Self-management Self-efficacy Research Articles

Participants’ experiences of an Education, self-management and upper extremity eXercise Training for people with Rheumatoid Arthritis programme (EXTRA)

BackgroundThe Education, self-management and upper extremity eXercise Training for people with Rheumatoid Arthritis programme (EXTRA) is an individualized, upper limb, home exercise regimen supplemented by four supervised, group sessions, a handbook and exercise dairy which improves upper extremity disability and self-efficacy. Objective and study designThis qualitative interview study explored participants’ experience of EXTRA to inform development and implementation of EXTRA into practice. ParticipantsAdults with Rheumatoid Arthritis who completed EXTRA were purposively sampled to include a range of ages, upper extremity disabilities, self-efficacy for arthritis self-management and attendance at EXTRA sessions. MethodsIndividual, semi-structured interviews were conducted with a single researcher until data saturation of themes was reached. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. ResultsTwelve participants (10 females; 32 to 87 years) were interviewed. Four overarching themes were identified: (i) empowering self-management; (ii) influence of others and (iii) the challenge of sustaining exercise, which resonate with the Social Cognition Theory, and (iv) refining EXTRA: consistent and personalised. ConclusionsEXTRA enhanced participants’ confidence to manage their arthritis independently and was adaptable so it could be integrated with other life commitments. Whilst healthcare professionals, peers and family and friends influenced exercise uptake, sustaining exercise was challenging. Participants desired consistent and continuing contact with a familiar physiotherapist (e.g. via follow-up appointments, digital health technologies) which accommodated individual needs (e.g. different venues, session frequency). Implementation of EXTRA needs to appreciate and address these considerations to facilitate success.

Beliefs in Antiretroviral Treatment and Self-Efficacy in HIV Management are Associated with Distinctive HIV Treatment Trajectories.

An online survey was conducted among people living with HIV (PLHIV) in Australia to discern key factors associated with distinctive ART use patterns. The sample (N=358), was further divided into three groups: those on ART continuously since initiation (n=208, 58.1%); those on ART intermittently (n=117, 32.7%); and those not on ART at the time of survey (n=33, 9.2%). ART non-users were the most likely to hold serious concerns about ART that outweighed perceived necessities (benefits) from ART (AOR=0.13; 95% CI 0.06-0.29; p<0.001). They were also the least self-efficacious in HIV disease management (AOR=0.29; 95% CI 0.09-0.87; p=0.028). Intermittent ART users were more likely to receive their HIV diagnosis prior to 2003 (AOR=0.38; 95% CI 0.28-0.53; p<0.001) and perceive lower HIV management self-efficacy (AOR=0.50, 95% CI 0.28-0.87; p=0.015) than continuous users. ART-related beliefs and perceived self-efficacy in HIV self-management play an important role in achieving universal treatment uptake and sustained high levels of adherence.

Validating a Measure of Patient Self-efficacy in Disease Self-management Using a Population-based IBD Cohort: The IBD Self-efficacy Scale.

Self-efficacy describes a person's confidence in their ability to manage demands, and is predictive of health outcomes in chronic disease such as hospitalization and health status. However, meaningful measurement must be domain (e.g., disease) specific. This study aims to provide validation of the Inflammatory Bowel Disease Self-Efficacy scale (IBD-SE), using a population-based IBD sample. Manitoba IBD Cohort Study participants completed a survey and clinical interview at a mean of 12 years postdiagnosis (n = 121 Crohn's disease; n = 108 ulcerative colitis), which included validated measures of psychological functioning, disability, disease-specific quality of life, perceived health, and current and recent disease activity, in addition to the IBD-SE. The IBD-SE had high internal consistency (Cronbach's α = 0.97), and a 4-factor structure was confirmed. Construct validity was demonstrated as follows: the IBD-SE was strongly correlated with mastery (r = 0.53), highly correlated in the expected directions with measures of psychological well-being (r = 0.70), stress (r = -0.78), distress (r = -0.71), disability (r = -0.48), disease-specific quality of life (r = 0.68), and overall perceived health (r = 0.52) (all P < 0.001). Those with currently inactive disease had higher self-efficacy than the active disease group (Crohn's disease: mean = 232 versus 195, P < 0.001; ulcerative colitis: mean = 233 versus 202, P < 0.01), with similar findings for recent symptomatic disease activity. The IBD-SE is a reliable, valid, and sensitive measure as demonstrated in this population-based sample, supporting its utility in IBD. Because self-efficacy is a modifiable psychological characteristic that can contribute to positive health outcomes, the IBD-SE may prove to be a valuable instrument for research and in targeted intervention with IBD patients.

Identification of subtypes of Chinese schizophrenia patients before discharge: A cluster analysis

IntroductionPeople with schizophrenia is a highly heterogeneous group. Identifying subtypes of people with schizophrenia before discharge may help develop targeted discharge plans.ObjectivesTo explore possible subtypes among people with schizophrenia before discharge by their self-management ability, self-efficacy and cognitive function status.AimsTo identify possible subtypes among people with schizophrenia before discharge.MethodsTotally, 150 Chinese people with schizophrenia before discharged from a tertiary psychiatric hospital in Beijing were assessed by Self-management Instrument for People with Schizophrenia and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Cluster analysis using SPSS 20.0 package was performed to categorize subjects based on their scores.ResultsFour different types of subjects were revealed. Type I low cognition with no participation (n = 25), patients’ self-management ability, self-efficacy and cognitive function were very poor; type II medium cognition with blind confidence (n = 42), patients’ self-efficacy was good, while self-management ability was poor and cognitive function is medium; type III high cognition with high level skill (n = 46), patients’ cognitive function, self-management ability and self-efficacy were good; type IV low cognition with medium level skill (n = 37), patients’ cognition was very poor, while self-management ability and self-efficacy were medium. These four types of subjects had significant differences in long-term use of antipsychotics and primary caregivers’ education level (P &lt; 0.05).ConclusionsThe finding of different subtypes of people with schizophrenia presenting in this sample may help health professionals give effective screening and targeted discharge measures which can further promote patients’ recovery and reduce readmission rates.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The impact of sharing personalised clinical information with people with type 2 diabetes prior to their consultation: A pilot randomised controlled trial

AimTo assess the impact of sharing personalised clinical information with people with type 2 diabetes prior to their out-patient consultation on patient involvement during the consultation, diabetes self-management self-efficacy and glycaemic control. MethodsA pilot three-arm randomised controlled trial. The ‘intervention booklet’ group received a booklet including personalised clinical information, a ‘general information booklet’ control group received a booklet with no personalised clinical information and a ‘usual care’ control group received no written information. Results136 people took part. The intervention group were significantly more likely to have shown the booklet to a ‘significant other’, (48% V 23%, p<0.05), brought the booklet with them to the clinic (85% V 35%, p<0.005) and to refer to the booklet during the consultation (45% V 13%, p<0.005). No significant differences in patient involvement during the consultation, diabetes management self-efficacy or glycaemic control were found between the three groups. ConclusionsAlthough participants found it useful to receive their clinical results, no differences were found in the patient outcomes measured. Practice ImplicationsFurther pilot work on the timing of the intervention, who it is targeted at and what outcomes are measured is warranted before proceeding to a full-scale RCT.

Effect of an education program on knowledge, self-care behavior and handwashing competence on prevention of febrile neutropenia among breast cancer patients receiving Doxorubicin and Cyclophosphamide in Chemotherapy Day Centre

Objective:To evaluate the efficacy of an education program on the prevention of febrile neutropenia (FN) among breast cancer patients receiving AC regimen.Methods:Randomized controlled trial with the repeated-measures design was conducted in a Chemotherapy Day Centre of an acute hospital in Hong Kong. Twenty-five subjects in the intervention group received an individual education session followed by three follow-up sessions and routine care. Twenty-four subjects in the control group received routine care. Primary outcomes included the incidence of admission due to FN, the self-care behavior adherence, the knowledge level on prevention of FN and the self-efficacy in self-management, handwashing competence were assessed by self-designed questionnaires, Chinese version of patient activation measure, and handwashing competence checklist.Results:No statistically significant difference between the intervention group and the control group on the incidence of admission due to FN, the self-efficacy in self-management, and the knowledge on prevention of FN. The self-care behavior adherence was significant at cycle 4 of AC regimen in favor of the intervention group (P = 0.036). Handwashing competence improved more significantly among subjects in the intervention group than the control group (P = 0.009).Conclusions:The education program on the prevention of FN had significantly favorable effects on self-care behavior adherence and handwashing competence across time. However, the intervention did not lead to statistically significant improvement on the incidence of admission due to FN, the self-efficacy in self-management and the knowledge level on prevention of FN.

HeLP-Diabetes: randomised controlled trial protocol.

BackgroundType 2 Diabetes Mellitus (T2DM) is common, affecting nearly 400 million people worldwide. Achieving good health for people with T2DM requires active self-management; however, uptake of self-management education is poor, and there is an urgent need to find better, more acceptable, cost-effective methods of providing self-management support. Web-based self-management support has many potential benefits for patients and health services. The aim of this trial is to determine the effectiveness and cost-effectiveness of a web-based self-management support programme for people with T2DM.MethodsThis will be a multi-centre individually randomised controlled trial in primary care, recruiting adults with T2DM who are registered with participating general practices in England. Participants will be randomised to receive either an evidence-based, theoretically informed, web-based self-management programme for people with T2DM which addresses medical, emotional, and role management, called Healthy Living for People with type 2 Diabetes (HeLP-Diabetes) or a simple information website. The joint primary outcomes are glycated haemoglobin (HbA1c) and diabetes-related distress, measured by the Problem Areas In Diabetes (PAID) questionnaire. Secondary outcomes include cardiovascular risk factors, depression and anxiety, and self-efficacy for self-management of diabetes. Health economic data include health service use, costs due to the intervention, and EQ-5D for calculation of Quality Adjusted Life Years (QALYS). Data will be collected at baseline, 3 months and 12 months, with the primary endpoint at 12 months. Practice nurses, blinded to patient allocation, collect clinical data; patients complete online questionnaires for patient reported measures. A sample size of 350 recruited participants allows for attrition of up to 15 % and will provide 90 % power of detecting at a 5 % significance level a true average difference in the PAID score of 4.0 and 0.25 % change in HbA1c (both small effect sizes). The analysis will follow a pre-specified analysis plan, based on comparing the groups as randomised (intention-to-treat).DiscussionThe findings of this trial are likely to be of interest to policy makers, clinicians, and commissioners, all of whom are actively seeking additional forms of self-management support for people with T2DM.Trial registrationThe Trial Registration number is ISRCTN 02123133; date of registration 14.2.13.

Distress and type 2 diabetes-treatment adherence: A mediating role for perceived control.

To better understand independent pathways linking emotional distress, medication adherence, and glycemic control in adults with Type 2 diabetes, as well as the potential mediating effects of perceived control over illness and self-efficacy. Adults with Type 2 diabetes (N = 142) were recruited for an intervention study evaluating cognitive-behavioral therapy for adherence and depression. Depressive symptom severity was assessed via semistructured interview. Validated self-reports assessed diabetes-related distress, perceived control over diabetes (perceived control), self-efficacy for diabetes self-management, and medication adherence. Glycemic control was evaluated by hemoglobin A1C. Only baseline data were included in correlational and linear regression analyses. Perceived control was an important mediator of emotional distress for both medication adherence and A1C outcomes. Specifically, regression analyses demonstrated that diabetes distress, but not depression severity, was significantly related to medication adherence and A1C. Self-efficacy and perceived control were also independently associated with medication adherence and A1C. Mediation analyses demonstrated a significant indirect effect for diabetes distress and medication adherence through perceived control and self-efficacy. The relationship between distress and A1C was accounted for by an indirect effect through perceived control. Results demonstrated that diabetes-related emotional distress is associated with poorer treatment adherence and glycemic control among adults with Type 2 diabetes; these relationships were partially mediated through perceived control over diabetes. Perceptions of one's personal ability to influence the course of diabetes may be important in understanding the pathway between emotional distress and poor diabetes-treatment outcomes.

Prevalence of Low Mobility and Self-Management Self-Efficacy in Manual Wheelchair Users and the Association With Wheelchair Skills

ObjectiveTo estimate the prevalence of low wheelchair-mobility and self-management self-efficacy and to evaluate the association with wheelchair skills. DesignCross-sectional. SettingCommunity. ParticipantsCommunity-dwelling manual wheelchair users (N=123) who were ≥50 years of age (mean, 59.7±7.5y) and from British Columbia and Quebec, Canada. InterventionsNone. Main Outcome MeasuresThe 13-item mobility and 8-item self-management subscales from the Wheelchair Use Confidence Scale–Short Form (standardized scores range, 0–100) measured self-efficacy, and the 32-item Wheelchair Skills Test, Questionnaire Version (scores range, 0–100) measured wheelchair skills. A score of 50 was used to differentiate individuals with high and low self-efficacy, and a score of 72 differentiated between high and low wheelchair skills. ResultsThe prevalence of low wheelchair-mobility and self-management self-efficacy was 28.5% (95% confidence interval [CI], 20.6–36.4) and 11.4% (95% CI, 5.8–17.0), respectively, and their bivariate association with wheelchair skills was r=.70 and r=.39, respectively. Of the sample, 16% reported conflicting mobility self-efficacy and skill scores; 25% reported low self-efficacy and high skills. Of the participants, 30% reported conflicting scores between self-management self-efficacy and wheelchair skills, with 8.1% reporting lower self-efficacy than skill. ConclusionsLow self-efficacy was relatively high in this sample as was its discordance with wheelchair skills. Interventions to address low self-efficacy and/or offset the discordant self-efficacy/skill profiles are warranted.

Multi-factor analysis of influencing factors of the self-care efficacy for PHC patients by transcatheter arterial chemoembolization of different age groups

Objective The objective of this study was to explore the difference factors for PHC pa-tients by transcatheter arterial chemoembolization of different age groups of senior people in China and sup-port reference for individualized intervention by clinical medical workers. Methods 153 cases of PHC pa-tients by TACE were selected by convenience sampling method from October 2013 to June 2014. The data were collected using general data questionnaire, Health Promotion Strategy Scale, QOL-LC, Memorial Symp-tom Assessment Scales and Social Support Scale to evaluate the physical, psychological and social aspects of the PHC patients. We divided the patients into young, middle-aged and elderly groups. Single factor and multiple factors regression analysis were used to compare the status and influencing factors. Results Psy-chological function, value of blood AFP, marital status entered the model and were self-care efficacy and correlated factors of young-aged patients, which could explain 50.6% of the total varience. Physical symptoms, exploitation degree of support and intervention treatment times entered the model and were self-care efficacy and correlated factors of middle-aged patients, which could explain 47.8% of the total varience. Symp-tom distress, degree of cultural and psychological function entered the model and were self-care efficacy and correlated factors of elderly-aged patients, which could explain 42.4% of the total varience. Conclusions The self-care efficacy were low in all ages of PHC patients by TACE, it is associated with a variety of factors. Doc-tors and nurses should pay more attention to the self-care efficacy for PHC patients by transcatheter arterial chemoembolization with different age groups. Also we should evaluate and make well-targeted policies and personalized inter-ventions to promote self-management self-efficacy. Key words: Transcatheter arterial chemoembolization; Primary hepatic carcinoma; Self-care ef-ficacy; Multiple regression

Correlates of participation in meaningful activities among people with multiple sclerosis.

To explore the associations between impairments, self-management self-efficacy, self-management behaviors, and environmental factors and their role in predicting participation in meaningful activities among people with multiple sclerosis. Online cross-sectional survey. Randomly selected individuals (n = 335) from a large multiple sclerosis patient registry. Participation in activities that are meaningful to the individual was measured with Community Participation Indicators (CPI), the dependent variable. Independent variables included symptom severity, activities of daily living limitations, cognitive problems, stages of change for physical activity, nutritional behaviors, self-efficacy, and environmental barriers. A backwards selection regression analysis was used to compare the relative contributions of independent variables in predicting the CPI. A path analysis was conducted to explore the associations between independent variables and their direct and indirect effects on the CPI. The final regression model included self-management self-efficacy (β = 0.12), environmental barriers (β = -0.16), cognitive problems (β = -0.22), and stages of change for physical activity (β = 0.12). Path analysis indicated that impairments and environmental barriers might negatively influence self-management self-efficacy. Self-management self-efficacy might have indirect effects on the CPI via engagement in self-management behaviors. Future research should explore whether interventions that promote self-management self-efficacy can facilitate participation in meaningful activities.

노인의 당뇨병 관리 자기효능감 측정도구 개발 및 평가

Purpose: The purpose of this study was to develop and validate a diabetes management self-efficacy scale for older adults (DMSES-O). Methods: A preliminary DMSES-O of 22 items was derived from a literature review and seven domains of self-management behaviors. Content validity was confirmed by experts in diabetes self-management education. To test the reliability and validity of the DMSES-O, data were collected from 150 older adults with type 2 diabetes. The data were analyzed using exploratory factor analysis, and Cronbach's ⍺ and Pearson's correlation coefficients were calculated. Results: From the exploratory factor analysis, 17 significant items in six subscales were derived. Factors derived were named “problem solving for hypoglycemia and self-monitoring blood glucose,” “problem solving for hyperglycemia,” “coping with psychological distress and taking medication,” “reducing risks of diabetes complications,” “appropriate exercise,” and “healthy eating.” The criterion-related validity of the DMSES-O was established by its correlation with the Summary of Diabetes Self-care Activities Questionnaire. Cronbach's ⍺, a measure of internal consistency, was .84 for the overall scale and ranged from .54 to .80 for the subscales. Conclusion: The DMSES-O is a reliable and valid instrument to measure selfefficacy for diabetes self-management among older adults.

Exploring prostate cancer survivors' self-management behaviours and examining the mechanism effect that links coping and social support to health-related quality of life, anxiety and depression: A prospective longitudinal study

ObjectiveLittle is known about the influence of psycho-social factors on health-related quality of life (HRQoL), anxiety and depression in men affected by prostate cancer. Developing an understanding in this area can help to identify men who are at high risk of inadequate support and suggest directions for appropriately targeted interventions. Moreover, little is known about how men affected by prostate cancer mobilise social support in their self-management behaviours over time. This is the first study to test the effects of coping and social support on HRQoL and emotional outcome, and assessed the self-management behaviours of men affected by prostate cancer overtime. MethodsThe study population was 74 prostate cancer patients with a mean age of 67.3 (SD 7.9) years and mixed treatment modalities. The EORTC QLQ-C30, PR25 and HADS were used to assess the dependant variables before treatment and at six months follow-up. Statistical analysis was performed in SPSS version 17.0 using parametric tests and non-parametric tests. ResultsA significant decline in quality of life was observed at 6 months post diagnosis (p < 0.001). Perceived social support before radical treatment was the most important social support construct that predicted better global quality of life and less depression at six months, explaining approximately 30% of the variance. Despite men's self-management efforts and use of social support overtime, self-management self-efficacy significantly reduced at six months (p < 0.05). ConclusionThese findings provide support towards the development of a psycho-social intervention study to improve quality of life, self-management self-efficacy and improve patients' symptom management.

유방암예방 자원봉사활동에 참여한 유방암 생존자들의 자기효능감, 우울 및 외상 후 성장의 변화

본 연구는 유방암예방 자원봉사활동을 통한 유방암 생존자들의 자기효능감, 우울, 및 외상 후 성장의 장기적 효과를 탐색하기 위해 실시되었다. 본 예비연구는 종단적 방법을 이용하였으며 참여자는 유방암예방교육프로그램에 참여한 유방함 생존자 14명이었다. 자료는 2013년 2월부터 8월까지 수집되었으며 자가보고식 설문지를 이용하여 유방암 자가관리에 대한 자기효능감, 우울, 및 외상 후 성장을 교육 전(T0), 교육 후 1개월(T1), 교육 후 3개월(T2), 교육 후 6개월(T3)에 각각 측정하였다. 효과분석을 위해 일반화 추정 방정식을 사용하였다. 자기효능감 점수는 T0과 비교했을 때 T1(<TEX>${\chi}^2$</TEX>=5.56, p=.018),T3(<TEX>${\chi}^2$</TEX>=4.56,p=.033)시점에 유의하게 증가하였다. 6개월 동안 우울은 일반인에 비해 낮은 수준으로 큰 변화가 없었고 외상 후 성장은 비교적 높은 점수가 유지되었다. 이러한 결과는 유방암 생존자들의 유방암예방 자원봉사활동이 자기효능감을 향상시키고 심리적 안녕을 유지하는데 효과적일 수 있음을 시사한다. 유방암 생존자의 유방암예방 자원봉사활동은 일반인 뿐 아니라 참여한 유방암 경험자들에게도 유용한 교육프로그램임을 보여주었다. Purpose : This study was to explore the long-term effects of breast cancer prevention volunteering on self-efficacy, depression, and posttraumatic growth among survivors with breast cancer. Methods: This pilot study utilized a longitudinal design. Participants were 14 women with breast cancer who participated in the breast cancer prevention educational program The data were collated between February and August in 2013. Self-report questionnaires were used to measure the self-efficacy for self-management of breast cancer, depression, and posttraumatic growth at pre-education(T0), 1 month(T1), 3 months(T2), and 6 months(T1) post-education. A generalized estimating equation regression model was used to identify the effects. Results: The scores of self-efficacy increased significantly at T1(<TEX>${\chi}^2$</TEX>=5.56, p=.0l8) and D(<TEX>${\chi}^2$</TEX>=4.56, p=.033) compared with T0. Depression and posttraumatic growth remained stable with fairly good levels throughout the 6-month period. Conclusion: The results of this study suggest that breast cancer prevention volunteering in survivors with breast cancer can be effective for enhancing their self-efficacy and maintaining psychological well-bang. Also the study showed that such volunteering activity could be a useful program not only for the general public but also for breast cancer survivors.

Effect of Self-care Education at a Diabetes Camp on Diabetes Management Behaviors, Knowledge and Self-efficacy in Children with Type 1 Diabetes.

PURPOSE: Study purposes were to exam effects of self-care education for children with type 1 diabetes on their diabetes management behaviors and to explore the relationship among diabetes management behaviors, knowledge, self-efficacy and clinical variables.METHODS: This study was a one group quasi-experimental study. Study participants were children with type 1 diabetes and attended a four hour self-care education of a diabetes camp. Data were collected using structured questionnaires including Diabetes Management Behavior Scale (DMBS), Michigan Diabetes Research and Training Center's Brief Diabetes Knowledge Test and Self-Efficacy for Diabetes Self-Management.RESULTS: The mean age of the participants was 12 (+/-2.3) years. After the education, their DMBS and knowledge improved, but the improvement was not statistically significant (t=1.758, p=.101; t=0.528, p=.606). Two areas of DMBS, daily prevention behaviors and modification of care plan, were associated with study variables. Daily prevention behaviors were associated with duration of diabetes (r=.653, p=.008), HbA1c (r=.563, p=.038) and having a complication (r=-2.788, p=.015). Modification of care plan was associated with age at diagnosis (r=-.552, p=.033).CONCLUSION: Children with type 1 diabetes could improve some parts of their diabetes management behaviors even after a short diabetes camp.

Diabetes Peer Coaching

The purpose of this study was to identify characteristics of peer coaches associated with improvement in diabetes control among low-income patients with type 2 diabetes. Low-income patients with type 2 diabetes who spoke English or Spanish from 6 urban clinics in San Francisco, California, were invited to participate in the study. Twenty participants received training and provided peer coaching to 109 patients over a 6-month peer coaching intervention. Primary outcome was average change in patient glycosylated hemoglobin (A1C). Characteristics of peer coaches included age, gender, years with diabetes, A1C, body mass index (BMI), levels of diabetes-related distress, self-efficacy in diabetes self-management, and depression. Patient improvement in A1C was associated with having a coach with a lower sense of self-efficacy in diabetes management (P < .001), higher level of diabetes-related distress (P = .01), and lower depression score (P = .03). Coach characteristics are associated with patient success in improving A1C. "Better" levels of coach diabetes self-efficacy and distress were not helpful and, in fact, were associated with less improvement in patient A1C, suggesting that some coach uncertainty about his or her own diabetes might foster improved patient self-management. These coach characteristics should be considered when recruiting peer coaches.

Long-term Efficacy of Occupational Lifestyle Redesign Programme for Strokes

Objective/Background To devise an Occupational Lifestyle Redesign Programme (OLSR), in addition to the existing conventional therapy programme, in a local rehabilitation hospital in order to help stroke outpatients improve their self-efficacy and commitment in self-management after a stroke attack using goal-oriented, challenging, and well-being building activities. The long-term effect on the poststroke quality of life (QOL) and community integration has to be explored. Methods This is a retrospective study performed to compare two groups of matched samples of participants (25 each) who have or have not joined the OLSR programme. A telephonic interview was performed to gather the participants’ responses. Self-reported outcome measures, including sickness impact [Stroke Adapted Sickness Impact Profile-30 (SA-SIP30)], motivation for general activity [General Activity Motivation Measure (GAMM)], community integration (Community Integration Questionnaire), and subjective well-being [World Health Organization Well-Being Index (WHO-5)] scores were assessed. Results Subjective well-being measures had significantly higher scores in the OLSR group (F = 5.52; p = .023). The OLSR group also reported a significantly better score in social integration (F = 4.302; p = .043). The SA-SIP30 mean score of the OLSR group [mean = 6.64; standard deviation (SD) = 4.35] was much lower, however, with significant difference in Mobility (F = 4.47; p = .04) and Household Management (F = 6; p = .015) subscores. The mean score of GAMM was also high in the OLSR group (mean = 41.32; SD = 11.98; p = .06). Improving “productive activity,” “social interaction,” “home management,” and “emotion” scores (based on factor analysis) are important goals to be achieved in a stroke rehabilitation programme so as to extend its scope from just physical restoration to building a better poststroke life. Conclusion The positive effect of OLSR programme has been shown to be effective in filling the gap of psychosocial adaptation in conventional stroke rehabilitation programmes. The patients in the OLSR programme had improved motivation levels and predicted better QOL in long term.

Association of Self-Efficacy and Outcome Expectations with Physical Activity in Adults with Arthritis

Background and Purpose. The purpose of this study is to determine whether higher baseline levels of (a) self-efficacy for physical activity, (b) self-efficacy for arthritis self-management, and (c) outcome expectations for exercise are associated with higher physical activity levels following an exercise intervention for adults with arthritis. Methods. A secondary analysis of the intervention cohort (n = 130) within a randomized controlled trial of the People with Arthritis Can Exercise program was performed. Multiple linear regression evaluated the relationship between physical activity at a time point three months after the completion of an exercise intervention and three main explanatory variables. Results. After controlling for baseline physical activity, neither self-efficacy for arthritis self-management nor outcome expectations for exercise related to three-month physical activity levels. There was a relationship between three-month physical activity and self-efficacy for physical activity. Conclusions. Future research is needed to evaluate the ability of self-efficacy-enhancing programs to increase physical activity in adults with arthritis.

Effect of empowerment education on self-management ability and self-efficacy in patients with PICC

Objective To compare the influence on self-management ability and self-efficacy in patients with peripherally inserted central catheter (PICC) between empowerment education and tranditional healtheducation.Methods Totally 60 cancer patients with PICC were randomly divided into two groups,30 patients in the experimental group with empowerment education method and 30 patients in the control group with tranditional health education method.The effect of health education was evaluated by using self-management behavior scale,self-effcacy questionnaire scale,the incidence of PICC complication and compared between the two groups.Results One month after discharge,the self-care ability score of patients was (89.61 ± 8.19) in the control group,(103.06 ± 16.2) in the experimental group,the difference was statistically significant between the two groups (t =2.403,P ＜ 0.05).Three months after discharge,the self-efficacy score of patients was (22.47 ±4.86) in the control group,(27.61 ± 5.35) in the experimental group,the difference was statistically significant between the two groups (t =4.116,P ＜ 0.01).One month after discharge,the incidence of PICC complication of patients was 50％ in the control group,10％ in the experimental group,the difference was statistically significant between the two groups (x2 =4.414,P ＜ 0.05).Conclusions Empowerment education can obviously improve the self-efficacy in patients with PICC,enhance their management ability and confidence on disease,reduce the incidence of PICC complications and improve their quality of life. Key words: PICC ; Authorized education; Self-care ability; Self-efficacy

RAHelp: An Online Intervention for Individuals With Rheumatoid Arthritis

To test an intervention for improving self-management in rheumatoid arthritis (RA) using an online, cognitive-behavioral, self-management group program (RAHelp), with weekly telephone support. A 2-group, randomized study design was used to compare an intervention for RA versus a waiting-list control condition. The intervention used a secure web site (RAHelp.org) to provide a 10-week program with weekly educational modules for improving self-efficacy in self-management of RA, plus tools for group interaction. Weekly telephone contacts were made to encourage use of program tools and apply newly learned skills. A nationwide convenience sample of 106 adult participants (mean age 50 years, 93% women) was recruited primarily through online advertisements. Main outcome measures included the Arthritis Impact Measurement Scales 2 (affective, physical, role, social, and pain/symptom components), Arthritis Self-Efficacy Scale (ASES), Center for Epidemiologic Studies Depression Scale, Quality of Life Scale (QLS), Rapid Assessment of Disease Activity in Rheumatology, Social Provisions Scale, and University of California, Los Angeles Loneliness Scale 3. Group differences with large and moderate effect sizes (ES) were found immediately postintervention for self-efficacy (ASES; ES 0.92, P = 0.00001) and quality of life (QLS; ES 0.66, P = 0.003), respectively. At 9 months postintervention, differences in self-efficacy (ASES; ES 0.92, P = 0.00001) and quality of life (QLS; ES 0.71, P = 0.004) remained robust. RAHelp appears to have beneficial effects in terms of self-efficacy and quality of life among individuals with RA who are willing to use an online service format.