabetes mellitus (DM) and its determinants at Diabetic Centre, Prince Mansur Military Hospital for Community Medicine, Taif, Kingdom of Saudi Arabia A cross-sectional study was adopted. It included adult DM type 2 patients (18-60 years), at (PMFCH), Armed Forces Hospital, Taif region. Successful control of type 2 DM has been defined strictly by achievement of targeted glycemic control glycated hemoglobin (HBA1C) <7. An Arabic self-administered questionnaire was utilized to collect data from patients. It includes demographic data, disease history, and lifestyle (social factors). HBA1C was recorded from the file of the patient. Trained nurse measured the weight (in kg) and height of each patient to calculate body mass index (BMI). Among 370 diabetic patients, 331 returned completed questionnaire giving a response rate of 89.5%. More than one-quarter of them (27.2%) aged over 60 and 48.4% aged between 40 and 60 years. DM was controlled among only 27.5% of the diabetic patients (HBA1C <7%) while it was uncontrolled among most of them (72.5%). In logistic regression analysis, the duration of DM, diabetes treatment, BMI, family support, and compliance with diabetic diet regimen were all significantly related to glycemic control based on HBA1C value. The patients with poor glycemic control were high, which is nearly comparable to that reported from many countries. Longer duration of diabetes, and not adherent to diabetes self-care management behaviors, obesity, combination therapy, and lack of family support were associated with poor glycemic control.

Self-care of patients with multiple chronic conditions and their caregivers during the COVID-19 pandemic: A qualitative descriptive study.

Explore the self-care experiences of patients with multiple chronic conditions (MCCs) and caregivers' contributions to patient self-care during COVID-19 pandemic. A descriptive qualitative design was used. The COREQ checklist was used for study reporting. Individual semi-structured interviews were used to collect data from patients with MCCs and caregivers selected from the dataset of an ongoing longitudinal study. Data analysis was performed through deductive thematic analysis. The middle-range theory of self-care of chronic illness, which entails the three dimensions of self-care maintenance, monitoring and management, was used as a theoretical framework to guide data collection and analysis. A total of 16 patients and 25 caregivers were interviewed from May to June 2020. The participants were mainly women, with a mean age for patients of 76.25years and caregivers of 45.76years; the caregivers were mainly the patients' children (72%). During the pandemic, some patients reported remaining unchanged in their self-care maintenance, monitoring and management behaviours, others intensified their behaviours, and others decreased them. Caregivers played an important role in protecting patients from the risk of contagion COVID-19 and in ensuring patients' self-care of chronic diseases through direct and indirect interventions. Critical events can modify the self-care experiences of chronically ill patients and caregivers' contributions, leading to maintenance, increase or decrease of self-care and contributions to self-care behaviours. Patients with MCCs and their caregivers can react in different ways in their performances of self-care and contribution to patients' self-care behaviours when ordinary daily life is disrupted; therefore, nurses should assess such performances during critical events to identify the individuals at risk of reduced self-care and promote the most suitable healthcare services (e.g. eHealth) to implement individualised interventions.