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Sima C, Taani MH, Apchemengich I, Andargeery SY. Associations Between Components of Self-Management Theory and Falls Among Older Adults. J Gerontol Nurs 2024; 50:19-28. [PMID: 39088049 DOI: 10.3928/00989134-20240703-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE To examine the relationship of key individual and family self-management theory (IFSMT) components, including self-management process variables on proximal (self-management behaviors) and distal (falls) outcomes in older adults. METHOD A secondary data analysis was conducted using data of 99 older adults living in continuing care retirement communities in the U.S. Midwest. Descriptive statistics, multiple regression, and logistic regression were performed to analyze the data. RESULTS The multiple regression model demonstrated a positive association between self-efficacy for physical activity and steps per day. The logistic regression model showed that high expectations regarding aging are associated with reduced likelihood of meeting daily protein intake. CONCLUSION Key components of the IFSMT, such as self-efficacy, steps per day, and expectations regarding aging, are important when designing self-management interventions to prevent falls. [Journal of Gerontological Nursing, 50(8), 19-28.].
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Liu Y, Jiang F, Zhang M, Niu H, Cao J, Du S, Chen H, Wang H, Gong L, Rao F, Wu H. Health literacy and self-management among middle-aged and young hypertensive patients: a parallel mediation effect of illness perception and self-efficacy. Front Psychol 2024; 15:1349451. [PMID: 38765827 PMCID: PMC11099212 DOI: 10.3389/fpsyg.2024.1349451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Background Hypertension is increasingly prevalent among young and middle-aged populations in rural China, accompanied by suboptimal self-management. Given that this population forms the backbone of the labor force, enhancing their self-management capabilities is crucial for improving overall population health. Studies indicate that individuals with good health literacy are more likely to effectively manage their health. Methods Grounded in the health literacy skills framework, a model was constructed in this study to examine the impact of health literacy on self-management among young and middle-aged hypertensive patients in rural China. Meanwhile, the mediating roles of illness perception and self-efficacy were also verified. Using a multi-stage stratified random sampling method, 338 patients were recruited to participate in the study. Structural equation modeling was utilized to establish the relationship model, and bootstrap tests were carried out to examine the mediating effects. Results The average self-management score was 70.45 ± 11.36. Health literacy exhibited a positive correlation with self-management (standardized β = 0.372, p < 0.001). The mediating effects through illness perception and self-efficacy were 0.040 and 0.236, constituting 6.68 and 39.31% of the total effect, respectively. Conclusion Illness perception and self-efficacy serve as parallel mediators amid the association between health literacy and self-management. Implementing psychological counseling and health education is imperative for augmenting self-management competence and cultivating an adaptive coping mentality.
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Affiliation(s)
| | - Feng Jiang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Hisaki F, Aga M, Tomitani N, Okawara Y, Harada N, Kario K. Daily self-reported behavioural efficacy records on hypertension digital therapeutics as digital metrics associated with the reduction in morning home blood pressure: post-hoc analysis of HERB-DH1 trial. Hypertens Res 2024; 47:120-127. [PMID: 37717116 DOI: 10.1038/s41440-023-01434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/18/2023]
Abstract
Digital therapeutics for hypertension, proven effective in the HERB-DH1 trial, enable patients to record and track their daily actions and achievements to improve their lifestyles using an app. However, the association between recording daily behaviours and blood pressure (BP) reduction has not yet been investigated. We conducted a post-hoc analysis to investigate the relationship between them in the HERB-DH1 trial. We defined the counts of daily records of antihypertensive behaviour taken by the patient into the app as daily self-reported behavioural efficacy records (SER). SER was categorised into quartiles, and the trend of changes from baseline to week 12 in morning home systolic blood pressure (SBP), salt intake checklist score, and body weight was assessed. A total of 156 patients with hypertension were included in the analysis. A higher total count of SER was associated with greater SBP reduction (P for trend: 0.049). Patients with a higher SER for salt intake and weight reduction showed reductions in SBP (P for trend: 0.034 and 0.027, respectively). Furthermore, patients with higher salt intake SER exhibited a decrease in the salt intake checklist scores, and patients with greater weight reduction SER experienced a reduction in body weight (P for trend: 0.001 and 0.007, respectively). SER during digital therapeutics is associated with a reduction in morning home SBP in patients with hypertension. Enhancing patients' intrinsic motivation and self-efficacy, as evaluated by the SER, can play an important role in reducing BP by promoting lifestyle improvement. Daily self-reported behavioural efficacy records (SER) defined as the number of patient's app inputs of recall of day-by-day activity of behaviours at the end of the day, is partially affected by self-efficacy and affinity of app, resulting in the effectiveness of digital therapeutics.
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Affiliation(s)
- Fumi Hisaki
- CureApp, Inc. Medical Division, Tokyo, Japan
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | | | - Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Yukie Okawara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Noriko Harada
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
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Lim WL, Koh YLE, Tan ZE, Tan YQ, Tan NC. Self-Efficacy in Patients With Hypertension and Their Perceived Usage of Patient Portals. J Prim Care Community Health 2024; 15:21501319231224253. [PMID: 38212904 PMCID: PMC10785728 DOI: 10.1177/21501319231224253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Self-efficacy in individuals optimizes their hypertension management. Electronic patient portals are being increasingly used to support chronic disease management, as they raise the health literacy of patients and enable them in self-management. However, the association between the use of patient portals and self-efficacy in hypertension management remains unclear. The study aimed to determine the association between self-efficacy among patients with hypertension who are managed in primary care and their demographic characteristics and usage patterns of patient portals. METHOD A cross-sectional survey was conducted at a public primary care clinic in urban Singapore. Multi-ethnic adult patients with hypertension were invited to participate in a self-administered electronic questionnaire. Chi-square test was performed for bivariate analysis; adjusted logistic regression models were used for factors with P value <.1. RESULTS A total of 310 patients (66.8% Chinese, 55.5% males, mean age of 63.1 years) completed the survey. Patient portal users had higher self-efficacy scores than non-users (mean score=63 vs 60, maximum = 80, P = .011). The factors associated with increased patient portal access included younger age <65 years (absolute odds ratio [AOR] = 2.634, 95%CI = 1.432-4.847; P = .002), monthly income >$5000 (AOR = 2.324, 95%CI = 1.104-4.892; P = .026), and post-secondary education level (AOR = 3.128, 95%CI = 1.675-5.839; P < .001). Most patients (93.1%) used the portal to check medical appointments but only1.3% of them used it to record home blood pressure measurements (HBPM). CONCLUSIONS Patient portal usage was associated with higher self-efficacy scores in patients with hypertension. These users were younger, more educated, and earned more than the non-users, but only 1.3% of them used it for HBPM documentation.
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Affiliation(s)
| | | | - Zhi En Tan
- SingHealth Polyclinics, Singapore, Singapore
| | - Yu Quan Tan
- SingHealth Polyclinics, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
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Fotouhi F, Shahidi A, Hashemi H, Saffarpour M, Yekta A, Esmaieli R, Esteki T, Derakhshan HB, Khabazkhoob M. Hypertension prevalence in Iran's elderly according to new criteria: the Tehran Geriatric Eye Study. J Diabetes Metab Disord 2023; 22:1489-1498. [PMID: 37975137 PMCID: PMC10638178 DOI: 10.1007/s40200-023-01272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 07/27/2023] [Indexed: 11/19/2023]
Abstract
Purpose To determine the prevalence of hypertension in a population above 60 years of age and its relationship with demographic and anthropometric factors. Methods A cross-sectional population-based study was conducted in 2019. Using a multistage random cluster sampling, 160 clusters were selected from 22 districts of Tehran. All participants were interviewed to collect demographic, anthropometric, and socioeconomic information. Then, systolic (SBP) and diastolic (DBP) blood pressures were measured under standard conditions twice, 10 min apart. A third measurement was performed if the two measurements showed a difference of ≥ 10 mmHg in SBP or ≥ 5 mmHg in DBP. Hypertension was defined as a SBP > 130 mmHg or a DBP > 80 mmHg (new criteria), being a known case of hypertension, or use of blood pressure lowering medications. Results Of 3791 invitees, 3310 participated in the study (87.3%). The mean age of the participants was 68.25 ± 6.54 years (60-97 years). The prevalence of hypertension was 81.08% (95% CI: 79.57-82.59) in the whole sample; 82.96% (95% CI: 81.02-84.91) in females, and 79.15% (95% CI: 76.6 -81.69) in males. The prevalence of hypertension ranged from 75.47% (95% CI: 72.65-78.29) in the age group 60-64 years to 88.40% (95% CI: 83.71-93.08) in the age group ≥ 80 years. The prevalence of hypertension unawareness was 32.84% (95% CI: 30.82-34.86). The highest and lowest prevalence of hypertension was seen in illiterate subjects (89.41%) and those with a university education (77.14%), respectively. According to the multiple logistic regression analysis, older age, lower education level, obesity and overweight, neck circumference, and diabetes were significantly associated with the prevalence of hypertension. Conclusion A significant percentage of Iranian elderly have hypertension and one of every 3 affected individuals is unaware of their disease. Considering the population aging in Iran, urgent and special attention should be paid to the elderly population. Caring for the elderly, informing families, and using non-traditional screening methods are recommended by families at the first level and policymakers at the macro level.
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Affiliation(s)
- Farid Fotouhi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aida Shahidi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mahshid Saffarpour
- Department of Restorative Dentistry, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Abbasali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roghayeh Esmaieli
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taraneh Esteki
- Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoon Bana Derakhshan
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Geremew G, Ambaw F, Bogale EK, Yigzaw ZA. Adherence to Lifestyle Modification Practices and Its Associated Factors Among Hypertensive Patients in Bahir Dar City Hospitals, North West Ethiopia. Integr Blood Press Control 2023; 16:111-122. [PMID: 38050636 PMCID: PMC10693782 DOI: 10.2147/ibpc.s436815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/23/2023] [Indexed: 12/06/2023] Open
Abstract
Background Globally, hypertension affects 1.4 billion adults, accounting for 31% of the world population. The prevention and control of hypertension is not addressed only by pharmacological management. Even though the prevalence of uncontrolled hypertension and its complications is increasing every day, Adherence to lifestyle modification practice among diagnosed hypertensive individuals is low for a number of reasons. The study aims to assess adherence to lifestyle modification practices and associated factors among hypertensive patients at Bahir Dar city hospitals, in North West Ethiopia. Methods An institutional-based cross-sectional study design was conducted at Bahir Dar city from October 30 to November 30, 2022. A stratified sampling technique was used. For the data quality pre-test was done, the questionnaire was checked for completion, the assumption of binary logistic regression (VIF 1.8 and no outlier), and model fit using the Hosmer and Lemeshow's test was checked. Binary logistic and multivariate logistic regression were used to find significant variables after the data were entered into EpiInfo and analyzed using SPSS version 23. Results The overall adherence to lifestyle modification practices was about 32.4%. From the independent factors, above secondary educational status (AOR = 0.201 95% CI (0.081-0.499)), good knowledge (AOR = 3.323 95% CI (1.79-6.168)), good self-efficacy (AOR = 3.553 95% CI (1.91-6.613)), good social support (AOR = 8.339 95% CI (4.251-16.357)), and good patient-physician relationship (AOR = 2.424 95% CI (1.309-4.490)) were statistically significant predictors of adherence to lifestyle modification practices. Conclusion Only one-third of the participants had adhered to the recommended lifestyle modifications. Educational status, knowledge, self-efficacy, social support, and patient-physician relationships were significant factors. Healthcare organizations should develop programs to raise hypertension patients' awareness and degree of self-efficacy that aid in adherence to advised lifestyle changes.
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Affiliation(s)
- Gebeyaw Geremew
- Department of Nursing, Tibebe Ghion Comprehensive Specialized Hospital, Bahir Dar, Ethiopia
| | - Fentie Ambaw
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zeamanuel Anteneh Yigzaw
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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METİN T, SEMERCİ V, ÇETİNKAYA ÖZDEMİR S. The Relationship Between Alexithymia Levels and Self-Efficacy of Hypertension Patients. CELAL BAYAR ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2023; 10:188-197. [DOI: 10.34087/cbusbed.1315499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
Giriş: Hipertansiyon hastalarında kan basıncının kontrol altına alınmasında aleksitiminin yönetilmesi ve öz etkililiğin değerlendirilmesi önemlidir.
Amaç: Bu çalışmadaki amaç hipertansiyon hastalarının tanımlayıcı özelliklerinin ve aleksitimi düzeylerinin öz etkililik düzeylerinin yordayıcısı olup olmadığını belirlemektir.
Yöntem: Bu araştırma nicel araştırma yönteminin korelasyon desenine göre yapıldı. Araştırmanın verileri Aralık 2022-Mayıs 2023 tarihleri arasında toplandı. Araştırmanın evrenini Türkiye’de yaşayan hipertansiyonlu hastalar oluşturdu ve çalışmaya toplam 103 hipertansiyon hastası katıldı. Araştırmanın verileri “Hasta Tanılama Formu”, “Toronto Aleksitimi Ölçeği” ve “Hipertansiyon Öz-Etkililik Ölçeği” ile toplandı. Veriler bağımsız örneklem t testi, pearson korelasyon ve çoklu linear regresyon analizi ile değerlendirildi.
Bulgular: Yaş ortalaması 45.37 ± 17.03 olan hipertansiyon hastalarının %63.1’inin kadın olduğu belirlendi. Hastaların öz-etkililikleri ile aleksitimi düzeyleri arasında istatistiksel olarak anlamlı bir ilişki bulunmadı (r = -0.071, p > .05). Aleksitiminin dışa-dönük düşünme alt boyutu, yaş, ailede hipertansiyon varlığı ve ilaçları düzenli kullanma bağımsız değişkenlerinin hastaların öz-etkililik düzeyleri üzerindeki varyansın %22.7’sini açıkladığı görüldü.
Sonuç: Hastaların öz-etkililiği ile aleksitimi düzeyleri arasında ilişki olmadığı görüldü. Aleksitiminin dışa-dönük düşünme alt boyutu, yaş, ailede hipertansiyon varlığı ve ilaçları düzenli kullanma değişkenlerinin hipertansiyon hastalarının öz etkililik düzeylerini yordadığı bulundu. Hastaların öz-etkililiği ile aleksitimi düzeyleri arasında ilişkiyi ve yordayıcı değişkenleri inceleyen daha kapsamlı çalışmaların yapılması önerilir.
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Assefa B, Zeleke H, Sergo T, Misganaw M, Mekonnen N. Self-care practice and associated factors among hypertensive follow-up patients at East Gojam zone public hospitals, North West Ethiopia, 2021. J Hum Hypertens 2023; 37:854-861. [PMID: 36402827 DOI: 10.1038/s41371-022-00775-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/18/2022] [Accepted: 11/01/2022] [Indexed: 11/21/2022]
Abstract
Uncontrolled hypertension leads to cardiovascular complications and organ damage. Self-care practice is crucial for the prevention and management of hypertension by improving quality of life, preventing complications and decreasing health care expenditure. The study aimed to assess self-care practice and its associated factors among hypertensive follow up patients at East Gojjam Zone public hospitals; in Northwest Ethiopia. Quantitative cross-sectional study design and qualitative phenomenological approach were applied. The quantitative result was supported by in-depth interview. Out of 480 patients included in the study, 49% have good self-care practices. Out of the total participants 44.6% have poor in antihypertensive medication adherence, 92.5% have low in diet management, 82.8% were poorly practiced physical activity and 62.5% poor practice to weight management. Participants who cannot read and write (AOR = 3.1, 95% CI: 1.6-5.9), and have no comorbidity (AOR = 0.4, 95% CI: 0.2-0.6), uncontrolled blood pressure status (AOR = 2.1, 95% CI: 1.2-3.6), poor social support status (AOR = 2.5, 95% CI: 1.5-4.3) and unfavorable attitude (AOR = 3.1, 95% CI: 1.9-5.2) are the factors for poor self-care practice. During interview; family meal preparation habits, inadequate information about self-care practice during follow-up time, inconvenient working environment, pressure during social events to share food, negligence, and poor self-efficacy were highly described as challenges for practicing and sustaining self- care. The level of hypertension self-care practices was found to be low. Therefore, hypertension self-care practices should be strengthened throughout their follow-up time, and creating awareness in the community is highly encouraged.
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Affiliation(s)
- Birtukan Assefa
- Department of Pediatric Nursing, College of Health Sciences, Debre-Markos University, Debre-Markos, Ethiopia
| | - Haymanot Zeleke
- Department of Nursing, College of Health Sciences, Debre-Markos University, Debre-Markos, Ethiopia.
| | | | - Mekdes Misganaw
- Department of Nursing, College of Health Sciences, Bahir Dar university, Bahir Dar, Ethiopia
| | - Nakachew Mekonnen
- Department of Public Health, College of Health Sciences, Debre-Markos University, Debre Markos, Ethiopia
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Rasyid A, Pemila U, Aisah S, Harris S, Wiyarta E, Fisher M. Self-Efficacy and Self-Care as Risk Factors for Ischemic Stroke: Development and Validation of a Nomogram. J Clin Med 2023; 12:5665. [PMID: 37685732 PMCID: PMC10489054 DOI: 10.3390/jcm12175665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND This study addresses the knowledge gap on how self-efficacy and self-care affect stroke risk as factors and develops a valuable tool for clinicians to assess stroke risk. METHODS From January 2022 to January 2023, this nested-case control study was conducted. Medical data including gender, age, ethnicity, locality, education, marital status, employment, caregiver, social environment, blood viscosity, Barthel Index, modified Rankin Scale (mRS), stroke risk score, self-care score, and self-efficacy score were collected. Logistic regression was used to predict stroke risk, and a nomogram was developed and validated. RESULTS 240 patients were included in the analysis. Stroke risk score (OR: 3.513; p = 0.005), self-efficacy score (OR: 0.753; p = 0.048), and self-care score (OR: 0.817; p = 0.018) were predictors of ischemic stroke. Internal validation was carried out, with a C-index of 0.774, and the Hosmer-Lemeshow test indicated a good fit (p = 0.92). The calibration plot also shows that this nomogram model has good calibration abilities. The decision curve analysis (DCA) results show a threshold probability range of 10-95%. CONCLUSION A nomogram has been developed with good validity, calibration, and clinical utility, including self-care and self-efficacy as risk factors for predicting ischemic stroke.
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Affiliation(s)
- Al Rasyid
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta 10430, Indonesia
| | - Uke Pemila
- Directorate of Health Service Governance, Indonesian Ministry of Health, Jakarta 12940, Indonesia
| | - Siti Aisah
- Department of Medical Surgery, Faculty of Nursing, Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta 10430, Indonesia
| | - Salim Harris
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta 10430, Indonesia
| | - Elvan Wiyarta
- Department of Medical Science, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta 10430, Indonesia
| | - Marc Fisher
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Brewer L, Jones C, Slusser J, Pasha M, Lalika M, Chacon M, Takawira P, Shanedling S, Erickson P, Woods C, Krogman A, Ferdinand D, Underwood P, Cooper L, Patten C, Hayes S. Mobile Health Intervention to Promote Hypertension Self-Management among African Americans Receiving Care at a Community Health Center: Formative Evaluation of the FAITH! Hypertension App. JMIR Form Res 2023. [PMID: 37115658 DOI: 10.2196/45061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND African Americans (AAs) are at a higher risk of premature death from cardiovascular diseases compared to White Americans, with disproportionate attributable risk from uncontrolled hypertension. These health disparities are rooted in structural racism with resultant adverse social determinants of health (SDOH) including limited access to quality healthcare. Given their high usage among AAs, mobile technologies, including smartphones, show promise in increasing access to reliable health information. Thus, culturally tailored mobile health (mHealth) interventions may promote hypertension self-management among this population. OBJECTIVE This formative study assessed the feasibility of integrating an innovative mHealth intervention into clinical and community settings to improve blood pressure (BP) control among AAs. METHODS A mixed methods study of AA patients with uncontrolled hypertension was implemented over two consecutive phases. In Phase 1, patients and clinicians from two federally qualified health centers (FQHCs) in the Minneapolis-St. Paul, Minnesota metropolitan area provided input through a focus group series to refine an existing culturally tailored mHealth app (FAITH! [Fostering African-American Improvement in Total Health!] App) to promote hypertension self-management among AA patients with uncontrolled hypertension. Phase 2 was a single-arm pre-post intervention pilot study to assess feasibility and patient satisfaction. Patients receiving care at an FQHC participated in a 10-week intervention utilizing the refined FAITH! Hypertension App synchronized with a wireless BP monitor and support from a community health worker (CHW) to address SDOH-related social needs. The multimedia app consisted of a 10-module educational series focused on hypertension and cardiovascular risk factors with interactive self-assessments, medication/BP self-monitoring and social networking. Primary outcomes were feasibility (app engagement/satisfaction) and preliminary efficacy (change in BP) at immediate post-intervention. RESULTS In Phase 1, 13 AA patients (69% age ≥50, 77% female) and 16 clinicians (69% age ≥50, 88% female, 63% AA) participated in focus groups. Based on their feedback, app modifications included addition of: BP/medications-tracking, BP self-care task reminders, and culturally sensitive contexts. In Phase 2, 16 AA patients were enrolled (mean age 52.6 years [SD 12.3], 75% female). Of the 16, 38% completed at least half of 10 education modules. Seven of the 16 completed the post-intervention assessment. These patients rated the intervention a 9 (out of 10) as helpful in hypertension self-management. Qualitative data revealed that these patients viewed the app as user-friendly, engaging, and informative, and CHWs were perceived as providing accountability and support. Of the 7 patients, mean systolic and diastolic BPs decreased by 6.4 mmHg (p=.15) and 2.8 mmHg (p=.78) at immediate post-intervention, respectively. CONCLUSIONS A culturally tailored mHealth app, with reinforcement by CHW support, may improve hypertension self-management among under-resourced AAs receiving care at FQHCs. A future randomized efficacy trial of the intervention is warranted. CLINICALTRIAL Registration: ClinicalTrials.gov Identifier: NCT03777709.
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Affiliation(s)
- LaPrincess Brewer
- Mayo Clinic College of Medicine, Department of Cardiovascular Medicine, 200 1st St S.W., Rochester, US
| | | | - Joshua Slusser
- Mayo Clinic, Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Rochester, US
| | | | - Mathias Lalika
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, US
| | - Megan Chacon
- Minnesota Department of Health, Heart Disease and Stroke Prevention Unit, St. Paul, US
| | - Patricia Takawira
- Minnesota Department of Health, Heart Disease and Stroke Prevention Unit, St. Paul, US
| | - Stanton Shanedling
- Minnesota Department of Health, Heart Disease and Stroke Prevention Unit, St. Paul, US
| | - Paul Erickson
- NorthPoint Health and Wellness Center, Minneapolis, US
| | | | - Ashton Krogman
- Mayo Clinic College of Medicine, Department of Cardiovascular Medicine, Rochester, US
| | - Daphne Ferdinand
- Healthy Heart Community Prevention Project, Inc., New Orleans, US
| | | | - Lisa Cooper
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, US
| | - Christi Patten
- Mayo Clinic College of Medicine, Department of Psychiatry and Psychology, Rochester, US
| | - Sharonne Hayes
- Mayo Clinic College of Medicine, Department of Cardiovascular Medicine, Rochester, US
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Avegno KS, Roberson KB, Onsomu EO, Edwards MF, Dean EL, Bertoni AG. Evaluating a Telephone and Home Blood Pressure Monitoring Intervention to Improve Blood Pressure Control and Self-Care Behaviors in Adults with Low-Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5287. [PMID: 37047903 PMCID: PMC10094475 DOI: 10.3390/ijerph20075287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
Hypertension (HTN) affects nearly 75 million in the United States, and percentages increase with low socioeconomic status (SES) due to poor access to, and quality of, care, and poor self-care behaviors. Federally Qualified Health Centers (FQHCs) employ evidence-based strategies, such as telehealth interventions, to improve blood pressure (BP) control in under-resourced communities, yet a southeastern FQHC could achieve a BP control rate of only 27.6%, well below the Health People 2020 goal of 61.2%. This pilot project used a pre/post, matched-cohort design to evaluate the effect of a telehealth intervention on BP control and self-care behaviors. Secondary outcomes included self-efficacy and perceived stress. Frequency and percentage, Wilcoxon signed-rank, and McNemar tests were used for statistical analysis of results from a convenience sample of 27 participants. Baseline HTN management guidance that incorporated home blood pressure monitoring (HBPM) was reinforced through telephone counseling every two weeks. Although BP control was not achieved, average scores for systolic and diastolic blood pressures decreased significantly: 13 mm Hg (p = 0.0136) and 5 mm Hg (p = 0.0095), respectively. Statistically significant differences were also seen in select self-care behaviors. Greater BP reduction aligned with higher self-efficacy scores and call engagement. Overall, telephone counseling and HBPM were feasible and effective in reducing BP and increasing self-care behaviors. The inability to control BP may be attributable to under-recognition of stress, lack of medication adherence/reconciliation, and underutilization of guideline-based prescribing recommendations. Findings elucidate the potential effectiveness of a sustainable telehealth intervention to improve BP in low-SES populations.
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Affiliation(s)
- Komlanvi S. Avegno
- Division of Nursing, School of Health Sciences, Winston-Salem State University, 601 S. Martin Luther King, Jr Dr., Winston-Salem, NC 27110, USA
| | - Kristina B. Roberson
- Division of Nursing, School of Health Sciences, Winston-Salem State University, 601 S. Martin Luther King, Jr Dr., Winston-Salem, NC 27110, USA
| | - Elijah O. Onsomu
- Division of Nursing, School of Health Sciences, Winston-Salem State University, 601 S. Martin Luther King, Jr Dr., Winston-Salem, NC 27110, USA
| | - Michelle F. Edwards
- Triad Adult and Pediatric Medicine, 1002 S. Eugene Street, Greensboro, NC 27406, USA
| | - Eric L. Dean
- Dean Internal Medicine, 1409 Yanceyville St., Ste C, Greensboro, NC 27405, USA
| | - Alain G. Bertoni
- School of Medicine, Wake Forest University, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA
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12
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Forman R, Viscoli CM, Meurer K, Sheth KN, Sansing LH, de Havenon A, Sharma R, Mariscal M, Kernan WN. Technical Dissonance in Home Blood Pressure Monitoring After Stroke: Having the Machine, but Not Using Correctly. Am J Hypertens 2023; 36:195-200. [PMID: 36520024 PMCID: PMC10016067 DOI: 10.1093/ajh/hpac129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/30/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In individuals with hypertension (HTN), lowering blood pressure (BP) after a stroke can lower the risk of stroke recurrence, but many patients do not reach the goal. Home blood pressure monitoring (HBPM) can help patients get to the goal, but rates of use and quality of technique have not been evaluated. METHODS We conducted a cross-sectional study of patients with stroke. Patients were eligible if they had a stroke within 2 years, had HTN, and lived at home. We classified patients as correctly performing HBPM if they used an arm cuff, sat ≥ 1 min before measurement, took ≥ 2 measurements, and use within 6 months. The primary outcome was the proportion of patients who had an HBPM and used it correctly, which we calculated according to race and ethnicity. We also asked patients what they would do if they found results outside the goal. RESULTS Among 150 participants, 120 (81%) possessed an HBPM and 29 (21%) used it correctly. We observed no significant disparity in rates of possession or correct use between non-Hispanic White participants and participants from underrepresented groups. Seventy percent of non-Hispanic White patients said they would contact their provider if their BP was above goal vs. 52% of underrepresented patients (P = 0.21). CONCLUSIONS Most patients after stroke have an HBPM, but only about 1 in 5 use it correctly. Approximately half of the patients from underrepresented racial or ethnic groups do not have a plan for responding to the values above goal. Our results indicate opportunities to improve the dissemination and correct use of HBPM.
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Affiliation(s)
- Rachel Forman
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Catherine M Viscoli
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Katherine Meurer
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lauren H Sansing
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Adam de Havenon
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Richa Sharma
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Melissa Mariscal
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Walter N Kernan
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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13
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Haung Z, Hong SA. Prevalence and factors associated with treatment and control of hypertension among adults with hypertension in Myanmar. Int Health 2023; 15:207-215. [PMID: 35851920 PMCID: PMC9977219 DOI: 10.1093/inthealth/ihac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/03/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Due to a dearth in the number of studies conducted in low- and middle-income countries, this study aimed to identify the prevalence and determinants of the treatment and control of hypertension among patients with hypertension in Myanmar. METHODS This community-based cross-sectional study was conducted among 410 adults who were registered for hypertensive treatment in health centers in Myitkyina Township, Kachin State, Myanmar. Multiple logistic regression was used to identify the associated factors. RESULTS The prevalence of treatment and control of hypertension was 48.1% and 20.5%, respectively. The factors associated with treatment were age (OR=2.60 for 46-60 y and OR=2.29 for 61-70 y compared with 30-45 y), ethnicity (OR=1.87), monthly family income (OR=1.90), comorbidity (OR=2.33), knowledge (OR=2.63) and adherence to physical activity (OR=1.86). Controlled hypertension was associated with age (OR=3.03 for 46-60 y and OR=2.27 for 61-70 y compared with 30-45 y), education (OR=1.81), comorbidity (OR=1.67) and adherence to medication (OR=3.45). CONCLUSIONS The prevalence of treated and controlled hypertension was relatively low in this study. To improve the prevalence of hypertension treatment and control in this study population, effective and culturally sensitive intervention programs under universal health coverage should be established with an emphasis on individuals with lower educational attainment and younger ages.
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Affiliation(s)
- Ze Haung
- Township Department of Public Health, Myitkyina Township, Kachin State, Myanmar
| | - Seo Ah Hong
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phuthamonthon, Nakhon Pathom 73170, Thailand
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14
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Tebelu DT, Tadesse TA, Getahun MS, Negussie YM, Gurara AM. Hypertension self-care practice and its associated factors in Bale Zone, Southeast Ethiopia: A multi-center cross-sectional study. J Pharm Policy Pract 2023; 16:20. [PMID: 36732868 PMCID: PMC9893557 DOI: 10.1186/s40545-022-00508-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/21/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hypertension is a serious threat to public health globally owing to its high prevalence and related complications. It is the main risk factor for cardiovascular disease, kidney disease, eye problems, and death. Self-care practices have been emphasized as a major element in reducing and preventing complications from hypertension. Thus, this study aimed to assess hypertension self-care practices and associated factors in Bale Zone, Southeast Ethiopia. METHODS A health facility-based cross-sectional study was conducted at three public hospitals from April 1 to May 31, 2021. Data were entered into Epi-Data version 4.6 and exported to Statistical Package for the Social Sciences (SPSS) version 25.0 for analysis. The study participants were characterized using descriptive statistics. The associations between self-care practice and independent variables were modeled using binary logistic regression analysis. Adjusted odds ratios with a 95% confidence interval were used to estimate the association between self-care practice and independent variables. The statistical significance of the association was declared at p < 0.05. RESULTS This study involved 405 hypertensive patients, with a response rate of 96.7%. The overall level of good self-care practice was 33.1% (95% CI: 28.6, 37.5). The multivariable logistic regression model showed that age under 65 years (AOR = 3.77, 95% CI: 1.60-8.89), good knowledge of hypertension self-care practice (AOR = 6.36, 95% CI: 2.07-19.56), absence of a depression (AOR = 6.08, 95% CI: 1.24-29.73) and good self-efficacy (AOR = 3.33, 95% CI: 1.12-9.87) were independent predictors of good self-care practice. CONCLUSION The level of good hypertension self-care practice in the study area was low. Hence, it is crucial to expand non-communicable disease control programs and implement public health interventions on self-care for hypertension. Moreover, to enhance hypertension self-care practices, patient-centered interventions are essential.
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15
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Metin ZG, Eren MG, Ozsurekci C, Cankurtaran M. Turkish Validity and Reliability of the Self-care of Hypertension Inventory (SC-HI) among Older Adults. J Community Health Nurs 2023; 40:64-77. [PMID: 36602776 DOI: 10.1080/07370016.2022.2078163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To assess the psychometric properties of the Turkish version of the Self-care of Hypertension Inventory (SC-HI) among older adults with hypertension. DESIGN This was a methodological study. METHODS The study sample enrolled 176 older adults. The study carried out preliminary psychometric analyses. FINDINGS Item-level content validity index ranged between 0.87 to 1.0, and the index of content validity was 0.98. The Cronbach's α for the total scale was 0.84. CONCLUSION The cross-cultural adaptation of SC-HI has been realized successfully in Turkish. CLINICAL EVIDENCE Health care providers may utilize the scale to evaluate "older individuals" hypertension self-care abilities.
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Affiliation(s)
- Zehra Gok Metin
- Faculty of Nursing, Internal Medicine Nursing Department, Hacettepe University, Ankara, Turkey
| | - Merve Gulbahar Eren
- Faculty of Health Science, Internal Medicine Nursing Department, Sakarya University, Sakarya, Turkey
| | - Cemile Ozsurekci
- Faculty of Medicine, Internal Medicine Department, Geriatric Science, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Mustafa Cankurtaran
- Faculty of Medicine, Internal Medicine Department, Geriatric Science, Hacettepe University, Ankara, Turkey
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16
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Suriyawong W, Kao TSA, Robbins LB, Ling J, Malete L. Psychosocial Determinants of Recommended Lifestyle Behaviors among Hypertensive Patients: An Integrative Literature Review. West J Nurs Res 2022; 45:455-468. [PMID: 36515369 DOI: 10.1177/01939459221144177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Healthy lifestyle levels are low among adults with hypertension (HTN). Unfortunately, psychosocial factors contributing to patients' inability to meet healthy lifestyle recommendations are not well-understood. This integrative review examined the relationships of three psychosocial factors (self-efficacy, outcome expectancy, and social support) with dietary adherence (DA) and physical activity (PA) among adults with HTN. In total, 24 peer-reviewed studies were assessed. Results showed self-efficacy had small-to-large relationships with PA (r = 0.02-0.46) and DA (r = 0.06-0.79), with the strength of the associations varying by the assessed domain and country of origin. However, few studies reported a small relationship between the remaining factors (outcome expectancy and social support) and PA and DA. Thus, more efforts are needed to delineate the contributions of social support and outcome expectancies on DA or PA. When designing an intervention that focuses on improving PA or DA among adults with HTN, these psychosocial factors should be targeted.
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Affiliation(s)
- Wachira Suriyawong
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.,College of Nursing, Michigan State University, East Lansing, MI, USA
| | | | | | - Jiying Ling
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Leapetswe Malete
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
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17
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ROKNI SOMAYEH, REZAEI ZAHED, NOGHABI ALIDELSHAD, SAJJADI MOOSA, MOHAMMADPOUR ALI. Evaluation of the effects of diabetes self-management education based on 5A model on the quality of life and blood glucose of women with gestational diabetes mellitus: an experimental study in eastern Iran. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E442-E447. [PMID: 36415299 PMCID: PMC9648546 DOI: 10.15167/2421-4248/jpmh2022.63.3.2611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/31/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is an important condition during pregnancy. The aim of the current study was to evaluate the effects of self-management education based on 5A model on the quality of life and blood glucose level of women with GDM. METHODS This quasi-experimental study was conducted on 54 pregnant women referred to the urban health care centers affiliated to the Gonabad University of Medical Sciences from March 2019 to March 2020 based on purposive sampling method. Participants were randomly allocated into intervention and control groups based on stratified random sampling using permuted block randomization method. The intervention group received self-management education program based on 5A model in five sessions during two months. Demographic data, blood glucose level, and diabetes quality of life (DQOL) questionnaire were collected for each participant. Data analysis was performed using the SPSS software version 16 and the level of statistical significance was set at 0.05. RESULTS Mean age of the participants was 33.11 ± 5.35 years old. At the end of the intervention, the mean blood glucose level of the participants in the intervention group was significantly lower compared to the control group (p < 0.001). The quality of life in the intervention group was significantly improved at the end of the intervention compared to the control group (p < 0.001). CONCLUSIONS Self-management education based on 5A model can effectively improve quality of life and blood glucose levels in women with GDM.
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Affiliation(s)
- SOMAYEH ROKNI
- Department of Medical Surgical Nursing, School of Nursing, Gonabad University of Medical Science, Gonabad, Iran
| | - ZAHED REZAEI
- Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran
| | - ALI DELSHAD NOGHABI
- Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - MOOSA SAJJADI
- Department of Medical Surgical Nursing, School of Nursing, Nursing Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - ALI MOHAMMADPOUR
- Department of Medical Surgical Nursing, School of Nursing, Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran
- Correspondence: Ali Mohammadpour, Department of Medical Surgical Nursing, School of Nursing, Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran. Tel.: +989151779436 - E-mail:
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18
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Tse CS, Siegel CA, Weaver SA, Oliver BJ, Bresee C, van Deen WK, Melmed GY. Health Confidence Is Associated With Disease Outcomes and Health Care Utilization in Inflammatory Bowel Disease: A Nationwide Cross-sectional Study. Inflamm Bowel Dis 2022; 28:1565-1572. [PMID: 34893849 DOI: 10.1093/ibd/izab313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND We aimed to examine the associations between health confidence (one's belief on the degree of control on their health and disease), inflammatory bowel disease (IBD) outcomes, and health care utilization among adults with IBD. METHODS In total, 17,205 surveys were analyzed from a cross-sectional sample of IBD patients at 23 gastroenterology (GI) practices participating in the Crohn's and Colitis Foundations' IBD Qorus Learning Health System. We used bivariate analyses and multivariable logistic regression to examine associations between health confidence and disease activity, opioid use, glucocorticoid use, well-being, and health care utilization. We used receiver operating curve analysis to determine a clinically relevant cutoff for health confidence (0-10 Likert scale). RESULTS Health confidence was highly correlated with patients' well-being, symptomatic disease activity, opioid use, and glucocorticoid use (all P < .0001). Health confidence scores <8 had 69% sensitivity for emergency department (ED) visits and 66% for hospitalizations. In patients with inactive disease, patients with low health confidence (<8) were 10 times more likely to call/message the GI office >4 times/month (adjusted odds ratio [aOR], 10.3; 95% CI, 6.1-17.3; P < .0001), 3-4 times more likely to have an IBD-related ED visit (aOR, 4.0; 95% CI, 2.9, 5.4. P < .0001), or hospitalization (aOR, 3.0, 95% CI, 2.1, 4.1, P < .0001) compared with patients with high health confidence (≥8). CONCLUSIONS In a large, national sample of adults with IBD, there were strong associations between patients' health confidence and multiple disease outcome measures. Health confidence scores <8 on a 0-10 Likert scale may be clinically useful to screen for patients who are at risk for ED visits and hospitalizations.
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Affiliation(s)
- Chung Sang Tse
- Inflammatory Bowel Disease Preceptorship, University of California, San Diego, La Jolla, CA, USA
| | - Corey A Siegel
- Section Chief of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Brant J Oliver
- Departments of Community & Family Medicine, Psychiatry, and The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Health and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Catherine Bresee
- Biostatistics Core, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Welmoed K van Deen
- Assistant Professor, Erasmus School of Health Policy and Management, Health Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Gil Y Melmed
- Co-Director, Cedars-Sinai Inflammatory Bowel Disease Center, Karsh Division of Gastroenterology, Cedars-Sinai, Los Angeles, CA, USA
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Adherence to Self-Care among Patients with Hypertension in Ethiopia: A Systematic Review and Meta-Analysis. Int J Hypertens 2022; 2022:5962571. [PMID: 35879985 PMCID: PMC9308551 DOI: 10.1155/2022/5962571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/01/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Self-care adherence for hypertensive patients is a cornerstone for the control of it and prevention of its complications. However, there are inconsistent findings for self-care adherence of hypertensive patients in Ethiopia. Thus, this systematic review and meta-analysis was done to determine the pooled estimate self-care adherence. Methods This systematic review and meta-analysis was reported based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. An intensive search of online databases such as PubMed (MEDLINE), CINHAL, Google Scholar, and advanced Google search was made to access both published and unpublished articles that report self-care adherence among hypertensive patients in Ethiopia. The pooled estimate was done with STATA version 11 metan commands in a 95% confidence interval. The presence of heterogeneity and publication bias were detected by I2 and Egger's test, respectively. A random-effect model was obtained, and subgroup analysis was done for the management of heterogeneity. Result A total of 24 articles with a total of 7224 participants were included in the final systematic review and meta-analysis. The pooled estimate of overall self-care adherence among hypertensive patients was 36.98% (95% CI: 27.13–46.83). In subgroup analysis, the highest overall self-care adherence was observed in the Amhara region at 53% (95% CI: 46.54, 59.47). The pooled estimate of self-care dimensions such as medication adherence, low-salt diet, physical activity, smoking abstinence, alcohol abstinence, and weight management was 62.71%, 65.96%, 47.28%, 92.53%, 67.59%, and 52.54%, respectively. Conclusion The pooled estimate of good self-care adherence among hypertensive patients was low. From the dimensions of self-care, the lowest level was in physical activity and the highest level was in smoking abstinence. Comparing all regions, the lowest level of overall self-care adherence was observed in Addis Ababa, Tigray region, and South Nations and Nationalities of Ethiopia. Screening of adherence to self-care and health education should be provided to every patient during every visit.
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20
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Zareban I, Araban M, Rohani MR, Karimy M, Zamani-Alavijeh F, Babanejad M, Stein LAR. High blood pressure self-care among hypertensive patients in Iran: a theory-driven study. J Hum Hypertens 2022; 36:445-452. [PMID: 33077805 DOI: 10.1038/s41371-020-00429-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 11/09/2022]
Abstract
High blood pressure is becoming a universal epidemic for both developed and developing countries; it is one of the main public health problems all over the world. This research was conducted to assess blood pressure self-care among hypertensive patients in Iran. This cross-sectional analytic study was conducted on 527 patients with hypertension recruited from Zarandieh, Iran in 2018. Data were gathered using questionnaires assessing socio-demographic information, social support, health belief model (HBM) constructs (perceived benefits to healthy behavior, barriers to healthy behavior, perceived disease threat, self-efficacy to engage in healthy behavior, and cues to action), and self-care activities to address blood pressure. A stepwise multiple linear regression analysis was used to determine factors associated with self-care behaviors. Overall, 512 patients (215 men and 297 women) participated in this study. Participants who were married, and more educated engaged in more self-care behaviors. At least one-half of the patients (47.6%) demonstrated a moderate level of self-care behaviors with a mean score of self-care equal to 9.32 ± 3.6 (out of 18). All the elements of HBM and social support were significant predictors of self-care behaviors and self-efficacy was the strongest predictor, followed (in descending order) by perceived barriers, social support, perceived disease threat, and perceived benefits. Health education based on HBM, enhanced with attention to social support, may help patient enact healthier behaviors to reduce blood pressure.
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Affiliation(s)
- Iraj Zareban
- Health Promotion Research Center, Zahedan of University Medical Sciences, Zahedan, Iran
| | - Marzieh Araban
- Department of Health Education and Promotion, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Reza Rohani
- Internal Medicine Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mahmood Karimy
- Ph.D. of Health Education Promotion, Department of Public Health, Faculty of Health, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
| | - Fereshteh Zamani-Alavijeh
- Ph.D. of Health Education Promotion, Department of Public Health, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehran Babanejad
- Ph.D. of Health Education Promotion, Department of Public Health, Faculty of Health, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - L A R Stein
- Department of Social & Behavioral Sciences, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral Health, Developmental Disabilities & Hospitals, Cranston, RI, USA.,Rhode Island Training School, Department of Children, Youth & Families, Cranston, RI, USA.,Department of Psychology, University of Rhode Island, South Kingstown, RI, USA
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21
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Melaku T, Bayisa B, Fekeremaryam H, Feyissa A, Gutasa A. Self-care practice among adult hypertensive patients at ambulatory clinic of tertiary teaching Hospital in Ethiopia: a cross-sectional study. J Pharm Policy Pract 2022; 15:23. [PMID: 35317847 PMCID: PMC8939157 DOI: 10.1186/s40545-022-00421-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, hypertension is a major public health problem and a strong predictor of cardiovascular disease complications. To reduce and prevent complications from hypertension, it is important to adapt self-care behaviors. This study aimed to assess the self-care practices of adult hypertensive patients at a tertiary teaching hospital in Ethiopia. METHODS A health facility-based prospective cross-sectional study was conducted at Jimma Medical Center in Ethiopia between February 2021 and July 2021. Binary and logistic regression was performed to assess the strength of associations between independent and dependent variables. Data entry and analysis were done using Statistical Package for social science (SPSS) software version 22.0. A p-value < 0.05 was considered to declare statistical significance. RESULTS From a total of 422 respondents included to the study, male accounted 55.7% and the mean ± SD age of the respondents was 58.7 ± 9.75 years. About 53.1% of patients had poor self-care practices toward hypertension. Not attending formal education [AOR = 2.15; 95% CI (1.74, 6.39); p ≤ 0.001], uncontrolled blood pressure [AOR = 2.14 95% CI (1.27, 3.61); p = 0.003], chronic disease co-morbidity [AOR = 1.48; 95% CI (0.25, 7.73); p ≤ 0.001], unfavorable attitude toward hypertension[AOR = 3.13; 95% CI (1.95, 7.52); p ≤ 0.001], and poor social support [AOR = 2.75; 95% CI (1.45, 6.43); p ≤ 0.001] were independent predictors of poor self-care practice. CONCLUSION The level of self-care practices for hypertension in the study area was low. In particular, the level of adherence to the DASH diet, exercise, and weight control was very low. Patient-specific targeted interventions are required to improve self-care practices for hypertension.
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Affiliation(s)
- Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Bodena Bayisa
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Helen Fekeremaryam
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Alemayehu Feyissa
- Center for Disease Control and Prevention, Oromia Regional Health Bureau, Finfinnee, Ethiopia
| | - Alemayehu Gutasa
- Department of Pharmacy, Black Lion Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
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22
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Krousel-Wood M, Peacock E, Bradford WD, Mohundro B, Craig LS, O'Connell S, Bazzano L, Shi L, Ford M. Time Preference for Immediate Gratification: Associations With Low Medication Adherence and Uncontrolled Blood Pressure. Am J Hypertens 2022; 35:256-263. [PMID: 34788786 DOI: 10.1093/ajh/hpab175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/27/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In search of innovative approaches to the challenge of uncontrolled hypertension, we assessed the association between preference for immediate gratification (i.e., high discounting rate), low medication adherence, and uncontrolled blood pressure (BP) in adults with hypertension. METHODS Using a probability discounting model and the Collier-Williams hypothetical discount rate framework, participants in this cross-sectional study reported their preference for a smaller amount of money available immediately (high discount rate; immediate gratification preference) vs. a larger amount available 1 year later (low discount rate; delayed gratification preference). Multivariable Poisson regression was used to test the association of high discounting rates with low antihypertensive medication adherence using the validated 4-item Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4 score ≥1). Mediation of the association between high discounting rate and uncontrolled BP (systolic/diastolic BP ≥ 130/80 mm Hg) by low adherence was tested using the counterfactual approach. RESULTS Among 235 participants (mean age 63.7 ± 6.7 years; 51.1% women; 41.9% Black), 50.6% had a high 1-year discount rate, 51.9% had low K-Wood-MAS-4 adherence, and 59.6% had uncontrolled BP. High discounting rates were associated with low adherence (adjusted prevalence ratio 1.58, 95% confidence interval (CI) 1.18, 2.12). Forty-three percent (95% CI 40.9%, 45.8%) of the total effect of high discount rate on uncontrolled BP was mediated by low adherence. CONCLUSIONS Adults with preference for immediate gratification had worse adherence; low adherence partially mediated the association of high discount rate with uncontrolled BP. These results support preference for immediate gratification as an innovative factor underlying low medication adherence and uncontrolled BP.
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Affiliation(s)
- Marie Krousel-Wood
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Office of Academic Affairs, Tulane University, New Orleans, Louisiana, USA
| | - Erin Peacock
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - W David Bradford
- Department of Public Administration and Policy, University of Georgia School of Public and International Affairs, Athens, Georgia, USA
| | - Brice Mohundro
- Blue Cross Blue Shield of Louisiana, Baton Rouge, Louisiana, USA
| | - Leslie S Craig
- John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Samantha O'Connell
- Office of Academic Affairs, Tulane University, New Orleans, Louisiana, USA
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Milam Ford
- Blue Cross Blue Shield of Louisiana, Baton Rouge, Louisiana, USA
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Effectiveness of a patient-centred sleep study report in the management of obstructive sleep apnoea. Sleep Breath 2022; 26:1931-1937. [PMID: 35138550 DOI: 10.1007/s11325-022-02573-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/23/2021] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Obstructive sleep apnoea (OSA) is a common condition with a range of short- and long-term health implications. Providing patient-centred care is a key principle to ensure patients are well informed and empowered to participate in clinical decision making. This study aimed to develop a patient-centred sleep study report for patients with obstructive sleep apnoea and to determine whether or not its implementation led to improved patient understanding of their disease. METHODS The study was performed in two phases. The first phase utilised the Delphi-survey technique to develop and critically appraise a patient-centred sleep study report (PCSR) for patients with OSA, to accurately and simply convey key components of the patient's diagnosis and management. The second phase was a prospective, randomised controlled trial to assess the effect of the PCSR on patient knowledge, self-efficacy, and understanding as measured through validated patient questionnaires. RESULTS The PCSR was developed on key concepts deemed to be important by the surveyed physicians, senior sleep scientists and patients. This included ensuring the results were customised, highlighting the patient's apnoea-hypopnea index, oxygen desaturation index and arousal index and limiting technical information to a few key pieces. Patients randomised to receive the PCSR had improved understanding and perceived patient-physician interaction compared to those randomised to standard care. CONCLUSION The development and implementation of the PCSR was feasible and improved patient understanding and perceived patient-physician interaction in patients with moderate to severe OSA. Whether or not use of the PCSR will translate to improved compliance with therapy will require further evaluation.
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Guo J, Lv W, Jiang S, Tang Y, Long Q, Yang J, Wiley JA, Parry M. Biological and sociocultural determinants of increased blood pressure among women with a history of gestational diabetes mellitus in rural China: a retrospective cohort study. BMJ Open 2022; 12:e049625. [PMID: 35063956 PMCID: PMC8785171 DOI: 10.1136/bmjopen-2021-049625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) increases the risk of hypertension and cardiovascular events among mothers later in life. This risk has not been well recognised by healthcare professionals in rural China. Our objectives were to (1) describe the proportion of rural women with increased blood pressure and a history of GDM; and (2) explore the biological and sociocultural factors associated with increased blood pressure. DESIGN A retrospective cohort study using data from a cross-sectional survey. SETTING Data were collected in two county-level hospitals in the central south of China between November 2017 and June 2018. PARTICIPANTS Postpartum women aged >18 years with a history of GDM (N=397). METHODS Biological and sociocultural variables were examined. We used bivariate analyses to examine the associations between time since delivery and 2-hour postload glucose, and logistic regression to determine the biological and sociocultural factors associated with increased postpartum blood pressure. RESULTS Approximately 20% (n=78) of women had increased blood pressure, defined as a systolic blood pressure ≥130 mm Hg and/or a diastolic blood pressure ≥85 mm Hg. The biological factors of advanced age, family history of hypertension and abnormal 2-hour postload plasma glucose levels were positively associated with increased blood pressure (p<0.05). General self-efficacy was the only sociocultural factor negatively associated with increased blood pressure (p<0.05). CONCLUSIONS One in five rural Chinese postpartum women with a history of GDM were found to have increased blood pressure. Biological and sociocultural factors were associated with increased postpartum blood pressure; women with lower general self-efficacy were more likely to have increased blood pressure. Disseminating knowledge about the high risk of developing increased blood pressure among women with prior GDM in rural China is indicated. Diabetes prevention programmes could consider adding general self-efficacy promotion strategies in this population.
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Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Wencong Lv
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Shan Jiang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yujia Tang
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Qing Long
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jundi Yang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
| | - James Allen Wiley
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Monica Parry
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Taani MH, Strath SJ, Schiffman R, Fendrich M, Harley A, Cho CC, Yamada Y, Kovach CR. Self-management processes, sedentary behavior, physical activity and dietary self-management behaviors: impact on muscle outcomes in continuing care retirement community residents. BMC Geriatr 2022; 22:48. [PMID: 35022022 PMCID: PMC8756701 DOI: 10.1186/s12877-021-02691-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite the known benefits of non-sedentary behavior, physical activity, and protein and caloric intake to health and muscle mass, strength, and function, many older adults do not meet physical activity and dietary recommendations. A better understanding of the factors associated with sedentary behavior, physical activity and dietary self-management behaviors, and muscle outcomes (muscle mass, strength, and function) is needed, particularly among continuing care retirement community residents. The objective of this study was to examine the factors associated with sedentary behavior, physical activity and dietary self-management behaviors, and muscle outcomes among continuing care retirement community residents. It also aimed to determine whether sedentary behavior and physical activity and dietary self-management behaviors mediate the relationships between self-efficacy, goal congruence, aging expectations, social support, and muscle outcomes. METHODS A sample of 105 continuing care retirement community residents (age > 70 years) participated in this correlational, cross-sectional study. Questionnaires on pain, self-efficacy, goal congruence, aging expectation, social support, and daily protein and caloric intake were administered. Physical activity and sedentary behavior (ActiGraph wGT3X-BT), muscle mass (ImpediMed SFB7), muscle strength (Jamar Smart Digital Hand Dynamometer), and muscle function (Short Physical Performance Battery) were measured. Multiple regression, logistic regression, and mediation analyses were performed. RESULTS Low goal congruence predicted engagement in sedentary behavior and light physical activity. Higher levels of self-efficacy and social support were associated with increased likelihoods of achieving greater moderate physical activity and meeting daily recommendations for caloric intake, respectively. Self-efficacy and goal congruence predicted muscle function and strength. Moreover, sedentary behavior and achieving greater moderate physical activity were found to partially but significantly mediate the relationship between self-efficacy and muscle function. CONCLUSION Future research should evaluate whether attempts to reduce sedentary behavior and promote physical activity and dietary self-management behaviors and muscle outcomes are more successful when modifications to the self-management process factors are also targeted.
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Affiliation(s)
- Murad H Taani
- College of Nursing, University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 53211, USA.
| | - Scott J Strath
- College of Health Sciences, University of Wisconsin-Milwaukee, 2400 E Hartford Ave, Milwaukee, WI, 53211, USA
| | - Rachel Schiffman
- College of Nursing, University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 53211, USA
| | - Michael Fendrich
- School of Social Work, University of Connecticut, Mansfield, USA
| | - Amy Harley
- UWM Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N 10th St, Milwaukee, WI, 53205, USA
| | - Chi C Cho
- College of Health Sciences, University of Wisconsin-Milwaukee, 2400 E Hartford Ave, Milwaukee, WI, 53211, USA
| | - Yosuke Yamada
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, 162-8636, Japan
| | - Christine R Kovach
- College of Nursing, University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI, 53211, USA
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Deng B, Chen Y, Meng Y, Zhang Y, Tan X, Zhou X, Zhang M. A self-efficacy-enhancing intervention for Chinese patients after total hip arthroplasty: study protocol for a randomized controlled trial with 6-month follow-up. J Orthop Surg Res 2022; 17:1. [PMID: 34983553 PMCID: PMC8725334 DOI: 10.1186/s13018-021-02689-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/23/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a common and effective surgical method for advanced hip arthritis. Rehabilitation exercises are important to improve joint function after THA and are usually conducted in a home-based program. Poor patient adherence limits improvements in pain and function, affecting quality of life. The increasing use of THA in the aging Chinese population underscores the need to develop strategies that maximize functional outcomes. The purpose of this pilot study is to develop and assess the feasibility of a self-efficacy-enhancing intervention (SEEI) to improve exercise adherence in patients undergoing THA. METHODS This single-blinded, parallel, randomized control trial will recruit 150 patients after THA and randomly assign them to an intervention or control group using computer-generated block randomization. The control group will receive usual care using evidence-based guidelines. The intervention group will receive the 6-month SEEI comprising personalized exercise guidance and self-efficacy education delivered using one face-to-face education session and four telephone consultations, supplemented by written materials. Participants are encouraged to build confidence in their own abilities, set rehabilitation goals, and self-monitor their physical exercise. RESULTS Assessments will be conducted at baseline and 1, 3, and 6 months postsurgery. The outcome indicators are exercise adherence, physical function, anxiety and depression, self-efficacy of rehabilitation, joint function, and quality of life. CONCLUSIONS This study will test a theory-based intervention program to improve self-efficacy in rehabilitation, which may significantly impact out-of-hospital rehabilitation. The results will provide evidence to inform the postoperative recovery of patients undergoing THA or similar procedures. TRIAL REGISTRATION Chinese Clinical Trials Registry, ChiCTR2000029422 , registered on 31 January 2020.
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Affiliation(s)
- Bo Deng
- Nursing Department, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yumei Chen
- Nursing Department, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Ya Meng
- School of Nursing, Sun Yat-sen University, 74, Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, China
| | - Yiheng Zhang
- School of Nursing, Sun Yat-sen University, 74, Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, China
| | - Xingxian Tan
- Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Xiaohong Zhou
- Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Meifen Zhang
- School of Nursing, Sun Yat-sen University, 74, Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, China.
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Self-Care Practice and Associated Factors among Hypertensive Patients in Debre Tabor Referral Hospital, Northwest Ethiopia, 2020. Int J Hypertens 2021; 2021:3570050. [PMID: 34422407 PMCID: PMC8376450 DOI: 10.1155/2021/3570050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/07/2021] [Indexed: 12/11/2022] Open
Abstract
Background Hypertension prevalence is continuously rising and is projected to be 1.56 billion cases by the year 2025. Despite the great progress made in the treatment of hypertension, many patients still do not achieve optimal results and experience devastating complications due to uncontrolled high blood pressure. Objective The aim of this study is to assess self-care practice and associated factors among hypertensive patients. Methods An institution-based cross-sectional study was conducted at Debre Tabor Referral Hospital, Northwest Ethiopia, from October to November 2020. A single population proportion formula and systematic random sampling technique was used to recruit 392 study participants. The data were entered to Epi-Info software version 7.1 and then exported to SPSS version 23 for analysis. A descriptive statistic was expressed as percentage, frequency, and mean. Finally, multivariable logistic regression was used to identify factors associated with dependent variable using a p value of <0.05. Results A total 392 eligible hypertensive patients participated in the study. The self-care practice among hypertension patients was found to be 54.1%. Urban residency (AOR = 2.17; 95% CI, 1.2-3.9), social support (AOR = 2.12; 95% CI, 1.13-3.39), good knowledge (AOR = 1.83; 95% CI, 1.15-2.91), age between 40 and 64 (AOR = 3.15; 95% CI, 1.19-8.3), age ≥65 (AOR = 3.81; 95% CI, 1.35-10.7), and stress control (AOR = 1.6; 95% CI, 1.06-2.67) were predictors of hypertension self-care practice. Conclusion and Recommendation. The study revealed that almost one out of two hypertension patients had good hypertension self-care practice. Good social support, age greater than 40 years, urban residency, good basic knowledge, and having stress control were positively associated with hypertensive self-care practice.
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Andualem A, Liknaw T, Edmealem A, Gedefaw M. Adherence to antihypertensive medications among adult hypertensive patients attending chronic follow-up units of Dessie Referral Hospital, Northeastern Ethiopia: A cross-sectional study. Medicine (Baltimore) 2021; 100:e26818. [PMID: 34397841 PMCID: PMC8341316 DOI: 10.1097/md.0000000000026818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 07/16/2021] [Indexed: 11/25/2022] Open
Abstract
Hypertension is the leading cause of increased morbidity and mortality rates worldwide. Despite adherence to therapies is the important determinant of treatment success to reduce apparent resistant hypertension, maintaining good adherence to antihypertensive medications remained the most serious challenge. Thus, this study aimed to assess adherence to antihypertensive medications among adult hypertensive patients in Dessie Referral Hospital.A cross-sectional study design was conducted among hypertensive patients during May and June 2020. The study participants were selected using a systematic random sampling technique. The collected data were entered into EpiData version 4.4 and exported to SPSS version 25.0 software for data cleaning and analysis. Data were analyzed using bivariable and multivariable logistic regression at a 95% confidence interval (CI). A variable that has a P-value < .05 was declared as statistically significant. Hosmer-Lemeshow test was used to test goodness-of-fit and multicollinearity was tested.The overall good adherence to antihypertensive medications was 51.9%; 95% CI: (46.8-58.3%) and poor adherence was 48.1%. Factors associated with good adherence were: sex-female adjusted odd ratio (AOR) = 1.31; 95% CI (1.06-2.52), occupational status-employed AOR = 2.24; 95% CI (1.33-3.72), good knowledge of the disease AOR = 2.20; 95% CI (1.34-3.72) and good self-efficacy AOR = 1.38; 95% CI (1.20-2.13).This study revealed that almost half of the hypertensive patients in Dessie Referral Hospital had good antihypertensive medication adherence. Sex, occupational status, knowledge, and self-efficacy were factors associated with good adherence. Therefore, health education should be given to patients on the importance of complying with medication and patients should be monitored by health extension workers.
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Affiliation(s)
- Atsedemariam Andualem
- Department of Nursing, School of Nursing and Midwifery, Wollo University, Dessie, Ethiopia
| | - Tiliksew Liknaw
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Afework Edmealem
- Department of Nursing, School of Nursing and Midwifery, Wollo University, Dessie, Ethiopia
| | - Mihretie Gedefaw
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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An E, Irwin MR, Doering LV, Brecht M, Watson KE, Corwin E, Macey PM. Mindfulness effects on lifestyle behavior and blood pressure: A randomized controlled trial. Health Sci Rep 2021; 4:e296. [PMID: 34136657 PMCID: PMC8178963 DOI: 10.1002/hsr2.296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND AIMS HTN affects nearly 50% of U.S. adults and is the leading modifiable cardiovascular risk factor. A healthy diet and exercise can improve BP control, but adherence to these interventions is low. We tested whether a multimodal mind-body program, Mindful Awareness Practices (MAP) could improve BP and lifestyle behaviors associated with HTN when compared to a Health Promotion Program (HPP). METHODS Adults with BP >120/80 were randomized to MAP or HPP. Outcome measurements of BP, self-reported diet, and exercise were analyzed with intent-to-treat group comparisons using repeated measures linear mixed models. RESULTS There was an MAP-HPP between-group difference in interactions of time-by-systolic BP (P = 0.005) and time-by-diastolic BP (P = .003). The mean drops in SBP from baseline to week 13 for the MAP group was 19 mm Hg (138 ± 15 mm Hg-119 ± 6 mm Hg) compared to 7 mm Hg (134 ± 18 mm Hg-127 ± 22 mm Hg) in the HPP group. Similarly, a greater reduction in DBP was observed in the MAP group compared to the HPP group, 12 mm Hg (89 mm Hg ± 11-77 ± 7 mm Hg) and 1 mm Hg (81 ± 16 mm Hg-80 ± 18 mm Hg), respectively. Mediational analysis of the MAP group showed the total effect of mindfulness practice minutes on SBP with indirect effect (ab) of -.057 was significant, resulting in a 40% lower SBP for total effect (c) compared to direct (c') effect alone. The mediational model suggests MAP has a modest positive influence on participants initiating lifestyle behavior change, which partially explains the greater reduction in BP by the MAP group. CONCLUSION Our findings suggest a multimodal mind-body program involving mindfulness practice may improve BP control in adults with HTN.
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Affiliation(s)
- Eunjoo An
- School of NursingColumbia UniversityNew YorkNew York
| | - Michael R. Irwin
- Department of Psychiatry and Biobehavioral SciencesDavid Geffen School of Medicine at UCLALos AngelesCA
- Brain Research InstituteUniversity of CaliforniaLos AngelesCalifornia
| | | | | | | | | | - Paul M. Macey
- Brain Research InstituteUniversity of CaliforniaLos AngelesCalifornia
- School of NursingUCLACalifornia
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Effects of Behaviorally Supported Exercise and Exercise-Induced Mood Changes on Elevated Blood Pressure and Hypertension in African American Adults with Severe Obesity. J Immigr Minor Health 2021; 24:721-729. [PMID: 34036517 PMCID: PMC8147905 DOI: 10.1007/s10903-021-01220-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 10/29/2022]
Abstract
African Americans with obesity have high rates of hypertension. Exercise has been shown to significantly reduce high blood pressure; however, effects through associated reductions in anxiety and depression are unclear. African American adults with either class 2 or 3 obesity (n = 86; Mage = 43.4 years) and either elevated blood pressure (n = 16) or stage 1 (n = 33) or stage 2 (n = 37) hypertension participated in a theoretically driven community-based weight-management program. There were significant increases in exercise outputs; while systolic and diastolic blood pressure, anxiety, and depression significantly decreased from baseline-month 6. Increased exercise significantly predicted reduced anxiety, depression, and diastolic blood pressure. Change in anxiety significantly mediated the relationship between exercise and both systolic and diastolic blood pressure changes. Increasing exercise from the equivalent of 1.5 to 4.5 moderate bouts/week reduced elevated blood pressure/hypertension in African American adults with severe obesity largely through their exercise-associated improvement in anxiety.
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Khadoura KJ, Shakibazadeh E, Mansournia MA, Aljeesh Y, Fotouhi A. Effectiveness of motivational interviewing on medication adherence among Palestinian hypertensive patients: a clustered randomized controlled trial. Eur J Cardiovasc Nurs 2021; 20:411-420. [PMID: 34009313 DOI: 10.1093/eurjcn/zvaa015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/16/2020] [Accepted: 10/23/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND This trial aimed to evaluate the effectiveness of motivational interviewing (MINT) among medication non-adherent hypertensive patients attending primary healthcare centres in Gaza Strip. METHODS AND RESULTS A clustered randomized controlled trial was run among 355 hypertensive participants; who were identified as non-adherent by a self-reported adherent scale and were recruited from 10 centres by two stages cluster random sampling approach (five centres were randomly allocated to each group). Standard of hypertension care was provided to 173 participants, parallel to 182 one who received their standard of care including non-blinded MINT sessions for 3 months. The change in medication adherence status was the primary outcome and within-patient changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), self-efficacy and intrinsic motivation were the secondary outcomes. Data were collected via an interview-based structured questionnaire and were analysed by generalizing equation estimation model adjusting for covariates. The results showed a significant improvement in medication adherence status among participants in the intervention group (n = 159) [OR= 6.28; 95% confidence interval (CI): 3.20, 12.33; P < 0.001] compared with those in the control group (n = 151). Moreover, there were significant drops in both SBP (OR = 0.18; 95% CI: 0.06, 0.55; P = 0.002) and DBP (OR = 0.26; 95% CI: 0.09, 0.76; P = 0.013) and significant positive changes in both within-patient's self-efficacy (OR = 15.4; 95% CI: 3.9, 60.6; P < 0.001) and intrinsic motivation (OR = 31.7; 95% CI: 13.9, 71.9; P < 0.001). CONCLUSION Standard of care including MINT is an effective client-centred approach which promoted medication adherence, decreased mean blood pressure, and improved self-efficacy and intrinsic motivations among hypertensive patients.
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Affiliation(s)
- Khalid Jamal Khadoura
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences-International Campus, Tehran, Iran.,Department of Nursing, Faculty of Medical Sciences, Israa University-Gaza, Palestine
| | - Elham Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Aljeesh
- Faculty of Nursing, Islamic University of Gaza, Gaza, Palestine
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Haung Z, Hong SA, Tejativaddhana P, Puckpinyo A, Myint MNHA. Multiple self-care behaviors and associated factors in community-dwelling patients with hypertension in Myanmar. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:363-376. [PMID: 32581415 PMCID: PMC7276404 DOI: 10.18999/nagjms.82.2.363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aimed to identify the prevalence of self-care behaviors and the associated factors among hypertensive patients in primary care in Myanmar. This cross-sectional study was conducted from April to May 2019 among 410 hypertensive patients in Myitkyina Township, Kachin State, Myanmar. Hypertensive patients aged 30–70 years old and being registered at the community health centers in Myitkyina Township were selected using multi-stage cluster random sampling. Self-care behaviors were measured by Hypertensive Self-Care Activity Level Effect (H-SCALE). Chi-square test and multiple logistic regression analysis were used to explore the associated factors. Prevalence of adherence to multiple self-care behaviors were low: avoidance of tobacco use at 50.2%, followed by physical activity at 24.9%, medication at 24.1%, weight management at 9.5%, and healthy diet at 2.7%, while abstinence from harmful alcohol drinking was high at 97.8%. Multiple logistic regression analysis indicated that younger patients, low family income, inadequate knowledge, and no comorbidity were associated with non-adherence to medication. Living in rural area and having poor self-efficacy were associated with non-adherence to weight management, while being younger, female and having poor self-efficacy were also associated with non-adherence to physical activity. Compared with Kachin, other ethnics were more likely to be non-adherent to avoidance of tobacco use. Although a majority of respondents were not harmful drinkers, adherence to medication, healthy diet, physical activity, weight management and avoidance of tobacco use were very low. Health practitioners should provide education programs for hypertensive patients to direct them towards practical techniques in managing their blood pressure.
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Affiliation(s)
- Ze Haung
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand.,Township Department of Public Health, Myitkyina, Myanmar
| | - Seo Ah Hong
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | | | - Apa Puckpinyo
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
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Hutchison KN, Sweeney J, Bechtel C, Park B. Reimagining Relationship-Based Health Care in a Post-COVID World. J Patient Exp 2021; 8:2374373521998622. [PMID: 34179395 PMCID: PMC8205340 DOI: 10.1177/2374373521998622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The US health care system has a long history of discouraging the creation
and maintenance of meaningful relationships between patients and
providers. Fee-for-service payment models, the 1-directional,
paternalistic approach of care providers, electronic health records,
anddocumentation requirements, all present barriers to the development
of meaningful relationships in clinic visits. As patients and
providers adopt and experiment with telemedicine and other systems
changes to accommodate the impact of Coronavirus disease 2019, there
is an opportunity to reimagine visits entirely—both office-based and
virtual—and leverage technology to transform a unidirectional model
into one that values relationships as critical facilitators of health
and well-being for both patients and providers.
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Affiliation(s)
| | | | | | - Brian Park
- Family Medicine, Oregon Health & Science University, Portland, OR, USA.,Relational Leadership Institute, Portland, OR, USA
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Ajani K, Gowani A, Gul R, Petrucka P. Levels and Predictors of Self-Care Among Patients with Hypertension in Pakistan. Int J Gen Med 2021; 14:1023-1032. [PMID: 33790631 PMCID: PMC8006970 DOI: 10.2147/ijgm.s297770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
Background Globally, hypertension is the leading non-communicable disease and strongest predictor of cardiovascular diseases. To mitigate and prevent hypertension-related complications, self-care behavior adaptation has proven to be vital. In this study, we examined the six clinically prescribed levels of self-care as prescribed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and its predictors among a select sample of hypertensive individuals in Karachi, Pakistan. Methods This study reports the cross-sectional survey of a sequential mixed method study which assessed the levels of self-care of hypertensive individuals residing in an urban cosmopolitan setting within Karachi Pakistan. Four hundred and two patients were screened using the H-SCALE questionnaire, while socio-demographic predictors of self-care and level of knowledge of hypertension were identified using a study-specific checklist. Self-care was assessed against six clinical domains including medication adherence, diet, weight management, physical activity, and abstinence from alcohol. Results Participants were recruited from the two largest tertiary care hospitals in Karachi. Good knowledge about hypertension, including its causes, management, and complications was reported by 4.47% of the participants. Highest levels of self-care adherence were found for abstinence from alcohol (100%), smoking cessation (83.33%), and medication compliance (71.89%), whereas lowest levels were found for diet (27.11%), and physical activity (24.88%). In terms of predictors for self-care, age, male gender, and self-checking of blood pressure at home, followed by the level of education were the most common predictors for each self-care behavior in the given population. Conclusion Overall knowledge of self-care for hypertension is sub-optimal among hypertensive patients in Pakistan which is reflected in their behaviors. There is a need to introduce healthcare educational programs in Pakistan which can improve self-care behaviors of hypertensive individuals and potentially reduce the prevalence of associated cardiovascular diseases and its complications.
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Affiliation(s)
| | - Ambreen Gowani
- School of Nursing, Aga Khan University, Karachi, Pakistan
| | - Raisa Gul
- School of Nursing, Aga Khan University, Karachi, Pakistan.,School of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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35
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Craig LS, Peacock E, Mohundro BL, Silver JH, Marsh J, Johnson TC, Kelly PA, Bazzano LA, Cunningham M, Petty RE, Krousel‐Wood M. Implicit and Explicit Attitudes Toward Antihypertensive Medications Explain Variation in Pharmacy Refill and Self-Reported Adherence Beyond Traditional Risk Factors: Potential Novel Mechanism Underlying Adherence. J Am Heart Assoc 2021; 10:e018986. [PMID: 33660523 PMCID: PMC8174192 DOI: 10.1161/jaha.120.018986] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/13/2021] [Indexed: 12/21/2022]
Abstract
Background In pursuit of novel mechanisms underlying persistent low medication adherence rates, we assessed contributions of implicit and explicit attitudes, beyond traditional risk factors, in explaining variation in objective and subjective antihypertensive medication adherence. Methods and Results Implicit and explicit attitudes were assessed using the difference scores from the computer-based Single Category Implicit Association Test and the Necessity and Concerns subscales of the Beliefs about Medicines Questionnaire, respectively. Antihypertensive medication adherence was measured using pharmacy refill proportion of days covered (PDC: mean PDC, low PDC <0.8) and the self-report 4-item Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4: mean K-Wood-MAS-4, low adherence via K-Wood-MAS-4 ≥1). Hierarchical logistic and linear regression models controlled for traditional risk factors including social determinants of health, explicit, and implicit attitudes in a stepwise fashion. Community-dwelling insured participants (n=85: 44.7% female; 20.0% Black; mean age, 62.3 years; 43.5% low PDC, and 31.8% low adherence via K-Wood-MAS-4) had mean (SD) explicit and implicit attitude scores of 7.188 (5.683) and 0.035 (0.334), respectively. Low PDC was inversely associated with more positive explicit (adjusted odds ratio [aOR], 0.87; 95% CI, 0.78-0.98; P=0.022) and implicit (aOR, 0.12; 95% CI, 0.02-0.80; P=0.029) attitudes, which accounted for an additional 8.6% (P=0.016) and 6.5% (P=0.029) of variation in low PDC, respectively. Lower mean K-Wood-MAS-4 scores (better adherence) were associated only with more positive explicit attitudes (adjusted β, -0.04; 95% CI, -0.07 to -0.01; P=0.026); explicit attitudes explained an additional 5.6% (P=0.023) of K-Wood-MAS-4 variance. Conclusions Implicit and explicit attitudes explained significantly more variation in medication adherence beyond traditional risk factors, including social determinants of health, and should be explored as potential mechanisms underlying adherence behavior.
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Affiliation(s)
- Leslie S. Craig
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Erin Peacock
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | | | - Julia H. Silver
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - James Marsh
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - Taylor C. Johnson
- Department of MedicineTulane University School of MedicineNew OrleansLA
| | - P. Adam Kelly
- Department of MedicineTulane University School of MedicineNew OrleansLA
- Southeast Louisiana Veterans Health Care SystemNew OrleansLA
| | - Lydia A. Bazzano
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
| | - Michael Cunningham
- Department of PsychologyTulane University School of Science and EngineeringNew OrleansLA
| | | | - Marie Krousel‐Wood
- Department of MedicineTulane University School of MedicineNew OrleansLA
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
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Tan FCJH, Oka P, Dambha-Miller H, Tan NC. The association between self-efficacy and self-care in essential hypertension: a systematic review. BMC FAMILY PRACTICE 2021; 22:44. [PMID: 33618661 PMCID: PMC7901221 DOI: 10.1186/s12875-021-01391-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The successful management of hypertension requires sustained engagement in self-care behaviour such as adhering to medication regimens and diet. Bandura's Social Cognitive Theory suggests that self-efficacy is a major determinant of engagement in self-care behaviour. Self-efficacy refers to an individual's belief in their capacity to execute behaviours necessary to produce specific performance attainments. This systematic review of observational studies aims to summarise and evaluate the quality of evidence available to support the association between self-efficacy and engagement in self-care behaviour in hypertension. METHODS Searches were performed of the Pubmed, MEDLINE, CINAHL and OpenSIGLE databases from database inception to January 2020. Reference lists and individual journals were also hand searched. Observational studies in English quantifying self-efficacy and self-care behaviour in hypertensive adults were included. The quality of included articles was assessed with the National Institute of Health Quality Assessment Tool for observational studies. RESULTS The literature search identified 102 studies, of which 22 met the inclusion criteria for full-text review. There were 21 studies which reported that higher self-efficacy was associated with engagement in self-care behaviours including medication adherence (n = 9), physical activity (n = 2) and dietary changes (n = 1). Of these, 12 studies were rated as 'good' on the quality assessment tool and 10 were 'fair'. A common limitation in these studies was a lack of objectivity due to their reliance on self-reporting of engagement in self-care behaviour. CONCLUSION Our review suggests an association between self-efficacy and self-care. However, the evidence supporting this association is of low to medium quality and is limited by heterogeneity. Our findings suggest the need for further well-designed interventional studies to investigate this association.
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Affiliation(s)
- Felicia Clara Jun Hui Tan
- Ministry of Health Holdings, 1 Maritime Square, #11-25 HarbourFront Centre, Singapore, 099253, Singapore.,SingHealth Polyclinics, 167 Jalan Bukit Merah Connection One (Tower 5), #15-10, Singapore, 150167, Singapore
| | - Prawira Oka
- Ministry of Health Holdings, 1 Maritime Square, #11-25 HarbourFront Centre, Singapore, 099253, Singapore.,SingHealth Polyclinics, 167 Jalan Bukit Merah Connection One (Tower 5), #15-10, Singapore, 150167, Singapore
| | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, 167 Jalan Bukit Merah Connection One (Tower 5), #15-10, Singapore, 150167, Singapore. .,SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore.
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37
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Van Truong P, Wulan Apriliyasari R, Lin MY, Chiu HY, Tsai PS. Effects of self-management programs on blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension: Meta-analysis of randomized controlled trials. Int J Nurs Pract 2021; 27:e12920. [PMID: 33590947 DOI: 10.1111/ijn.12920] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022]
Abstract
AIM To assess the effects of self-management interventions on systolic blood pressure, diastolic blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension. BACKGROUND Effective treatment of hypertension may require the practice of self-management behaviours. However, evidence on effects of self-management interventions on blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension is lacking. DESIGN A systematic review and meta-analysis. DATA SOURCES CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science and other sources were searched to October 2020. REVIEW METHODS Data were analysed using Comprehensive Meta-Analysis 2.0 and quality assessment was done using ROB 2.0. The pooled effect sizes were reported as Hedges' g values with corresponding 95% confidence intervals using a random-effects model. RESULTS Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly decreased blood pressure and increased self-efficacy and medication adherence in older adult patients with hypertension, with no significant effect on body mass index. CONCLUSIONS Self-management interventions have considerable beneficial effects in older adults with hypertension. Health care providers should implement self-management interventions to strengthen the patient's role in managing their health.
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Affiliation(s)
- Pham Van Truong
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Nursing Department, Vinmec Times City Hospital, Vinmec HealthCare System, Hanoi, Vietnam
| | - Renny Wulan Apriliyasari
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Cendekia Utama, Kudus, Central Java, Indonesia
| | - Mei-Yu Lin
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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38
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Khairy S, Aslan A, Samara AM, Mousa I, Alkaiyat AS, Zyoud SH. Factors associated with self-efficacy in patients with hypertension: a cross-sectional study from Palestine. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:1. [PMID: 33563337 PMCID: PMC7874607 DOI: 10.1186/s41043-021-00225-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Self-efficacy is a widely applied psychosocial concept that is commonly used in association with management of chronic diseases, including hypertension. The aim of this study was to assess self-efficacy of hypertension management and patient-physician communication, as well as the factors associated with self-efficacy and patient-physician communication among patients with hypertension in Palestine. METHODS We conducted face-to-face, questionnaire-based interviews using validated instruments to assess self-efficacy in managing hypertension (Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6C)) and patient-physician communication (Perceived Efficacy in Patient-Physician Interaction Questionnaire (PEPPI)) in patients with hypertension at the three main primary healthcare centers in Nablus district in northern West Bank, Palestine. We also performed a multiple linear regression analysis to determine the variables independently associated with PEPPI and SES6C scores. RESULTS We enrolled 377 participants with hypertension in this study. The average age (measured in years) was 56.8 with a standard deviation of 11.6. The mean PEPPI and SES6C scores were 20.0 (SD 4.4) and 41.1 (SD 10.6), respectively. In a multiple linear regression model, subjects who were city dwellers (B=3.597, p=0.004), and subjects with high education levels (B=4.010, p=0.001) achieved higher PEPPI scores, whereas subjects in the normal weight category (B=5.566, p<0.001) and those with higher PEPPI scores (B=0.706, p<0.001) achieved higher SES6C scores. CONCLUSIONS We found that impairment in self-efficacy was linked to overweight and obesity, as well as lower patient-physician communication. Moreover, our results showed that lower patient-physician communication was independently associated with low education level as well as non-city residency types. We recommend making the appropriate changes by both the policy-makers and the health care providers to improve the health facilities and its services, especially outside the cities. We also suggest holding specific counseling and training session on the management and control of hypertension.
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Affiliation(s)
- Salam Khairy
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Asala Aslan
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ahmad M. Samara
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Ibrahim Mousa
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Abdulsalam S. Alkaiyat
- grid.11942.3f0000 0004 0631 5695Public Health Department, College of Medicine and Health Sciences, An-Najah National University Hospital, An-Najah National University, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- grid.11942.3f0000 0004 0631 5695Clinical Research Centre, An-Najah National University Hospital, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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39
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The Effect of Cognitive-Behavioral Intervention on Self-Care Behaviors and Blood Pressure Control in Patients with Primary Hypertension. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2021. [DOI: 10.52547/jech.8.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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40
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Fotokian Z, Nasresabetghadam S, Jahanshahi M, Nasiri M, Hajiahmadi M. The effects of Orem's self-care theory on self-care behaviors among older women with hypertension: A randomized controlled trial. Nurs Midwifery Stud 2021. [DOI: 10.4103/nms.nms_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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41
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Liu Q, Zhu X, Shen M, Wu J, Chen S, Wang Z, Yu W, Shi J, Huang J, Wang Z. Community Pharmacist Services for Hypertensive Patients: A Novel Practice in Shanghai, China. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211020874. [PMID: 34078162 PMCID: PMC8182196 DOI: 10.1177/00469580211020874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 04/18/2021] [Accepted: 05/07/2021] [Indexed: 11/19/2022]
Abstract
For Chinese community pharmacists, there is a lack of guidance before and after the drug treatment process for community residents. This study aimed to investigate community pharmacists' role in hypertension management. One hundred ninety-six hypertensive patients were randomly selected from the studied community. For patients in the intervention group, monthly meetings were scheduled with a community pharmacist. Patients in the non-intervention group received standard care from their physicians. In the intervention group, the percentage using information from pharmacists increased significantly, from 54.3% to 94.2% (P < .05). Awareness of self-management was also enhanced, with community self-management group attendance increasing from 53.4% to 77.7% (P < .05), but the non-intervention group did not change significantly. Hypertensive patients' beliefs about community pharmacists also improved significantly. Hypertension status also showed a significant improvement, whereas for participants without intervention, it worsened over time. In addition to increasing knowledge regarding drug use, care provided by community pharmacists can also significantly improve blood pressure status. For those who did not receive intervention, a disproportionate level of health deterioration could be seen.
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Affiliation(s)
- Qian Liu
- Tongji University, Shanghai,
China
| | - Xiaoyan Zhu
- Shanghai Jiao Tong University School of
Medicine, Shanghai, China
| | - Mei Shen
- Shanghai Ouyang Road Community Health
Service Center, Shanghai, China
| | - Jianping Wu
- Shanghai Ouyang Road Community Health
Service Center, Shanghai, China
| | - Shuqin Chen
- Shanghai Ouyang Road Community Health
Service Center, Shanghai, China
| | | | - Wenya Yu
- Shanghai Jiao Tong University School of
Medicine, Shanghai, China
| | - Jianwei Shi
- Shanghai Jiao Tong University School of
Medicine, Shanghai, China
| | - Jiaoling Huang
- Shanghai Jiao Tong University School of
Medicine, Shanghai, China
| | - Zhaoxin Wang
- Shanghai Jiao Tong University School of
Medicine, Shanghai, China
- Southern Medical University, Guangdong,
China
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42
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Meyer M, Enguidanos S, Zhu Y, Likar D, Batra R. Community Medication Education, Data, & Safety (C-MEDS): Findings from a Pilot Project. J Am Geriatr Soc 2020; 69:813-821. [PMID: 33355939 DOI: 10.1111/jgs.16981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/28/2020] [Accepted: 11/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Medication-related problems remain one of the largest health risks for older adults, yet there are few resources available to effectively reduce medication-related problems for community dwelling older adults. The aim of this pilot program was to determine the effectiveness of a multifaceted medication intervention on medication adherence and self-efficacy in medication use. DESIGN A single sample, pre-post-test design. SETTING This pilot study was conducted at Independence at Home, a Senior Care Action Network (SCAN) community service in Southern California. PARTICIPANTS One hundred and eighty community-dwelling, diverse older adults with potential medication-related problems and their caregivers. INTERVENTION The Community Medication Education, Data, & Safety (C-MEDS) Program identified community-dwelling older adults with potential medication-related problems and provided in-depth personalized medication safety, management and support, based on an in-home assessment and interventions delivered by trained geriatrics experts including pharmacists, nurses, a community health worker, and a pharmacy technician. MEASUREMENTS The primary outcomes included medication use self-efficacy, measured by the MUSE, and select medication adherence measures. Adherence was measured via pill count and via the MedAdhIR tool, a scale that measures risk for medication non-adherence. RESULTS Following participation in the C-MEDS program, community-dwelling older adult C-MEDS graduates (n = 105) had higher self-efficacy in managing medications (P < .001). Additionally, C-MEDS graduates also exhibited increased adherence to three types of medications (statins, diabetes-related, and certain hypertension drugs; P < .001). Moreover, risk of non-adherence declined significantly following C-MEDS graduation (P < .001). CONCLUSION C-MEDS holds promise as an effective intervention among community-dwelling older adults in improving medication self-efficacy, medication adherence among select medications, and reducing risk for non-adherence. Additional studies are needed to assess replicability and impact on clinical outcomes.
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Affiliation(s)
- Marsha Meyer
- Independence at Home, SCAN Health Plan, Long Beach, California, USA
| | - Susan Enguidanos
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, California, USA
| | - Yujun Zhu
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, California, USA
| | - Denise Likar
- Independence at Home, SCAN Health Plan, Long Beach, California, USA
| | - Romilla Batra
- Independence at Home, SCAN Health Plan, Long Beach, California, USA
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43
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Shen Z, Shi S, Ding S, Zhong Z. Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients With Hypertension. Front Pharmacol 2020; 11:569092. [PMID: 33364943 PMCID: PMC7750474 DOI: 10.3389/fphar.2020.569092] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/27/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Studies have reported that medication literacy had a positive effect on medication adherence in patients with hypertension. However, little is known about the mechanism underlying this relationship in patients with hypertension. Objective: The purpose of this study was to investigate the mediating effect of self-efficacy between medication literacy and medication adherence. Methods: A total of 790 patients with hypertension were investigated using the Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP), the Morisky Medication Adherence Scale-8 (MMAS-8) and the Medication Adherence Self-efficacy Scale-Revision (MASES-R). Hierarchical regression and the bootstrap approach were used to analyze the mediating effect of self-efficacy on the relationship between medication literacy and medication adherence. Results: A total of 60.9% of hypertensive patients were low adherent to their antihypertensive drug regimens. Self-efficacy had a significant positive correlation with medication literacy (r= 0.408, p < 0.001) and medication adherence (r = 0.591, p < 0.001). Self-efficacy accounts for 28.7% of the total mediating effect on the relationship between medication literacy and adherence to antihypertensive regimens for hypertensive patients. Conclusion: More than half of the hypertensive patients in the study were low adherent to antihypertensive regimens. Self-efficacy had a partial significant mediating effect on the relationship between medication literacy and medication adherence. Therefore, it was suggested that hypertensive patients' medication adherence might be improved and driven by increasing self-efficacy. Targeted interventions to improve patients' self-efficacy should be developed and implemented. In addition, health care providers should also be aware of the importance of medication literacy assessment and promotion in patients with hypertension.
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Affiliation(s)
- Zhiying Shen
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shuangjiao Shi
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhuqing Zhong
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
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44
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Taani MH, Ellis JL, Zabler B, Kelber ST, Tsai PY. Medication interventions for African-American adults: Practice-based evidence from two nurse-led clinics. Public Health Nurs 2020; 38:77-84. [PMID: 33270931 DOI: 10.1111/phn.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was conducted to describe and examine the impact of medication intervention practices among African-American clients in two nurse-led community nursing centers (CNCs). METHODS This study used a retrospective-descriptive design. Omaha System data from visits of 196 African-American adults living with chronic disease and having two or more CNC visits in which medication regimen was an identified problem and the main reason for the visit was analyzed. RESULTS The sample had a mean age of 53.1 (6.67) and was primarily women (82%), uninsured, and with high school or less education. A total of 9,259 Medication regimen interventions were documented and implemented during 1,146 client CNC visits. A paired samples t test revealed statistically significant improvements in Knowledge (t = 2.434, p < .01). Behavior (t = 0.077, p = .94) and Status (t = 1.489, p = .14) remained unchanged, although the ratings trended toward improvement for each. CONCLUSION This study provides evidence that the nursing center model of care does improve the knowledge of medications among African-American clients. The study also demonstrated the Omaha System's utility to evaluate the impact of nursing interventions in community settings.
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Affiliation(s)
- Murad H Taani
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Julie L Ellis
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Bev Zabler
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Sheryl T Kelber
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Pei-Yun Tsai
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Hussen FM, Adem HA, Roba HS, Mengistie B, Assefa N. Self-care practice and associated factors among hypertensive patients in public health facilities in Harar Town, Eastern Ethiopia: A cross-sectional study. SAGE Open Med 2020; 8:2050312120974145. [PMID: 33329893 PMCID: PMC7720317 DOI: 10.1177/2050312120974145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Self-care practice is the activity that a hypertensive patient undertakes intending to improve their health. Poor self-care practice leads to uncontrolled hypertension. Therefore, strategies designed to prevent and control hypertension-related death, disability, and morbidity should consider the level of the patient’s self-care practice and risk factors. This study assessed self-care practice and associated factors among hypertensive patients in public health facilities of Harar Town in eastern Ethiopia. Method: An institution-based cross-sectional study was conducted among 398 randomly selected hypertensive patients from 25 March 2019 to 16 April 2019. Pretested structured questionnaires adapted from validated tools were used to collect data from participants using electronic Open Data Kit software through face-to-face exit interview. Data were analyzed by SPSS version 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with self-care practice. Adjusted odds ratio with 95% confidence interval was used to report association and the significance was declared at p-value < 0.05. Results: Level of good self-care practice was 29.9% (95% confidence interval: 25.3% and 34.7%). Age ⩾ 60 years (adjusted odds ratio = 3.4, 95% confidence interval: 1.2 and 9.3), formal education (adjusted odds ratio = 2.3, 95% confidence interval: 1.3 and 4.2), absence of comorbidities (adjusted odds ratio = 1.8, 95% confidence interval: 1.1 and 3.1), adequate knowledge about hypertension (adjusted odds ratio = 4.7, 95% confidence interval: 2.5 and 8.8), good social support (adjusted odds ratio = 2.7, 95% confidence interval: 1.6 and 4.7), and being khat abstainer (adjusted odds ratio = 1.9, 95% confidence interval: 1.1 and 3.5) were significantly associated with good self-care practice. Conclusion: The prevalence of good self-care practice was low. In this study, good self-care practice was significantly associated with age, formal education, comorbidities, knowledge about hypertension, social support, and current khat chewing condition. Regular check-up and follow-up of patients’ compliance with self-management protocol, and more emphasis should be given to identify factors that potentially impeding patients’ adherence to hypertension self-management protocol.
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Affiliation(s)
- Feysal Mohammed Hussen
- Department of Public Health, College of Health Science, Kebridehar University, Kebridehar, Ethiopia.,School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hassen Abdi Adem
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hirbo Shore Roba
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bezatu Mengistie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Still CH, Margevicius S, Harwell C, Huang MC, Martin L, Dang PB, Wright Jnr JT. A Community and Technology-Based Approach for Hypertension Self-Management (COACHMAN) to Improve Blood Pressure Control in African Americans: Results from a Pilot Study. Patient Prefer Adherence 2020; 14:2301-2313. [PMID: 33262580 PMCID: PMC7695598 DOI: 10.2147/ppa.s283086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/31/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Adoption of technology has increased to support self-managing chronic diseases. However, behavioral interventions evaluating such technology have been understudied in African Americans with hypertension. The aim of this study was to explore a community and technology-based intervention for hypertension self-management (COACHMAN) intervention on blood pressure (BP) control and health-related quality of life (HRQoL) in African Americans with hypertension. METHODS Sixty African Americans (mean age 60; 75% females) who were prescribed antihypertensive medications and owning a smartphone were randomized to the COACHMAN (n = 30) or enhanced usual care (n = 30) group for 12 weeks. COACHMAN is comprised of four components: web-based education, home BP monitoring, medication management application, and nurse counseling. Hypertension knowledge, self-efficacy, technology adoption/use, medication adherence, BP, and HRQoL scores were assessed. RESULTS Mean systolic and diastolic BP at baseline was 150.49 (SD = 13.89) and 86.80 (SD = 13.39), respectively. After completing the 3-month intervention to improve hypertension self-management, the groups did not significantly differ in BP control and HRQoL. Clinically relevant BP reduction was observed in the intervention group. Paired t-test showed that mean medication-taking adherence scores significantly improved in the intervention group (P = 0.023) compared to the control group (P = 0.075). CONCLUSION Using technology may have a positive impact on supporting hypertension self-management, particularly in medication-taking adherence. Further research is warranted in a larger sample and should include standardization of medication management to isolate the effects of behavioral interventions on changes in BP. CLINICALTRIALSGOV IDENTIFIER NCT03722667.
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Affiliation(s)
- Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Carla Harwell
- Department of Internal Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ming-Chun Huang
- Department of Electrical Engineering and Computer Science, Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - LaTonya Martin
- Community Partners, Cleveland Council of Black Nurses, Cleveland, OH, USA
| | - Phuong B Dang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Jackson T Wright Jnr
- Department of Internal Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Nephrology and Hypertension, Clinical Hypertension Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Adherence to Hypertension Medications and Lifestyle Recommendations among Underserved African American Middle-Aged and Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186538. [PMID: 32911772 PMCID: PMC7558819 DOI: 10.3390/ijerph17186538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/13/2023]
Abstract
Background: For African American middle-aged and older adults with hypertension, poor adherence to medication and lifestyle recommendations is a source of disparity in hypertension outcomes including higher rates of stroke in this population relative to whites. Aims: To study demographic, social, behavioral, cognitive, and medical predictors of adherence to medication and lifestyle recommendations among underserved African American middle-aged and older adults with hypertension. Methods: This was a community-based cross-sectional survey in South Los Angeles with 338 African American middle-aged and older adults with hypertension who were 55 years or older. Age, gender, continuity of care, comorbidity, financial difficulty, self-rated health, depression, educational attainment, adherence knowledge, and adherence worries were the independent variables. Data was analyzed using linear regression with two outcomes, namely, adherence to medication (measured by the first 9 items of the Blood Pressure Self-Care Scale) and adherence to lifestyle recommendations (measured by the second 9 items of the Blood Pressure Self-Care Scale). Results: There were about twice more females than males, with a total mean age of 70 years (range 55–90 years). Various demographic, social, behavioral, and medical factors predicted adherence to medication but not adherence to lifestyle recommendations. Females with hypertension with higher continuity of care, less financial strain, higher knowledge, less negative general beliefs, and concerns about antihypertensive medications had higher adherence to antihypertensive medications. The presence of depressive symptoms, reduced knowledge, and disease management worries were associated with a reduced adherence to lifestyle recommendations. Conclusions: There seem to be fewer demographic, social, behavioral, cognitive, and medical factors that explain adherence to lifestyle recommendations than adherence to medication in economically disadvantaged underserved African American middle-aged and older adults with hypertension. More research is needed on factors that impact adherence to lifestyle recommendations of African American middle-aged and older adults with hypertension.
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Effects of Self-Efficacy, Depression, and Anger on Health-Promoting Behaviors of Korean Elderly Women with Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176296. [PMID: 32872450 PMCID: PMC7504112 DOI: 10.3390/ijerph17176296] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/25/2022]
Abstract
The prevalence of hypertension among women in Korea aged 65 years or older is 61.7%. Past research has emphasized the importance of health-promoting behaviors in hypertension management for the elderly. The purpose of this cross-sectional study was to identify the effects of self-efficacy, depression, trait anger, and anger expression on the health-promoting behaviors of elderly women with hypertension. Self-report questionnaires were completed by 208 women aged 65 and older (age range: 65 to 85) diagnosed with hypertension by physicians and living in the communities of G city and N city of Gyeonggi-do in South Korea. A hierarchical regression analysis revealed that exercise (β = 0.36, p < 0.001) had the most significant effect on health-promoting behaviors, followed by depression (β = −0.31, p < 0.001), trait anger (β = 0.21, p = 0.002), anger control (β = 0.20, p < 0.001), religion (β = 0.18, p = 0.001), and self-efficacy (β = 0.18, p = 0.003). Trait anger and anger control were identified to have a more significant effect on health-promoting behaviors than self-efficacy. Thus, health-promoting behaviors were influenced by exercise, depression, anger, religion, and self-efficacy. It is necessary to implement a nursing intervention strategy which pays attention to these factors to improve health-promoting behaviors of Korean community-dwelling elderly women.
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The Impact of an Educational Program Based on the BASNEF Model on Knowledge and Self-Care Behaviors of Patients with Hypertension. HEALTH SCOPE 2020. [DOI: 10.5812/jhealthscope.95588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Hypertension is an important health problem that can be controlled by self-care. Objectives: The present study aimed to determine the impact of an educational program based (BASNEF) model on knowledge and self-care behaviors for hypertensive patients in Bastak, Iran. Methods: This quasi-experimental study was performed on 180 patients with hypertension who were admitted to health centers of the Bastak city. The participants were randomly assigned to intervention (n = 90) and control (n = 90) groups. Data were collected using a questionnaire that had three sections of demographic information, knowledge, and BASNEF constructs. The questionnaires were completed before the intervention and two months after providing the intervention. After the pre-test, an appropriate educational intervention was designed and implemented only among the intervention group. To analyze the data, paired t-test, independent t-test, and chi-square tests were run by SPSS version 19. Results: The mean age of the participants was 50.62 ± 7.549 years. The results showed a statistically significant difference in the mean scores of attitudes, subjective norms, enabling factors, and self-care behaviors in the intervention group pre- and post-intervention (P = 0.001). Besides, it was found that enabling factors (0.311) play a significant role in predicting self-care behaviors. Conclusions: The results of this study support the effectiveness of educational interventions in raising awareness and improving self-care behaviors in patients with hypertension using the BASNEF model. Therefore, with an emphasis on enabling factors, the BASNEF model can be used as a framework to develop educational interventions for self-care.
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Nassim G, Redmond ML, Ofei-Dodoo S, Benton M, Lu K. Nutrition Self-Efficacy and Dietary Patterns among Older African American Women in Kansas. Kans J Med 2020; 13:209-213. [PMID: 32843925 PMCID: PMC7440852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/12/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Nutrition is the key contributor to disparities in many chronic diseases. However, little is known about the dietary habits and nutrition self-efficacy beliefs of older African American women with chronic diseases. This study looked at the relationship between nutrition self-efficacy and dietary patterns among older African American women. METHODS A total of 115 African American women 55 years and older, with one or more chronic diseases such as hypertension, diabetes, and hyperlipidemia, were recruited from a midwestern city in Kansas. Participants completed a survey comprised of dietary intake items and the Physical Activity and Nutrition Self-Efficacy (PANSE) scale. Data were analyzed with descriptive statistics, Spearman correlation, and Wilcoxon rank sum test (Mann-Whitney U Test). RESULTS There was a 79% (91/115) participation rate. Participants were confident in their ability to maintain healthy behaviors (57.67/72; SD = 11.22). The mean dietary score for fats and carbohydrate consumption was 32.67 ± 2.48 compared to 5.89 ± 3.52 for fruit and vegetable intake. A significant positive correlation was observed between fruit and vegetable intake and nutrition self-efficacy. A higher fruit and vegetable intake were observed among married women (mean = 7.35; SD = 4.45). CONCLUSION Our findings shed new light on older African American women's perceptions of healthy eating and the confidence to eat heathy. Based on these results, older African American women met the daily fruit and vegetable recommendations; however, more work is needed to understand how to intervene to improve dietary behaviors regarding fat and carbohydrate consumption in this population. While more research is needed, the findings indicated behavioral theories such as nutrition self-efficacy may have utility in tailoring nutrition interventions in an older African American population.
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Affiliation(s)
- Grace Nassim
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Michelle L. Redmond
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Samuel Ofei-Dodoo
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Mary Benton
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Kelsey Lu
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
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