Self-management and self-efficacy status in liver recipients

Mediating effect of self-efficacy on self-perceived burden and kinesiophobia in patients with coronary heart disease after percutaneous coronary intervention in China: a cross-sectional study

OBJECTIVES

To analyse the current state of kinesiophobia, self-perceived burden and self-efficacy in patients with coronary heart disease (CHD) following percutaneous coronary intervention (PCI). In addition, to study the mediating effect of self-efficacy between self-perceived burden and kinesiophobia.

DESIGN

Cross-sectional study.

SETTING

A tertiary-level hospital in Anhui Province, China.

PARTICIPANTS

We recruited a total of 255 patients for this study. The eligible subjects were patients diagnosed with coronary artery disease who underwent successful transradial PCI. The exclusion criteria included patients who had both diseases affecting their exercise ability and severe psychiatric disorders.

PRIMARY AND SECONDARY OUTCOME MEASURES

We used questionnaires consisting of the Self-Efficacy Scale for Chronic Disease (SESC), the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), the Self-Perceived Burden Scale (SBPS) and a general information data sheet to obtain participant information. SPSS Bootstrap was used for mediated effects analysis.

RESULTS

The total patient score for kinesiophobia, self-perceived burden and self-efficacy was 42.96±5.00, 24.36±7.84 and 7.61±1.46, respectively. Kinesiophobia was negatively and positively associated with self-efficacy (r=-0.368, p<0.01) and self-perceived burden (r=0.271, p<0.01), respectively. The mediating effect of self-efficacy between self-perceived burden and kinesiophobia in patients was 0.046 (95% CI 0.018 to 0.081), accounting for 26.59% of the total effect.

CONCLUSION

Self-efficacy partially mediates self-perceived burden and kinesiophobia in patients. The medical staff of facilities should strengthen the evaluation and monitoring of patients' self-efficacy and self-perceived burden and conduct intervention measures to reduce their kinesiophobia.

Association Factors of Self-Management Behaviour Among Lung Transplant Recipients Based on Health Belief Model: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Effective self-management after lung transplantation is critical. The Health Belief Model is frequently used to predict and explain the health behaviour in chronic ill patients. The purpose of this study was to explore the status and association factors of self-management among lung transplantation recipients based on the Health Belief Model.

METHODS

A questionnaire survey was conducted on 123 lung transplantation recipients at the lung transplant unit of a general hospital from March 2022 to October 2023. The survey instruments included the Perceived Social Support Scale, the Champion Health Beliefs Model Scale, and the Self-Management Questionnaire for Lung Transplant Recipients. SPSS 25.0 was adopted to perform descriptive statistics, univariate analysis, and multivariate regression analysis.

RESULTS

Scoring indicators of self-management dimensions in lung transplantation recipients were lifestyle management (82.8%), communication with physicians (50.0%), cognitive symptom management (36.0%), and exercise (21.7%). Multiple linear regression analysis showed that the number of postoperative complications, perceived seriousness, perceived benefits, and health motivation explained 22.3% of the total variation in the exercise dimension; health motivation and social support explained 13.5% and 17.4% of the variation in cognitive symptom management dimension and communication with physicians dimension, respectively; and health motivation, social support, and perceived barriers explained 24.0% of the total variation in the lifestyle management dimension.

CONCLUSIONS

Health motivation, perceived seriousness, perceived benefits and barriers, social support, and the number of postoperative complications were the main association factors of self-management behaviour among lung transplant recipients.

Health Locus of Control and Physical Activity in Liver Transplant Recipients

INTRODUCTION

Health locus of control has the potential to influence health behavior among individuals with chronic diseases. However, little is known regarding the relationship between locus of control and physical activity in transplant recipients. The aim of the study was to investigate health locus of control and physical activity in liver transplant recipients.

METHODS

Seventy-six liver transplant recipients were enrolled. The Multidimensional Health Locus of Control - Form C, including internal, chance, doctors, and powerful others subdimensions, was used to evaluate the health locus of control. Physical activity was assessed with the International Physical Activity Questionnaire - Short Form.

RESULTS

The median internal health locus of control score was 28.54. Thirty-six participants had low, 35 participants had moderate, and five participants had high physical activity. Internal health locus of control was higher in patients having moderate activity compared to patients with low activity (p=0.04). "Doctors" subdimension of health locus of control was negatively correlated with walking (r=-0.38, p=0.02) and total activity scores among patients with low activity (r=-0.37, p=0.02).

CONCLUSION

Liver transplant recipients with moderate activity present higher internal health locus of control scores, suggesting a possible influence of physically active behavior on the beliefs of one's own control over disease management. As the activity level increases, the belief that health outcomes are largely the responsibility of health professionals decreases among liver transplant recipients with low activity. Promoting physical activity will help develop the control of one's own actions on health after liver transplantation.

Personal Resources and Expectations and Health Behaviors Among Solid Organ Transplant Recipients-A Multicenter Study

BACKGROUND

The long-term success of organ transplantation (Tx) depends on the transplant recipient's ability to self-manage symptoms, treatment, lifestyle changes, and psychosocial consequences. Health behavior (HB) determinants include personality traits such as optimism, self-efficacy, and health locus of control.

PURPOSE

Assessing the relationship between personal resources and expectations and health behaviors of organ transplant recipients.

MATERIAL AND METHODS

The study was conducted between 01/04/2018 and 30/10/2019 at 3 transplant centers in Poland. The study group consisted of 243 Tx recipients of kidney, heart, liver, and lung. The Health Behavior Inventory, Multidimensional Health Locus of Control Scale (MHLC), General Self-Efficacy Scale, Dispositional Optimism Scale, and Hospital Anxiety and Depression Scale were used to collect data.

FINDINGS

The study group had medium levels of dispositional optimism (mean 15) and high levels of self-efficacy (mean 30.18). The MHLC scale was dominated by a belief in the influence of others and an internal locus of control over one's health. The respondents presented a high level of HB (mean 92.09). A positive relationship was found between personal resources (self-efficacy and optimism), MHLC and HB. The presence of depression and anxiety negatively affected personal resources and internal locus of health control and HB in terms of a positive mental attitude. Type of Tx differentiated internal locus of health control and HB. Predictors of HB were dispositional optimism, self-efficacy, influence of others with health locus of control, symptoms of depression, age and time since transplantation-explaining between 6.1% and 14.5% of health behavior categories.

CONCLUSIONS

To improve health practices among organ recipients, strengthening their personal resources is recommended. It is necessary to form an internal locus of control for adherence to positive HB.

Effects of empowerment education on the self-management and self-efficacy of liver transplant patients: a randomized controlled trial

BACKGROUND

Despite the increasing survival rates, liver transplant patients experience numerous postoperative complications and encounter significant challenges in long-term self-management. This study aims to examine the effectiveness of empowerment education in enhancing self-management skills and self-efficacy among liver transplant recipients.

METHODS

A randomized, single-blind, single-center trial was conducted in China between August 2019 and September 2020, involving liver transplant recipients. The intervention group received 12 weeks of empowerment education, while the control group received 12 weeks of routine education. .The study assessed the patients' self-management and self-efficacy using the Liver Transplant Recipient Self-Management Questionnaire and the Self-efficacy for Managing Chronic Disease 6-Item Scale. Follow-up assessments were conducted at 1, 3, and 6 months after the intervention.

RESULTS

Eighty-four patients were initially randomized to either the intervention group (n1 = 42) or the routine education group (n2 = 42). Twelve patients were excluded from the analysis due to loss of follow-up or discontinuation of the intervention, leaving 72 patients (n1 = 35, n2 = 37) for the final analysis. The scores for exercise and lifestyle management were significantly higher in the intervention group than in the control group at 1, 3, and 6 months after the intervention (t = 3.047, 5.875, 8.356, and t = 5.759, 4.681, 11.759, respectively; P < 0.05). At 3 and 6 months after the intervention, the scores for cognitive symptom management, communication with physicians, and self-efficacy were significantly higher in the intervention group than in the control group (t = 5.609, 6.416, and t = 5.576, 11.601, and t = 6.867, 15.071, respectively; P < 0.001). Within the intervention group, self-management scores increased significantly over time, while within the control group, the scores for communication with physicians, lifestyle, and self-efficacy showed a significant decline from 3 to 6 months after routine health education.

CONCLUSIONS

The results of this study suggest that empowerment education is an effective means of improving the self-management and self-efficacy of liver transplant patients, with better outcomes compared to routine health education. These findings have important implications for nursing practice and provide valuable guidance for clinical education of liver transplant patients.

TRIAL REGISTRATION

ChiCTR2200061561.

Vitality, mental health and role-physical mediate the influence of coping on depressive symptoms and self-efficacy in patients with non-alcoholic fatty liver disease: A cross-sectional study

OBJECTIVE

Our aim was to determine whether the association between active coping and depressive symptoms in patients with non-alcoholic fatty liver disease (NAFLD) was mediated by vitality, and whether diabetes and obesity could impact on this relationship. We also wanted to find out whether mental health and role-physical modulated the relationship between passive/avoidance coping and self-efficacy, and the role of liver fibrosis.

METHODS

Depressive symptoms (BDI-II), self-efficacy (GSE), coping (COPE-28) and quality of life (SF-12) were evaluated in 509 biopsy-proven NAFLD patients in this cross-sectional study. Mediation and moderated mediation models were conducted using the SPSS PROCESS v3.5 macro.

RESULTS

Vitality mediated the relationship between active coping and depressive symptoms (-2.254, CI = -2.792 to -1.765), with diabetes (-0.043, p = 0.017) and body mass index (BMI) (-0.005, p = 0.009) moderating the association. In addition, mental health (-6.435, CI = -8.399 to -4.542) and role-physical (-1.137, CI = -2.141 to -0.315) mediated the relationship between passive/avoidance coping and self-efficacy, with fibrosis stage (0.367, p < 0.001) moderating this association. Specifically, the presence of diabetes and significant fibrosis, and a higher BMI, were associated with greater negative impact on participant depressive symptoms or self-efficacy.

CONCLUSION

A maladaptive coping style was associated with poorer vitality, mental health and role-physical in NAFLD patients, which along with the presence of metabolic comorbidity (diabetes and obesity) and significant fibrosis predicted more depressive symptoms or poorer self-efficacy in these patients. These results suggested incorporating emotional and cognitive evaluation and treatment in patients with NAFLD.

Effectiveness of mobile health-based self-management application for posttransplant cares: A systematic review

BACKGROUND AND AIMS

Patients after transplantation need medical management for the rest of their lives, and self-management seems to lead to greater adherence to medical standards, improve early physical changes, and increase patient empowerment. The main objective of this article is to systematic review of the consideration to mobile health applications (m-Health apps) used in transplantation.

METHODS

A systematic search was conducted MEDLINE (through PubMed), Web of Science, Scopus, and Science Direct from inception to November 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was used in this study. Comprehensive research was carried out using a combination of keywords and MeSH terms associated with m-Health, empowerment, self-management, and transplantation. Two independent reviewers screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Eligible studies were original research articles that included posttransplant care and mobile phone-based applications to support self-management and self-care. Also, thesis, book chapters, letters to editors, short briefs, reports, technical reports, book reviews, systematic reviews, or meta-analysis were excluded.

RESULTS

We divided all the reviewed articles into four categories, self-management (medication adherence, adherence to medical regimen, and remote monitoring), evaluation, interaction, and interface; 37.5% of the studies were focused on lung transplantation. In 56.25% of the studies, medication adherence was considered because one of the main reasons for the rejection and graft loss is stated medication nonadherence. Also, 62.5% of the studies demonstrated that the use of m-health improved medication adherence and self-management in transplantation.

CONCLUSIONS

The use of m-Health apps interventions to self-management after transplantation has shown promising feasibility and acceptability, and there is modest evidence to support the efficacy of these interventions. We found that m-Health solutions can help the patient in self-management in many ways after transplantation.

Symptom Experience and Related Predictors in Liver Transplantation Recipients

PURPOSE

Symptom experience after liver transplantation (LT) provides healthcare professionals with important information about the benefits and limitations of LT from patients' perspective. This study aims to explore the multidimensional symptom experience and analyze related predictive factors in LT recipients.

METHODS

This cross-sectional study evaluated the occurrence, frequency, intensity, and level of distress of 40 symptoms in 265 LT recipients. Stepwise multiple regression analysis was performed to analyze the influencing factors of symptom experience.

RESULTS

The analysis of patient-reported data indicated that the ten most common symptoms were fatigue (42.3%), frequent sleep interruptions (38.9%), difficulty falling asleep (35.9%), decreased memory (34.0%), dreaminess (29.8%), itch (28.7%), muscular weakness (26.4%), shortness of breath (25.3%), anxiety (24.5%), and hand tremor (21.9%). Patients were classified into four groups according to survival time (1-month, 2-6-month, 7-12-month, and >1-year groups) after LT, and the most common symptom was fatigue in the one-month and 2-6-month groups, difficulty falling asleep in the 7-12-month group, and decreased memory in the >1-year group. Type of the primary caregiver, complications, concerns about the decreased ability to perform household and outdoor activities, and concerns about being a burden to the family were predictors of symptoms burden.

CONCLUSION

LT recipients experienced complicated symptoms. In clinical practice, it is critical to integrate physicians, nurses, and social workers as a medical team to help LT recipients develop suitable coping strategies that can potentially address patients' concerns, increase the sense of confidence, and improve symptom outcomes.

WITHDRAWN: Self-Management Behavior, Symptom Occurrence, and Psychological Distress in Liver Transplant Recipients in China: A Descriptive Correlational Study

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Self-management in liver transplantation

BACKGROUND

Self-management is crucial for liver transplant (LT) recipients to maintain transplants and optimize health outcomes. However, previous literature has been primarily limited to examining medication adherence; there is a knowledge gap regarding self-management in the LT population.

AIM

The aims of this study were to 1) comprehensively describe self-management behaviors and activities in LT recipients, 2) explore levels of overall self-management, and 3) explore the relationships of self-efficacy, cognition, and health information seeking behavior with self-management.

METHODS

Adult LT recipients (n = 113) who had a functioning transplant for at least 6 months participated in this cross-sectional, descriptive study. Participants were asked to identify self-management behaviors and rate their performance of those behaviors, including symptom management and medication adherence. They also completed a cognitive assessment and questionnaires measuring self-efficacy and health information seeking behavior. Descriptive statistics, latent profile analysis, and probit model for path analysis were used for the data analysis.

RESULTS

LT recipients acknowledged engaging in various self-management behaviors including symptom management, physical activity, maintenance of positive attitudes, and communication with healthcare providers. Three levels of self-management (i.e., low, medium, and high) were found; a high level of self-management was related to self-efficacy and health information seeking behavior.

CONCLUSIONS

The findings indicate that self-management may be improved with interventions aimed at increasing self-efficacy and health information seeking behavior. Findings from this study will inform future interventions, to improve self-management and subsequent health outcomes in this population. Future longitudinal studies are necessary to confirm the causality of the identified relationships.

Self-Management Behaviors Among Patients With Liver Cirrhosis in Shanghai, China: A Cross-Sectional Study

Effective self-management of liver cirrhosis requires medication adherence and lifestyle modifications. The purpose of this study was to investigate the self-management behaviors of liver cirrhosis patients and how their knowledge of cirrhosis, psychological status, and self-efficacy contributes to self-management practices in Shanghai, China. Subjects were recruited from the hepatology units in an infectious hospital in Shanghai, China. Self-administered questionnaires were collected and medical charts were reviewed by the research staff. A total of 134 subjects were enrolled from November 2016 to March 2017. The results indicate that the self-management behaviors mean score was 2.51 out of 4 and that depression, severity of cirrhosis, and self-efficacy significantly affected self-management behaviors and explained 22.9% of the total variance. The findings also indicate that psychological stress, disease severity, and self-efficacy affected self-management behaviors in liver cirrhosis patients. Interventions focusing on decreasing depression and enhancing self-efficacy according to disease severity should improve self-management behaviors in this population.

Self-Management in Liver Transplant Recipients

Introduction:

Although self-management is essential for liver transplant recipients, there is no review that has synthesized findings related to self-management in this population.

Objective:

This narrative review aimed to synthesize the current findings and identify the gaps in knowledge about self-management in liver recipients.

Methods:

A search of PubMed, CINAHL Plus, PsychINFO, ProQuest, and Web of Science was conducted using the following terms: [Self-care OR Self-management OR Health behavior] AND [Liver transplantation]. Peer-reviewed published research articles focusing on self-management of adult recipients were selected. A total of 23 articles were included for review. Two reviewers independently reviewed the full text of selected articles and extracted the data about definitions, measurements, and findings regarding self-management.

Results:

Three areas of self-management were identified, including medication nonadherence (n = 11), alcohol recidivism (n = 11), and health maintenance (n = 5). Reported rates of medication nonadherence ranged from 8% to 66%. Medication nonadherence was related to recipients’ demographic (eg, age or sex), transplant-related (eg, time since transplant), and pretransplant variables (eg, history of substance/alcohol abuse). Reported alcohol recidivism rates ranged from 3% to 95%. Age, pretransplant variables (eg, abstinent time before transplant), and personality disorder were identified to be related to alcohol recidivism after transplant. The health maintenance studies discussed behaviors such as smoking, clinic appointment attendance, or vaccination/health screening behaviors of recipients.

Discussion:

Self-management studies in liver recipients have been narrowly focused on medication nonadherence and alcohol recidivism. To improve self-management in recipients, self-management beyond medication nonadherence and alcohol recidivism should be comprehensively examined.