Self-care Management Research Articles

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

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

Abstract 4141453: The Pandemic influenced the Self-care of African Immigrants with Diabetes and Hypertension

Background: Self-Care is essential for chronic illness management. Self-Care comprises three domains: Self-Care maintenance (daily behaviors to maintain health [e.g., medication adherence]), Self-Care monitoring (surveillance for changes), and (3) Self-Care management (prompt response to symptoms). The COVID-19 pandemic challenged self-care in some populations, but little is known about how it influenced the self-care of African immigrants living in the US with chronic illnesses such as hypertension and diabetes. Methods: Using a qualitative descriptive design, we enrolled a purposeful sample of 24 sub-Saharan African immigrant adults with self-reported symptomatic hypertension or diabetes. Participants who spoke English were enrolled between March 2020 and September 2021. Individual audio-taped interviews were transcribed and analyzed. Inductive and deductive thematic analysis was guided by the Theory of Self-Care of Chronic Illness. Results: Participants were mean=59 years (range 40-72). Most were Nigerian (n=16), male (n=16), married (n=17), living with family (n=21), highly educated (n=21), and reporting enough income to meet their needs (n=21). Five major themes were identified: (1) Being especially careful in following COVID-19 precautions (e.g., use of facemasks). (2) A focus on self-care maintenance (e.g., healthy diet, staying active while at home). Fear of COVID-19 increased medication adherence. Participants were diligent in taking medications as prescribed due to fear of COVID-19. (3) Close monitoring for symptoms. (4) Trouble reaching providers to discuss symptoms. (5) Access to resources. Participants reported loss of health insurance/jobs and lack of provider access, which impacted their ability to perform self-care. Conclusions: COVID-19 increased focused attention on self-care but also created barriers for sub-Saharan African Immigrants. Most impacted was self-care maintenance. Interventions to promote self-care in this population should leverage heightened vigilance to self-care and address challenges around access to resources.

Evaluation of continued 2-monthly or annual urate monitoring in gout: an extension of the GoutSMART randomised controlled feasibility trial

Aim: Improved outcomes for patients with gout are associated with reduced urate levels and many guidelines recommend regular urate monitoring. There is no consensus on how frequently monitoring should be performed, and so we have used a supported self-management approach which incorporates urate self-testing to evaluate 2-monthly urate monitoring compared to annual monitoring. Methods: This study was an extension of a 12-month feasibility trial in 60 gout patients randomised 2:1 to support gout self-management or usual care. Participants exiting the self-management arm were offered 2-monthly urate monitoring, with usual care participants offered annual monitoring. Additional participants were randomised 1:1 to either arm. All participants were offered initial dose titration to a urate target of 0.3 mmol/L. The primary outcome was the proportion of participants with urate ≤ 0.36 mmol/L at 24 months with an intention-to-treat analysis. Results: Between September 2020, and September 2021, 67 patients were enrolled. The mean age was 55.5 (SD 14.0) years. 61 (91%) self-reported as cisgender male, 5 (7.5%) as cisgender female and 1 (1.5%) as transgender female. 62 (92.5%) were White, 4 (6.0%) were Asian and 1 (1.5%) was Black. 40 participants were allocated to 2-monthly monitoring (including 10 new participants), and 27 participants to annual monitoring (including 12 new participants). The primary study outcome of urate ≤ 0.36 mmol/L at 24 months was achieved by 38 (95%) 2-monthly monitoring participants, compared to 17 (62.9%) annual monitoring participants (risk difference 0.32 [95% CI 0.13 to 0.52]; p = 0.0021). 5 (7.5%) participants withdrew with 4 allocated to annual monitoring. 2 annual monitoring participants died. Conclusions: 2-monthly monitoring of urate is associated with improved maintenance of urate targets after 2 years compared to annual monitoring, a result influenced by an increased withdrawal rate amongst annual monitoring participants. Further trials evaluating the cost-effectiveness and optimal frequency of urate monitoring are now needed (ClinicalTrials.gov identifier: NCT03274063).

The Impact of The Alphabet Strategy for Diabetes Mellitus: A Literature Review

Background: The number of people with diabetes continues to increase, and the inability to control blood glucose increases the risk of complications, morbidity, and mortality. Diabetes mellitus requires lifelong self-care management to keep blood glucose levels within normal limits and reduce the risk of complications. One effective self-care management strategy is the alphabet strategy, which is proven to improve glycemic control. Objective: This study aims to evaluate the effectiveness of the alphabet strategy in improving outcomes for individuals with diabetes. Methods: This systematic literature review was conducted in accordance with PRISMA guidelines. We searched four major databases ScienceDirect, PubMed, Springer, and Wiley using keywords defined by the PICO framework. Results: The findings indicated a significant reduction in HbA1c levels, a decrease in systolic blood pressure, and improved medication adherence as a result of the alphabet strategy implementation. Conclusion: The alphabet strategy is an effective, adaptable, and cost-efficient intervention for diabetes management, offering significant improvements in clinical outcomes and feasibility across various healthcare settings.

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

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

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

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

Family support and self-care management of patients with chronic kidney disease undergoing hemodialysis

Background: Self-care management refers to the proactive steps taken by patients to engage in their own healthcare in order to reach optimal health. Family support is demonstrated through positive responses and acceptance of the family member. Purpose: To investigate the impact of family support on self-care management among chronic kidney disease patients receiving hemodialysis. Method: The study employed a quantitative analytical method with a cross-sectional design. The population included patients diagnosed with chronic kidney disease at Ir. Soekarno General Hospital in Sukoharjo. A total of 44 respondents were chosen through purposive sampling. Data analysis was conducted using the Pearson correlation test. Results: Show a correlation coefficient of r=0.671 with p=0.000 < 0.05, indicating a strong relationship between family support and self-care management in patients undergoing hemodialysis. This suggests that various aspects of family support contribute to improving the patients' ability to manage their self-care. Conclusion: Strong family support plays a crucial role in enhancing the self-care management of hemodialysis patients, helping them achieve improved health outcomes.

Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study.

Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete. This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization. We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission. In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (Padj=.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ρ=-0.30; Padj=.06), but not with the number of admissions (Spearman ρ=-0.03; Padj=.84). Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions.

Effectiveness of Animation Video about Diabetes Mellitus Self-Care Management on The Level of Knowledge among Elderly

Diabetes Mellitus is a common chronic disease among the elderly, and effective self-care management is essential to control this condition. Elderly knowledge about self-care management is important in the care of Diabetes Mellitus. One of the media that can be used to improve knowledge in the elderly is using educational videos. This study aims to evaluate the effectiveness of animated videos about self-care management of diabetes mellitus in improving the knowledge of elderly individuals in RW 01 and RW 02 in Rampal Claket Village, Malang City. The research design used quasi-experimental with pre-test and post-test. The sample in this study was 30 respondents, the sampling technique in this study used purposive sampling technique. The instrument to assess the level of knowledge before and after the animated video intervention using the DMSQ questionnaire. Data analysis used a paired t-test to determine the difference in knowledge scores. The results of this study showed a significant increase in the knowledge of elderly individuals regarding diabetes self-care management after the animated video intervention. The average knowledge score before the intervention was 29.27, which increased to 41.20 after the intervention, an increase of 39.76%. Animated videos have been proven effective in increasing the knowledge of elderly individuals about self-care management of diabetes mellitus with a p-value of 0.000. This study recommends the use of innovative educational media to improve public understanding of chronic disease management.

Cocreation of a Video Feedback Tool for Managing Self-Care at Home With Pairs of Older Adults: Remote Experience-Based Co-Design Study.

Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs. This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home. This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework. The identified influencing factors guiding the contents and format development of 2 new self-care exercises were that pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, "Breathing exercises" and "Picking up from the floor," revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested. This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support.

The effects of a dyadic empowerment-based heart failure management (De-HF) programme on self-care and HRQL : a randomized controlled trial

Abstract Background The ever-growing epidemiology of heart failure (HF) and its detrimental impacts on patients’ quality of life and healthcare cost urge for effective interventions to ameliorate the modifiable prognostic factors. As substantial evidence suggests ineffective self-care as an important candidate especially for the post-discharge outcomes, various care approaches are developed to optimize this behavioral outcome. However, even family carers are heavily involved in the self-care process, dyadic approach to improve the health outcomes of both interactive partners are least applied in the HF transitional care model. Purpose To evaluate the effects of a dyadic empowerment-based heart failure management program (De-HF) on dyadic health and hospital service utilization outcomes. Methods This double-blind RCT randomized 88 HF patient-carer dyads to receive the De-HF program or a dialectic education program, after hospital discharge. Based on the Theory of Dyadic Illness Management, the 16-week De-HF Program, comprising i) a dyadic assessment, ii) five online empowerment modules and iii) follow-up telecare, integrated explicit strategies (scenario-based training, teach-back and goal-setting) to actively engage the care dyads in collaborative disease management. Figure 1 is the graphical presentation of the De-HF Program. The primary outcome is health-related quality of life (HRQL) of the care dyads. Secondary outcomes include patients’ self-care as well as shared care and perceived control of the dyad. Results The mean age of the HF patients was 76.8 (9.4). The patients were in moderate disease severity [NYHA II/II: 56/44%; mean LVEF = 42.5%]. Figure 2 shows the consort flow diagram. After adjusting the socio-demographic characteristic, two-way analysis of covariance showed that patients in the De-HF program showed significantly greater improvement in patients’ self-care domains [Mean difference in change of score (95% CI): Self-care maintenance = 7.15 (1.82-12.46),Cohen’s d = 0.26, p=0.009; Self-care management = 10.04(3.29-16.79), Cohen’s d=0.65, p=0.004; symptom perception = 15.59 (8.20-22.98), Cohen’s d=0.928, p<0.001] and Minnesota Living with Heart Failure score [Mean different in the change of score (95% CI) = -11.45 (-18.24 - -4.66). Cohen’s d = -0.742, p=0.001]. The patient-carer dyads also have significantly greater improvement in perceived control (p=0.001) and collaborative disease management in terms of joint decision-making (p=0.001) and sense of reciprocity (p=0.026). Conclusion Dyadic science has evolved in self-care research for HF. This trial provides the first evidence to inform the positive effects of a theory-based dyadic transitional care program in improving the collaborative self-care management in a family context and patient health outcome. Longer-term evaluation on the effects of De-HF program on health service utilization outcomes and cost-effectiveness will be followed.The De-HF Managment ProgramThe Consort Flow Diagram

Self-Care of Older Patients Affected by at Least Two Chronic Conditions Between Heart Failure, Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: A Comparative Study.

This study aims to describe disease-specific self-care behaviours in patients with heart failure (HF), diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) in various combinations; to compare these self-care behaviours within patient groups; and to evaluate differences across these groups. Cross-sectional study. A total sample of 1079 older patients was recruited from outpatient clinics and home settings. Eligible patients were aged ≥ 65 years and had a diagnosis of HF and/or DM, and/or COPD, along with at least one additional chronic condition. Data were collected using validated tools: the Self-Care of Heart Failure Index, Self-Care of Diabetes Inventory and Self-Care of Chronic Obstructive Pulmonary Disease Inventory. Descriptive statistics were used to analyse disease-specific self-care behaviours. Group comparisons were performed using Student's t-test and univariate, followed by multivariate analyses of variance. The analysis focused on a subset of 223 patients who had a combination of at least two chronic conditions between HF, DM and/or COPD. The mean age of participants was 77.3 (SD 7.5) years, with a majority being female (53.4%). Self-care maintenance, monitoring and management for HF and COPD were found to be inadequate across all patient groups. Adequate self-care was only observed in DM management among those with HF and DM and in DM maintenance for those with DM and COPD treated with insulin. Significant differences in all self-care dimensions were observed across groups, particularly in patients managing all three conditions (HF, DM and COPD). The findings provide valuable insights into the complexities of self-care in patients with multiple chronic conditions, underscoring the need for tailored, integrated and patient-centred interventions. Healthcare strategies should focus on enhancing patient education and developing personalised approaches to improve health outcomes and quality of life in this population. All the authors have adhered to the EQUATOR guidelines STROBE Statement. A convenience sample of patients was recruited in outpatient clinics and their homes. Data were collected between March 2017 and August 2022, by face-to-face during routine outpatient visits or directly at the patient's home.

The trajectory of self-care over a 12-month period in patients with heart failure, comparing those with consistently good and poor self-care

Abstract Background Self-care behaviour plays a pivotal role in enhancing the quality of life for patients with heart failure (HF) and reducing mortality and morbidity rates, but many patients struggle with suboptimal self-care behaviours. It is crucial to understand the factors influencing long-term self-care management. Purpose To assess the trajectory of self-care over a 12-month period and assess differences between patients who have constantly good self-care over a 12-month period compared to constantly poor self-care. Method This study use data from a randomised controlled intervention study, called the HF-Wii study. We included patients who had complete data on self-care during on baseline, 3, 6 and 12 months. Self-care was measured with the European Heart Failure Self-care Behaviour scale (EHFSBs). A threshold score of equal or higher than 70 was used to define self-care behaviour as good and a score lower than 70 as poor self-care. Based on literature, the following characteristics (collected from questionnaires and medical records at baseline) were considered in the analysis: age, sex, marital status, education, history of myocardial infarction, duration of HF, New York Heart Association (NYHA) functional class, LVEF, comorbidity. Other factors assessed were Health-related Quality of Life (HrQoL, Minnesota living with HF questionnaire), depressive symptoms (Hospital Anxiety and Depression scale), cognition (Montreal Cognitive Assessment), sleep (Minimal Insomnia Symptom Scale) and level of HF knowledge (Dutch HF knowledge scale). Logistic regression was performed with backwards elimination of the factors considered associated with the differences between patients who have constantly good self-care at baseline, 3, 6 and 12 months compared to constantly poor self-care. Results In total, 407 patients were included in this study. At baseline, the mean self-care was 65±21, with 41% of the patients (n=245) performing good self-care. In total, 126 patients had a constantly good self-care over 12 month (31%), 120 patients had a constantly bad self-care over 12 months (30%) and 161 (39%) fluctuated in their self-care (Figure). In the multivariate analysis, patients that had continuously good self-care over 12-months were of older age (68±10 vs. 64±12, odds ratio (OR) 1.061, P-value<0.001), had higher HF knowledge (score 13±2 vs. 12±2, OR 1.439, P-value<0.001) and had higher HrQoL (score 28±20 vs 36±22, OR 0.984, P-value=0.022). compared to patients with consistently poor self-care. The variance was explained by 20%. Conclusion Younger patients with HF tend to struggle with consistent self-care over a year, underscoring the necessity for tailored interventions for this group. Conversely, patients with greater HF knowledge and higher HrQoL maintained good self-care habits.

The Effect of Heart Failure Symptom Clusters on Quality of Life: The Moderating Effect of Self-Care Behaviours.

Although heart failure (HF) symptoms affect patients' quality of life (QoL), improving patients' QoL requires certain self-care behaviours. However, the specific role of self-care behaviours in the relationship between HF symptoms and QoL has not been clarified. To evaluate the status of symptom clusters, self-care behaviours and QoL in HF patients, and to analyse and test the moderating effect of self-care behaviours between symptom clusters and QoL. This study is a cross-sectional study. A total of 320 HF patients who treated in thethree hospitals in Chengdu, China, from December 2022 to July 2023 were selected as the research subjects. The patients were evaluated using The General Information Questionnaire, Memorial Symptom Assessment Scale Heart Failure, Self-Care of Heart Failure Index and Minnesota Living with Heart Failure Questionnaire. The statistical analysis methods were exploratory factor analysis, Pearson correlation analysis, hierarchical regression analysis and simple slope analysis. There were five symptom clusters in HF patients: emotional symptom cluster (sadness, anxiety, irritability, feeling nervous), digestive symptom cluster (lack of appetite, dry mouth, weight loss, nausea, abdominal distension), ischemic symptom cluster (dizziness, chest pain, palpitations, fatigue), dyspnoea symptom cluster (difficulty breathing when lying flat, waking up breathless at night, sleep difficulty) and congestion symptom cluster (cough, shortness of breath, oedema). There was a significant correlation between HF symptom group, self-care behaviours and QoL (p < 0.05). Both self-care maintenance (β = -0.262, p < 0.001) and self-care management (β = -0.258, p < 0.001) had a moderating effect between symptom clusters and QoL. There are a variety of symptom clusters in HF patients. Improving the self-care behaviours ability of HF patients is conducive to reducing the impact of HF symptom clusters on QoL. The study used the STROBE checklist for reporting. Medical staff should focus on the impact of HF symptom clusters and self-care behaviours on QoL, and formulate corresponding interventions for HF symptom clusters and self-care behaviours to improve the QoL of patients. The head nurse of the cardiovascular department actively assisted us in collecting questionnaires from HF patients, and all HF patients surveyed participated in this study seriously.

Design and Development of Diabestfriend Application for Digital Self Care Management of Type 2 Diabetes Mellitus Patients

Objective: The availability of the results of the Android-based Diabestfriend Application for digital self-care management of type 2 diabetes mellitus patients. Theoretical Framework: The numerous interventions that come under the more general term "self-care" and are helpful in understanding the self-care suite have been categorized into three domains: self-awareness, self-testing, and self-care. Methods: The ADDIE development model is used in this study in three stages. Ten patients with type 2 diabetes who completed questionnaires, along with validators from one media expert and one material expert, comprise the implementation stage, which is the application assessment stage. The questionnaires consist of three sections: a total of 16 questions for patient application assessment, 21 questions for media expert validation, and 25 questions for material expert validation. Results and Discussion: The validation score of media experts was 83.8 with the very good category, the validation score of the material experts was 81.6 with the very good category and the response score of diabetes mellitus patients was 88.95 with the very good category. Research Implications: Further research on the efficacy of the Diabestfriend Application as a digital self-care management tool in type 2 diabetes mellitus patients will provide insight into how the use of the application affects the patients' level of self-care management. Originality/Value: The Diabestfriend Application is appropriate for use as a digital self-care management tool for patients with type 2 diabetes mellitus, according to validation from media experts, material experts, and 10 diabetes patients.

Mind-Body Medicine in the Treatment of Depression: A Narrative Review of Efficacy, Safety and Mechanisms.

This narrative review examines the efficacy, mechanisms and safety of mind-body medicine (MBM) in the treatment of depression. We reviewed the potential effects of various MBM interventions such as yoga, tai chi, qigong, mindfulness-based interventions and nutrition on clinical and subthreshold depressive symptoms. Current studies indicate a growing interest in the use of MBM for psychiatric disorders, including depression. MBM interventions demonstrate efficacy in reducing depressive symptoms with fewer adverse effects and costs compared to pharmacological treatments. MBM has significant potential to improve mental health outcomes for depression. These interventions encourage self-care and stress management through behavioural, exercise, relaxation and nutritional approaches. While existing data are promising, further, more rigorous studies are required to confirm long-term effectiveness and to determine the role of MBM in comprehensive depression treatment strategies.

African American Patients' Perspectives on Determinants of Hemodialysis Adherence and Use of Motivational Interviewing to Improve Hemodialysis Adherence.

Compared to White patients, African American (AA) patients have a four-fold higher prevalence of kidney failure and higher hemodialysis non-adherence. Adherence behaviors are influenced by psychosocial factors, including personal meaning of a behavior and self-confidence to enact it. We assessed perspectives of AA hemodialysis patients on unique factors impacting dialysis adherence, and use of motivational interviewing, an evidence-based intervention, to improve these factors, dialysis adherence, and outcomes in AAs. Self-identified AA hemodialysis patients (N=22) watched a brief video describing motivational interviewing and then completed a semi-structured interview or focus group session. Interview questions explored unique barriers and facilitators of hemodialysis adherence in AAs, and perceived utility of motivational interviewing to address these obstacles. Verbatim transcripts and an iterative inductive/deductive approach were used to develop a hierarchical coding system. Three experienced coders independently coded the same two transcripts. Coding was compared and discrepancies were reconciled by a fourth coder or consensus. Transcripts, quotations, and codes were managed using Microsoft Excel 2016 and SPSS version 28.0. Themes and sub-themes emerged and culminated in a novel conceptual model informed by three theoretical models of behavior change: Theory of Self-Care Management for Vulnerable Populations; Social Cognitive Theory; and Self Determination Theory. This conceptual model will inform the design of a culturally tailored, motivational interviewing-based intervention to improve dialysis adherence in AAs. Integrating AA hemodialysis patient perspectives is critical for enhancing dialysis care delivery and the design of effective interventions such as motivational interviewing to improve dialysis adherence in AA and promote kidney health equity. AA hemodialysis patients view motivational interviewing as a tool to clarify patient priorities, build trust, and promote patient-provider therapeutic alliance. Cultural tailoring of motivational interviewing to address unique barriers of AAs with kidney failure will improve adherence and health outcomes in these vulnerable patients.

Social determinants of health and diabetes self-care management in South Africa

ObjectiveDiabetes is an incapacitating condition affecting millions of people in South Africa. Maintaining optimal glycaemic control is crucial in preventing diabetes complications, highlighting the importance of diabetes self-care. This study examined how Social Determinants of Health (SDoH) are associated with self-care management practices in individuals with diabetes in South Africa using the framework developed by the Healthy People 2020 initiative.MethodsThis study utilised cross-sectional Project Mind baseline data collected in 2017. Self-care management was coded on a scale from ‘0’ (never) to ‘7’ (daily adherence). For analysis, this scale was dichotomised into two categories: low self-care (scores 0–5) and high self-care (scores 6–7). Furthermore, adherence with these daily self-care activities was categorised into three levels: no adherence, partial adherence (inconsistent or partial adherence to activities), and full adherence (consistent adherence to all self-care activities).ResultsThe analytical sample (n = 539) was predominantly female (76%), with a mean age of 54 years, urban residents (60%), unemployed (70%), and attained secondary education (11.3%). In determining the attainment of a higher scale of self-care, age (AOR = 1.02, CI=[0.99,1.05]) and secondary education (AOR = 1.13, CI=[1.02, 2.03]) were associated with an increase in the scale of self-care. Conversely, urban residency (AOR = 0.50, CI=[0.29,0.88]) and being obese (AOR = 0.43, CI=[0.19,1.00]) were associated with a lower scale of self-care. Although not statistically robust, food insecurity decreased while being a woman and having a stable house showed an increased association. Travelling longer distances to access healthcare was positively associated with no adherence, and urban residency has a negative association with full adherence relative to partial adherence.ConclusionsThe associations between SDoH and diabetes self-care management within a South African context highlight the need for a more holistic understanding and approach to interventions. Future endeavours should examine these determinants more broadly and formulate integrative strategies to ameliorate diabetes self-care.

STRIVING FOR DIABETES SELF-CARE MANAGEMENT IN THE OLDER PEOPLE BASED ON SELF-DETERMINATION THEORY

Introduction: Older people with diabetes mellitus need disease management through self-management which is quite complex because the disease will have an impact on their health condition both physically and psychologically. Based on Self Determination Theory, motivation is important component in improving psychological health and treatment effectiveness of patients with diabetes mellitus. The purpose of this community service is to strive for diabetes self-care management so that blood sugar levels can be controlled reduce the risk of complications and achieve a prosperous psychological condition. Methods: The method of implementing this community service is in the form of health education, early screening, diabetes gymnastics, and family assistance in carrying out family healthcare functions. This community service was carried out at Jenggawah Public Health Center in March 2023. The participants of this community service activity are older people with diabetes mellitus. Results: There is an increase in the motivation of older people to carry out self-care activities, and the older people and families can also practice diabetes gymnastics by what has been taught. Conclusion: With optimal management behavior of diabetes mellitus in older people, the psychological aspects of the elderly with Diabetes Mellitus will improve so that further complications of this disease can be prevented.

DiaBetter Together: Clinical trial protocol for a strengths-based Peer Mentor intervention for young adults with type 1 diabetes transitioning to adult care

BackgroundType 1 diabetes (T1D) management is challenging for young adults, who are expected to transfer from the pediatric to adult T1D healthcare system while also managing typical developmental demands (e.g., social, financial, work/school, residential). Many young adults have extended gaps in care before following up in adult care, increasing risk for poor health outcomes. There are few evidence-based programs to support young adults with T1D to promote a timelier transition during this period. This paper reports on the design of DiaBetter Together, a randomized controlled trial to evaluate a 12-month Peer Mentor-delivered intervention compared to usual care among young adults with T1D during the transfer from pediatric to adult care. MethodsOne-hundred young adults (age 17–25) with T1D and 29 Peer Mentors enrolled in this randomized clinical trial. Peer Mentors are experienced, older young adults with T1D, trained by the study team to share transition experiences and strategies to successfully navigate the adult healthcare system, help young adults prepare for the first adult care visit, and use strengths-based support strategies to teach and model skills for managing T1D-related challenges. ResultsThe primary outcome of the trial is HbA1c, and secondary outcomes include time to adult care, engagement in diabetes self-management behaviors, and psychosocial well-being. ConclusionThe goal of this research is to evaluate a developmentally appropriate, supportive intervention that can improve T1D self-management and successful transfer of care during the difficult young adult years and promote optimal T1D health outcomes.