Self-care Regimens Research Articles

Is diabetes-specific health literacy associated with diabetes-related outcomes in older adults?

The present study examined the association between a measure of diabetes-specific health literacy and three different Type 2 diabetes outcome indicators in a national sample of older adults. Data were taken from the Health and Retirement Study (HRS) 2003 Diabetes module and the HRS 2002 core wave. Analysis was performed on data from 1318 respondents aged 42-96 years [mean (±SD) 67.96 ± 8.65 years] who submitted responses on all relevant independent variable measures along with an HbA1c test kit. The index of diabetes-specific health literacy was constructed from responses to 10 diabetes self-care regimen items (α = 0.927). Using a multivariate regression strategy to analyze weighted data, the diabetes-specific health literacy index was significantly and positively associated with self-graded assessment of diabetes self-care (R2 = 0.231). However, diabetes-specific health literacy was not independently associated with the HbA1c level or the average number of days five recommended self-management behaviors were practiced each week. No previous single study has focused on the relationship between diabetes-specific health literacy and multiple diabetes-related outcomes. The direct association of diabetes-specific health literacy with patients' assessment of their self-care practice acumen is useful information for the design of effective patient intervention and/or communication strategies. Health literacy is a broad, multidimensional construct that bridges basic literacy skills and various health and illness contexts. Because it is so important to adults engaged in the self-management of chronic illness, indicators of disease-specific knowledge and/or understanding should be included in efforts to measure health literacy.

Epidemiology and treatment of depression in patients with chronic medical illness

There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.

P03-573 - Depression and anxiety in patients with diabetes mellitus: a conceptual discussion of treatment adherence issues and current treatment recommendations

A growing body of literature suggests that depression and subclinical diabetes-related distress are common in patients with type 1 and 2 diabetes. Likewise, anxiety disorders are more prevalent in patients with diabetes compared to the normal adult population.Importantly, both depression and anxiety have been associated with non-adherence to the diabetes self-care regimen, thus increasing the risk for hyperglycemia and other serious diabetes-related complications.This presentation will discuss the recent literature on the association between depression, anxiety, and reduced treatment adherence, including evidence for plausible biological and behavioral mechanisms. We will then examine current treatment recommendations for both diabetes specialist and generalist healthcare providers. Recommended screening and assessment measures will be reviewed, as well as individual and group stress management and other cognitive-behavioral interventions. The suitability and adaptibility of general cognitive-behavioral and stress management approaches will be discussed, including suggestions for tailoring them to patients with diabetes and specific diabetes components. In general, through this evidence-based discussion, we hope to increase awareness of and sensitivity toward these important issues in the general medical and psychological communities. Further, we hope to encourage dialogue between providers and patients regarding stress in managing diabetes, and make prevention and screening for co-morbided psychological illnesses a focus in routine clinic visits.

The Effects of the Self-Efficacy Method on Adult Asthmatic Patient Self-Care Behavior

The prevalence of asthma and associated mortality is higher among adults than among children, as are associated morbidity and hospital readmission rates. The literature shows that promoting patient self-care behaviors and self-efficacy helps reduce recurrence and hospital readmission rates. Therefore, self-care behaviors and self-efficacy represent critical issues in successful asthma management. This study was developed to investigate the effects of a self-efficacy intervention on (a) the self-care behaviors of adult asthma patients and (b) the self-efficacy of adult asthmatic patients. The study used a pretest-posttest experimental design. A total of 60 asthma outpatients who visited the chest medicine division of a medical center in Kaohsiung City between March 2, 2009, and January 31, 2010, were assessed. Patients were randomly divided into two groups (experimental and control), with 30 patients assigned to each. Experimental group participants received the self-efficacy intervention program, which included watching a 15- to 20-minute DVD, received a healthcare booklet on self-efficacy for adult asthmatic patients, were asked to share their illness experience with support groups, and received medical follow-ups by telephone. Control group patients received conventional health education administered by the outpatient department. Study instruments included a self-care behavior scale for adult asthmatic patients (content validity index = .95, Cronbach's α = .82) and a self-efficacy scale for adult asthmatic patients (content validity index = .98, Cronbach's α = .82). The two key findings of this study were as follows: (a)There was a significant improvement in the self-care behaviors of patients who received self-efficacy intervention in terms of medication adherence (p= .008), self-monitoring (p= .000), avoidance of antigens (p = .001), regular follow-up visits (p = .000), and regular exercise (p = .016); and (b) the program improved participant self-efficacy in terms of both asthma attack prevention (p = .030) and management during asthma attacks (p = .017). On the basis of these results, self-efficacy intervention has been demonstrated a beneficial addition to adult asthmatic patient self-care regimens.

Ensuring effective technique in colostomy irrigation to improve quality of life

The formation of a stoma causes physical changes to a patient's body that can cause alterations in his/her body image (Vujnovich, 2008). It is vital to an ostomist's wellbeing that he/she achieves a self-care management regimen which is suitable to his/her lifestyle. Colostomy irrigation is a safe and effective means of enabling colostomists to regain their bowel control, which has a significant impact on self-esteem and quality of life. Yvette Perston explains how colostomy irrigation works, who can use it, and the proper technique to ensure patient safety and minimal discomfort. By understanding the rationale behind the technique, health professionals can better assist patients in successful emptying of the bowel.

A Qualitative Descriptive Study of the Work of Adherence to a Chronic Heart Failure Regimen

Despite the known benefit of self-care strategies for symptom management in heart failure (HF), most patients are unable to perform self-care activities successfully. This study therefore examined how communication about the HF regimen between patients and their physicians is experienced and understood by both partners. Six pairs (n = 12) of adult patients with HF who were admitted for acute symptom exacerbation and their physicians were interviewed for this qualitative descriptive study in the inpatient setting. Semistructured in-depth interviews were conducted. Data were analyzed using content analysis. Both patients and providers described adherence to the HF regimen as "work." Both reported the same list of tasks and knowledge requirements as key components of the HF regimen, and both reported delegating their own regimen-related work to others. Despite these similarities, perceptions of the nature and complexity of the work of the HF regimen differed. Patients described the regimen as "hard work," but physicians perceived patients as nonparticipatory in self-care, in spite of the instructions being "easy." Patients perceived themselves as understanding what to do but needing help with how to carry out self-care. By contrast, physicians perceived patients as not understanding what the regimen requires and therefore needing more repetition of knowledge-based instructions. The self-care regimen in chronic HF is characterized by both patients and physicians as work, but patient-physician dyads show divergent understandings of that work. Future research to improve adherence should move beyond the patient to look at the nature of the work itself and the relationship of the patient and caregivers to the work.

Heart Failure

This article provides an overview of the latest in the standard of care and approaches for heart failure treatment. It presents two new American Heart Association Scientific Statements related to heart failure risk. The first addresses the prevention of heart failure with an emphasis on risk reduction. The second statement focuses on efforts to reduce hypertension, a primary risk factor for heart failure, through a self-care regimen that features home blood pressure monitoring. Implications for home care practice are presented.

Depression and Diabetes among Low-Income Hispanics: Design Elements of a Socio-Culturally Adapted Collaborative Care Model Randomized Controlled Trial

This article describes design elements of the Multifaceted Depression and Diabetes Program (MDDP) randomized clinical trial. The MDDP trial hypothesizes that a socioculturally adapted collaborative care depression management intervention will reduce depressive symptoms and improve patient adherence to diabetes self-care regimens, glycemic control, and quality-of-life. In addition, baseline data of 387 low-income, 96% Hispanic, enrolled patients with major depression and diabetes are examined to identify study population characteristics consistent with trial design adaptations. The PHQ-9 depression scale was used to identify patients meeting criteria for major depressive disorder (1 cardinal depression symptom + a PHQ-9 score of > or = 10) from two community safety net clinics. Design elements included sociocultural adaptations in recruitment and efforts to reduce attrition and collaborative depression care management. Of 1,803 diabetes patients screened, 30.2% met criteria for major depressive disorder. Of 387 patients enrolled in the clinical trial, 98% had Type 2 diabetes, and 83% had glycated hemoglobin (HbA1c) levels > or = 7%. Study recruitment rates and baseline data analyses identified socioeconomic and clinical factors that support trial design and intervention adaptations. Depression severity was significantly associated with diabetes complications, medical comorbidity, greater anxiety, dysthymia, financial worries, social stress, and poorer quality-of-life. Low-income Hispanic patients with diabetes experience high prevalence of depressive disorder and depression severity is associated with socioeconomic stressors and clinical severity. Improving depression care management among Hispanic patients in public sector clinics should include intervention components that address self-care of diabetes and socioeconomic stressors.

Reduction of Complications and Associated Costs with Flexitouch® Therapy for Lymphedema

Lymphedema is a chronic condition requiring multiple clinic visits over several weeks for costly treatment and education by a trained therapist, followed by lifelong in-home self-care. The self-care regimen can be physically and psy- chologically demanding and inadequate treatment can lead to progression of the lymphedema and serious complications. The patient described in this report was diligent with a home care program yet experienced difficulty controlling her lym- phedema independently, necessitating a return to skilled therapy for repeated treatments. This case study describes the impact that an advanced pneumatic device, the Flexitouch ® system, had on the costs of treatment and quality of life for a patient with lymphedema. Substantial long- and short-term cost reductions and quality-of-life gains may have been real- ized as the patient achieved successful maintenance of a home care program without any lymphedema-related complica- tions or infections requiring hospitalization, antibiotic therapy, or in-clinic lymphedema therapy.

Type 1 Diabetes Among Adolescents

The aim of this study was to examine the association between social anxiety and adherence to diabetes self-care and quality of life and to determine the effects of fear of hypoglycemia on these associations in adolescents with type 1 diabetes. It is hypothesized that (1) social anxiety will be negatively associated with adherence and quality of life and (2) that fear of hypoglycemia will mediate this relationship. It is also hypothesized that (3) girls will have higher social anxiety than boys. Adolescents with type 1 diabetes were recruited during clinic visits at 2 international centers. Participants answered a survey containing questionnaires on social anxiety, behavioral adherence to the diabetes self-care regimen, quality of life, fear of hypoglycemia, and last hemoglobin A1C results. Seventy-six adolescents (33 boys, 43 girls), mean age 15.9 (1.44) years, participated. Social anxiety levels are not statistically different between genders. In boys, social anxiety is associated with worse diet and insulin injection adherence; no associations are found in girls. Social anxiety is positively correlated with poor quality of life in both genders. Fear of hypoglycemia mediates the relationship between social anxiety and insulin adherence in boys. Findings suggest that social anxiety, which is common in general populations of adolescents, may interfere with behavioral adherence and quality of life among adolescents with type 1 diabetes. Screening and treatment of social anxiety may result in better adherence and increased quality of life.

Self-care coping strategies in people with diabetes: a qualitative exploratory study

BackgroundThe management of diabetes self-care is largely the responsibility of the patient. With more emphasis on the prevention of complications, adherence to diabetes self-care regimens can be difficult. Diabetes self-care requires the patient to make many dietary and lifestyle changes. This study will explore patient perceptions of diabetes self-care, with particular reference to the burden of self-care and coping strategies among patients.MethodsA maximum variation sample of 17 patients was selected from GP practices and diabetes clinics in Ireland to include patients with types 1 and 2 diabetes, various self-care regimens, and a range of diabetes complications. Data were collected by in-depth interviews; which were tape-recorded and transcribed. The transcripts were analysed using open and axial coding procedures to identify main categories, and were reviewed by an independent corroborator. Discussion of the results is made in the theoretical context of the health belief, health value, self-efficacy, and locus of control frameworks.ResultsPatients' perceptions of their self-care varied on a spectrum, displaying differences in self-care responsibilities such as competence with dietary planning, testing blood sugar and regular exercise. Three patient types could be distinguished, which were labeled: "proactive manager," a patient who independently monitors blood glucose and adjusts his/her self-care regime to maintain metabolic control; "passive follower," a patient who follows his/her prescribed self-care regime, but does not react autonomously to changes in metabolic control; and "nonconformist," a patient who does not follow most of his/her prescribed self-care regimen.ConclusionPatients have different diabetes self-care coping strategies which are influenced by their self-care health value and consequently may affect their diet and exercise choices, frequency of blood glucose monitoring, and compliance with prescribed medication regimens. Particular attention should be paid to the patient's self-care coping strategy, and self-care protocols should be tailored to complement the different patient types.

A systematic review of the efficacy of non‐pharmacological treatments for depression on glycaemic control in type 2 diabetics

This paper reported a systematic review of three randomised controlled clinical trials evaluating the efficacy of non-pharmacological treatment of depression on glycaemic control in individuals with type 2 diabetes. Depression is associated with poor adherence to self-care regimen in individuals with diabetes. A significant relationship between depression and poor glycaemic control has also been suggested. Hence, the management of depression becomes an important aspect of diabetes care. Systematic review. Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words - depression, mood disorder, depressive symptoms, diabetes mellitus, glycaemic control, glycated haemoglobin, glucose, psychological therapy, psychotherapy, non-pharmacological therapy and cognitive behaviour therapy. The publication date was limited from 1996-2007. Studies were selected if they used a randomised controlled trial design, were written in English, used non-pharmacological treatments for treating depression, included individuals with type 2 diabetes mellitus as participants and included depressive symptoms and glycaemic control (determined by haemoglobin A(1)C) as outcomes. Non-pharmacological treatments of depression reduce depressive symptoms in diabetic patients. However, cognitive behaviour therapy did not improve glycaemic control. The treatment effect sizes for glycaemic control in the two collaborative-care programmes were also small. The available evidence indicated that non-pharmacological treatment of depression had limited effect on glycaemic control in individuals with type 2 diabetes. The depression-focused interventions might not achieve optimal diabetes-related outcomes. The beneficial effect of psychological treatment for glycaemic control may be strengthened by employing treatments tailored to each individual's diabetes self-care needs in addition to depression management.

Practice Implications of What Couples Tell Us About Type 2 Diabetes Management

Diabetes is a significant and growing chronic health problem in the United States. Substantial research has documented the consistently strong link between social relationships and health. With respect to diabetes, social relationships, and particularly marriage or cohabitation, have been shown to mediate lifestyle and medical surveillance behaviors, glycemic control, and other health outcomes. Further exploration of the marital or cohabiting relationship may be especially relevant to clinicians and educators because the self-care regimen often involves spouses or significant others. With this in mind, the purpose of this study was to listen to and draw conclusions from what couples tell us about managing daily life with type 2 diabetes. Analyses revealed four core themes: educate yourselves, talk about the disease, work together, and be your own advocate. This qualitative study provided a unique perspective on couples' needs for care, which have important implications for the health community in acknowledging the spousal or cohabiting relationship in the management of diabetes.

The role of partner relationships in the young person’s adherence to the diabetes self-care regime

This study investigated the role of partner relationships in the young person's experience of diabetes. It was predicted that those people reporting a better quality relationship would report greater social support and better diabetes management. Fifty young adults with diabetes and their spouse/partner completed web-based questionnaires. A better quality relationship did not correlate with high reported levels of social support or with better diabetes management. Path analysis demonstrated, however, that for males with diabetes high reported quality of relationship predicted better diabetes management. Relationship quality does not generally predict better diabetes management; however, there may be a unique feature to good relationships that support men's diabetes self-care.

The Hindu ascetic as fitness instructor: Reviving faith in yoga

Indian ascetics have recognized both the boom in the fitness industry in India and the global market potential for yoga and ayurveda. Swami Ramdev's yoga programme on Aastha channel broadcast daily on Indian television and available to diasporic and Western viewers is dipping in to this new era of the fitness consumer. Drawing from available nationalist and cultural repertoires, this new-age fitness guru imagines a new India embodied in the discipline associated with the practice of yoga and offers yoga as the effective ‘Indian’ antidote to both modern lifestyles and modern pharmaceuticals. His cures for consumerism denote a longing to transform discourses of health into commoditized regimens of medicalized self-help. He prescribes yoga not only as a personal self-care and spiritual development regimen, but as a way to create a nation of fit/healthy citizens. Such television-mediated religiosity variously aids the ideological work of Hindutva both within and outside India.

Behavioral and Psychosocial Interventions in Diabetes

A major task of diabetes care providers is to support patients in performing necessary self-care behaviors using well-accepted strategies such as recommending effective self-care regimens and educating patients in their use. Also critical are behavioral interventions that help patients implement self-care regimens in the face of life's exigencies. The purpose of this article is to identify key behavioral/psychosocial interventions available to diabetes care providers. We present a conceptual framework for organizing the application of these interventions, focusing on practical interventions that can be implemented by a typical health care provider, including referral to a behavioral/psychosocial specialist where this seems the most practical choice. A typical office visit lasts only 15 min (1). Therefore, feasibility is an important consideration in evaluating patient care recommendations. The strategies we propose should be no more time-consuming than these approaches, which are highly recommended for their feasibility. A previously demonstrated, effective counseling strategy for weight loss can be maintained by 15-min visits (2). A behavior change support approach, the 5As (ask, advise, assess, assist, arrange) Model, is estimated to take less than half the time of a normal office visit (3). An emotional support approach, the BATHE (background, affect, trouble, handling, empathy) Model, is estimated to take ∼15 min (4). Feasibility must also be assessed in terms of what it costs to ignore psychosocial problems or to employ an ineffective approach to behavior change. Patients who have psychological problems use health services more intensively, and if patients do not change their behavior, the clinician must spend time dealing with the problem at subsequent visits. Finally, research suggests that dealing with patients' concerns does not require additional time if done correctly (5). Thus, effective clinical procedure may also be efficient. The review we present is not exhaustive. We do not discuss all interventions that have …

Family support, perceived self‐efficacy and self‐care behaviour of Turkish patients with chronic obstructive pulmonary disease

The purpose of this study was to describe family support, self-efficacy perception and self-care behaviour among patients with chronic obstructive pulmonary disease and to ascertain the relationship between these variables. It is important to work at improving confidence in the patients' ability to follow a self-care regimen by increasing self-efficacy. Family support also plays an important role in self-care activities. The study design is descriptive and correlational. Of 230 patients with chronic obstructive pulmonary disease who were recruited for the study, 200 agreed to participate. The patients were recruited by the first author from an outpatient clinic in the Department of Chest Disease of a university hospital and a pulmonary hospital in Erzurum, eastern Turkey. Data were collected by using a demographic data form, the Perceived Social Support from Family Scale, the Chronic Obstructive Pulmonary Disease Self-efficacy Scale and the Alberto Chronic Obstructive Pulmonary Disease Self-care Behaviour Inventory. Although most participants (91.5%) perceived that they had family support and more than three quarters (73.0%) of the participants engaged in an adequate amount of self-care behaviours, only twenty five participants' (12.5%) perceived self-efficacy as high. There were statistically significant positive relationships between family support and self-care behaviour (r=0.302; p=0.01) and between self-efficacy and self-care behaviour (r=0.186; p=0.01). There was also a statistically significant positive relationship between family support and self-efficacy (r=0.412; p=0.01). The results of the study demonstrated weak to moderate, but statistically significant, relationships between family support and self-care behaviours, self-efficacy and self-care behaviour and family support and self-efficacy in Turkish patients with chronic obstructive pulmonary disease. The assessment of the family support, self-efficacy and self-care behaviours of the patients with chronic obstructive pulmonary disease should be an essential part of nursing practice. The study also provides the foundation for the conduct of future studies of self-care training for managing patients with chronic obstructive pulmonary disease.

Wie gehen COPD-Patienten mit ihrer Erkrankung um?

Chronic illness permanently changes a patient;s lifestyle and requires continuous adaptation. Chronic diseases like COPD and its treatment place extensive behavioral demands on patients. The need for precisely scheduled daily medication, regular physical exercise, visits to health care providers and monitoring are some of the demands. Exacerbations, inspiratory dyspnea, immobility, and the management of unpredictable situations aggravate the situation. These demands invade nearly every aspect of patients} lives. The quality of patients}self-management of disease depends largely on their assessment of health related quality of life, functioning, ability to comply and coping. COPD patients often have perceived barriers and factors, which will hinder or facilitate an optimal self-management. For instance their individual treatment goals can differ from those of the physician, or patients feel distressed about having a chronic disease. The comprehension of psychological factors in medical treatment is essential not only to be more effective in improving patients' confidence in their ability to follow a self-care regimen but also have beneficial effects in achieving treatment goals.

CMS Names Administrator; Prices Rise for 10 Most Frequently Prescribed Medications

CMS Names Administrator; Prices Rise for 10 Most Frequently Prescribed Medications

A Practical Use of Theory to Study Adherence

Chronic heart failure (CHF) is a costly Medicare expenditure, with approximately 70% of the costs of heart failure care attributable to acute, symptom-related hospitalizations. The most common preventable cause of rehospitalization is nonadherence to the CHF regimen. Theoretic models have been used to study adherence; however, these models are predominantly designed for health behavior interventions (ie, smoking cessation, diet modification, or exercise) and focus less on conceptualizing the work involved in carrying out complex self-care regimens. The purpose of this paper was to present one approach for operationalizing the Trajectory Theory of Chronic Illness to study adherence in patients with heart failure. The trajectory model offers unique opportunities to study adherence, specifically because measurable patient attributes are clearer when evaluated in the context of the work required to adhere over time. Using trajectory theory may allow providers to better understand and facilitate patient adherence to the CHF regimen.