Self-management Domains Research Articles

P0823 Access to an integrated Inflammatory Bowel Disease diet clinic improves patient-reported outcomes and dietary self-confidence in a tertiary service previously without dietetic services

Abstract Background Disability and impaired food-related quality of life (FRQoL) is prevalent in people with inflammatory bowel disease (IBD). The aim of this study was to examine whether access to specialised IBD diet care influenced patient-reported outcomes. Methods This was a prospective study of an IBD Diet Clinic (IBDDC) piloted at The Queen Elizabeth Hospital, South Australia between February 2021- September 2022. During routine IBD care, adults with diet-related issues were referred to a specialised IBD dietitian and invited to complete questionnaires evaluating before- and after dietary intervention. The primary outcome was change in FRQoL (defined as 0 (poor) and 149 (exceptionally high). Secondary outcomes included change in IBD-disability index (IBD-DI), domains of diet self-management including knowledge and self-confidence and satisfaction with IBD diet care. Appropriate statistical tests were applied to descriptive, categorical, and paired data. Results Of 91 who attended first consult in IBDDC, 55 completed before- and after-dietetic intervention questionnaires. FRQoL scores were 64.6 (SD 16.8) at baseline and improved by 13.9 points (95% CI 8.27, 19.6; p<0.001) following dietetic intervention. Similarly, IBD-DI scores improved by 3 points (95% CI 1.78, 4.22; p<0.001), knowledge of what to eat improved by 37% (p<0.001) and confidence in self-managing diet improved by 21% (p=0.003). Satisfaction with dietary advice was high; 46/55 (83%) were satisfied or extremely satisfied and 49/55 (89%) placed high or extremely high value on continuation of an integrated IBDDC within The Queen Elizabeth Hospital IBD service. Conclusion In an IBD service previously without a dedicated diet clinic, access to integrated, specialised and personalised IBD dietary care led to a significant improvement in all patient-reported outcomes and a high level of patient satisfaction. Poor baseline FRQoL was identified in IBD patients without access to specialised dietetic care and through attendance to an IBDDC, FRQoL, disability indices and dietary self-confidence improved.

Personality Feedback With Tailored Self-Care Recommendations Improves Self-Efficacy for Cancer Management: A Randomized Controlled Trial.

To test whether a personality feedback intervention improves three domains of cancer self-management: self-awareness, self-efficacy, and positive affect. From 11/2020-02/2021, 372 adults diagnosed with cancer participated in a randomized controlled trial (RCT) of an intervention that entailed reading a brief personality-related excerpt during an online survey. Eligibility included self-reported age ≥ 18years, current or past cancer diagnosis, and ability to read English. The survey included a baseline assessment with a personality questionnaire, then randomized participants to one of two groups. The intervention group (n=184) received a personality feedback report with tailored self-care tips, whereas the control group (n=188) received a generic reading on personality theory. At the end of the survey, participants completed outcome measures of self-awareness (primary), self-efficacy for illness management, and positive affect. General linear models tested between-group differences in changes from baseline to post-test on each outcome. There was no intervention effect on self-awareness (primary outcome) or positive affect. However, compared to controls, intervention participants experienced a greater increase in self-efficacy for illness management (d=0.33, p=0.002), including in 2 of 3 constituent domains: self-efficacy for managing symptoms (d=0.36, p<0.001) and self-efficacy for managing treatments/medication (d=0.22, p=0.035). Despite the primary outcome's null results, this was the first RCT of a personality feedback intervention to show improvements in self-efficacy for managing chronic illness. Given the important role of self-efficacy in self-management, the intervention has implications for other cancer outcomes. Follow-up studies on longer-term outcomes such as health behaviors and quality of life should be explored. NCT04625439.

Qualitative acceptability testing of a paper-based care planner in patients with metastatic non-small cell lung cancer (mNSCLC).

259 Background: Patients with cancer and their caregivers often describe the fragmented, multi-modal and multi-provider cancer care experience as undertaking a difficult expedition without a map. Based on her experience in 2020 and using self and family management theories (doi: 10.1016/j.outlook.2008.10.004.), Daswani developed a pan-cancer patient planner, which helps patients and families prepare for appointments, track symptoms, and manage their care. It has been available since 2021 through hospitals, advocacy organizations and online retail channels. We adapted and customized the pan-cancer planner for patients with mNSCLC. We tested acceptability through a series of structured patient interviews, and a brief, in-person survey tool. Methods: A lung cancer survivor recruited members of the lung cancer community to participate in a 30-minute structured virtual interview. After reviewing the planner, interviewees were asked: 1) about their diagnosis and treatment experience and 2) to provide semi-structured feedback. We conducted interviews until thematic saturation was reached. We modified the planner based on interview results, distributed planners to patients and care-partners at a major lung cancer patient summit and immediately collected a brief survey to assess patient knowledge of their diagnosis and motivation for planner access. Results: The table shows high level thematic groups of interview responses. Interviewed patients concluded that the planner would have improved their experience because they would have: Stayed organized, facilitated note-taking during appointments, better tracked and managed symptoms &amp; meds, been more confident in decision-making and been able to journal, stay grounded and more mindful. Of 94 planners distributed at the summit, 49 patients knew their diagnosis, 31 knew their stage, 28 knew their cancer mutation status. Of the four domains of self-management, positive responses were: 1. Increase confidence 44 (47%) 2. Gain peace of mind 40 (43%) 3. Stay organized 58 (62%) 4. Manage meds &amp; symptoms 42 (45%). Conclusions: A paper based mNSCLC specific planner is acceptable to patients and they anticipate it would help with all four domains of self management (confidence, peace of mind, organization, med and symptom management) and enhance a difficult experience. We plan further usability testing as we did with the breast cancer planner (JCO Oncol Pract 19, 2023 (suppl 11; abstr 552)). Interviews of 8 (7 female, 1 male) patients (3 with English as a second language) were held in December 2023. Diagnosis Biomarker Testing Treatment Living with lung cancer Medical terms difficult to understand “Mutation” term caused anxiety Understanding options important Need for community Diagnosis often delayed Loss of agency Gratitude for care team Digital tools desired Cumulative trauma Additional languages Young adult survivorship desired

Assessing the performance of AI chatbots in answering patients’ common questions about low back pain

ObjectivesThe aim of this study was to assess the accuracy and readability of the answers generated by large language model (LLM)-chatbots to common patient questions about low back pain (LBP).MethodsThis...

Identifying the deficiencies of currently available CGM to improve uptake and benefit.

The use of diabetes technologies is increasing worldwide, with health systems facilitating improved access to devices. Continuous glucose monitoring is a complex intervention that provides information on glucose concentration, rate and direction of change, historical data and alerts and alarms for extremes of glucose. These data do not themselves change glycaemia and require translation to a meaningful action for impact. It is, therefore, crucial that such systems advance to better meet the needs of individuals using them. Narrative review of the use of, engagement with, limitations and unmet needs of continuous glucose monitoring systems. CGM devices have made a significant contribution to the self-management of diabetes; however, challenges with access and user experience persist, with multiple limitations to uptake and benefit. These limitations include physical size and implementation, with associated stigma, alarm fatigue, sleep disturbance and the challenge of addressing large volumes of real-time data. Greater personalisation throughout the continuous glucose monitoring journey, with a focus on usability, may improve the benefits derived from the device and reduce the burden of self-management. Healthcare professionals may have unconscious biases that affect the provision of continuous glucose monitors due to deprivation, education, age, ethnicity and other characteristics. Continuous glucose monitoring exerts a dose-dependent response; the more it is used, the more effective it is. For optimal use, continuous glucose monitors must not just reduce the burden of management in one dimension but facilitate net improvement in all domains of self-management for all users.

Exploring the relationship between illness perception, self-management and quality of life among HIV-positive men who have sex with men.

This study aimed to explore the mediating effect of self-management (SM) on the relationship between illness perception and quality of life (QOL) among Human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). A cross-sectional study. We explored the effect of illness perception and self-management on QOL using the multiple regression model. Moreover, we conducted a simple mediation analysis to examine the role of SM in the relationship between illness perception and QOL. In addition, a parallel mediation analysis was performed to investigate the differences in domains of SM on the relationship between illness perception and QOL. Among 300 Chinese HIV-positive MSM, the mean score of SM was 39.9 ± 6.97, with a range of 14.0-54.0. The higher score in SM indicated a higher level of HIV SM. SM was negatively related to illness perception (r = -0.47) while positively related to QOL (r = 0.56). SM partially mediated the relationship between illness perception and QOL, accounting for 25.3% of the total effect. Specifically, both daily self-management health practices and the chronic nature of the self-management domain played a parallel role in mediating the relationship between illness perception and QOL. Our study demonstrated that SM was a significant factor influencing QOL among HIV-positive MSM. Focusing on daily self-management health practices and the chronic nature of self-management could be the potential key targets for enhancing HIV self-management strategies. This study emphasized the role of SM in the well-being of HIV-positive MSM and underscored the importance of developing interventions that integrate SM strategies to improve QOL in this population. No patient or public contribution.

An Imperative Responsibility in Professional Role Socialization: Addressing Incivility

The study used a thematic analysis to examine student and faculty responses to two qualitative questions focused on their perceptions of the consequence of incivility and solutions that would embed civility expectations as a key element to professional role socialization in higher education. Participants included students and faculty across multiple academic programs and respondent subgroups at a regional university in the southern United States. A new adapted conceptual model using Clark’s in Nursing Education Perspectives, 28(2), 93–97 (2007, revised 2020) Conceptual Model for Fostering Civility in Nursing Education and Daniel Goleman’s in Emotional intelligence: Why it can matter more than IQ. Bantam Books (1995) Emotional Intelligence domains was used as the framework for this study to give meaning and context to its findings. For this group of respondents, the study found that seventy percent of faculty and students agree that incivility has the largest impact on the emotional intelligence domain of self-management, which includes negative emotional outcomes, loss of respect, negative professional and student outcomes, poor academic outcomes, attrition, and less success. Leadership in higher education will strengthen their institutions by using a relational approach centered on communication skill-building to ensure that faculty have been socialized to the importance of civil professional behavior and that stakeholders collectively explore and agree on the meaning and organizational integration of civility.

The Impact of the COVID-19 Pandemic on Diabetes Self-Management in Saudi Arabia.

The COVID-19 pandemic disrupted healthcare worldwide, potentially impacting disease management. The objective of this study was to assess the self-management behaviors of Saudi patients with diabetes during and after the COVID pandemic period using the Arabic version of the Diabetes Self-Management Questionnaire (DSMQ). A cross-sectional study was conducted in patients aged ≥18 years diagnosed with type 2 diabetes mellitus who had at least one ambulatory clinic visit in each of the specified time frames (Pre-COVID-19: 1 January 2019-21 March 2020; COVID-19 Time frame: 22 March 2020 to 30 April 2021) utilizing the DSMQ questionnaire, with an additional three questions specifically related to their diabetes care during the COVID pandemic. A total of 341 patients participated in the study. The study results revealed that the surveyed patients showed moderately high self-care activities post-COVID-19. Total DSMQ scores were significantly higher in patients aged >60 years versus younger groups (p < 0.05). Scores were significantly lower in patients diagnosed for 1-5 years versus longer durations (p < 0.05). Patients on insulin had higher glucose management sub-scores than oral medication users (p < 0.05). Overall, DSMQ scores were higher than the pre-pandemic Saudi population and Turkish post-pandemic findings. DSMQ results suggest that, while COVID-19 negatively impacted some self-management domains, the Saudi patients surveyed in this study upheld relatively good diabetes control during the pandemic. Further research is warranted on specific barriers to optimize diabetes care during public health crises.

Influence of central aspects of pain on self-management in people with chronic low back pain

ObjectiveThis observational study investigated whether central aspects of pain are associated with self-management domains in individuals with chronic low back pain (CLBP) undertaking a pain management program. MethodsIndividuals with CLBP provided pain sensitivity and self-management data at baseline (n = 97) and 3-months (n = 87). Pressure pain detection threshold (PPT) at the forearm, temporal summation (TS) and conditioned pain modulation (CPM), Widespread Pain Index (WPI), and a Central Aspects of Pain factor (CAPf) were considered as central aspects of pain. Self-management was measured using the 8 domains of the Health Education Impact Questionnaire, as well as Pain Self Efficacy and Health Care Utilisation questionnaires. ResultsPPT, CPM, WPI and CAPf predicted worse performance in several self-management domains at 3-months (r = 0.21 to 0.54, p < 0.05 overall). In multivariable regression models (adjusted for baseline scores of self-management, depression, catastrophization, pain and fatigue) low PPT, high TS, and high CAPf at baseline predicted poorer self-management at 3 months (R2 =0.14 to 0.52, β = −0.37 to 0.35, p < 0.05). ConclusionsCentral aspects of pain are associated with impaired self-management, over and above effects of pain intensity, fatigue, depression and catastrophizing. Practice implicationsTreatments that target central aspects of pain might help improve self-management in people with CLBP.

Examining the Impact of Selected Sociodemographic Factors and Cancer-related Fatalistic Beliefs on Patient Engagement via Health Information Technology among Older Adults - A Cross-Sectional Analysis.

Despite the role of Health Information Technology (HIT) in patient engagement processes and government incentives for HIT development, research regarding HIT is lacking among older adults, with a high burden of chronic diseases like cancer. This study examines the role of selected sociodemographic factors and cancer-related fatalistic beliefs on patient engagement expressed through HIT usage for patient engagement in adults 65 or older. We controlled cancer diagnosis to account for its potential influence on patient engagement. This study has two aims 1- To investigate the role of sociodemographic factors of race, education, poverty index, and psychosocial factor of cancer fatalistic beliefs on accessing and utilizing HIT in older adults. 2- To examine the association of access and utilization of HIT to the self-management domain of patient activation that serves as a precursor to patient engagement. This is a secondary data analysis of a subset of the Health Information National Trend Survey (HINTS 4, Cycle 3). The subset includes individuals 65 and older with and without a cancer diagnosis. The relationships between access to and utilization of HIT to several sociodemographic variables and psychosocial factors of fatalistic beliefs were analyzed. Logistic regression and linear regression models were fit to study these associations. In this study, the total number of individuals over 65 years of age with a cancer diagnosis was 180 and without a diagnosis was 398. This analysis indicated that having less than a college education level, being nonwhite, and living in poverty were significantly associated with decreased access to HIT. Reduced HIT utilization was associated with less than a college education level and poverty. This analysis also indicated that cancer fatalistic beliefs were significantly associated with lower HIT utilization. Specifically, a one-point increase in cancer fatalistic belief score is associated with a 36% decrease in HIT utilization. We found that controlling for cancer diagnosis did not affect the outcome for sociodemographic variables. However, the self-management domain of patient activation was significantly associated with the higher utilization of HIT and patients with a prior cancer diagnosis. Sociodemographic factors (education, race, poverty, and cancer fatalistic beliefs) impact HIT access and utilization in older adults, regardless of prior cancer diagnosis. HIT users among older adults report higher self-management, essential for patient activation and engagement.

A multisectoral and multidisciplinary endeavor: a review of diabetes self-management apps in China

BackgroundWhile the use of self-management apps has considerable promise to efficiently reduce the diabetes burden that disproportionally affects low- and middle-income countries (LMICs), and the multisectoral and multidisciplinary approaches have been encouraged to be used in diabetes management, little is known about the status of the integration of these approaches in the existing diabetes self-management apps. This review examines the diabetes apps in China as an indication of the current status of integrating multisectoral and multidisciplinary approaches in diabetes mHealth care in LMICs. MethodsEligible diabetes apps were searched on major Chinese app stores up to December 23, 2022. The app comprehensiveness index (ranging 0–80) regarding the app functions and diabetes management domains was created. The multisectoral and multidisciplinary features were summarized using indices derived from current guidance. ResultsSixty-six apps were reviewed, all developed by private companies. The average comprehensiveness score was 16, with many major self-management domains and functions not represented among the reviewed apps. Forty apps (61%) involved multiple sectoral entities, with public/private and private/private collaborations being the most common collaborative combinations. Thirty-seven apps (56%) involved multiple disciplines, among which endocrinology/metabolism, nutrition, and cardiovascular medicine were the top three most common disciplines. Compared to non-multidisciplinary apps, multidisciplinary apps tended to provide more comprehensive services in apps (6.14 vs. 5.18, p = 0.0345). Different sectors and disciplines tended to work independently, without robust interactions, in providing diabetes management services in the reviewed apps.ConclusionMultisectoral and multidisciplinary features has presented in the current diabetes self-management apps in China; however, it is still in its infancy and significant limitations existed. More engagement of civil society organizations and community groups and innovative collaborations between sectors and disciplines are needed to provide comprehensive, continuous, and patient-centered mHealth care for patients with diabetes in LMICs like China. Clear guidance for integrating and evaluating the multisectoral and multidisciplinary efforts in self-management apps is necessary to ensure the effective use of mHealth solutions for diabetes management in LMICs.

Psychological insulin resistance and its impact on self-management in type II diabetes mellitus patients treated with insulin therapy.

Psychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self-management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self-management in patients with type II diabetes mellitus treated with insulin therapy. We adopted a cross-sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self-management using the barriers to insulin treatment questionnaire and the partners in health scale. A total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self-management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin-related outcomes, no diabetes-related complications, less fear of injection and self-testing, no hypoglycaemia within the previous year, and younger age. Insulin therapy injection by patient and no diabetes-related complications were the most common factors associated with overall self-management and with each domain of self-management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self-management.

PA20 Assessing the value of transition readiness assessment clinics within a dermatology service

Abstract Successful transition of healthcare from paediatric to adult services is a key component of developmentally appropriate healthcare for young people with long-term conditions. Poor preparation for transfer and shifting social roles results in up to 25% of young individuals regularly missing follow-up visits and poor treatment adherence once transferred to adult services. Transition clinics were developed as an intervention to support young people in navigating the journey from paediatric to adult care. The Ready Steady Go (RSG) tool was implemented by Southampton Children’s hospital and endorsed by the Royal College of Paediatrics and Child Health and the National Institute for Health and Care Excellence for use in transition clinics. It considers the developmentally appropriate healthcare domains of self-management of long-term conditions, independence and self-advocacy, sexual health, mental health and emotional wellbeing, and activities of daily living (ADLs). The role and success of the RSG tool in many medical specialties has been documented. However, it has not yet been routinely implemented within dermatology departments. The aim of this project was to assess the additional value of the use of the RSG tool by a paediatrician with expertise in adolescent health, in a transition readiness assessment clinic piloted within a dermatology service. Notes of all patients attending the transition clinic between January and December 2022 were reviewed. Details of any interventions provided during the RSG-guided clinical appointment were compared with interventions previously received by the same patients in their routine dermatology appointments over the preceding 24 months. Intervention types included the assessment of independence, verbal advice, written leaflets, links to websites and direction to self-help services. Sixteen patients were seen in the transition clinic and included in the analysis. All patients were seen without their parents for at least part of the consultation. With the use of the RSG tool, 100% of patients received one or more intervention concerning self-management of their long-term condition, self-advocacy and ADLs vs. 44%, 81% and 75% in their previous clinic attendances for each of these domains, respectively. Eighty-seven per cent of patients received advice on sexual health/family planning, and 87% received information on mental health help with use of the RSG tool in the transition clinic, where 0% and 37% patients, respectively, had received information about these domains at previous dermatology appointments. All patients successfully achieved transition, with 44% having attended their first adult dermatology appointment, while the remaining 56% have their adult appointments still pending at time of writing. This study highlights the value and yield of a transition-readiness assessment for paediatric dermatology patients. During this presentation, we will discuss the RSG tool and the practicalities of implementing its use in dermatology services.

The Personalized Priority and Progress Questionnaire (PPPQ): A personalized instrument for quality of life and self-management for use in clinical trials and practice

PurposeThe aim of this study was to develop and validate a brief personalized instrument that (1) defines patients’ priorities for improvement, (2) measures progress in prioritized quality of life (QoL) and self-management outcomes, and (3) is applicable in both clinical practice and clinical trials.MethodsThe instrument was developed based on the literature on personalized assessment and patient priorities, feedback by clinicians, and six cognitive interviews with patients with chronic kidney disease. The resulting questionnaire, the Personalized Priority and Progress Questionnaire (PPPQ), contains a baseline and follow-op measurement. The baseline measurement assesses functioning on QoL (8 items) and self-management (5 items). The final item evaluates patients’ priorities for improvement. The follow-up measurement assesses progress in QoL and self-management. A personalized progress score can be calculated indicating the amount of progress on the QoL or self-management domain that is prioritized by the individual patient. Psychometric properties of the PPPQ were evaluated among patients with chronic kidney disease (n = 121) and patients with kidney failure treated with dialysis (n = 22).ResultsThe PPPQ showed to be a feasible instrument that is easy and quick to complete. Regarding the construct validity, small to large correlations were found between the items and existing validated questionnaires measuring related constructs.ConclusionThe PPPQ proved to be a feasible and valid instrument. The PPPQ can be adapted to match diverse populations and could be a useful tool both in clinical practice (e.g., to identify priorities and tailor treatment) and clinical trials (e.g., to evaluate the effectiveness of personalized interventions).

Relationship of Mindfulness with Depression, Self-Management, and Quality of Life in Type 2 Diabetes Mellitus: mindfulness is a Predictor of Quality of Life.

Mindfulness interventions have shown promising results in both psychological and clinical outcomes of type 2 diabetes mellitus. Depression, self-management, and quality of life (QOL) have shown improvement with mindfulness interventions; however, little is known about dispositional mindfulness and its relationship with depression, self-management, and QOL in type 2 diabetes mellitus. The aim of this study is to assess the relationship of dispositional mindfulness with depression, self-management, and QOL in patients of type 2 diabetes. Noncommunicable disease outpatient department of a tertiary care medical center of East India. Cross-sectional study. Ninety-nine patients with type 2 diabetes completed the Five Facets Mindfulness Questionnaire, Diabetes Self-Management Questionnaire, and World Health Organization QOL BREF questionnaire and Hamilton Rating Scale for depression. Pearson's correlation and hierarchical regression analysis using the SPSS software version 20.0. Describing, acting with awareness, and nonjudging facets of mindfulness showed a negative correlation with depression (P < 0.05). Acting with awareness and nonreactivity to inner experience were positively correlated with the physical activity domains of self-management (P < 0.05). All facets of mindfulness showed a positive correlation with four domains of QOL. In hierarchical regression analysis, after controlling for sociodemographic and clinical variables, mindfulness predicted the psychological domain of QOL, explaining 31% of the variance (P ≤ 0.001). However, mindfulness did not predict depression or self-management. Dispositional mindfulness is a strong predictor of QOL in type 2 diabetes mellitus and hence can be targeted with interventions to improve psychological outcomes.

Factors Influencing Self-Management Behaviors among Hemodialysis Patients.

To investigate the factors affecting hemodialysis patients' self-management ability at a dialysis center in Taiwan. Taiwan has the highest incidence and prevalence of end-stage kidney disease (ESKD) in the world. Over 90% of patients with ESKD receiving hemodialysis (HD) and self-management behaviors are critical among these patients. Failure to adhere to self-managed care increases the cost of medical care and the risk of morbidity and mortality. In this cross-sectional study, a total of 150 HD patients were observed for their self-management behaviors and the factors influencing these behaviors including education level, comorbid conditions, biochemical analysis, depression, and social support, etc., were analyzed. Self-management behaviors in HD patients were significantly impaired in the presence of diabetes mellitus, hypertension, anemia, hypoalbuminemia, and depression. The major predictor of patients' self-management was depression, explaining 14.8% of the total variance. Further addition of social support, hypertension, and diabetes mellitus into the regression model increased the total explained variance to 28.6%. Of the various domains of self-management, the partnership domain received the highest score, whereas emotional processing received the lowest score. This study found the important factors influencing self-management behaviors; through this acknowledgement and early correction of these factors, we hope to improve HD patients' individual life quality and further decrease their morbidity and mortality.

The Stroke Self-Efficacy Questionnaire Brazil (SSEQ-B): a structural validity analysis

ABSTRACT Background Self-efficacy has been shown to play an important role in rehabilitation outcomes of stroke patients. The Stroke Self-Efficacy Questionnaire Brazil (SSEQ-B) is designed to assess self-efficacy of functional performance after stroke. Objective This research sought to address the structural validity of the SSEQ-B using exploratory and confirmatory factorial analyses. Methods This is a cross-sectional study. We performed a reliability assessment and structural validation of the SSEQ-B in 115 Brazilian stroke survivors living in Rio Grande do Sul or São Paulo. Results: Sample mean age was 62.7 ± 14.2 years. Internal consistency presents a Cronbach’s Alpha (αC) of 0.829. Exploratory factorial analysis using the scree plot method revealed a bifactorial structure, consisting of activity and self-management domains. While confirmatory factorial analysis suggested a trifactorial structure, the loading ranges between factors 1 and 3 were very similar, suggesting they could be collapsed – resulting in the same factors found in the scree plot analysis. Both structures with subscales showed good construct validity. Conclusion SSEQ-B is a valid and reliable measure of stroke self-efficacy. The preferred structure of the SSEQ-B is bifactorial and includes the domains activity and self-management.

Factors Influencing Adherence to mHealth Apps for Prevention or Management of Noncommunicable Diseases: Systematic Review.

BackgroundMobile health (mHealth) apps show vast potential in supporting patients and health care systems with the increasing prevalence and economic costs of noncommunicable diseases (NCDs) worldwide. However, despite the availability of evidence-based mHealth apps, a substantial proportion of users do not adhere to them as intended and may consequently not receive treatment. Therefore, understanding the factors that act as barriers to or facilitators of adherence is a fundamental concern in preventing intervention dropouts and increasing the effectiveness of digital health interventions.ObjectiveThis review aimed to help stakeholders develop more effective digital health interventions by identifying factors influencing the continued use of mHealth apps targeting NCDs. We further derived quantified adherence scores for various health domains to validate the qualitative findings and explore adherence benchmarks.MethodsA comprehensive systematic literature search (January 2007 to December 2020) was conducted on MEDLINE, Embase, Web of Science, Scopus, and ACM Digital Library. Data on intended use, actual use, and factors influencing adherence were extracted. Intervention-related and patient-related factors with a positive or negative influence on adherence are presented separately for the health domains of NCD self-management, mental health, substance use, nutrition, physical activity, weight loss, multicomponent lifestyle interventions, mindfulness, and other NCDs. Quantified adherence measures, calculated as the ratio between the estimated intended use and actual use, were derived for each study and compared with the qualitative findings.ResultsThe literature search yielded 2862 potentially relevant articles, of which 99 (3.46%) were included as part of the inclusion criteria. A total of 4 intervention-related factors indicated positive effects on adherence across all health domains: personalization or tailoring of the content of mHealth apps to the individual needs of the user, reminders in the form of individualized push notifications, user-friendly and technically stable app design, and personal support complementary to the digital intervention. Social and gamification features were also identified as drivers of app adherence across several health domains. A wide variety of patient-related factors such as user characteristics or recruitment channels further affects adherence. The derived adherence scores of the included mHealth apps averaged 56.0% (SD 24.4%).ConclusionsThis study contributes to the scarce scientific evidence on factors that positively or negatively influence adherence to mHealth apps and is the first to quantitatively compare adherence relative to the intended use of various health domains. As underlying studies mostly have a pilot character with short study durations, research on factors influencing adherence to mHealth apps is still limited. To facilitate future research on mHealth app adherence, researchers should clearly outline and justify the app’s intended use; report objective data on actual use relative to the intended use; and, ideally, provide long-term use and retention data.

Measuring Readiness for Self-Directed Learning in Medical Undergraduates.

PurposeTo measure the readiness for self-directed learning in medical students for the evaluation of self-directed learning in the study population.Materials and MethodsThe survey was conducted in undergraduate students. The instrument used was Fisher’s readiness scale comprising of self-management, desire for learning, and self-control domains. The data were analyzed by Mann–Whitney U-test and bivariate and partial correlations. The results were compared with the reported ones.ResultsTotal students surveyed were 300. Of these, 96 responded - 73 (76%) of preclinical and 23 (24%) of clinical classes. The mean readiness score was 124. The mean domains’ scores for self-management, desire for learning, and self-control were 38, 38, and 48, respectively. The preclinical group had a mean score of 122 for readiness, 37 for self-management and desire for learning each, and 48 for self-control. The clinical group’s scores were 129, 40, and 49, respectively. Preclinical and clinical groups differed significantly in self-management domain (P = 0.03). The difference was not significant in desire for learning (P = 0.08), self-control domains (P = 0.40) and readiness score (P = 0.12). The domains of self-control and desire for learning had a positive correlation if self-management was controlled, and self-control and self-management had a positive correlation if desire for learning was controlled (P < 0.05).ConclusionThe measurement of readiness for self-directed learning helps in knowing the true value of self-directed learning in a particular setting. Relatively lower scores in our study mean self-directed learning alone cannot be relied upon to achieve optimum students’ learning. There is also a need for implementing strategies that will help students in improving their readiness for independent learning.

LEADERSHIP AND ISLAM WASATHIYAH PERSPECTIVE OF THE QUR'AN, HADITHS AND 'ULAMA

This paper discusses Leadership and Islam Wasathiyah Perspective of The Qur'an, Hadith and 'Ulama. The leadership displayed by a leader is an implication of his ability to manage his emotional intelligence and spiritual intelligence. Goleman in Abd. Kadim Masaong said that optimizing the management of emotional intelligence will produce four competency domains that are very effective in creating a leadership style, namely, the domains of selfawareness, self-management, social awareness and relationship management. Tawassuth is an attitude that is in the middle or between two attitudes, namely not too far to the right (fundamentalist) and too far to the left (liberalist). With this tawassuth attitude, Islam will be easily accepted in all walks of life. The character of tawassuth in Islam is the middle point between the two ends and it is a virtue that has been placed by Allah Subhana wata'ala from the start. The value of tawassuth, which has become a principle in Islam, needs to be applied in all fields so that the religion of Islam and the religious expressions of Muslims become witnesses of measuring the truth for all human attitudes and behavior in general.