Promoting self-efficacy in patients with chronic disease beyond traditional education: A literature review

Are We Transitioning Toward Person-centered Practice on Self-management Support? An Explorative Case Study Among Rheumatology Outpatient Clinic Nurses in Norway

Introduction

There are only a few studies investigating nurses’ views on self-management in the care of patients with rheumatic diseases.

Objective

The aim of this study is to explore how Norwegian rheumatology outpatient nurses describe their ways of supporting patients’ self-management focusing on the core dimensions of person-centered self-management support.

Methods

Ten individual semistructured interviews with rheumatology outpatient nurses were conducted in Norway from March to September 2017. The interviews were audiorecorded and transcribed verbatim. NVIVO was used to support a systematic analysis of themes and patterns.

Results

Nurses’ views on self-management support fell into three approaches; (1) narrowly biomedically orientated, (2) biomedically and holistic, and (3) person-centered. The nurse's views of self-management support varied and did not fully align with the core dimensions of person-centered practice.

Conclusion

The findings indicate that the biomedical paradigm continues to influence Norwegian rheumatology outpatient clinic nurses’ approach to self-management support. If person-centered principles of self-management support are to be translated into standard nursing practice, including identifying and supporting patient-defined self-management goals and processes, there is a need to challenge established structures in health care systems.

Understanding relationships between general self-efficacy and the healthy ageing of older people: An integrative review

AIMS AND OBJECTIVES

The aim of this integrative review was to investigate current literature exploring relationships between general self-efficacy and the healthy ageing of older people.

BACKGROUND

Enhancing the health and well-being of older adults, while mitigating consequences of illness and frailty are important priorities in healthy ageing. General self-efficacy is closely associated with human behaviour and has been linked with improved health and well-being.

DESIGN

An integrative review using the five-stage method described by Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546).

METHODS

Academic databases CINAHL, MEDLINE and APA PsycInfo were searched between 2010 and 2020 for original, peer-reviewed papers, published in English that investigated general self-efficacy and factors associated with the healthy ageing of older people. Included papers were critically appraised using the Appraisal tool for Cross-Sectional Studies (AXIS tool) and Critical Appraisal Skills Programme, and underwent data abstraction and synthesis via a constant comparative method. This review was also evaluated using the PRISMA checklist.

RESULTS

Twenty-one papers were included in this review. Two main themes emerged. The first highlights positive relationships between general self-efficacy and health and ageing perceptions, with subsequent influence on health behaviours. The second includes two sub-themes, which explores general self-efficacy's role in maintaining well-being through its effects on psychological health and overcoming physical decline through adaption to changing physical and health conditions.

CONCLUSIONS

Promoting general self-efficacy has potential benefits for the healthy ageing of older people through positive effects on ageing and health perceptions, health behaviours, psychological health and overcoming physical decline.

RELEVANCE TO CLINICAL PRACTICE

Understanding how general self-efficacy facilitates healthy ageing can guide nursing practices that reduce or mitigate consequences of illness and physical decline on the health and well-being of older people. Strategies aimed at increasing older people's general self-efficacy can help to facilitate subsequent positive effects on factors that promote healthy ageing.

Support Methodologies for African American Women With Lupus - Comparing Three Methods' Effects on Patient Activation and Coping

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease in which the immune system attacks healthy tissues. While pharmaceutical therapies are an important part of disease management, behavioral interventions have been implemented to increase patients' disease self-management skills, provide social support, and encourage patients to take a more active role in their care. Methods: Three interventions are considered in this study; peer-to-peer methodology, patient support group, and a patient navigator program that were implemented among largely African American women with SLE at the Medical University of South Carolina (MUSC). Outcomes of interest were patient activation and lupus self-efficacy. We used a Least Squares Means model to analyze change in total patient activation and lupus self-efficacy independently in each cohort. We adjusted for demographic variables of age, education, income, employment, and insurance. Results: In both unadjusted and adjusted models for patient activation, there were no statistically significant differences among the three intervention methodologies when comparing changes from baseline to post intervention. Differences in total coping score from baseline to post intervention in the patient navigator group (-101.23, p-value 0.04) and differences in scores comparing the patient navigator with the support group were statistically significant (116.96, p-value 0.038). However, only the difference in total coping from baseline to post intervention for the patient navigator program remained statistically significant (-98.78, p-value 0.04) in the adjusted model. Conclusion: Tailored interventions are a critical pathway toward improving disease self-management among SLE patients. Interventions should consider including patient navigation because this method was shown to be superior in improving self-efficacy (coping scores).

The neglected contributions of self-efficacy to older adults’ financial capacity

Purpose

An ageing population comes with its own set of challenges such as impaired financial capacity and resultant dependency on others to manage financial affairs. Dependency, in turn, as the evidence suggests, creates opportunities for financial exploitation of older adults. Related studies have primarily examined the clinical features and correlates of financial capacity or have attempted to develop its multidimensional measures. Both of which do little to resolve issues associated with impaired financial capacity. This paper aims to make a case for future researchers to assess older adults’ financial capacity from a non-clinical aspect.

Design/methodology/approach

Drawing on the notion of self-efficacy, as encapsulated within the social cognitive theory, this paper presents evidence from a host of different domains to demonstrate the potential contributions of self-efficacy to older adults’ financial capacity.

Findings

The contributions of self-efficacy in preserving older adults’ financial capacity appear to be much more profound than is currently acknowledged in the literature, thereby overlooking potentially promising and cost-effective interventions for autonomous ageing.

Originality/value

This paper presents a novel application of self-efficacy to autonomous ageing. Within this context, potential routes to the deployment of self-efficacy-based interventions are also discussed.

Effect of a Telecare Case Management Program for Older Adults Who Are Homebound During the COVID-19 Pandemic: A Pilot Randomized Clinical Trial

IMPORTANCE

Older adults who are homebound can be difficult to reach owing to their functional limitations and social distancing during the COVID-19 pandemic, leaving their health needs unrecognized at an earlier stage.

OBJECTIVE

To determine the effectiveness of a telecare case management program for older adults who are homebound during the COVID-19 pandemic.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial was conducted among 68 older adults in Hong Kong from May 21 to July 20, 2020, with a last follow-up date of October 20, 2020. Inclusion criteria were being 60 years or older, owning a smartphone, and going outside less than once a week in the previous 6 months.

INTERVENTIONS

Participants in the telecare group received weekly case management from a nurse supported by a social service team via telephone call and weekly video messages covering self-care topics delivered via smartphone for 3 months. Participants in the control group received monthly social telephone calls.

MAIN OUTCOMES AND MEASURES

The primary outcome was the change in general self-efficacy from before the intervention to after the intervention at 3 months. Self-efficacy was measured by the Chinese version of the 10-item, 4-point General Self-efficacy Scale, with higher scores representing higher self-efficacy levels. Analysis was performed on an intention-to-treat basis.

RESULTS

A total of 68 participants who fulfilled the criteria were enrolled (34 in the control group and 34 in the intervention group; 56 [82.4%] were women; and mean [SD] age, 71.8 [6.1] years). At 3 months, there was no statistical difference in self-efficacy between the telecare group and the control group. Scores for self-efficacy improved in both groups (β = 1.68; 95% CI, -0.68 to 4.03; P = .16). No significant differences were found in basic and instrumental activities of daily living, depression, and use of health care services. However, the telecare group showed statistically significant interactions of group and time effects on medication adherence (β = -8.30; 95% CI, -13.14 to -3.47; P = .001) and quality of life (physical component score: β = 4.99; 95% CI, 0.29-9.69; P = .04).

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, participants who received the telecare program were statistically no different from the control group with respect to changes in self-efficacy, although scores in both groups improved. After the intervention, the telecare group had better medication adherence and quality of life than the control group, although the small sample size may limit generalizability. A large-scale study is needed to confirm these results.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04304989.

Interventions to empower cardiorenal patients: A systematic review

AIMS

To identify the most effective interventions to empower cardiorenal patients.

DESIGN

A systematic review of the literature has been carried out.

DATA SOURCES

The PubMed, CINAHL, PsycINFO and Cochrane databases were reviewed, and journals in the field were manually searched between January and February 2020.

REVIEW METHODS

Five randomized clinical trials and quasi-experimental studies that met the selection and CONSORT & TREND methodological quality criteria were selected.

RESULTS

The evidence supports that there are no existing interventions aimed at empowering cardiorenal patients. However, the interventions to empower people with chronic kidney disease and heart failure suggest that their integration should address seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life.

CONCLUSION

A gap has been revealed in the literature regarding the empowerment of cardiorenal patients. This review provides relevant information to help design, implement and evaluate interventions to empower these patients by describing the strategies used to empower people experiencing both chronic conditions and the tools used for their assessment.

IMPACT

There is a need for further research to design, implement and evaluate a multidimensional intervention that favours the empowerment of cardiorenal patients by using valid and reliable instruments that measure the domains that constitute it in an integrated manner. Interventions aimed at empowering the cardiorenal patient should include seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life.

Exploring the experiences and perceptions of haemodialysis patients observing Ramadan fasting: a qualitative study

BACKGROUND

The festival of Ramadan is a month of spiritual reflection for Muslims worldwide. During Ramadan, Muslims are required to refrain from eating and drinking during daylight hours. Although exempted from fasting, many patients undergoing maintenance haemodialysis (HD) opt to participate in this religious practice. Many studies have explored the effects of Ramadan on health outcomes, however, the exploration from patients' own point of view pertaining to this religious practice is lacking. Thus, we aimed to explore the experiences and perceptions of Muslim HD patients observing Ramadan fasting from three HD centres in Klang Valley, Malaysia.

METHOD

An exploratory phenomenology qualitative study was conducted whereby subjects were purposively selected based on previous experience in observing Ramadan fasting. Face-to-face in-depth interviews were conducted, and study data were analyzed thematically and iteratively coded using a constant comparison method.

RESULTS

Four major themes emerged from the data, namely: (i) "fasting experiences", (ii) "perceived side effects of fasting", (iii) "health-seeking behavior" and, (iv) "education and awareness needs". Patients expressed the significance of Ramadan fasting as well as the perceived impact of fasting on their health. Additionally, there is lack of health-seeking behaviour observed among patients thus, raising needs for awareness and education related to Ramadan fasting.

CONCLUSIONS

Findings of this study shed light on patients' experiences and perceptions regarding Ramadan fasting which warrants the needs for an effective communication between patients and health care practitioners through a structured-Ramadan specific education program.

Health-Related Difficulty in Internet Use Among Older Adults: Correlates and Mediation of Its Association With Quality of Life Through Social Support Networks

Background and Objectives

Internet use is increasingly a necessity. However, older adults may not use the internet due to either nonhealth reasons (e.g., lack of digital literacy or internet access) or health-related reasons (e.g., visual impairment or movement difficulties). While researchers have studied internet use among older adults, most do not discriminate whether nonuse is due to health-related reasons or otherwise. We therefore examine the key correlates of health-related difficulty in internet use among older adults, and how it may affect the quality of life (QoL) through their perceived social support networks.

Research Design and Methods

Data were from a national survey of older Singaporeans (N = 3,966) conducted in 2016–2017. Multinomial logistic regression and mediation analysis were used to identify older adult subgroups more likely to experience health-related difficulty in internet use, and whether such difficulty affected older adults’ QoL through their social support networks.

Results

Those of male gender, of Malay ethnicity, with less education, and with more instrumental activity of daily living limitations were more likely to experience health-related difficulty in internet use. Social support networks mediated the relationship between health-related difficulty in internet use and QoL.

Discussion and Implications

Disparities in internet use are not just shaped by access or skill, but also health. Health-related difficulties in internet use are related to older adults’ social support networks and quality of life. As social connections become increasingly based around networked individuals due to technological advancements, more attention should be given to addressing these health-related difficulties.

Effect of Behavioral Weight Management Interventions Using Lifestyle mHealth Self-Monitoring on Weight Loss: A Systematic Review and Meta-Analysis

Alongside an increase in obesity, society is experiencing the development of substantial technological advances. Interventions that are easily scalable, such as lifestyle (including diet and physical activity) mobile health (mHealth) self-monitoring, may be highly valuable in the prevention and treatment of excess weight. Thus, the aims of this systematic review and meta-analysis were to estimate the following: (i) the effect of behavioral weight management interventions using lifestyle mHealth self-monitoring on weight loss and (ii) the adherence to behavioral weight management interventions using lifestyle mHealth self-monitoring. MEDLINE via PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and the Web of Science databases were systematically searched. The DerSimonian and Laird method was used to estimate the effect of and adherence to behavioral weight management interventions using lifestyle mHealth self-monitoring on weight loss. Twenty studies were included in the systematic review and meta-analysis, yielding a moderate decrease in weight and higher adherence to intervention of behavioral weight management interventions using lifestyle mHealth self-monitoring, which was greater than other interventions. Subgroup analyses showed that smartphones were the most effective mHealth approach to achieve weight management and the effect of behavioral weight management interventions using lifestyle mHealth self-monitoring was more pronounced when compared to usual care and in the short-term (less than six months). Furthermore, behavioral weight management interventions using lifestyle mHealth self-monitoring showed a higher adherence than: (i) recording on paper at any time and (ii) any other intervention at six and twelve months.