Self-care Support Research Articles

Self-care confidence mediates self-care maintenance and management in patients with heart failure

BackgroundLiterature highlights the influence of self-care confidence on self-care in patients with heart failure (HF), but little is known whether it explains the influence of other determinants of self-care. ObjectivesTo examine whether confidence explained the associations of social support and HF-knowledge with self-care. MethodsIn a descriptive, correlational study, 100 patients with HF completed questionnaires on self-care, social support, and HF-specific knowledge. Regression analyses were used to examine associations between perceived support and HF-knowledge and self-care. ResultsSelf-care confidence mediated the association between social support and self-care maintenance (path reduced from Beta = 0.713 to 0.395) and HF-knowledge and maintenance (path reduced from Beta = 2.569 to 1.798) and management (path reduced from Beta = −0.272 to −0.144). ConclusionSelf-care confidence explains the influence of social support and knowledge on self-care. Supporting self-care confidence may be a key target for interventions to improve disease management and behaviors in patients with HF.

Community-Driven Priorities in Smartphone Application Development: Leveraging Social Networks to Self-Manage Type 2 Diabetes in a Low-Income African American Neighborhood.

Social networks have the potential to enhance Type 2 Diabetes Mellitus (T2DM) self-management. We used qualitative methods to study if and how mobile application (app) functions that mobilize social resources to improve T2DM management would be desired in a low-income African American community. Data were collected through community discussions and in-depth interviews with 78 participants in 2016–2018. Participants included individuals with self-reported pre-diabetes, T2DM, close family members or friends of a T2DM patient, and healthcare providers. Open-ended questions solicited information about challenges with T2DM management and gathered ideas on features of a mobile app that could address them. Data were transcribed and thematically coded by two coders using Atlas-ti. Regarding types of app functions, main themes included: (1) the importance of having support in diabetes self-care; (2) using informal networks to help to each other; and (3) monitoring one another through an app. Suggested app features included reminders for and transportation to medical visits, sharing information and exercise companionship, and providing opportunities for monitoring by friends/family members, especially in case of emergencies. Participants viewed an app as a potential vehicle for reinforcing accomplishments in T2DM self-management. Future research should implement and test an app with these features in this or similar communities.

Supporting Oral Self-care of Patients With Periodontitis Through Motivational Interview

Supporting Oral Self-care of Patients With Periodontitis Through Motivational Interview

Symptoms and QOL in breast cancer patients receiving hormone therapy in Japan.

The aim was to clarify subjective symptoms and quality of life (QOL) in breast cancer patients receiving hormone therapy. After obtaining approval from the research ethics committee, an observational study using a self-administered questionnaire was conducted at outpatient clinical oncology offices in 3 facilities that targeted breast cancer patients under the age of 50 who had been undergoing hormone therapy for less than 1year. The study examined elements such as the breast cancer patients' basic information, symptoms, pain in daily life, QOL, and depression/anxiety. There were 214 valid responses. The respondents had an average age of 43.6. Of them, 100% were also treated with Tamoxifen and 30% with LH-RH agonist. There were 75% who were cognizant of side effects. Difficult symptoms that occurred with high frequency were stiff shoulders/back pain, decreased physical strength, hot flashes, and sweating. Over half the respondents were uncertain as to whether the subjective symptoms were side effects. They lost confidence in their physical strength and felt distressed over weight gain. There were 51 with a HADS anxiety score of 8 or higher, and 46 who scored 8 points or higher for depression. Breast cancer patients undergoing hormone therapy experience a variety of pains, and some also have serious psychological symptoms. Reassessing support systems to examine screening and self-care support is an issue going forward.

Are we doing it right? Self-care support for patients with type 2 diabetes in urban areas in Malaysia

The purpose of this study is to explore the self-care support provision for patients with type 2 diabetes by diabetes educators and to explore the challenges that they encountered in providing the intended services. Single embedded qualitative case study design using in-depth individual face to face interviews were adopted. Twelve diabetes educators from three diabetes clinics in urban areas in Malaysia were purposively selected and interviewed within the period of eight months (November 2012-June 2013). The data were transcribed verbatim and analyzed using Framework technique. The practice of diabetes educators revolved around the traditional paternalistic approach but emphasize on individualized support. However, their practice was restricted by several factors, including patients' acceptance and interest in self-care, lack of confidence and opportunity to practice, and fragmented health care system. The current practice of diabetes educators is very limited to knowledge provision and rather a generalist. Considering a more specialized role would increase opportunities for diabetes educators to provide high-quality self-care support provision.

A novel mindful-compassion art therapy (MCAT) for reducing burnout and promoting resilience for end-of-life care professionals: a waitlist RCT protocol

IntroductionEnd-of-life (EoL) care professionals are prone to burnout given the intense emotional nature of their work. Previous research supports the efficacy of art therapy in reducing work-related stress and enhancing emotional health among professional EoL caregivers. Integrating mindfulness meditation with art therapy and reflective awareness complementing emotional expression has immense potential for self-care and collegial support. Mindful-compassion art therapy (MCAT) is a novel, empirically informed, and highly structured intervention that aims to reduce work-related stress, cultivate resilience, and promote wellness. This study aims to assess the potential effectiveness of MCAT for supporting EoL care professionals in Singapore.MethodsThis is an open-label waitlist randomized controlled trial. Sixty EoL care professionals, including doctors, nurses, social workers, and personal care workers, are randomly allocated to one of two groups: (i) an intervention group that receives MCAT immediately and (ii) a waitlist-control group that receives MCAT after the intervention group completes treatment. Face-to-face self-administered outcome assessments are collected at three different time points—baseline (T1) for both groups, post-intervention (T2), and 6-week follow-up (T3) for intervention group—as well as pre-intervention (T2) and post-intervention (T3) for the waitlist-control group. The primary outcome measure is burnout, and secondary measures include emotional regulation, resilience, compassion, quality of life, and death attitudes. Between- and within-participant comparisons of outcomes are conducted, and the appropriate effect size estimates are reported. An acceptability and feasibility study is to be conducted by using a triangulation of qualitative data with framework analysis.DiscussionThe outcomes of this study will contribute to advancements in both theories and practices for supporting professional EoL caregivers around the world. It will also inform policy makers about the feasibility, acceptability, and effectiveness of delivering a multimodal psycho-socio-spiritual intervention within a community institutional setting. The study has received ethical approval from the institutional review board of Nanyang Technological University.Trial registrationClinicalTrials.gov Identifier: NCT03440606. Retrospectively registered February 21, 2018.

Pediatric Heart Transplantation: Transitioning to Adult Care (TRANSIT): Feasibility of a Pilot Randomized Controlled Trial

Background:Young-adult heart transplant recipients transferring to adult care are at risk for poor health outcomes. We conducted a pilot randomized controlled trial to determine the feasibility of and to test a transition intervention for young adults who underwent heart transplantation as children and then transferred to adult care. Methods:Participants were randomized to the transition intervention (4 months long, focused on heart-transplant knowledge, self-care, self-advocacy, and social support) or usual care. Self-report questionnaires and medical records data were collected at baseline and 3 and 6 months after the initial adult clinic visit. Longitudinal analyses comparing outcomes over time were performed using generalized estimating equations and linear mixed models. Results:Transfer to adult care was successful and feasible (ie, excellent participation rates). The average patient standard deviation of mean tacrolimus levels was similar over time in both study arms and < 2.5, indicating adequate adherence. There were no between-group or within-group differences in percentage of tacrolimus bioassays within target range (> 50%). Average overall adherence to treatment was similarly good in both groups. Rates of appointment keeping through 6 months after transfer declined over time in both groups. Conclusions:The feasibility of the study was demonstrated. Our transition intervention did not improve outcomes.

糖尿病患者への予防的フットケア─フットケアとセルフケア支援の実際（事例を含む）─

糖尿病患者への予防的フットケア─フットケアとセルフケア支援の実際（事例を含む）─

Effectiveness of a self-management support program for type 2 diabetes patients in the first years of illness: Results from a randomized controlled trial.

AimsTo evaluate the immediate and six-month effectiveness of a group-based self-management support program for people diagnosed with type 2 diabetes (1–3 years post diagnosis) on diabetes self-care, distress and cognitions.MethodsPeople with type 2 diabetes were randomized into the intervention (four group-based interactive sessions) or the control group (a single educational lecture) with their partners. Outcomes were measured at baseline, immediately after the third course session and six months later using validated questionnaires on diabetes self-care, distress, illness perceptions, diabetes-related attitudes, empowerment and partner support. Multilevel analyses were conducted according to the intention-to-treat principle using the data from 82 intervention and 86 control group participants, to test for differences in changes over time between the two groups.ResultsThe intervention group showed a significantly higher increase in physical activity and fruit and vegetable intake immediately after the program, whereas the low baseline levels of diabetes distress remained unaffected. Furthermore, the intervention group believed their illness to be more likely to be caused by chance/bad luck, but also felt more empowered to handle their condition and its treatment immediately after the program compared with the control group. Six months later, only the differences in empowerment had persisted.ConclusionsGroup-based self-management support results in favorable short-term behavioral changes and more persistent alterations in (perceived) empowerment in people living in the first years of type 2 diabetes. In order to achieve more sustainable behavioral changes, more prolonged support is necessary. This could be achieved by integrating attention to patients’ illness perceptions and continuous self-management support in regular diabetes care.Trial registrationNetherlands Trial Registry NL3158.

Health systems strengthening for noncommunicable disease control and healthy aging: integrated actions in Aruba and Curaçao.

ABSTRACTCaribbean countries are experiencing social, epidemiological, and demographic transitions shaped by the growing elderly population and the rise of noncommunicable diseases (NCDs)—now responsible for 78% of all deaths. These circumstances demand rethinking the model of care to improve health outcomes and build more sustainable health systems with new orientations in policy, service delivery, organization, training, technology, and financing. Policy must be aimed towards healthy living, leveraging interventions that ensure healthy aging. The health system must proactively structure interventions to reduce the incidence of new NCD cases and to prevent related complications. Interventions should be focused on optimizing the individual’s capacity, functional ability, and autonomy within adapted environments, as well as with the necessary preventive, long-term care, self-care, community care, and health system support.

48-LB: Long-Term A1C Benefit from Using One Drop

One Drop (OD) provides self-care support via an evidence-based mobile app, a Bluetooth-connected glucometer and testing supplies, and in-app coaching from CDEs. The app with coaching is associated with a 0.9 to 1.3% lab hemoglobin (A1c) improvement over 3 months. The full solution is associated with a 1.9% eA1c improvement over 3 months. We enrolled people with diabetes to participate in an IRB-approved study examining OD’s long-term effect on A1c. Adults with lab-verified ≥ 7.0% A1c and no prior OD account participated in a single-group longitudinal study. Participants used OD for an average 7.7 months. Lab A1c was assessed at baseline, 3, and 8 months. Descriptive statistics characterized the sample. Repeated measures ANOVA tested A1c change over time. Bonferroni-corrected post hoc tests examined A1c change between timepoints. Participants (N = 10) were 53 ± 7 years old and half female. Sphericity was assumed (Mauchly’s W = .30, p = .05). A1c significantly changed over time, F(2, 12) = 5.62, p &amp;lt; 0.019, partial eta = .48 (see Figure 1). When adjusted for multiple comparisons, baseline to 3-mo A1c change (MDiff = .64%, p = .10) and 3-mo to 8-mo Alc change trended significant (MDiff = 1.74 %, p = .10). Using OD for up to 8 months is associated with improved A1c. This is the first OD study to observe participants beyond 3 months and collect multiple measures of lab A1c over time. An accumulation of non-experimental and experimental evidence suggests OD improves A1c among people with diabetes. Disclosure A. Hirsch: Employee; Self; Informed Data Systems Inc. Research Support; Self; Fitbit, Inc., MannKind Corporation. Stock/Shareholder; Self; Informed Data Systems Inc. C.Y. Osborn: Employee; Self; One Drop. M. Heyman: Consultant; Self; Lexicon Pharmaceuticals, Inc., Lilly Diabetes, Tandem Diabetes Care. Employee; Self; One Drop. B. Huddleston: Employee; Self; One Drop. J. Dachis: Stock/Shareholder; Self; Informed Data Systems Inc.

Medicare Spending and the Adequacy of Support With Daily Activities in Community-Living Older Adults With Disability: An Observational Study.

Identifying factors that affect variation in health care spending among older adults with disability may reveal opportunities to better address their care needs while offsetting excess spending. To quantify differences in total Medicare spending among older adults with disability by whether they experience negative consequences due to inadequate support with household activities, mobility, or self-care. Observational study of in-person interviews and linked Medicare claims. United States, 2015. 3716 community-living older adults who participated in the 2015 NHATS (National Health and Aging Trends Study) and survived for 12 months. Total Medicare spending by spending quartile in multivariable regression models that adjusted for individual characteristics. Negative consequences were experienced by 18.3% of participants with disability in household activities, 25.6% with mobility disability, and 20.0% with self-care disability. Median Medicare spending was higher for those who experienced negative consequences due to household ($4866 vs. $4095), mobility ($7266 vs. $4115), and self-care ($10935 vs. $4436) disability versus those who did not. In regression-adjusted analyses, median spending did not differ appreciably for participants who experienced negative consequences in household activities ($338 [95% CI, -$768 to $1444]), but was higher for those with mobility ($2309 [CI, $208 to $4409]) and self-care ($3187 [CI, $432 to $5942]) disability. In the bottom-spending quartile, differences were observed for self-care only ($1460 [CI, $358 to $2561]). No differences were observed in the top quartile. This observational study could not establish causality. Inadequate support for mobility and self-care is associated with higher Medicare spending, especially in the middle and lower ends of the spending distribution. Better support for the care needs of older adults with disability could offset some Medicare spending. The Commonwealth Fund.

A Call to Restore Your Calling: Self-care of the Emergency Physician in the Face of Life-Changing Stress-Part 1 of 6.

Few practicing emergency physicians will avoid life-changing stressors such as a medical error, personal illness, malpractice litigation, or death of a patient. Many will be unprepared for the toll they will take on their lives. Some may ultimately experience burnout, post-traumatic stress disorder, and suicidal ideation. Medical education, continuing education, and maintenance of certification programs do not teach physicians to recognize helplessness, moral distress, or maladaptive coping mechanisms in themselves. Academic physicians receive little instruction on how to teach trainees and medical students the art of thriving through life-changing stressors in their career paths. Most importantly, handling a life-changing stressor is that much more overwhelming today, as physicians struggle to meet the daily challenge of providing the best patient care in a business-modeled health care environment where profit-driven performance measures (eg, productivity tracking, patient reviews) can conflict with the quality of medical care they wish to provide.Using personal vignettes and with a focus on the emergency department setting, this 6-article series examines the impact life-changing stressors have on physicians, trainees, and medical students. The authors identify internal constraints that inhibit healthy coping and tools for individuals, training programs, and health care organizations to consider adopting, as they seek to increase physician satisfaction and retention. The reader will learn to recognize physician distress and acquire strategies for self-care and peer support. The series will highlight the concept that professional fulfillment requires ongoing attention and is a work in progress.

Attitudes towards, facilitators and barriers to the provision of diabetes self-care support: A qualitative study among healthcare providers in Ghana

Statement of the problemSelf-care support provided by healthcare providers (HCPs) is critical to diabetes self-care. However, a number of barriers prevent HCPs from providing self-care support to people with diabetes. We explored attitudes towards, barriers and facilitators of the provision of diabetes self-care support among Ghanaian HCPs. MethodsFourteen semi-structured interviews were conducted among HCPs recruited from three diabetes clinics in Tamale, Ghana. All interviews were digitally recorded and transcribed verbatim. Transcripts were coded and analysed thematically. ResultsHCPs reported a sense of responsibility and urgency to provide self-care education to diabetes patients; while believing it was the patients' responsibility to self-care for their diabetes condition. Accordingly, HCPs perceived their role to be limited to information sharing rather than behaviour change interventions. Facilitators to the provision of self-care support included patients’ motivation, and team work among healthcare professionals. Barriers that hindered self-care support included language barriers and poor inter-professional collaboration. Furthermore, HCPs discussed that they felt inadequately trained to provide self-care support. Healthcare-system-related barriers were inadequate office space, lack of professional development programmes, high patient numbers, inadequate staff numbers, inadequate health insurance and a lack of sufficient supplies and equipment in the hospital. ConclusionHCPs attitudes were generally favourable towards supporting self-care, albeit with a focus on information provision rather than behaviour change. Training in effective strategies for providing self-care support are needed, and better use of the resources that are available.

Empowerment of Self-Care Management Among Women Using Vaginal Pessaries on Vaginal Symptoms and Quality of Life

Background: A vaginal pessary is one type of nonsurgical treatment for pelvic organ prolapse, which preferred by a wide of women with pelvic organ prolapse. The aim of the current study was to evaluate the effect of empowering self management among women using vaginal pessaries on vaginal symptoms and quality of life. A Quasi-experimental design was utilized in the current study. Setting: The study was conducted in outpatient clinic affiliated at Obstetrics & Gynecological Department at Banha University Hospital during the period from January 2017 and completed at the end of December 2017. Subjects: A purposive sample of total 80 women using vaginal support pessaries. Tools: Three tools were used for data collection, general characteristic interviewing questionnaire, pessaries related knowledge and reported self -care practice assessment tool, The International Consultation on Incontinence Modular Questionnaire & the prolapse quality of life tool. Results of the study showed a highly statistically significant differences regarding knowledge and self-care practice vaginal support pessaries and quality of life at different times of assessment (p < 0.000). Conclusion: empowerment of self-management among women using vaginal pessaries was highly effective on reducing severity of vaginal symptoms and improving quality of life. Recommendation: Based on the findings of this study the following should be recommended: The nurses should be familiar with self-care measures for vaginal pessaries in addition to more researches should be conducted considering the demographic and obstetric factors that have a crucial role in precipitating self management for vaginal pessary.

Empowerment of Self-Care Management Among Women Using Vaginal Pessaries on Vaginal Symptoms and Quality of Life

Background: A vaginal pessary is one type of nonsurgical treatment for pelvic organ prolapse, which preferred by a wide of women with pelvic organ prolapse. The aim of the current study was to evaluate the effect of empowering self management among women using vaginal pessaries on vaginal symptoms and quality of life. A Quasi-experimental design was utilized in the current study. Setting: The study was conducted in outpatient clinic affiliated at Obstetrics & Gynecological Department at Banha University Hospital during the period from January 2017 and completed at the end of December 2017. Subjects: A purposive sample of total 80 women using vaginal support pessaries. Tools: Three tools were used for data collection, general characteristic interviewing questionnaire, pessaries related knowledge and reported self -care practice assessment tool, The International Consultation on Incontinence Modular Questionnaire & the prolapse quality of life tool. Results of the study showed a highly statistically significant differences regarding knowledge and self-care practice vaginal support pessaries and quality of life at different times of assessment (p < 0.000). Conclusion: empowerment of self-management among women using vaginal pessaries was highly effective on reducing severity of vaginal symptoms and improving quality of life. Recommendation: Based on the findings of this study the following should be recommended: The nurses should be familiar with self-care measures for vaginal pessaries in addition to more researches should be conducted considering the demographic and obstetric factors that have a crucial role in precipitating self management for vaginal pessary.

Patient Adherence to a Mobile Phone-Based Heart Failure Telemonitoring Program: A Longitudinal Mixed-Methods Study.

BackgroundTelemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients consistently adhere to taking prescribed home readings.ObjectiveThe objectives of this study were to (1) quantify the degree to which patients adhered to taking prescribed home readings in the context of a mobile phone–based TM program and (2) explain longitudinal adherence rates based on the duration of program enrollment, patient characteristics, and patient perceptions of the TM program.MethodsA mixed-methods explanatory sequential design was used to meet the 2 research objectives, and all explanatory methods were guided by the unified theory of acceptance and use of technology 2 (UTAUT2). Overall adherence rates were calculated as the proportion of days patients took weight, blood pressure, heart rate, and symptom readings over the total number of days they were enrolled in the program up to 1 year. Monthly adherence rates were also calculated as the proportion of days patients took the same 4 readings over each 30-day period following program enrollment. Next, simple and multivariate regressions were performed to determine the influence of time, age, sex, and disease severity on adherence rates. Additional explanatory methods included questionnaires at 6 and 12 months probing patients on the perceived benefits and ease of use of the TM program, an analysis of reasons for patients leaving the program, and semistructured interviews conducted with a purposeful sampling of patients (n=24) with a range of adherence rates and demographics.ResultsOverall average adherence was 73.6% (SD 25.0) with average adherence rates declining over time at a rate of 1.4% per month (P<.001). The multivariate regressions found no significant effect of sex and disease severity on adherence rates. When grouping patients’ ages by decade, age was a significant predictor (P=.04) whereby older patients had higher adherence rates over time. Adherence rates were further explained by patients’ perceptions with regard to the themes of (1) performance expectancy (improvements in HF management and peace of mind), (2) effort expectancy (ease of use and technical issues), (3) facilitating conditions (availability of technical support and automated adherence calls), (4) social influence (support from family, friends, and trusted clinicians), and (5) habit (degree to which taking readings became automatic).ConclusionsThe decline in adherence rates over time is consistent with findings from other studies. However, this study also found adherence to be the highest and most consistent over time in older age groups and progressively lower over time for younger age groups. These findings can inform the design and implementation of TM interventions that maximize patient adherence, which will enable a more accurate evaluation of impact and optimization of resources.International Registered Report Identifier (IRRID)RR2-10.2196/resprot.9911

Accounts of Family Conflict in Home Hospice Care: The Central Role of Autonomy for Informal Caregiver Resilience.

End-of-life caregiving is a highly stressful experience often fraught with conflict and tension. However, little is known about the ways family conflict manifests for informal caregivers of home hospice patients (IHCs). Framed by relational dialectics theory, the purpose of this study was to provide nurses and other health care professionals with an empirical understanding of how IHCs experience family conflict and tensions associated with caregiving. A second aim was to determine what strategies IHCs use to manage these family conflicts. Data used in this qualitative secondary analysis were originally collected as part of a randomized clinical trial of an IHC support intervention. Based on thematic analysis of data from 25 IHCs who reported family conflict, a conceptual model of caregiver resilience was developed from the themes and categories that emerged during the coding stage. Autonomy was identified as a central tension. IHCs used several strategies to address family conflict including communication, formal support, and emotional self-care.

Behavioral health of US military veterinary personnel deployed to Afghanistan.

OBJECTIVE To compare symptoms of compromised behavioral health (BH symptoms) and factors protecting against those symptoms (protective factors) in military veterinary and nonveterinary health-care personnel deployed to Afghanistan. DESIGN Cross-sectional survey. SAMPLE 237 deployed military health-care personnel (21 veterinary and 216 nonveterinary). PROCEDURES Surveys were administered to participants during combat deployment in Afghanistan in 2013 to collect information on BH symptoms and protective factors. Data were compared between veterinary and nonveterinary health-care personnel by use of regression models controlling for demographic characteristics and deployment experiences. Partial correlations were computed to assess relationships between protective factors and BH symptoms, controlling for personnel type. RESULTS Less than 15% of veterinary and nonveterinary health-care personnel were at risk for suicidal ideation, major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder. After adjusting for covariates, both personnel types had similar levels of depression, posttraumatic stress disorder, and anxiety symptoms; however, veterinary personnel reported more distressing secondary traumatic stress symptoms and a greater number of anger reactions. Self-care, team support, and perceived supportive leadership were inversely associated with BH symptoms regardless of personnel type. Veterinary personnel engaged in less self-care, provided less team care, and rated leadership behaviors less positively than nonveterinary health-care personnel. CONCLUSIONS AND CLINICAL RELEVANCE Compared with nonveterinary health-care personnel, deployed veterinary personnel were at greater risk of generalized anxiety disorder and reported more secondary traumatic stress and anger reactions, but were less likely to be engaged in and exposed to protective factors. Interventions designed to promote self-care and team support for veterinary personnel and their leaders may reduce the occupational risk of BH symptoms in deployment and perhaps other settings.

Perceived Self -Efficacy among Patients with Psoriasis

Skin diseases are very common. Psoriasis vulgaris is a common inflammatory and hyper-proliferative skin disease. Self-efficacy refers to the patients that they belief that he / she can carry out behaviour necessary to reach a desired goal, even when a situation contains unpredictable and stressful elements. The functional component that serves as boon to them is self-care management support. The objective of the study is to assess the perceived self- efficacy by using self- efficacy of managing chronic disease – 6 items. A descriptive cross-sectional study design was used where 168 patients with psoriasis were selected for the study using consecutive sampling. The result was highlighted that there was a high behaviour noted for their self- efficacy to care for themselves.