Self-care Management Research Articles

A Cross-sectional Study of Factors Affecting Quality of Life of People with Type 2 Diabetes

Diabetes is a chronic illness that negatively impacts quality of life. However, the quality of life of people with type 2 diabetes could be improved with sufficient literacy and abilities to perform self-management, such as managing blood glucose, maintaining a healthy diet, and proper exercise. This descriptive cross-sectional study aimed to describe the relationships among health literacy, self-management, and quality of life and to determine the predictors of quality of life of people with type 2 diabetes. Data were collected through purposive sampling from 218 individuals with type 2 diabetes in Manado City, Indonesia, between July and October 2021. We used the European Health Literacy Survey Questionnaire, Diabetes Self-management Questionnaire, and Diabetes Quality of Life Questionnaire. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation, and hierarchical regression analysis. The study revealed that health literacy was significantly associated with self-management and quality of life. Furthermore, age, occupation, health literacy, and self-management were significant predictors and collectively explained 25.3% of the variance in quality of life. Hence, higher health literacy and improved self-management practices were linked to a higher quality of life for people with type 2 diabetes. Since the explained variance of quality of life in this study is only 25.3%, further studies should include other factors such as social and family support and communication with health care providers to predict quality of life. Nevertheless, nurses can use this study to design interventions to improve self-care management skills and health literacy levels, which may enhance quality of life. However, testing the effectiveness is needed.

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.

Knowledge, attitude and practice of self-administered insulin by diabetes mellitus patients: A cross sectional study

Diabetes mellitus is a heterogeneous clinical syndrome secondary to defects in insulin secretion, action, or both. India is emerging as the world's diabetic capital. Inadequate awareness about the use of insulin is likely to influence its acceptance and adherence. To assess the knowledge, attitude, and practice (KAP) of self-administered insulin by patients of diabetes mellitus. It was a cross-sectional study conducted by the department of pharmacology at a tertiary care teaching hospital over a period of six months at the medicine outpatient department. A prevalidated questionnaire was used to assess the KAP of insulin use. Informed consent was obtained from the patients prior to giving them a questionnaire. Among the 151 responses, 58 were male and 93 were female. Among them, 66% knew about different types of insulin, and 32% knew about different insulin delivery devices. Around 40% of patients were not aware of HbA1c as a monitoring tool. Nearly 48% patients knew the complications of diabetes. Half of the patients were confident about the self-administration of insulin. About 54% patients took insulin for treatment. Among current insulin users, 75% injected insulin at the upper arm, 83% missed insulin doses, 74% had never used a glucometer, and 32% failed to rotate the site. Knowledge and attitude were good in the majority of patients, but practice regarding the use of insulin was poor. Skilled health care providers could educate diabetes mellitus patients on self-care management and insulin self-therapy and bridge this gap.

Nondisclosure of Type 1 Diabetes in Adolescence: A Single-Center Experience.

The aim of this study was to assess the extent of nondisclosure of type 1 diabetes in adolescents and investigate its association with several psychosocial parameters and clinical outcomes. This was a cross-sectional study based on data collected from 69 adolescents with type 1 diabetes who were 12-18 years of age and followed at our diabetes clinic. The degree of disclosure, demographics, diabetes management, and psychosocial issues were assessed via questionnaires. Clinical parameters were derived from medical records. Associations between nondisclosure status and clinical and psychosocial study variables were assessed. Fifty-three participants (77%) reported some extent of nondisclosure. Nondisclosure was associated with low self-esteem, reduced friend support, and increased diabetes-related worries. Nondisclosure was also found to be associated with diminished self-care behaviors related to insulin administration and with elevated A1C. Our results demonstrate that nondisclosure of type 1 diabetes in adolescents may be more common than initially recognized and is likely associated with unfavorable psychological outcomes and reduced self-care and diabetes management. Our results emphasize the importance of social interactions and disclosure in adolescents and may serve as a potential stepping stone to address other social barriers hindering diabetes management.

Qualitative Study of the Mobile Application Concept Among T2D Patients

Self-care is the most fundamental and vital component of diabetes management. It necessitates patient participation in disease management activities such as nutrition, physical activity, medication adherence, and foot care procedures. However, developments in smartphone technology have created new options for diabetes self-management and diabetes education. The purpose of this study is to gain an overview of the mobile application concept that is expected among T2D patients in order to build application-based therapies based on the research site. This research method employs qualitative approaches in conjunction with a grounded theory approach. The approach employed is the sampling quota selection method. A Focus Group Discussion (FGD) was held with all qualified participants. A grounded theory technique was used to analyze the data. The findings of the study highlighted six themes: 1) Diet, 2) psychological activity, 3) medication alarms, 4) blood glucose monitoring, and 5) reduced worry (knowledge about health problems), 6) Consulting with health-care providers and asking questions. Self-care management can improve the quality of life of T2D patients. Diabetes patients in Indonesia are treated in a variety of ways; a link between patient experience, care, and health support is required.

Role of community-based health clubs in promoting patients’ health education for diabetes self-care management: an interventional qualitative study in a Ugandan urban setting

BackgroundSelf-care management support is a core component of the Chronic Care Model that emphasises the need for empowering and preparing patients to manage their healthcare. In diabetes mellitus (DM) management,...

Personal factors related to self-care management among people with hypertension at primary health care: A cross-sectional study

Background: Hypertension requires long-term treatment and can last a lifetime. Recommendations for hypertensive patients, where it is necessary to change behavior related to self-care, consist of increasing a healthy diet, limiting sodium intake, increasing physical activity, reducing smoking, and reducing alcohol consumption. Objective: The purpose of this study was to identify the self-care model of patients with hypertension in primary healthcare in Kota Malang. Methods: This study's design was descriptive analytic with a cross-sectional methodology. Using G Power, 321 hypertension patients were used as samples. Purposive sampling was used in this study. The instruments used H-SCALE, also known as the Hypertension Self-Care Activity Level Effects. Pearson Chi-squared test was used to examine correlations among variables. Results: Factors of gender (p=0.001) and education (p=0.020) are related to self-care in hypertensive patients. Majority of respondents were women, 223 people (69.5%), Most of the respondents had elementary school education, 136 people (41.4%), the majority of the 321 respondents (216, 67.3%) have moderate self-care category. Gender and age were significant factors associated with self-care among hypertensive patients (p<0.05) Conclusion: Gender and education level have significant correlation with self-care management of hypertension. Providing self-management intervention by considering gender and education level needs improvement. Other factors need to be explored in further research.

The Efficacy of Self-care Behaviors, Educational Interventions, and Follow-up Strategies on Hospital Readmission and Mortality Rates in Patients with Heart Failure.

Heart failure (HF), a worldwide epidemic with significant morbidity and mortality risks, is frequently secondary to cardiovascular disorders and probably is the common final way to survive patients. Almost 25% of hospitalized patients with acute HF are expected to be readmitted within 30 days post-discharge, and the rates of rehospitalization increase to almost one-third at 60 days and 60 percent within one year of discharge. Although care planning for patients with heart failure is complex, multidisciplinary, and resource-dependent, optimal self-care management along with appropriate educational intervention and follow-up strategy could be able to reduce readmissions, decline the duration of hospitalization, increase life expectancy, decrease the rates of mortality, and reduce costs of healthcare services for patients with HF. However, there are contradictions in previous reports about the efficacy of self-care, mainly due to patients' non-adherence to self-care behaviors. Therefore, the current study aimed to review the investigations on the effectiveness of self-care of HF patients in reducing hospital readmissions and increasing quality of life, and discuss novel approaches for predischarge educational interventions and postdischarge follow-up strategies.

Patient and Physician Perspectives on the Use of a Connected Ecosystem for Diabetes Management: International Cross-Sectional Observational Study.

Collaboration between people with type 2 diabetes (T2DM) and their health care teams is important for optimal control of the disease and outcomes. Digital technologies could potentially tie together several health care-related devices and platforms into connected ecosystems (CES), but attitudes about CES are unknown. We surveyed convenience samples of patients and physicians to better understand which patient characteristics are associated with higher likelihoods of (1) participating in a potential CES program, as self-reported by patients with T2DM and (2) clinical benefit from participation in a potential CES program, as reported by physicians. Adults self-reporting a diagnosis of T2DM and current insulin use (n=197), and 33 physicians whose practices included ≥20% of such patients, were enrolled in the United States, France, and Germany. We surveyed both groups about the likelihood of patient participation in a CES. We then examined the associations between patients' clinical and sociodemographic characteristics and this likelihood. We also described characteristics of patients likely to clinically benefit from CES use, according to physicians. Compared with patients in Germany and France, US patients were younger (mean age 45.3 [SD 11.9] years vs 61.9 [SD 9.2] and 65.8 [SD 9.4] years, respectively), more often female, more highly educated, and more often working full-time. In all, 51 (44.7%) US patients, 16 (36.4%) German patients, and 18 (46.3%) French patients indicated strong interest in a CES program, and 115 (78.7%) reported currently using ≥1 connected device or app. However, physicians believed that only 11.3%-19.2% of their patients were using connected devices or apps to manage their disease. Physicians also reported infrequently recommending or prescribing connected devices to their patients, although ≥80% (n=28) of them thought that a CES could help support their patients in managing their disease. The factors most predictive of patient likelihood of participating in a CES program were cost, inclusion of medication reminders, and linking blood glucose levels to behaviors such as eating and exercise. In all countries, the most common patient expectations for a CES program were that it could help them eat more healthfully, increase their physical activity, increase their understanding of how blood glucose relates to behavior such as exercise and eating, and reduce stress. Physicians thought that newly diagnosed patients, sicker patients-those who had been hospitalized for diabetes, were currently using insulin, or who had any comorbid condition-and patients who were nonadherent to treatment were most likely to benefit from CES use. In this study, there was a high degree of interest in the future use of CES, although additional education is needed among both patients with T2DM and their physicians to achieve the full potential of such systems to improve self-management and clinical care for the disease.

Work Place Self-Management by Academic Cum Clinical Physiotherapist – A Case Study

One of the main issues in industrialized nations is work-related musculoskeletal disorders (WMSD), which are linked to demanding and repetitive work environments. Repetitive actions and work without leisure can lead to musculoskeletal problems. To prevent this occurrence, promoting healthy lifestyle self-care management is essential. The main objective of this case study was to assess the risk of work-related musculoskeletal disorders in professional physiotherapist and their workplace self-management. Case Description: a case of a 39-year-old male assistant professor cum clinical practitioner with 12 years of experience in the profession, who engages in using the computer for 6 hours a day for his academic and clinical documentation purposes, was assessed in the workstation. He complains of neck and shoulder pain after engaging in front of the computer for more than one hour, which he manages during the routine practice. He manages his pain by doing simple exercises like chin tuck-in and shoulder bracing by taking a short break every hour while working on a computer. Musculoskeletal-related pain was analyzed using the VAS score (visual analogue scale), and the level of the risks was analyzed using the rapid entire body assessment (REBA) scale. The case study showed that professional physiotherapists have a high risk of MSDs due to their engagement in multiple tasks and less attention to body posture. Regular exercise in the workstation and ergonomic workplace awareness would prevent the occurrence of work-related MSD.

Prevalence of maternal mortality causes based on ICD-MM: a systematic review and meta-analysis

BackgroundMaternal mortality is a universal public health challenge. ICD-Maternal Mortality (ICD-MM) was introduced in 2012 to facilitate the gathering, analysis, and interpretation of data on maternal deaths worldwide. The present study aimed to estimate the global prevalence of maternal death causes through a systematic review and meta-analysis.MethodsA systematic literature search was conducted using various databases, including Web of Science, PubMed, Scopus, ScienceDirect, Cochrane Library, as well as Persian databases such as MagIran and Scientific Information Database (SID). The search encompassed articles published until August 21, 2022. Thirty-four eligible articles were included in the final analysis. Analysis was performed using a meta-analysis approach. The exact Clopper-Pearson confidence intervals, heterogeneity assessment, and random effects models with Mantel-Haenszel methods were employed using the STATA software version 14.2.ResultsThe most prevalent causes of maternal deaths, listed in descending order from highest to lowest prevalence, were non-obstetric complications (48.32%), obstetric hemorrhage (17.63%), hypertensive disorders of pregnancy, childbirth, and the puerperium (14.01%), other obstetric complications (7.11%), pregnancy with abortive outcome (5.41%), pregnancy-related infection (5.26%), unanticipated complications of management (2.25%), unknown/undetermined causes (2.01%), and coincidental causes (1.59%), respectively.ConclusionNon-obstetric complications, obstetric hemorrhage, and hypertensive disorders of pregnancy, childbirth, and puerperium were the most common causes of maternal deaths. To reduce the burden of maternal mortality causes, increasing awareness and promoting self-care management among women of reproductive age, and implementing effective screening mechanisms for high-risk mothers during pregnancy, childbirth, and the puerperium can play a significant role. ICD-MM enables the uniform collection and comparison of maternal death information at different levels (local, national, and international) by facilitating the consistent collection, analysis, and interpretation of data on maternal deaths. Our findings can be utilized by policymakers and managers at various levels to facilitate necessary planning aimed at reducing the burden of maternal mortality causes.

Clinical effectiveness of vaginal pessary self-management vs clinic-based care for pelvic organ prolapse (TOPSY): a randomised controlled superiority trial

Clinical effectiveness of vaginal pessary self-management vs clinic-based care for pelvic organ prolapse (TOPSY): a randomised controlled superiority trial

Self-care nursing assessment: cross-cultural adaptation and validation of the Spanish version of the Self-care of chronic illness inventory

BackgroundSelf‐care is the primary means of caring for a chronic condition. Therefore, it is necessary to assess it by using a good validity and reliability instrument. The Self-Care of Chronic Illness Inventory (SC-CII) is a generic instrument developed to measure self-care processes behaviors using three separate scales in patients with chronic illness. The original cross-cultural assessment concluded the need for future studies sampling patients from different sites to increase the generalizability of the psychometric evaluation results. It was unclear whether this tool had sound psychometrics properties in the context of Spanish culture. The purpose of this study was to cross-culturally adapt the SC-CII, test its psychometric properties and validate its use among Spanish people with chronic diseases.MethodsA cross-cultural translation of the SC-CII was performed from English to Spanish. The psychometric evaluation was conducted in a sample of 350 patients with chronic conditions through a multicenter cross-sectional study based on the STROBE guideline. Data were collected from face-to-face interviews during 2022. Internal validity was assessed with Confirmatory Factor Analysis, internal consistency reliability with Cronbach alpha for unidimensional scales and McDonald's Omega reliability coefficient for multidimensional scales.ResultsMost (63.4%) participants were older adults aged 65 years or older with a mean age of 65.45 ± 14.97. The average number of chronic conditions reported was 2.81%; the most common conditions were hypertension (52.3%), musculoskeletal disorders (46.3%) and diabetes (38.9%). Patients reported adequate self-care behaviors in all three scales of the SC-CII. The Self-Care Maintenance and Management scales were multidimensional, and the Self-Care Monitoring scale was unidimensional. In Confirmatory Factor Analysis, the Self-Care Maintenance and Monitoring scales had satisfactory fit indices. The Self-care Management scale had acceptable fit indices. The Omega reliability coefficient for multidimensional scales was 0.75 (Self-Care Maintenance) and 0.72 (Self-Care Management). The Cronbach alpha coefficient of the Self-Care Monitoring scale was 0.85. Item-total correlations were all significant except one. Test–retest reliability showed an intraclass correlation coefficient of 0.92.ConclusionsThe SC-CII has appropriate psychometrics characteristics and is a culturally suitable and reliable instrument for assessing to the self-care behaviors of patients with chronic disease in Spain. The scale provides a simple and rapid solution to assess the self-care process.

The feasibility of Technology, Application, Self-Management for Kidney (TASK) intervention in post-kidney transplant recipients using a pre/posttest design

BackgroundWeight gain after a kidney transplant remains a major problem that can lead to adverse effects on morbidity and mortality. The posttransplant phase provides a window of opportunity to improve the engagement of self-management of care for lifestyle modifications for diet and physical activity. The purpose of our study was to (1) test the feasibility of recruitment, retention, and adherence for using the Technology, Application, Self-Management for Kidney (TASK) intervention in post-kidney transplant recipients (≥ 18 years of age) at baseline, 4, 8, and 12 weeks; and (2) estimate the preliminary effects of the TASK intervention in producing change over time for blood pressure (BP), weight, fruits/vegetable intake, fiber intake, sodium intake, self-efficacy to exercise, and perceived stress.MethodsThis study used a 12-week pre/posttest design using to test the feasibility of the TASK intervention. We applied paired t-tests and McNemar’s test to compare the outcomes at weeks 4, 8, and 12.ResultsWe met our recruitment goal (N = 20) and found a 15% attrition rate (n = 3) at Week 12. Adherence rate among the study completers for recording daily food intake was 83–94% over the 12 weeks and for recording daily physical activity was 17–33% over the 12 weeks. We observed improvements over time for BP, weight, fruits/vegetable intake, fiber intake, and sodium intake; these differences were non-significant, although clinically important. We did find a significant difference from baseline to 12 weeks in weight reduction (p = 0.02), self-efficacy to exercise (p = 0.003), and perceived stress (p = 0.04).ConclusionsThe data suggest the TASK intervention was feasible for kidney recipients to use and resulted in weight control, increased self-efficacy to exercise, and decreased perceived stress.Trial registrationClinicalTrials.gov #:NCT05151445

Socio-demographic and environmental factors impacting asthma exacerbations in children in Taif city, Saudi Arabia

Background Asthma is a chronic inflammatory disorder of the airways resulting in episodic reversible obstruction of the airways leading to breathlessness, tightness, chest, cough and wheezing. Children with bronchial Asthma lifestyles are disrupted to various extents based on bronchial Asthma severity. School-aged children with asthma experience more hospitalizations, more school absenteeism, academic underachievement, decreased overall activity, and disruption of family functioning compared to healthy classmates. The incidence of asthma has increased considerably in the last few years. Aims: The aim of this study was to assess the role of associated sociodemographic and environmental risk factors in the severity of school-aged children's asthma in Taif, Saudi Arabia, for providing care to a child. Methodology: In a case-control cross-sectional study, the incidence and severity of asthma symptoms were carried out through well-designed questionnaires distributed during the period from April to May 2023 according to 11 standardized methods of population-based survey protocols. Results: The incidence frequency of bronchial asthma was (51.09%). The highest incidence rate of asthma was reported among the age group of 8-10 having a percentage of 36% followed by the age group of 10-12 (33.5%) and the age group 6-8 (30.5%) having the lowest incidence rate of asthma. Allergens and weather conditions were the most prevalent factors triggering severe and exacerbating childhood bronchial Asthma attacks. Conclusion Pediatric Asthma is one of the most common chronic pediatric chest inflammatory disorders. Consistently children with Asthma have lower life quality. Children with asthma can live safely after narrowing these factors. Physicians must promote to patients the necessary knowledge and care for effective self-management of the disease process and improve life quality. These results offer sufficient information regarding the incidence rate and severity of asthma symptoms, asthma management, and related risk factors for Saudi Arabian health authorities to scale up surveillance initiatives, control, and high-impact treatments.

Effectiveness of Multidisciplinary Post-Acute Kidney Injury Clinic on Awareness and Knowledge in Acute Kidney Injury Survivors

Introduction: Acute kidney injury (AKI) awareness and knowledge among survivors is poor, leading to suboptimal self-management and follow-up care. The purpose of the study was to evaluate the impact of a multidisciplinary post-AKI clinic on AKI awareness and knowledge among survivors. Methods: We conducted a quasi-experimental study among stage 2-3 AKI survivors who were followed in the multidisciplinary post-AKI clinic, comprising nephrologists, renal nurses, pharmacists, and dietitians. Patients were evaluated before and after entering the clinic during a 3-month follow-up period, using a three-component questionnaire including the following: (1) Do you know of your AKI diagnosis during hospitalization? (yes/no), (2) how do you rate your AKI knowledge? (ranging from 1 or “very low” to 5 or “excellent”), and (3) 25-item objective AKI knowledge survey instrument that covered general knowledge of AKI, nutrition, medication, and symptoms of renal failure. Results: A total of 108 AKI survivors were enrolled, with 37.0%, 41.7%, and 21.3% being stage 2 AKI, stage 3 AKI, and stage 3-dialysis AKI, respectively. Before entering the clinic, 50% of patients were unaware of their AKI during hospitalization. After receiving education from the multidisciplinary post-AKI clinic, all patients became aware they had experienced AKI. The mean perceived knowledge and objective knowledge scores were significantly increased over the 3-month period from 1.6 (0.7) to 3.9 (0.7) out of 5 and 15.4 (3.5) to 21.4 (2.0) out of 25, respectively (p < 0.001 for both). Additionally, reverse transformation of the Likert scale to a percentage format also revealed a significant improvement in mean perceived AKI knowledge scores, transitioning from 13.8 ± 16.8 to 73.0 ± 17.6, p < 0.001. Conclusion: The multidisciplinary post-AKI clinic effectively enhanced AKI awareness and knowledge among survivors. These findings highlight the importance of follow-up care and the benefits of a multidisciplinary approach. Further studies are needed to determine the long-term outcomes associated with increased knowledge.

Telenursing-Based Self-Care Management Education Improves The Quality Of Life Of Hypertension Sufferers In The Rural Area Pragaan Health Center

Background: A person's view of their life within the framework of their culture and values, which encompass the areas of physical, psychological, social, and environmental activities, is referred to as their quality of life. In order to raise awareness and promote self-care, intervention measures are desperately needed. The purpose of this research is to evaluate how telenursing education affects hypertension patients' quality of life. Methods: This study used a quasi-experimental methodology. With a simple random sample, the population consisted of sixty hypertensive people. The sixty-person sample was split into two groups: thirty individuals in the treatment group got an educational intervention centered around supportive care, while thirty individuals in the control group were given hypertension pamphlets. Results: The quality of life score in the treatment group following the intervention was p = 0.000, according to research based on the independent t-test. The study's findings demonstrated the effectiveness of telenursing instruction in raising hypertension patients' quality of life; as such, this intervention may catalyze raising hypertensive patients' levels of self-care. Conclusion: In conclusion, telenursing education support has an impact on hypertension patients' quality of life.

Self-care Problems and Management Strategies Experienced by Rural Patient/Caregiver Dyads Living With Heart Failure: A Qualitative Study.

Rural patients with heart failure (HF) have higher mortality and hospitalization rates compared with their urban counterparts. Although research supports the inclusion of informal caregivers in daily self-care activities, data are limited regarding the problems encountered by rural patient/caregiver dyads living with HF in managing HF in the home and how these problems are managed. The aim of this study was to identify and describe HF self-care problems experienced by rural dyads in the home and how these problems are managed. Using a descriptive qualitative design, data were collected from rural patient/caregiver dyads living with HF via individual, semistructured, telephone interviews and analyzed using schematic content analysis. Interviews and data analysis occurred concurrently until data saturation was reached. Thematic data saturation was obtained with 11 dyads. On average, patients were 65.3 (±13.9) years old, and caregivers were 62 (±12.37) years old. Four themes illustrating dyadic HF self-care problems and management strategies emerged: (1) HF self-care components, namely, maintenance, symptom monitoring, and management (diet, exercise, activities, strategies); (2) environment (rural barriers, COVID-19); (3) caregiver contributors (confidence, role); and (4) dyadic contributors (dyadic relationship). Dyads described various self-care problems, with the type of relationship and presence of mutuality influencing the problem-solving process and development of management strategies. The identified themes emphasize the self-care problems experienced by rural dyads living with HF and the contributions of both dyad members to effectively manage these challenges. Findings support the need for culturally sensitive, tailored interventions targeting self-care in rural dyads living with HF.

Feasibility of a Text Messaging-Integrated and Chatbot-Interfaced Self-Management Program for Symptom Control in Patients With Gastrointestinal Cancer Undergoing Chemotherapy: Pilot Mixed Methods Study.

Outpatient chemotherapy often leaves patients to grapple with a range of complex side effects at home. Leveraging tailored evidence-based content to monitor and manage these symptoms remains an untapped potential among patients with gastrointestinal (GI) cancer. This study aims to bridge the gap in outpatient chemotherapy care by integrating a cutting-edge text messaging system with a chatbot interface. This approach seeks to enable real-time monitoring and proactive management of side effects in patients with GI cancer undergoing intravenous chemotherapy. Real-Time Chemotherapy-Associated Side Effects Monitoring Supportive System (RT-CAMSS) was developed iteratively, incorporating patient-centered inputs and evidence-based information. It synthesizes chemotherapy knowledge, self-care symptom management skills, emotional support, and healthy lifestyle recommendations. In a single-arm 2-month pilot study, patients with GI cancer undergoing chemotherapy received tailored intervention messages thrice a week and a weekly Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events-based symptom assessment via a chatbot interface. Baseline and postintervention patient surveys and interviews were conducted. Out of 45 eligible patients, 34 were enrolled (76% consent rate). The mean age was 61 (SD 12) years, with 19 (56%) being females and 21 (62%) non-Hispanic White. The most common cancer type was pancreatic (n=18, 53%), followed by colon (n=12, 35%) and stomach (n=4, 12%). In total, 27 (79% retention rate) participants completed the postintervention follow-up. In total, 20 patients texted back at least once to seek additional information, with the keyword "chemo" or "support" texted the most. Among those who used the chatbot system checker, fatigue emerged as the most frequently reported symptom (n=15), followed by neuropathy (n=7). Adjusted for multiple comparisons, patients engaging with the platform exhibited significantly improved Patient Activation Measure (3.70, 95% CI -6.919 to -0.499; P=.02). Postintervention interviews and satisfaction surveys revealed that participants found the intervention was user-friendly and were provided with valuable information. Capitalizing on mobile technology communication holds tremendous scalability for enhancing health care services. This study presents initial evidence of the engagement and acceptability of RT-CAMSS, warranting further evaluation in a controlled clinical trial setting.

Longitudinal Relationships Between Heart Failure Self-care and All-Cause Hospital Readmissions.

Many patients with heart failure (HF) are repeatedly hospitalized. Heart failure self-care may reduce readmission rates. Hospitalizations may also affect self-care. The purpose of this secondary analysis was to test the hypotheses that better HF self-care is associated with a lower rate of all-cause readmissions and that readmissions motivate patients to improve their self-care. This was a prospective cohort study of patients with HF (N = 400) who were enrolled during a stay at an urban teaching hospital between 2014 and 2016. The Self-Care of Heart Failure Index v6.2 was administered during the hospital stay, along with other questionnaires, and repeated at 6-month intervals after discharge. All-cause readmissions and deaths were ascertained for 24 months. A total of 333 (83.3%) were readmitted at least once, and 117 (29.3%) of the patients died during the follow-up period. A total of 1581 readmissions were ascertained. Higher Self-Care of Heart Failure Index Maintenance scores predicted more rather than fewer readmissions (adjusted hazard ratio, 1.09; 95% confidence interval, 1.01-1.17; P < .01). Conversely, more readmissions predicted higher Maintenance scores (b = 0.29; 95% confidence interval, 0.02-0.56; P < .05). These findings do not support the hypothesis that HF self-care maintenance or management helps to reduce the rate of all-cause readmissions, but they do suggest that the experience of multiple readmissions may help to motivate improvements in HF self-care.