Operational Definition of Self-Care Interventions for Adults with Chronic Illness

Does self-care improve coping or does coping improve self-care? A structural equation modeling study

BACKGROUND

Support interventions often address both self-care and coping. Different approaches are used to promote self-care and coping so clarifying the intervention effect can guide clinicians and researchers to provide interventions that achieve benefit.

PURPOSE

To compare two models to determine whether self-care improves coping or coping improves self-care.

METHODS

We used cross-sectional data from 248 caregivers obtained at enrollment into a randomized controlled trial testing the efficacy of a support intervention. Factor scores for scales measuring caregiver demand, self-care, coping, stress appraisal, and mental health were derived from exploratory factor analysis. Structural equation models were analyzed using the factor scores as estimates of each construct. To control possible spurious effects caregiver age, gender, relationship with the patient, and income adequacy were included.

RESULTS

Both models were compatible with the data, but the self-care model was stronger than the coping model. That model had a non-significant chi square and an excellent fit to the data, χ2(4, N = 248) = 2.64, p = .62. The percentage of variance explained by the self-care model was 54 % for mental health, 42 % for stress appraisal, 10 % for avoidance coping, and 6 % for active coping. In the coping model the explained variance of stress appraisal dropped to 33 %, avoidance coping dropped to 0 %, and active coping dropped to 3 %.

CONCLUSIONS

The self-care model was strongest, illustrating that self-care decreases stress, promotes coping, and improves mental health. These results suggest that promoting self-care may be more effective in improving mental health than interventions aimed at improving coping.

Effectiveness of self-management program for gastric cancer patients: A randomized controlled trial comparing gain vs. loss message framing

OBJECTIVE

This study aims to evaluate the effectiveness of a self-management program using gain/loss-framed messages in patients with gastric cancer.

METHODS

In this randomized controlled trial, 69 patients with gastric cancer who underwent gastrectomy at a university hospital were assigned to the gain- or loss-framed message group. The self-management program consisted of: 1) face-to-face education, 2) gain/loss-framed text messages, and 3) self-monitoring of health behaviors. Health outcomes (i.e., nutritional status, physical activity, exercise intensity, and distress), and health behaviors (i.e., dietary habits, physical activity performance, and distress management) were measured, and a generalized estimating equation was used for the analysis.

RESULTS

Nutritional status and dietary habits in the loss framed message group were statistically higher after the intervention compared to the counterpart (β = -1.72, p = .049; β = 0.36, p = .033, respectively). There was no time-group interaction effect on physical activity, exercise intensity, physical activity performance, distress or distress management.

CONCLUSIONS

A self-management program employing loss-framed messages was effective in promoting nutrition-related self-management among patients with gastric cancer.

PRACTICE IMPLICATIONS

Message-framing is an effective communication technique that can be easily used in clinical settings, and a loss-message-framing strategy may enhance nutrition-related self-management in patients with gastric cancer.

Clinical practice guidelines of foot care practice for patients with type 2 diabetes: A scoping review using self-care model

BACKGROUND

Type 2 diabetes can lead to severe foot complications, making self-care education, guided by clinical guidelines, crucial. However, fragmented and dispersed recommendations challenge effective implementation of these guidelines. Bringing together recommendations and presenting them according to a self-care model can provide a solid framework and facilitate the interpretation of results.

AIMS

to map the international guidelines that provide recommendations to nurses to enable people with type 2 diabetes for foot self-care and synthesize the recommendations according to the key concepts of the middle-range theory of self-care for chronic diseases.

DESIGN

A scoping review was undertaken, using the methodological guidance of the Joanna Briggs Institute.

DATA SOURCES

Databases were searched between September 2022 and June 2023, including PubMed, CINAHL, PsycINFO, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses Global, guideline websites and related professional association websites. The databases were chosen for their comprehensive coverage of the area.

METHODS

Eligible articles included guidance documents providing foot care recommendations for diabetes, published or updated between 2013 and 2023. Two reviewers summarized the recommendations presented in at least two guidelines according to the key concepts of the self-care model. The PRISMA-ScR checklist was used.

RESULTS

Seventeen guidelines were included. In total, we synthesized 175 recommendations. The recommendations were framed in three dimensions and their respective categories: Self-care maintenance (education for prevention, control of risk factors, daily foot care, footwear, and socks), Self-care monitoring (foot inspection, detection of signs of infection, and detection of other diabetes-related foot disease complications), and Self-care management (responses to signs and symptoms, foot wound care, follow-up with health professionals, and health services).

CONCLUSIONS

The main aspect of foot care revolves around daily care, including cleaning, moisturizing, nail care, selecting appropriate footwear, and regular inspection of both feet and footwear.

Chronic obstructive pulmonary diseasés impact on the affected person and next of kin: A mixed methods study

OBJECTIVES

Severe chronic obstructive pulmonary disease affects and changes the lives of both affected persons and next of kin. There is a need for support and a sense of coherence to manage the life situation and minimize the symptom and caregiver burden. The aim of this study was to diverge or converge views of symptom burden, caregiver burden, the need for support, and sense of coherence in persons with chronic obstructive pulmonary disease and their next of kin to gain a deeper and broader knowledge and understanding.

METHODS

A mixed methods study with data from interviews and four validated questionnaires from persons affected by chronic obstructive pulmonary disease in GOLD stages III and IV and their next of kin.

RESULTS

Questionnaires from 112 persons affected by chronic obstructive pulmonary disease, and 71 next of kin, together with 25 and 21 interviews, show that; there is a difference between estimated symptoms and caregiver burden and experiences expressed in their own words. There is also a defect regarding meaningfulness, comprehensibility, and manageability affecting daily life. Symptoms and caregiver burden, together with the sense of coherence, strengthen the need for support.

DISCUSSION

The complexity of the life situation leads to a need for supportive interventions to strengthen internal and external resources.

Development and psychometric testing of the Self-Care of Stroke Inventory

PURPOSE

To develop and evaluate the psychometric properties of the Self-Care of Stroke Inventory (SCSI).

MATERIALS AND METHODS

A cross-sectional, instrument development and the psychometric testing study was conducted. A 23-item self-report Self-Care of Stroke Inventory with 3 separate scales was developed. This study involved three stages: (a) Initial items generation; (b) Content and face validation; (c) Psychometric properties evaluation. The SCSI was validated by content validity, construct validity, convergent validity, internal consistency, and test-retest reliability.

RESULTS

From the initial 80-item pool, 24 items of 3 scales in the SCSI were retained by the expert consultation and item analysis. The scale's content validity was 0.976, 0.966, and 0.973. The EFA showed the total variance explained by the 3 scales of the SCSI were 73.417%, 74.281%, and 80.207%, respectively. The models of the 3 scales identified by EFA were all confirmed by the CFA. The SCSI scale shows evidence of good convergent validity. Cronbach's αs were 0.830, 0.930, and 0.831. Test-retest reliability of the SCSI was excellent, with an intraclass correlation coefficient of 0.945, 0.907, and 0.837.

CONCLUSIONS

The final 23-item SCSI presents good psychometric properties and can be used to explore the self-care of stroke in community settings.IMPLICATIONS FOR REHABILITATIONThis study developed and validated the Self-Care of Stroke Inventory (SCSI).The SCSI contains the following 3 scales: the Self-care Maintenance of Stroke scale, the Self-care Monitoring of Stroke scale, and the Self-care Management of Stroke scaleThe 23-item SCSI demonstrated strong psychometric properties.The SCSI may be used to develop future programmes to promote self-care for stroke survivors and improve their rehabilitation outcomes.

High Prevalence of Cardiometabolic Risks and Health Needs Among Patients With Hepatocellular Carcinoma After Treatment: A Cross-sectional Study

BACKGROUND

Many studies have indicated that inadequate health-related behavior is associated with the progression of cancer and cardiometabolic disorders. Because patients with hepatocellular carcinoma may adopt inadequate health behaviors, they are at risk for cancer recurrence, mortality, cardiometabolic disease progression, and worse quality of life.

OBJECTIVE

To explore the prevalence of cardiometabolic risks and health-promoting behaviors associated with quality of life among patients with hepatocellular carcinoma after treatment.

METHODS

A cross-sectional study was conducted from October 2021 to August 2022. Data were collected through face-to-face interviews using a structured questionnaire, and cardiometabolic information was recorded from medical charts.

RESULTS

In total, 115 patients with liver cancer after treatment were enrolled; 73% were male. The mean age was 67.7 years, and high prevalence rates of central obesity (72.2%) and metabolic syndrome (47%) were noted. Inadequate exercise, oral hygiene, and cigarette smoking were common. The health-promoting score was significantly associated with exercise, the number of remaining teeth, and metabolic syndrome, which correlated with quality of life, including positive functional and negative symptoms dimensions.

CONCLUSIONS

The findings demonstrated a high prevalence of cardiometabolic risks and inadequate health-related behaviors among patients with liver cancer after treatment. This study highlights the need for healthcare providers to help patients increase health literacy for preventing cardiometabolic risks at outpatient clinics.

IMPLICATIONS FOR PRACTICE

Findings from this study can be used to advise healthcare providers to educate patients with liver cancer during and after treatment on improving their health-promoting behaviors.

Nurse-led self-care interventions for older adults with multiple chronic conditions: A protocol for a systematic review and network meta-analysis

The importance of self-care interventions is progressively recognized, marked by a rapidly aging population that results in growing demands on costly tertiary and institutional care services, placing substantial pressure on health and social care systems. Against this background, in this study, we will provide evidence for the impact of self-care interventions on health-related quality of life by focusing on interventions led by nurses who can employ integrated approaches. Several databases, including Ovid MEDLINE, Cochrane, CINAHL, Embase, and PubMed, will be searched along with gray literature to prevent biased results. There will be no time restrictions, and all literature with English abstracts will be included. Using the Template for Intervention Description and Replication framework, we will evaluate intervention characteristics. The primary outcome will be health-related quality of life, and the secondary outcomes will be symptom burden, physical function, and cost-effectiveness. Pairwise and network meta-analyses will be performed, and network geometry and the surface under the cumulative ranking curve will be used to determine which type of nurse-led self-care intervention is best for health-related quality of life for older adults with multiple chronic conditions. We will secure study quality through PRISMA, AMSTAR 2, RoB 2.0, and the GRADE checklist. To ensure the quality of network meta-analysis, similarity will be checked based on the PICO framework. The consistency of the network meta-analysis results will be checked to ensure transitivity by using the Bayesian hierarchical framework. The study protocol is registered with PROSPERO (CRD42022365467).

Outcomes of a tailored self-care intervention for patients with heart failure and major depression: A secondary analysis of a randomized controlled trial

BACKGROUND

Depression is a recognized barrier to heart failure self-care, but there has been little research on interventions to improve heart failure self-care in depressed patients.

OBJECTIVES

To investigate the outcomes of an individually tailored self-care intervention for patients with heart failure and major depression, and to determine whether the adequacy of self-care at baseline, the severity of depression or anxiety, or other factors affect the outcomes of this intervention.

DESIGN

Secondary analysis of data from a pre-registered randomized controlled trial (NCT02997865).

METHODS

Outpatients with heart failure and comorbid major depression (n = 139) were randomly assigned to cognitive behavior therapy or usual care for depression. In addition, an experienced cardiac nurse provided the tailored self-care intervention to all patients in both arms of the trial starting eight weeks after randomization. Weekly self-care intervention sessions were held between Weeks 8 and 16; the frequency was tapered to biweekly or monthly between Weeks 17 and 32. The Self-Care of Heart Failure Index (v6.2) was used to assess self-care outcomes, with scores ≥70 on each of its three scales (Maintenance, Management, and Confidence) being consistent with adequate self-care. The Week 16 Maintenance scale score was the primary outcome for this analysis.

RESULTS

At baseline, 107 (77%) of the patients scored in the inadequate self-care range on the Maintenance scale. Between Weeks 8 and 16, Maintenance scores improved more in patients with initially inadequate than initially adequate self-care (11.9 vs. 3.2 points, p = .003). Sixty-six (48%) of the patients with initially inadequate Maintenance scores achieved scores in the adequate range by Week 32 (p < .0001). Covariate-adjusted predictors of better Maintenance outcomes included adequate Maintenance at baseline (p < .0001), higher anxiety at baseline (p < .05), and higher dosages of the self-care intervention (p < .0001). Neither treatment with cognitive behavior therapy nor less severe major depression predicted better self-care outcomes.

CONCLUSIONS

Depressed patients with inadequate heart failure self-care are able to achieve clinically significant improvements in self-care with the help of an individually tailored self-care intervention. Further refinement and testing are needed to increase the intervention's potential for clinical implementation.

Self-care in children and young people with complex chronic conditions: a qualitative study using Emotional Text Mining

Objectives

To explore: (1) self-care behaviors in children and young people (range: 6 months-24 years) with complex chronic conditions, characterized by the diagnosis of a severe chronic condition, substantial family-identified needs, functional limitations associated with technology dependence, and intensive use of healthcare services; (2) the contribution to self-care of family members and other persons involved in the child's health and daily life context (e.g., health professionals and teachers), and (3) the principal factors that might have influenced the self-care process associated with developmental age.

Methods

A qualitative descriptive study was conducted in an Italian academic tertiary pediatric hospital between September 2020 and May 2021. Overall, 25 focus groups and 7 online interviews were conducted via videoconferencing. Textual data were analyzed using Emotional Text Mining to identify three levels of communication: the factors, the main themes (clusters), and the sub-themes.

Results

A total of 104 participants were enrolled, including 27 patients with complex chronic conditions (12 males, mean age = 11.1 ± 4.40), 33 parents, 6 siblings, 33 health professionals, and 5 teachers. Participants described the process of self-care through four main factors: "self-care", "external settings", "family", and "management". Five clusters (themes) were identified: (1) Self-care management (device; consulting); (2) Shift of agency (influencing factors; parents; school); (3) Self-care support (normal life and personal development; multidisciplinary support); (4) Daily self-care maintenance/monitoring; (5) Treatment adherence. Self-care management was mostly relevant for parents of children aged between 6 months and 3 years.

Conclusion

The self-care process varies according to the needs related to the specific developmental age and the evolution of the clinical condition over time. The contribution of the family, health professionals, and social networks is fundamental for adequate self-care. To help families manage the unstable condition of their children at home, it is necessary to strengthen support networks implement home care, and ensure continuity of care.

The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care

Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care.