Self-care practices and health-seeking behavior among older persons in a developing country: Theories-based research

Health Coaching Intervention to Improve Self-Care Management of Hypertension Among Older People in Indonesia: A Randomized Controlled Study Protocol

Purpose

One-third of the global population is predicted to be diagnosed with hypertension (HTN) in 2025, with the percentage highest among older people. Without proper self-care management, uncontrolled HTN causes negative health consequences and decreases the quality of life. The previous scoping review identified various challenges that older adults may face in dealing with HTN and that effective approaches should consider each individual's circumstances and attributes. This study aims to investigate the efficacy and sustainable impact of an Indonesian adaptation of an 8-week nurse health coaching intervention on self-care management and self-efficacy among older people with HTN.

Patients and Methods

The coaching sessions will last for 30 min weekly for 8 weeks. The data will be measured at three points: baseline (initial), 1 week after the eighth health coaching session, and 3 months after concluding the intervention.

Discussion

This study will be the first health coaching intervention research based on motivational interviewing and cognitive behavioral therapy approach with Indonesian background adjustment. The study result will help develop a guideline for nurses and other health workers providing health coaching for older people in Indonesia and other countries with similar characteristics in terms of sociodemographics or lifestyle.

Trial Registration

thaiclinicaltrials.org Identifier: TCTR20230410001 (Date of registration: April 9, 2023).

Self-care behavior among adult patients with hypertension in Padang, West Sumatra, Indonesia: A cross-sectional study

Background

Self-care behavior is crucial in preventing chronic diseases, such as hypertension, which has become highly prevalent in Indonesia. Hypertension, often referred to as the "silent killer" due to its asymptomatic nature, can easily go unnoticed. Neglecting its treatment can lead to severe complications, including heart disease, heart failure, and stroke. Despite adults with hypertension feeling well, embracing self-care behavior, including making healthy lifestyle choices, disease management, and enhancing life quality, remains essential.

Objective

This study aimed to describe the self-care behavior of adult patients with hypertension in Indonesia.

Methods

A cross-sectional study design was employed, involving 270 participants selected through consecutive sampling. Data were collected between 15 March and 4 April 2023, using the Hypertension Blood Pressure Self Care Profile (HBP-SCP) questionnaire in six public healthcare centers in Padang City, West Sumatra, Indonesia. The data were analyzed using descriptive analysis, Mann-Whitney, and Kruskal-Wallis tests.

Results

The self-care behavior among adult patients with hypertension was at a moderate level (Mean = 49.78, SD = 6.64), and it had significant differences according to ethnicity (p = 0.041), marital status (p = 0.017), and body mass index (p = 0.008).

Conclusion

The findings highlight the influence of diverse ethnic backgrounds, various marital statuses, and differing body mass index levels, which may lead to distinct approaches to managing hypertension. These results offer valuable insights for nurses and other healthcare professionals to develop comprehensive strategies to enhance self-care among adult patients with hypertension.

Turkish Validity and Reliability of the Self-care of Hypertension Inventory (SC-HI) among Older Adults

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.

Enablers and Barriers of Accessing Health Care Services among Older Adults in South-East Asia: A Scoping Review

South-East Asia (SEA) is the home of the largest number of the world's older population. In this scoping review, we aimed to map the existing enablers and barriers of accessing healthcare services among older adults in SEA countries. Articles that were published from January 2001 until November 2021 were searched in four data sources (PubMed, Web of Science, EBSCO Host and The Cochrane Library). Studies pertaining to the factors which assist or obstruct older Southeast Asian adults from assessing healthcare services were chosen for this scoping review. First, two reviewers screened the titles and abstracts of articles in the data sources. After identifying appropriate articles, the reviewers read them. Data extracted by one reviewer were verified by the other reviewer. The findings were then classified according to Penchansky and Thomas's five domains of access. A total of 19 studies were included in the final scoping review. Accessibility and acceptability were the two factors most often identified as enablers or barriers to older adults from accessing healthcare. Other often mentioned factors were finances, transportation and social/family support. Older adults living in rural areas were especially impacted by these factors. To promote healthy ageing, optimum healthcare and wellbeing among older adults in Southeast Asia, it is extremely important to consider accessibility and acceptability when planning healthcare services.

Effect of Foot Massage on Decreasing Blood Pressure and Anxiety in Older People with Hypertension in Indonesia

Background:

Globally, the prevalence of hypertension, especially in older people, is relatively high and increasing annually. In addition to hypertension, many older people also experience anxiety. Interventions are needed to reduce blood pressure and overcome anxiety, one of which is foot massage.

Objective:

To determine the effect of foot massage on reducing blood pressure and anxiety in older people with hypertension.

Method:

This study was a one-group pre-test–post-test design with a time-series design for measuring blood pressure and assessing the degree of anxiety after foot massage intervention for 12 sessions. Thirty older people with hypertension and anxiety participated in this study.

Results:

A significant decrease in anxiety was observed after the 6th and 12th sessions of foot massage intervention ( P < 0.05). A significant decrease was observed in systolic blood pressure after the 12th intervention compared to baseline and 8th intervention ( P < 0.05).

Conclusion:

Foot massage intervention is effective in reducing blood pressure and anxiety in older people with hypertension.

Older People's Help-Seeking Behaviors in Rural Contexts: A Systematic Review

Help-seeking behavior (HSB) is vital for older people to sustain their health. As people in aging societies increasingly demand management of their multiple symptoms, communities should encourage HSBs. In rural communities, insufficient healthcare and human resources influence older people’s health. However, no related comprehensive evidence exists so far. This study investigates the present condition of older people’s HSBs in rural contexts in aging societies. We conducted a systematic review by searching six databases (PubMed, Cochrane Library, EMBASE, Medline, and Web of Science) for original studies regarding HSBs of older people in rural contexts published until January 2022. Extracted articles were analyzed based on participants, settings, HSB causes and contents, and older people’s HSB outcomes in rural contexts. Sixteen studies were included in the systematic review: seven investigated the associations between HSBs and participants’ backgrounds, and three the quality of life. Six studies investigated HSB perception, diagnosis, clarifying HSB contents, professional care trend, self-rated health, and mortality. Unlike few studies investigating the association between HSBs and health-related outcomes, this systematic review explains the current evidence regarding rural older people’s HSBs. Due to insufficient evidence from longitudinal studies in clarifying interventions for effective HSBs, future studies should use observational and interventional designs.

Factors influencing self-care behavior of socio-economically disadvantaged diabetic patients: A systematic review

Diabetes mellitus and its complications carry broad financial misfortune to the diabetic patients and their family, to the well-being frameworks, and to the public economies through direct clinical expenses and decreased work efficiency. The present study systematically reviewed the possible factors that are influencing self-care behavior of disadvantaged diabetic patients that contribute heavily to the management of this chronic illness. Structured searches were conducted on PubMed, ScienceDirect, and manual searches on Google Scholar for articles published between the years 2000 and 2020. The review was limited to a particular time frame due to the change in WHO criteria for diagnosis and classification of abnormal glucose tolerance. Initially, 96858 articles were identified, and following the screening and full-text reading, 10 studies that met the inclusion criteria were chosen for systematic review. Seven studies had reported the factors influencing self-care behavior among disadvantaged diabetic population. Three studies had reported the importance of intervention strategies and its impact on self-care behavior among them. Findings show that self-care management of socio-economically disadvantaged people entails dimensions including diabetes knowledge, lack of physical activities, social support, lack of access to services, life disruptions, denial of illness, societal attitudes, responsibilities, and treatment costs. It was additionally discovered that diabetes self-management support mediations are successful in drawing in lower economy patients, tending to contending life needs and hindrances to self-care, and encouraging behavior change. Taken together, future methodologically efficacious studies that establish health promoting behaviors and explorations of the factors influencing self-care behaviors of disadvantaged diabetic patients are needed.

Current Knowledge and Behavior towards Salt Reduction among Hong Kong Citizens: A Cross-Sectional Survey

Excessive dietary salt intake is prevalent in the Hong Kong community. Over the last decade, the Hong Kong Special Administrative Region Government has been actively promoting community participation to reduce salt intake. The aim of this study was to investigate the current knowledge levels and behaviors relating to dietary salt intake among Hong Kong adults. This cross-sectional survey involved 426 adults in Hong Kong. The findings of this study identified areas of knowledge deficit in the recommended upper limit of daily salt intake for an adult set by World Health Organization (n = 295, 69.2%) indicated a lack of awareness that the overconsumption of salt could cause coronary heart disease (n = 233, 54.7%). Disengagement with salt reduction behavior, such as rarely/never checking the sodium or salt content listed on the food label (n = 252, 59.2%) and rarely/never purchasing food labelled with low salt or no salt content (n = 292, 68.9%), was reported. Excessive salt intake in dietary habits remains an under-recognized non-communicable disease threat by Hong Kong citizens, indicating ineffective responsive risk communication. There is a need to refine existing salt reduction initiatives to aid in making appropriate decisions regarding dietary salt intake among Hong Kong citizens.

Evaluation of a self-care education program for older adults in Iran using a lifestyle improvement model

BACKGROUND

Older adults and their caregivers often believe it is either too late or too difficult to make health-focused lifestyle changes. However, this is inaccurate, as older adults can make health promotion focused lifestyle changes thereby improving their health. This study developed and evaluated a self-care education program using Pender's Health Promotion Model and its influence on health-focused behaviour changes among older Iranians.

METHOD

This was a quasi-experimental study with a convenience sample of 136 community-living older adults from Tabriz, Iran. The participants were randomly assigned to either an intervention (n = 69) or control (n = 67) group. Chi-square test, independent t tests and Analysis of covariance (ANCOVA) statistical methods were used to compare pre- and post-intervention data, control and intervention groups and changes over time. The intervention was an eight-week educational program with pre- and post-intervention data collected using the Health Promoting Lifestyle Profile II (HPLP II) questionnaire.

RESULTS

The mean difference and confidence limits of the older adults' health behaviours pre- and post-intervention scores were 2.228 (-5.450 - 9.916) and - 35.820 (-32.051 - 39.588). The covariance analysis adjusting for the baseline values showed significant differences post-intervention (p<0.0001) in the areas of interpersonal communication, physical activity, nutrition, stress management and spiritual growth.

CONCLUSION

The health promotion education intervention illustrated that older Iranians could improve their health outcomes in several areas. Thus, culturally tailored intervention programs can be successful in challenging the opinion that older adults cannot make behaviour changes supporting their health.

Self-Care Practice and Associated Factors among Hypertensive Patients in Debre Tabor Referral Hospital, Northwest Ethiopia, 2020

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.

Identifying hearing impairment and the associated impact on the quality of life among the elderly residing in retirement homes in Pretoria, South Africa

Background

Age-Related Hearing Loss (ARHL) is the most widespread sensory disorder in the elderly. Poor audiological support within retirement homes is one of the fundamental issues impacting the Quality of Life (QoL).

Objectives

The objectives of this study were to: (1) Identify the presence of hearing impairment through a hearing screening test battery in a sample of elderly participants residing in three retirement homes. (2) Determine the psychological, communication-related and social impact of the hearing impairment on the QoL in a sample of elderly participants residing in retirement homes.

Method

A prospective cross-sectional research design with quantitative methods of data analysis was used to obtain data from 70 elderly participants (mean age = 79 years, 79% were female). Ten of them used hearing aids. Hearing screening was conducted using otoscopy, tympanometry and air conduction screening (500 Hz–4 kHz). The World Health Organization Quality of Life (WHOQoL) questionnaire was adapted and utilised for the present study.

Results

Findings revealed that 77% of the sample obtained a refer result from the hearing screening protocol indicating a high presence of hearing impairment. Twenty-nine per cent (n = 16) of the participants felt depressed, worried and anxious because of their hearing loss and 20% of participants felt unaccepted by their significant others as a result of their hearing impairment. Hearing difficulties were significantly associated with a reduced QoL (p = 0.045). Eight of the 10 participants who wore hearing aids reported an overall improvement in QoL since receiving and utilising their hearing aids and 20% (n = 2) of hearing aid users reported challenges with maintaining their hearing aids.

Conclusion

The findings of this study emphasised the need for an increased role for audiological services provided by audiologists within retirement homes, thereby contributing to an improved QoL.

Regularity of Clinical Visits and Medication Adherence of Patients with Hypertension or Diabetes in Rural Yunnan Province of China

Chronic diseases can be controlled through effective self-management. The purpose of this study is to explore the regularity of clinical visits and medication adherence of patients with hypertension or diabetes (PWHD), and its association with the first experience with care and individual factors in rural Southwestern China. This cross-sectional study was carried out in Yunnan province in 2018 and recruited 292 PWHD and 122 village clinics from 122 villages in 10 counties. Participants were interviewed using a structured questionnaire. Results show around 39% of hypertensive and 25% of diabetic patients neither visited physicians nor took medicine regularly during the preceding three months of the interview date. The regression results further indicated that individual characteristics of the PWHD, including patient age, health status, and economic level, as well as their first experience with care, were significantly associated with their regular healthcare behavior. In addition to providing medical services, on average each sample village clinic, with around two physicians, simultaneously managed 180 hypertensive and 45 diabetic patients. This study revealed the need for further reforms in terms of improving self-management and thus recommends an increase in the quantity and the quality of human resources in the primary healthcare realm in rural China.