Health-seeking beliefs of cardiovascular patients: a qualitative study

The influence of culture on the health beliefs and health behaviours of older Vietnam-born Australians living with chronic disease

AIM

To explore the health beliefs and health behaviours of older Vietnam-born people living with chronic disease in Western Australia.

DESIGN

This study was designed as a focused ethnography guided by the interpretative research paradigm and Leininger's Theory of Culture Care.

METHODS

Data were collected through participant observation and interviews undertaken at participants' homes in Western Australia over 7 months in 2019. Data were analysed using Wolcott's approach for transferring qualitative data, comprising three phases: description, thematic analysis and interpretation.

RESULTS

This study included 12 participants. The health perspectives and practices of older Vietnam-born Australians significantly reflected the traditional Vietnamese values. These included the stigma towards chronic disease as an inevitable consequence of ageing; self-blame thoughts about chronic disease causations and maintained traditional dietary practices. However, some aspects of their health behaviours such as beliefs and practices in traditional medicine, Western medicine and physical exercise reflected a blended approach combining both Vietnamese-oriented and Westernized-orientated practices. Individual factors were also identified as contributing to chronic disease self-care among participants.

CONCLUSION

This study emphasizes culture played a significant role in shaping the way that older Vietnam-born Australians believed and behaved while living with chronic conditions. However, it also indicates that culture is not a stationary concept, it evolves gradually and is socially constructed.

IMPLICATIONS

A better understanding of the health beliefs and practices of older Vietnam-born Australians is expected to contribute to the delivery of culturally safe and effective support for this population. The achievement of culturally safe care requires a systemic approach and collaboration of strategies across sectors.

PATIENT AND PUBLIC CONTRIBUTION

This study encompassed the contribution of 12 older Vietnam-born Australians who offered the researcher the privilege to enter their world and the staff of social care organization who opened the gate for the researcher to approach participants.

"We are in the forgotten corner!" a qualitative study of experiences and challenges among Chinese older women at the onset of acute myocardial infarction

Background

Acute myocardial infarction (AMI) is a common and serious cardiovascular disease (CVD) that is one of the leading causes of death among women globally and in China. However, there are sex-associated differences and inequalities in the detection and management of AMI, especially in older people. There is little research demonstrating how challenges and barriers affect older women's help-seeking behavior and health-related procedures in China.

Purpose

The objective of this study was to explore the experiences of older women with AMI, focusing on their perception, challenges, and coping strategies at the onset of AMI in Wuhan, China.

Methods

This study utilized a qualitative research design approach and conducted semi-structured, in-depth, and audio-recorded interviews with 18 women aged 65-84 years, purposively selected from two tertiary hospitals in Wuhan City from November 2021 to April 2022.

Results

Interpretative Phenomenological Analysis (IPA) was used in this study to analyze the data on 18 participants and three major themes were generated: disease perception disorder, negative coping strategies, and barriers due to social-environmental contexts.

Conclusion

To reduce older women's delay in seeking help, healthcare professionals should provide public health education that emphasizes sex-related disparities, and age-specific knowledge-attitude aspects to high-risk groups. Policy-based and health administration recommendations, including e-health information support, access to care, and social-environmental factors, should be highlighted to promote women's health behavior.

The Moderating Effect of Mental Health on the Relationship Between Cardiovascular Disease Awareness and Health Behaviors of Middle-Aged Korean Chinese Workers With Cardiovascular Risk Factors in Korea

INTRODUCTION

Cardiovascular disease (CVD) remains a leading cause of death in China and Korea, yet little is known about in Korean Chinese workers. The purpose of the study was to investigate the effects of CVD awareness and mental health on health behaviors and evaluate the moderating effect of mental health on the relationship between CVD awareness and health behaviors among Korean Chinese workers.

METHOD

We used a cross-sectional design and convenience sampling of participants from Seoul in December 2021. Data were analyzed using descriptive statistics, Pearson's correlation coefficient, independent t tests, and hierarchical multiple regression analysis.

RESULTS

CVD awareness, mental health, and health behaviors were relatively low and mental health showed a moderating effect on the relationship between the two variables.

DISCUSSION

Understanding relationships between CVD awareness, socioculturally mediated health behaviors, and mental health issues is critical to CVD prevention among participants; moreover, mental health should be specifically assessed and targeted for improvement.

Self-care behaviours and related cultural factors among Chinese immigrants with cardiovascular disease in western countries: an integrative review

AIMS AND OBJECTIVES

This review aimed to demonstrate the self-care behaviours of first-generation Chinese immigrants with cardiovascular disease in western countries and identify related cultural factors.

BACKGROUND

Self-care is the cornerstone to mitigate disease symptoms and maintain health status. Chinese immigrants to western countries, operating within a cross-cultural context, may find self-care to manage their cardiovascular disease challenging.

DESIGN

An integrative review was conducted.

METHODS

Seven databases were searched Scopus, ProQuest Health & Medicine, Medline (Ovid), Embase (Ovid), AMED (Ovid), PsycINFO and CINAHL, with output limited to peer-reviewed studies published from 2000 to 2020 in English or Chinese. Initially, 2037 papers were screened. Six papers were retained and critiqued using the Joanna Briggs Institute critical appraisal tools. Deductive and inductive approaches were utilised to analyse the findings. The PRISMA 2020 checklist informed review reportage.

RESULT

In general, Chinese immigrants with cardiovascular disease took an active role in management of their cardiovascular disease, including through diet and activity adaptation and adherence to western medication. Families also played a significant role in disease decision-making and management. However, language and cultural barriers impeded their access to health information and resources in host countries.

RELEVANCE TO CLINICAL PRACTICE

Understanding self-care behaviours and associated cultural factors among Chinese immigrants with cardiovascular disease is important to improve nurses' culturally sensitive practices and provide tailored health education interventions to promote self-care behaviours among immigrant populations. The scarcity of literature on self-care behaviours among Chinese first-generation immigrants with cardiovascular disease indicates the need for further research in this area. Development of culturally and linguistically sensitive health resources and education programs is urgently needed.

Education interventions in Chinese cardiac patients on health behaviours, disease-related knowledge, and health outcomes: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to summarize and synthesize the available evidence in adult Chinese cardiac patients to determine the effect of education interventions on health behaviours, disease-related knowledge, self-efficacy, depressive symptoms, anxiety symptoms, health-related quality of life, morbidity, and mortality.

METHODS

Seven databases were searched from database inception until January 2020 for randomized controlled trials. Characteristics of education interventions were described and random-effects meta-analysis was performed where feasible.

RESULTS

Overall, 18 randomized controlled trials were included in this systematic review and suggested that education interventions are effective in improving patients' physical activity, dietary habits, medication behaviour, disease-related knowledge, and health-related quality of life. Meta-analysis of two studies demonstrated benefit on physical activity (standardized mean difference [SMD] 1.27, 95% confidence interval [CI] 1.06-1.48; participants = 422; I² = 0%), dietary habits (SMD 0.76, 95%CI 0.44-1.08; participants = 422; I² = 61%), and medication behaviour (mean difference [MD] 0.31, 95%CI 0.17-0.46; participants = 422; I² = 28%).

CONCLUSION

This study supports the benefits of education interventions for adult Chinese cardiac patients on health behaviours, disease-related knowledge, and health-related quality of life. Future studies should characterize their education interventions in detail to facilitate reproducibility and comparison.

PRACTICE IMPLICATIONS

This study identified the need for studies on the outcome of alcohol consumption and in Chinese immigrant populations.

Perceptions of patients undergoing percutaneous coronary intervention on pre-operative education in China: A qualitative study

Objectives

To explore the perceptions of patients undergoing percutaneous coronary intervention (PCI) regarding their pre‐operative health education.

Methods

A qualitative study using semi‐structured, in‐depth interviews was conducted in one cardiology unit in China from July 2019 to December 2019. Purposeful sampling of 17 patients undergoing PCI was interviewed about their perceptions of pre‐operative health education. Thematic analysis of the transcribed data was then used to identify the themes.

Results

Four themes emerged from the data:(a) triple roles of pre‐operative education with the categories of relief (reliving fear); burden (leading to stress); and meaningless (changing nothing); (b) family member involvement with the categories of shared responsibility and family members’ duty; (c) facilitators in the process of pre‐operative health education with the categories of emotional support, plain language and individualized pre‐operative education; (d) inhibitors in the process of pre‐operative health education with the categories of contradiction and threatening words.

Conclusions

Pre‐operative health education for patients undergoing PCI should be aligned with the individual patients’ information‐seeking styles and personal differences, emphasizing individualized patient education. Traditional Chinese philosophy should be considered in the practice of pre‐operative education for patients undergoing PCI, which emphasizes family member involvement; at the same time, patient empowerment and self‐care should also be stressed. In addition, emotional support and plain language from health professionals are important in pre‐operative health education for patients undergoing PCI; contradiction should be avoided, and threatening words should be used with caution and with consideration for cultural variations during pre‐operative education for patients undergoing PCI.

Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 3): Secondary Data Analysis

Background

Many app-based interventions targeting women with breast cancer have been developed and tested for effectiveness. However, information regarding the evaluation of the usage of these interventions is scarce. A better understanding of usage data is important to determine how women use apps and how these interventions affect health outcomes.

Objective

This study aimed to examine the usage duration and login frequency of an app-based intervention, the Breast Cancer e-Support (BCS) program, and to investigate the association between usage data and participants’ demographic and medical characteristics.

Methods

This study is a secondary data analysis of a randomized controlled trial assessing the effectiveness of the BCS program. The BCS program contains four modules: Learning Forum, Discussion Forum, Ask-the-Expert Forum, and Your Story Forum. A total of 57 women in the intervention group accessed the BCS program during their 12-week chemotherapy. The app’s background system tracked the usage duration and login frequency for each forum and the entire BCS program.

Results

The total usage duration per participant ranged from 0 to 9371 minutes, and the login frequency per participant ranged from 0 to 774 times. The Discussion Forum and the Learning Forum were the most frequently used modules. The general linear model showed that age, education, family monthly income, and employment were associated with BCS usage duration and/or login frequency. Age (F_1,45=10.09, P=.003, B=115.34, 95% CI 42.22-188.47) and education level (F_1,45=7.22, P=.01, B=1949.63, 95% CI 487.76-3411.50) were positively associated with the usage duration of the entire BCS program. Family monthly income was positively associated with the usage duration of the Learning Forum (F_1,45=11.85, P=.001, B=1488.55, 95% CI 617.58-2359.51) and the login frequency of the entire BCS program (F_1,45=4.47, P=.04, B=113.68, 95% CI 5.33-222.03). Employment was negatively associated with the usage duration of the Ask-the-expert Forum (F_1,45=4.50, P=.04, B=–971.87, 95% CI –1894.66 to –49.07) and the Your Story Forum (F_1,45=5.36, P=.03, B=–640.71, 95% CI –1198.30 to –83.11) and positively associated with the login frequency of the entire BCS program (F_1,45=10.86, P=.002, B=192.88, 95% CI 75.01-310.74). No statistical differences were found between BCS usage data and cancer stage, BMI, comorbidity, types of surgery, or cycles of chemotherapy.

Conclusions

Overall, this study found considerable variability in the usage of app-based interventions. When health care professionals incorporate app-based interventions into their routine care for women with breast cancer, the learning and discussion functions of apps should be strengthened to promote engagement. Additionally, characteristics of women with breast cancer, such as age, level of education, income, and employment status, should be taken in consideration to develop tailored apps that address their particular needs and therefore improve their engagement with the app.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12616000639426; http://www.ANZCTR.org.au/ACTRN12616000639426.aspx

Chinese Hospitalized Cardiovascular Patients' Attitudes Towards Self-Management: A Qualitative Study

PURPOSE

This study is aiming to investigate cardiovascular patients' attitudes towards self-management during hospitalization in China.

PATIENTS AND METHODS

Twenty-nine individuals living with cardiovascular disease from one designated Cardiology Department in Hangzhou, China, were recruited through a purposive sampling procedure. A qualitative descriptive methodology was used. Semi-structured interviews were also used to gain attitudes toward self-management. The interviews were audio-recorded, transcribed and analyzed by thematic analysis to develop the results.

RESULTS

Four themes were identified from the qualitative data: (1): Responsibilities of self-management; (2): Reflections on self-management; (3): Acknowledgement of self-management support; (4): Challenges in implementing and adherence to self-management. Additionally, interview data were also given to illustrate these main themes emerging during the analysis. Patients gradually took their responsibilities to manage chronic symptoms. During their self-management process, they did reflections to help correct their regiments through supportive interactions. Health system responsiveness, health disparities, social capital, and cultural setting were the main external factors influencing better self-management implementation and adherence.

CONCLUSION

This study revealed the hospitalized cardiovascular patients' attitudes towards self-management in China. These findings emphasized the importance of patients' responsibility, reflections, and various social support receiving and pointed out specific external factors influencing the health outcomes and their quality of life. This study also proves the guide for the policymakers and health system better instructions to develop individually and culturally tailored advanced self-management interventions and programs.

Cultural factors influencing self-care by persons with cardiovascular disease: An integrative review

BACKGROUND

Self-care is critical for maintaining health, minimizing disease complications, and improving quality of life. Understanding valid, culturally-specific practices and their influence on self-care behaviors can inform development of interventions to improve outcomes for individuals living with cardiovascular disease (CVD). To date, the influence of culture on self-care behaviors has not been adequately examined in different CVD populations.

AIM

The aim of this review was to synthesize past empirical literature examining cultural factors influencing self-care in patients with CVD.

METHOD

An integrative review method was used. A literature search was conducted using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Anthropology Plus, and the International Bibliography of the Social Sciences (IBBS) computerized databases. No limit was placed on publication date. Articles were included if they were: (1) peer-reviewed original primary research studies, (2) published in English with full-text availability, (3) conducted in adults (≥19 years), (4) addressed culture related to health and health behaviors, (5) related to self-care or elements of self-care, and (6) related to CVD. Fourteen articles met the inclusion criteria and were included in this review.

RESULTS

Culture influences self-care in general, but predominantly self-care maintenance behaviors. In African American and South Asian populations, cultural beliefs such as fatalism, collectivism and traditional gender roles clashed with dietary adherence. Traditional beliefs and ideas, collectivism, family and kinship ties, fatalism, cultural norms and normative thinking played critical roles in medication adherence and use of complementary/alternative medicine. Similarly, cultural beliefs and social norms influenced how individuals interpreted and responded to their symptoms.

CONCLUSION

The findings shed light on the importance of understanding cultural factors that help or hinder self-care behaviors among individuals with CVD. Understanding such influences is anticipated to facilitate the design of effective, tailored interventions.

Understanding Prevention and Management of Coronary Heart Disease Among Chinese Immigrants and Their Family Carers: A Socioecological Approach

Introduction: Health disparities among immigrants exist across socioecological domains. While Chinese immigrants face increased risk for coronary heart disease (CHD) after migration, the reasons are not well understood. Method: This descriptive qualitative study collected 18 semistructured interviews with Chinese immigrants with CHD and family carers from two Australian hospitals. Analysis was guided by the social–ecological model. Results: Poor knowledge and limited English proficiency increased CHD risk and difficulty navigating health care systems/resources. Interpersonal and family factors positively influenced health-seeking behaviors, acceptance of cardiac procedures, adoption of secondary preventive behaviors and information acquisition through social networks. A lack of culturally specific health information and programs in Chinese languages was described. Ethnic concordance between Chinese doctors and patients improved health literacy and engendered trust. Discussion: Culturally specific interventions could include health promotion materials in Chinese, inclusion of family in educational programs, and Chinese-focused public health campaigns about warning signs of heart attack.

Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 1): Qualitative Study of Women's Perceptions

Background

Women with breast cancer undergoing chemotherapy experience difficulty in accessing adequate cancer care in China. Mobile apps have the potential to provide easily accessible support for these women. However, there remains a paucity of randomized controlled trials to evaluate the effectiveness of app-based programs targeting specifically women with breast cancer undergoing chemotherapy. Moreover, women’s perceptions and experiences related to using and interacting within the app-based program have rarely been reported. Therefore, an app-based Breast Cancer e-Support program was developed and evaluated using a randomized controlled trial. Based on the incorporation of Bandura’s self-efficacy and social exchange theory, Breast Cancer e-Support program lasted for 12 weeks covering 4 cycles of chemotherapy and had 4 components: (1) a Learning forum, (2) a Discussion forum, (3) an Ask-the-Expert forum, and (4) a Personal Stories forum.

Objective

As a part of the randomized controlled trial, the aim of this study was to explore the participants’ perception of Breast Cancer e-Support program, its strengths and weaknesses, and suggestions to improve the program.

Methods

A descriptive qualitative study was employed. Thirteen women with breast cancer from 2 university-affiliated hospitals in China, who were randomly allocated to the Breast Cancer e-Support program in the randomized controlled trial, were interviewed from November 2016 to February 2017. Purposive sampling was used based on women’s scores of self-efficacy after the completion of the intervention. Inductive content analysis was used to analyze the transcripts, allowing the categories and subcategories to flow from the data.

Results

The qualitative interviews revealed that participants perceived the Breast Cancer e-Support program to be helpful in enhancing knowledge, improving confidence level, and promoting emotional well-being. Women also identified access to tailored advice from experts and convenience as the benefits of this program. Physical or psychological health status, stigma related with breast cancer, and app instability were mentioned as the challenges to engagement. Suggestions for improvement included adding message reminders to prompt instant communication and search engine to locate information quickly, supplementing more interesting and practical knowledge, updating the information more often, and quickening the responses to women’s questions. The participants recommended the Breast Cancer e-Support program to be incorporated as routine care to support women during chemotherapy.

Conclusions

This study demonstrates the potential of the Breast Cancer e-Support program to support women during chemotherapy. Future app-based programs should apply a family-centered approach and provide more support on stigma associated with the disease to encourage engagement with the app. Suggestions of improvement regarding the design, content, and operation of the app-based intervention should be addressed in future studies. It is promising to incorporate the Breast Cancer e-Support program into routine care to generalize the benefits.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12616000639426; http://www.ANZCTR.org.au/ ACTRN12616000639426.aspx (Archived by WebCite at http://www.webcitation.org/6v1n9hGZq)

The effectiveness and experience of self-management following acute coronary syndrome: A review of the literature

OBJECTIVES

To evaluate the effectiveness of interventions used to support self-management, and to explore patients' experiences after acute coronary syndrome in relation to self-management.

DESIGN

Scoping review.

DATA SOURCES

Keyword search of CINAHL Plus, Medline, the Cochrane Library, and PsycINFO databases for studies conducted with adult population and published in English between 1993 and 2014.

REVIEW METHODS

From title and abstract review, duplicated articles and obviously irrelevant studies were removed. The full texts of the remaining articles were assessed against the selection criteria. Studies were included if they were original research on: (1) effectiveness of self-management interventions among individuals following acute coronary syndrome; or (2) patients' experience of self-managing recovery from acute coronary syndrome.

RESULTS

44 articles (19 quantitative and 25 qualitative) were included. Most studies were conducted in western countries and quantitative studies were UK centric. Self-management interventions tended to be complex and include several components, including education and counselling, goal setting and problem solving skills which were mainly professional-led rather than patient-led. The review demonstrated variation in the effectiveness of self-management interventions in main outcomes assessed - anxiety and depression, quality of life and health behavioural outcomes. For most participants in the qualitative studies, acute coronary syndrome was unexpected and the recovery trajectory was a complex process. Experiences of making adjustment and adopting lifestyle changes following acute coronary syndrome were influenced by subjective life experiences and individual, sociocultural and environmental contexts. Participants' misunderstandings, misconceptions and confusion about disease processes and management were another influential factor. They emphasised a need for ongoing input and continued support from health professionals in their self-management of rehabilitation and recovery, particularly during the initial recovery period following hospital discharge.

CONCLUSIONS

Evidence of the effectiveness of self-management interventions among people with acute coronary syndrome remains inconclusive. Findings from the patients' experiences in relation to self-management following acute coronary syndrome provided important insights into what problems patients might have encountered during self-managing recovery and what support they might need, which can be used to inform the development of self-management interventions. Theoretical or conceptual frameworks have been minimally employed in these studies and should be incorporated in future development and evaluation of self-management interventions as a way of ensuring clarity and consistency related to how interventions are conceptualised, operationalised and empirically studied. Further research is needed to evaluate self-management interventions among people following acute coronary syndrome for sustained effect and within different health care contexts.

Cardiovascular Interventions for Immigrant Women: A Scoping Review

The purpose of this scoping review is to identify cardiovascular interventions that are designed to address the needs of immigrant women across North America and Europe. The articles retrieved were reviewed independently by both the first author and a trained research assistant. Although the search revealed many articles and resources related to supporting cardiovascular self-management behaviors among individuals, few focused on interventions designed for immigrant women who were diagnosed and living with cardiovascular disease. Also, it was difficult to determine the quality of the literature retrieved, as the main goal of this scoping review was to assess the body of literature and categorize materials by common themes and topics. A more in-depth structured systematic review is needed to determine the quality of evidence being presented and to serve as a rationale for the design and implementation of future culturally sensitive interventions delivered to immigrant women diagnosed with cardiovascular disease.

'An exploration of the health beliefs of Chinese nurses' and nurse academics' health beliefs: A Q-methodology study'

Q-methodology was used to investigate the health beliefs of Chinese clinical nurses and nurse academics. Twenty-eight participants from one hospital and nursing school in China were involved. The four stages of this study included: (i) concourse development from literature review, Internet searches, and key informant interviews; (ii) A pilot study to develop the Q-sample from the concourse; (iii) participants sorted the Q-sample statements along a continuum of preference (Q-sorting); and (iv) PQ data analysis using principal component analysis and varimax rotation. Five viewpoints were revealed: (i) factor 1--health management and the importance of evidence; (ii) factor 2--challenging local cultural belief, and Eastern and Western influences; (iii) factor 3--commonsense; (iv) factor 4--health and clinical practice; and (v) factor 5--health and nursing education. This study presents a need for nurses and nurse academics to think critically, examine their long-held health beliefs, and promote the use of evidence-based practice.

Experiences and perceptions about cause and prevention of cardiovascular disease among people with cardiometabolic conditions: findings of in-depth interviews from a peri-urban Nepalese community

BACKGROUND

Nepal currently faces an increasing burden of cardiovascular disease (CVD). Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice.

OBJECTIVE

This qualitative study aimed to deepen understanding of the community perspective on cardiovascular health from the patients' viewpoint.

DESIGN

We conducted in-depth interviews (IDIs) with 13 individuals with confirmed heart disease, hypertension, or diabetes mellitus. All participants provided verbal consent. We used an IDI guide to ask respondents about their perception and experiences with CVD, particularly regarding causation and preventability. We manually applied qualitative content analysis to evaluate the data and grouped similar content into categories and subcategories.

RESULTS

Respondents perceived dietary factors, particularly consumption of salty, fatty, and oily food, as the main determinants of CVD. Similarly, our respondents unanimously linked smoking, alcohol intake, and high blood pressure with cardiac ailments but reported mixed opinion regarding the causal role of body weight and physical inactivity. Although depressed and stressed at the time of diagnosis, respondents learned to handle their situation better over time. Despite good family support for health care, the financial burden of disease was a major issue. All respondents understood the importance of lifestyle modification and relied upon health professionals for information and motivation. Respondents remarked that community awareness of CVD was inadequate and that medical doctors or trained local people should help increase awareness.

CONCLUSIONS

This study provided insight into the perceptions of patients regarding CVD. Respondents embraced the importance of lifestyle modification only after receiving their diagnosis. Although better health care is important in terms of aiding patients to better understand and cope with their disease, interventions should be tailored to improve the community's cardiovascular health literacy and preventive practices.

Psychometric evaluation of the Perceived Barriers to Health Care-seeking Decision in Chinese patients with acute coronary syndromes

OBJECTIVES

This study aimed to develop the Chinese version of the Perceived Barriers to Health Care-seeking Decision (PBHSD-C) and evaluate its psychometric properties in Chinese patients with acute coronary syndromes (ACS).

BACKGROUND

The assessment of the level of perceived barriers in the care-seeking trajectory of ACS patients is important for the understanding of its impact on pre-hospital delay in seeking care.

METHODS

The psychometric properties of PBHSD-C were evaluated among 114 ACS patients in the cardiac unit of two major hospitals in Hong Kong.

RESULTS

The Content Validity Indexes were ranged from .88 to 1. The Cronbach's alpha of the PBHSD-C was .74. The intraclass correlation coefficients of all items were above .80. The convergent validity of the PBHSD-C was also supported.

CONCLUSION

The PBHSD-C is reliable and valid to be used to assess the level of perceived barriers in the care-seeking of Chinese patients with ACS.

Screening for determinants of self-care in patients with chronic heart failure

Heart failure self-care is vital to achieving clinical stability and improved health outcomes. Yet despite the attention it has been given, in both research and clinical practice, effective self-care remains elusive. It is recognised that there are many patient factors that impact on attaining effective self-care skills. Systematic research is warranted to resolve the knowledge gap of how patients process information and develop the necessary self-care skills. In addition, sound screening tools are needed to assess factors that hinder the development of effective heart failure self-care skills. In this manner, education and support strategies can be applied on an individualised needs basis to enhance health outcomes.