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Kähkönen O, Vähänikkilä H, Paukkonen L, Oikarinen A. Extension of the theory of adherence to treatment in patients with coronary heart disease. Chronic Dis Transl Med 2024; 10:227-237. [PMID: 39027194 PMCID: PMC11252433 DOI: 10.1002/cdt3.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 07/20/2024] Open
Abstract
Background Increased knowledge of the concept of adherence is needed for development patient-centered care, nursing interventions, and guidelines for patients with coronary heart disease (CHD). The aim of this study was to test and extend the Theory of Adherence to Treatment regarding informational support in patients with CHD. Methods The study utilized an explanatory and descriptive survey. The study was conducted in 2013 and involved 416 patients in five hospitals in Finland. The Adherence of Patients with Chronic Disease instrument and the Social Support for People with CHD instrument were used. The model was tested using structural equation modeling (SEM). Results SEM confirmed direct associations between motivation (β = 0.49, p < 0.001) and results of care (β = 0.29, p < 0.01), and indirect associations between sense of normality, fear of complications, support from nurses and next of kin, and informational support to adherence to a healthy lifestyle and medication. Informational support included information and advice on CHD risk factors, physical exercise, chest pain, medication, continuum of care, and rehabilitation. Indirect standardized path coefficients varied between 0.14 and 0.45. The model explained 45% of adherence to a healthy lifestyle and medication. Conclusion The results of this study showed that informational support is a justified extension to the original Theory of Adherence to Treatment in Patients with CHD. Informational support seems to offer a new perspective that can be used to develop patient-centered nursing interventions and thus support adherence to treatment by patients with a lifelong disease such as CHD.
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Affiliation(s)
- Outi Kähkönen
- Department of Nursing ScienceUniversity of Eastern FinlandKuopioFinland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of MedicineUniversity of OuluOuluFinland
| | - Leila Paukkonen
- Reseach Unit of Health Sciences and Technology, Faculty of MedicineUniversity of OuluOuluFinland
- Medical Research Center Oulu (MRC Oulu), Faculty of medicineUniversity of OuluOuluFinland
| | - Anne Oikarinen
- Reseach Unit of Health Sciences and Technology, Faculty of MedicineUniversity of OuluOuluFinland
- Medical Research Center Oulu (MRC Oulu), Faculty of medicineUniversity of OuluOuluFinland
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2
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Yu H. Understanding Health-Promoting Behaviors and Influential Factors in Schizophrenia Patients. Nutrients 2024; 16:1490. [PMID: 38794728 PMCID: PMC11124234 DOI: 10.3390/nu16101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: People who are diagnosed with schizophrenia experience a reduced average lifespan compared to the general population. Also, approximately 85% of individuals with schizophrenia have chronic physical illnesses. Moreover, 60% of premature deaths in this population could be prevented through the adoption of health-promoting behaviors. (2) Methods: This study involved the recruitment of 220 participants from an outpatient clinic in Seoul, South Korea. Inclusion criteria comprised adults aged 19 years or older with a confirmed diagnosis of schizophrenia. Data collection occurred between 25 May 2021 and 2 August 2021, utilizing self-report questionnaires. A total of 202 responses were subjected to analysis using SPSS 23.0 and AMOS 23.0. (3) Results: The findings indicate that the final model is characterized by the following values: Normed x2 = 2.240, RMSEA = 0.079, TLI = 0.926, x2 = 562.2 (p < 0.001), AGFI = 0.830, GFI = 0.814, and CFI = 0.938. Notably, health knowledge did not exhibit a significant direct or overall impact on health-promoting behaviors. Conversely, social support and psychiatric symptoms demonstrated direct, indirect, and total effects on health promotion through an intervening variable. This study underscores the pivotal role of self-efficacy as the most influential factor affecting health-promoting behaviors in individuals with schizophrenia. (4) Conclusions: enhancing self-efficacy emerges as a crucial element in the design and implementation of intervention programs aimed at improving health-promoting behaviors in individuals with schizophrenia.
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Affiliation(s)
- Heajin Yu
- College of Nursing, Sahmyook University, Seoul 01795, Republic of Korea
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3
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Oikarinen AK, Kähkönen O, Kaakinen P, Kääriäinen M, Virtanen M, Paalimäki-Paakki K, Hylkilä K, Männikkö N, Kerimaa H, Kivelä K, Jansson M, Kajula O, Männistö M, Lahtinen M, Vanhanen M, Rajala M. Nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings: A qualitative systematic literature review. J Clin Nurs 2024; 33:1684-1708. [PMID: 38332566 DOI: 10.1111/jocn.17050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
AIMS AND OBJECTIVES To identify and synthesise nurses' experiences of competence in lifestyle counselling with adult patients in healthcare settings. BACKGROUND Modifiable lifestyle risk behaviours contribute to an increased prevalence of chronic diseases worldwide. Lifestyle counselling is part of nurses' role which enables them to make a significant contribution to patients' long-term health in various healthcare contexts, but requires particular competence. DESIGN Qualitative systematic literature review and meta-aggregation. METHOD The review was guided by Joanna Briggs Institute's methodology for conducting synthesis of qualitative studies. PRISMA-checklist guided the review process. Relevant original studies were search from databases (CINAHL, PubMed, Scopus, Medic and Psych Articles, Ebscho Open Dissertations and Web of Science). After researcher consensus was reached and quality of the studies evaluated, 20 studies were subjected to meta-aggregation. RESULTS From 20 studies meeting the inclusion criteria, 75 findings were extracted and categorised into 13 groups based on their meaning, resulting in the identification of 5 synthesised findings for competence description: Supporting healthy lifestyle adherence, creating interactive and patient-centred counselling situations, acquiring competence through clinical experience and continuous self-improvement, collaborating with other professionals and patients, planning lifestyle counselling and managing work across various stages of the patient's disease care path. CONCLUSION The review provides an evidence base that can be used to support nurses' competence in lifestyle counselling when working with adult patients in healthcare settings. Lifestyle counselling competence is a complex and rather abstract phenomenon. The review identified, analysed and synthesised the evidence derived from nurses' experience which shows that lifestyle counselling competence is a multidimensional entity which relates to many other competencies within nurses' work. IMPLICATIONS FOR THE PROFESSION Recognising the competencies of nurses in lifestyle counselling for adult patients can stimulate nurses' motivation. The acquisition of these competencies can have a positive impact on patients' lives and their health. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution. IMPACT The research may enhance nurses' competence in lifestyle counselling, leading to improved health outcomes, better adherence to recommendations and overall well-being. It may also drive the development of interventions, improving healthcare delivery in lifestyle counselling. REPORTING METHOD The review was undertaken and reported using the PRISMA guidelines. PROTOCOL REGISTRATION Blinded for the review.
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Affiliation(s)
- Anne Kaarina Oikarinen
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
| | - Outi Kähkönen
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Pirjo Kaakinen
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
| | - Maria Kääriäinen
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
| | - Mari Virtanen
- Helsinki Metropolia University of Applied Sciences, Helsinki, Finland
| | | | - Krista Hylkilä
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
- Research Unit of Health Science and Technology, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Niko Männikkö
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
| | - Heli Kerimaa
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
| | - Kirsi Kivelä
- Wellbeing Services Country of North Ostrobothnia, Oulu, Finland
| | - Miia Jansson
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
- RMIT University, Melbourne, Australia
| | - Outi Kajula
- Oulu University of Applied Sciences, Oulu, Finland
| | - Merja Männistö
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
- Master School at Diaconia University of Applied Sciences, Helsinki, Finland
| | - Minna Lahtinen
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Minna Vanhanen
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
- Oulu University of Applied Sciences, Oulu, Finland
| | - Mira Rajala
- Research Unit of Health Science and Technology, Medical Research Centre Oulu, Faculty of Medicine, Oulu University, Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence Group, Helsinki, Finland
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4
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Rostami K, Maryami M, Rambod M. The effect of telephone counseling based on Orem's model on adherence to treatment and resilience of patients with coronary angioplasty: a randomized clinical trial. BMC Cardiovasc Disord 2023; 23:489. [PMID: 37794373 PMCID: PMC10552216 DOI: 10.1186/s12872-023-03529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND This study aimed to determine the effect of telephone counseling based on Orem's Self-Care Model on adherence to treatment and resilience of patients with coronary angioplasty. METHODS This randomized clinical trial was performed on 80 patients in the Cardiac Intensive Care Unit of Shiraz University of Medical Sciences. Patients were randomly divided into two groups of 40 (intervention and control). Questionnaires on adherence to treatment of chronic patients and resilience for patients with cardiovascular and respiratory diseases were filled out before and 8 weeks after the intervention. In the intervention group, the telephone call schedule consisted of three calls per week for 8 weeks. RESULTS Before the intervention, no significant difference was found between the groups about adherence to treatment and resilience. However, after the intervention, a significant difference was found between the groups as to adherence to treatment and resilience (P < 0.001). CONCLUSION Nursing consultation using telephone calls based on Orem's model increases the adherence to treatment and resilience of patients undergoing coronary angioplasty. Telephone counseling can help the patients adhere to their treatment plans and develop resilience skills.
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Affiliation(s)
- Khatereh Rostami
- Community Based Psychiatric Care Research Center, Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Maryami
- Student Research Committee of Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoume Rambod
- Community Based Psychiatric Care Research Center, Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran.
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Oikarinen A, Engblom J, Paukkonen L, Kääriäinen M, Kaakinen P, Kähkönen O. Effects of a lifestyle counselling intervention on adherence to lifestyle changes 7 years after stroke - A quasi-experimental study. Scand J Caring Sci 2023; 37:163-172. [PMID: 35766254 DOI: 10.1111/scs.13101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Adherence to medication and healthy lifestyle is crucial for preventing secondary strokes and other vascular events. However, there is not enough evidence on the long-term effects of hospital-initiated lifestyle counselling. AIM To determine the effects of The Risk Factor Targeted Lifestyle Counselling Intervention, which is implemented during acute hospitalisation, on adherence to lifestyle changes 7 years after stroke or TIA. METHODS Quasi-experimental design with 7-year follow-up period. Baseline data (n = 150) were gathered from a neurology unit in Finland between 2010 and 2011. Patients received either the studied intervention (n = 75) or the prevailing form of counselling at the time (n = 75). Data concerning lifestyle and clinical values were measured at the baseline time point, while adherence to lifestyle changes was assessed 7 years later (2017-2018). Analysis of covariance and multivariate ordinal logistic regression were used to describe the mean differences between the intervention and control groups. RESULTS Several between-group differences were detected, namely, members of the intervention group reported consuming less alcohol and having lost more weight during hospitalisation relative to the control group. No between-group differences in the prevalence of smokers were found, but the intervention group reported a greater number of daily cigarettes than the control group. Adherence to medication, importance of adherence to a healthy lifestyle, support from family and friends, and support from nurses were all significantly higher in the intervention group than in the control group. CONCLUSIONS The results suggest that the lifestyle counselling intervention was effective in decreasing alcohol use and weight, as well as increasing factors that are known to support adherence to a healthy lifestyle. RELEVANCE TO CLINICAL PRACTICE The results indicate that the adherence process already begins during acute phase counselling. To ensure long-lasting lifestyle changes, counselling should be started at the hospital, after which it can be provided by friends and family members.
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Affiliation(s)
- Anne Oikarinen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Janne Engblom
- Quantitative Methods in Management, Turku School of Economics University of Turku, Turku, Finland
| | - Leila Paukkonen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Northern Ostrobothnia Hospital District, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Northern Ostrobothnia Hospital District, Oulu, Finland
| | - Pirjo Kaakinen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Outi Kähkönen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland
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6
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Oliveira D, Knight H, Jones KA, Ogollah R, Orrell M. Motivation and willingness to increase physical activity for dementia risk reduction: Cross-Sectional UK survey with people aged 50 and over. Aging Ment Health 2022; 26:1899-1908. [PMID: 34607490 DOI: 10.1080/13607863.2021.1984393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
METHODS Attitudes to increasing physical activity to reduce risk of dementia were assessed in a national online survey promoted via online forums and public adverts. The Motivation to Change Behaviour for Dementia Risk Reduction (MOCHAD-10) scale examined motivation for lifestyle change. Multivariable logistic regression was used to identify the predictors of willingness and motivation to increase physical activity. RESULTS Data from 3,948 individuals showed most people were moderately/very physically active (80%). People more likely to be physically active had better health and education, were older, male, and had a partner. People willing to increase physical activity (73%) were more likely to be younger, non-White, underweight, had better health and lifestyles, and had experience caring for someone with dementia. People with higher levels of motivation to change lifestyle (MOCHAD-10 subscales) were more likely to be female, younger, in poorer physical/mental health, had lower perceived mental activity, and were a carer for someone with dementia. CONCLUSION Men and those with better health status were more physically active. Those who exercised less and those who were more motivated to increase physical activity were not necessarily able to be physically active. Multisectoral public health strategies should seek to use the high motivation levels among this group to mitigate the barriers related to physical activity for dementia risk reduction.
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Affiliation(s)
- Déborah Oliveira
- Department of Psychiatry, School of Medicine, Universidade Federal de Sao Paulo (UNIFESP), São Paulo, Brazil.,Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Holly Knight
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Katy A Jones
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Martin Orrell
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
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7
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He QH, Zheng J, Liu JL, Wang J, You LM. Predictors of Medication Adherence of Patients With Coronary Heart Disease After Percutaneous Coronary Intervention: A Structural Equation Modeling Based on the Extended Theory of Planned Behavior. J Cardiovasc Nurs 2022; 37:350-358. [PMID: 37707968 DOI: 10.1097/jcn.0000000000000755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The theory of planned behavior (TPB), combined with social support, forms the extended TPB, which has shown to predict adherence to health-related behavior effectively, but few studies have applied it to explain medication adherence in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). OBJECTIVES The aim of this study was to explore the factors associated with medication adherence and the underlying mechanisms based on the extended TPB among patients with CHD after PCI. METHODS A cross-sectional descriptive study was conducted among patients with CHD after PCI in 2 major hospitals in Guangzhou, China. Medication adherence was measured with the Medication Adherence Report Scale. Constructs of the TPB contributing to medication adherence were assessed by the Theory of Planned Behavior Questionnaire for Medication Adherence. Social support was measured by the Multidimensional Scale of Perceived Social Support. Structural equation modeling was used to examine the hypotheses based on the extended TPB. RESULTS A total of 300 patients were surveyed and 26.0% of them were nonadherent. The structural equation modeling had good fit indices and estimated 62.6% of the variance in medication adherence. Regarding the relationships between the extended TPB constructs and medication adherence, "intention" was directly associated with medication adherence, and "perceived behavioral control" positively predicted medication adherence directly and indirectly. "Affective attitude" and "subjective norm" were indirectly associated with medication adherence through "intention." Social support exerted an indirect effect on medication adherence through "subjective norm." CONCLUSIONS The extended TPB is an appropriate model to predict medication adherence and provides an effective framework for adherence-enhancing interventions.
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8
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Kähkönen O, Oikarinen A, Vähänikkilä H, Kyngäs H. Association between perceived health and adherence to treatment after percutaneous coronary intervention: A long-term follow-up study. J Adv Nurs 2022; 78:1653-1664. [PMID: 34636444 DOI: 10.1111/jan.15069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/16/2021] [Accepted: 09/26/2021] [Indexed: 12/17/2022]
Abstract
AIMS To identify associations between perceived health and treatment adherence six years after percutaneous coronary intervention. DESIGN A non-experimental descriptive long-term follow-up study. METHODS Baseline data (n = 416) were collected in 2013, with follow-up data collected in 2019 (n = 154), using the EuroQoL scale, EuroQoL visual analogue scale, and Adherence of Patients with Chronic Disease Instrument. Data were analysed using descriptive statistics and multivariate methods. RESULTS The average age of the 154 respondents was 68.5 years (SD 7.01), with a majority males (n = 118, 86.6%). Adherence to a healthy lifestyle, good perceived results of care, support from nurses, high sense of normality, low fear of complications, motivation, older age, and duration of coronary artery disease were associated with better general perceived health as well as its dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). CONCLUSION Support from nurses is a key factor to ensuring high perceived health among post-percutaneous coronary intervention patients. This support must be continuous and motivate the patient to adhere to a healthy lifestyle. Patients should feel comfortable sharing their problems and fears. This type of relationship will allow health care professionals to assess the patient's current situation and address potential problems about mobility, pain and discomfort, as well as anxiety and depression to strengthen the patient's sense of normality and enable them to confidently lead a normal life. IMPACT The research aimed to gain knowledge about how perceived health is associated with treatment adherence six years after percutaneous coronary intervention. The results emphasise that a nurse's support of patients is crucial to the care process, as adherence to treatment showed a clear positive association with perceived health in the analysed sample of post-PCI patients.
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Affiliation(s)
- Outi Kähkönen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure of Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu (MRC Oulu), Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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Mayr HL, Kelly JT, Macdonald GA, Russell AW, Hickman IJ. Clinician perspectives of barriers and enablers to implementing the Mediterranean dietary pattern in routine care for coronary heart disease and type 2 diabetes: A qualitative interview study. J Acad Nutr Diet 2022; 122:1263-1282. [DOI: 10.1016/j.jand.2022.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/25/2022]
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10
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Paukkonen L, Oikarinen A, Kähkönen O, Kyngäs H. Adherence to self-management in patients with multimorbidity and associated factors: A cross-sectional study in primary health care. J Clin Nurs 2021; 31:2805-2820. [PMID: 34704303 DOI: 10.1111/jocn.16099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/03/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to explore the adherence to self-management of patients with multimorbidity, identify associated factors, and determine explanatory factors of their adherence to self-management in terms of the Theory of Adherence of People with Chronic Disease. BACKGROUND Adherence to self-management is essential for successful care of multimorbid patients, but multimorbidity poses challenges for both patients and practitioners due to its care complexity and broad impact on patients' lives. DESIGN A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. METHODS Adult multimorbid patients who attended primary healthcare consultations in Finland were surveyed using self-administered questionnaires with several instruments including the Adherence of People with Chronic Disease Instrument, Kasari's FIT Index, and Alcohol Use Disorders Identification test. Responses of 124 patients were analysed using descriptive statistics, Spearman correlations, binary logistic regression analysis, and Chi-squared, or corresponding, tests. RESULTS Most patients' responses indicated good or adequate adherence to care regimens and medications. However, adherence to self-management for a healthy lifestyle was more frequently inadequate. Adherence was significantly associated with several patient-related factors, including demographic and health-related factors, perceived adequacy of loved ones, and patient activation. Significant explanatory factors for adherence included energy and willpower, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, from physicians, and from family and friends. Various factors were relevant for specific aspects of self-management. CONCLUSIONS Multimorbid patients' adherence to self-management is not an 'all or none phenomenon, but a multifaceted process with numerous associated and explanatory factors. RELEVANCE TO CLINICAL PRACTICE The findings highlight needs for an individualised whole-person approach in multimorbid patients' care to provide the required support for good adherence to self-management. Healthcare professionals, especially nurses working in primary health care, are well-positioned to meet this need.
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Affiliation(s)
- Leila Paukkonen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Outi Kähkönen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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11
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Nurmeksela A, Pihlainen V, Kettunen T, Laukkanen J, Peltokoski J. Nurse-led counseling for coronary artery disease patients: A 1-year follow-up study. Nurs Health Sci 2021; 23:678-687. [PMID: 33991019 DOI: 10.1111/nhs.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/12/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
Nurse-led counseling and systematic follow-up have been shown to reduce cardiovascular risk factor levels. The study aims were to investigate if cardiovascular risk factor levels could be reduced in patients with coronary artery disease with a nurse-led intervention and to report patients' evaluations of nurse-led counseling. The study design was a real-life longitudinal follow-up counseling intervention. Data were collected from November 2017 to May 2020. The nurse-led intervention and patients' follow-up time was 1 year. Of the 78 patients recruited, 74 completed the study. The most significant findings were in the levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides at every follow-up visit compared to their baseline levels and that waist circumference decreased during the 1-year follow-up. Patients assessed the quality of nurse-led counseling to be very good, though it decreased slightly during follow-up. The results suggest the integrated care path and specialized and primary care for coronary artery disease patients need further development. More research is needed on how to strengthen patients' self-management and what kind of counseling would best promote it.
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Affiliation(s)
- Anu Nurmeksela
- Faculty of Health Sciences, Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | | | - Tarja Kettunen
- Faculty of Sport and Health Sciences and Central Finland Health Care District, Unit of Primary Health Care, University of Jyvaskyla, Jyvaskyla, Finland.,Unit of Primary Health Care, Jyvaskyla, Finland
| | - Jari Laukkanen
- Department of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Central Finland Health Care District, Jyvaskyla, Finland
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12
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Jose P, Ravindranath R, Joseph LM, Rhodes EC, Ganapathi S, Harikrishnan S, Jeemon P. Patient, caregiver, and health care provider perspectives on barriers and facilitators to heart failure care in Kerala, India: A qualitative study. Wellcome Open Res 2021; 5:250. [PMID: 33959683 PMCID: PMC8078213 DOI: 10.12688/wellcomeopenres.16365.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Deficits in quality of care for patients with heart failure (HF) contribute to high mortality in this population. This qualitative study aimed to understand the barriers and facilitators to high-quality HF care in Kerala, India. Methods: Semi-structured, in-depth interviews were conducted with a purposive sample of health care providers (n=13), patients and caregivers (n=14). Additionally, focus group discussions (n=3) were conducted with patients and their caregivers. All interviews and focus group discussions were transcribed verbatim. Textual data were analysed using thematic analysis. Results: Patients’ motivation to change their lifestyle behaviours after HF diagnosis and active follow-up calls from health care providers to check on patients’ health status were important enablers of high-quality care. Health care providers’ advice on substance use often motivated patients to stop smoking and consuming alcohol. Although patients expected support from their family members, the level of caregiver support for patients varied, with some patients receiving strong support from caregivers and others receiving minimal support. Emotional stress and lack of structured care plans for patients hindered patients’ self-management of their condition. Further, high patient loads often limited the time health care providers had to provide advice on self-management options. Nevertheless, the availability of experienced nursing staff to support patients improved care within health care facilities. Finally, initiation of guideline-directed medical therapy was perceived as complex by health care providers due to multiple coexisting chronic conditions in HF patients. Conclusions: Structured plans for self-management of HF and more time for patients and health care providers to interact during clinical visits may enable better clinical handover with patients and family members, and thereby improve adherence to self-care options. Quality improvement interventions should also address the stress and emotional concerns of HF patients.
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Affiliation(s)
- Prinu Jose
- Public Health Foundation of India, New Delhi, India
| | - Ranjana Ravindranath
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
| | - Linju M Joseph
- Center for Chronic Disease Control, New Delhi, India.,University of Birmingham, Birmingham, UK
| | - Elizabeth C Rhodes
- Yale Center for Implementation Science, Yale School of Medicine, Connecticut, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, Connecticut, USA.,Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Connecticut, USA
| | - Sanjay Ganapathi
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
| | | | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
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Jose P, Ravindranath R, Joseph LM, Rhodes EC, Ganapathi S, Harikrishnan S, Jeemon P. Patient, caregiver, and health care provider perspectives on barriers and facilitators to heart failure care in Kerala, India: A qualitative study. Wellcome Open Res 2021; 5:250. [PMID: 33959683 PMCID: PMC8078213 DOI: 10.12688/wellcomeopenres.16365.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 02/23/2024] Open
Abstract
Background: Deficits in quality of care for patients with heart failure (HF) contribute to high mortality in this population. This qualitative study aimed to understand the barriers and facilitators to high-quality HF care in Kerala, India. Methods: Semi-structured, in-depth interviews were conducted with a purposive sample of health care providers (n=13), patients and caregivers (n=14). Additionally, focus group discussions (n=3) were conducted with patients and their caregivers. All interviews and focus group discussions were transcribed verbatim. Textual data were analysed using thematic analysis. Results: Patients' motivation to change their lifestyle behaviours after HF diagnosis and active follow-up calls from health care providers to check on patients' health status were important enablers of high-quality care. Health care providers' advice on substance use often motivated patients to stop smoking and consuming alcohol. Although patients expected support from their family members, the level of caregiver support for patients varied, with some patients receiving strong support from caregivers and others receiving minimal support. Emotional stress and lack of structured care plans for patients hindered patients' self-management of their condition. Further, high patient loads often limited the time health care providers had to provide advice on self-management options. Nevertheless, the availability of experienced nursing staff to support patients improved care within health care facilities. Finally, initiation of guideline-directed medical therapy was perceived as complex by health care providers due to multiple coexisting chronic conditions in HF patients. Conclusions: Structured plans for self-management of HF and more time for patients and health care providers to interact during clinical visits may enable better clinical handover with patients and family members, and thereby improve adherence to self-care options. Quality improvement interventions should also address the stress and emotional concerns of HF patients.
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Affiliation(s)
- Prinu Jose
- Public Health Foundation of India, New Delhi, India
| | - Ranjana Ravindranath
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
| | - Linju M. Joseph
- Center for Chronic Disease Control, New Delhi, India
- University of Birmingham, Birmingham, UK
| | - Elizabeth C. Rhodes
- Yale Center for Implementation Science, Yale School of Medicine, Connecticut, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Connecticut, USA
| | - Sanjay Ganapathi
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
| | | | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
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Liao CT, Hsieh TH, Shih CY, Liu PY, Wang JD. Cost-effectiveness of percutaneous coronary intervention versus medical therapy in patients with acute myocardial infarction: real-world and lifetime-horizon data from Taiwan. Sci Rep 2021; 11:5608. [PMID: 33692425 PMCID: PMC7947011 DOI: 10.1038/s41598-021-84853-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/15/2021] [Indexed: 12/04/2022] Open
Abstract
Although some studies have assessed the cost-effectiveness of percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI), there has been a lack of nationwide real-world studies estimating life expectancy (LE), loss-of-LE, life-years saved, and lifetime medical costs. We evaluated the cost-effectiveness of PCI versus non-PCI therapy by integrating a survival function and mean-cost function over a lifelong horizon to obtain the estimations for AMI patients without major comorbidities. We constructed a longitudinal AMI cohort based on the claim database of Taiwan's National Health Insurance during 1999–2015. Taiwan's National Mortality Registry Database was linked to derive a survival function to estimate LE, loss-of-LE, life-years saved, and lifetime medical costs in both therapies. This study enrolled a total of 38,441 AMI patients; AMI patients receiving PCI showed a fewer loss-of-LE (3.6 versus 5.2 years), and more lifetime medical costs (US$ 49,112 versus US$ 43,532). The incremental cost-effectiveness ratio (ICER) was US$ 3488 per life-year saved. After stratification by age, the AMI patients aged 50–59 years receiving PCI was shown to be cost-saving. From the perspective of Taiwan's National Health Insurance, PCI is cost-effective in AMI patients without major comorbidities. Notably, for patients aged 50–59 years, PCI is cost-saving.
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Affiliation(s)
- Chia-Te Liao
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan.,Department of Electrical Engineer, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Tung-Han Hsieh
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chia-Yin Shih
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan
| | - Ping-Yen Liu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan. .,Department of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital Tainan, No. 1, University Road, Tainan, 701, Taiwan.
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15
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Kivelä K, Elo S, Kyngäs H, Kääriäinen M. The effects of health coaching on frequent attenders’ adherence to health regimens and lifestyle factors: a quasi‐experimental study. Scand J Caring Sci 2020; 35:1075-1085. [DOI: 10.1111/scs.12920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kirsi Kivelä
- Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland
| | - Satu Elo
- Lapland University of Applied Sciences Kemi Finland
| | - Helvi Kyngäs
- Medical Research Center Oulu University Hospital University of Oulu Oulu Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management Oulu University Hospital University of Oulu Oulu Finland
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16
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Bårdsgjerde EK, Landstad BJ, Hole T, Nylenna M, Gjeilo KH, Kvangarsnes M. Nurses' perceptions of patient participation in the myocardial infarction pathway. Nurs Open 2020; 7:1606-1615. [PMID: 32802382 PMCID: PMC7424437 DOI: 10.1002/nop2.544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/20/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023] Open
Abstract
Aim To explore nurses' perceptions of patient participation in different phases of the myocardial infarction pathway. Design Qualitative design with a hermeneutical approach. Methods Five focus groups were conducted at two hospitals, one with and one without percutaneous coronary intervention facilities, between February-November 2018. Participants were recruited through purposive sampling. Twenty-two nurses experienced in cardiac care participated. The analysis had a hermeneutical approach. Results The findings revealed nurses' perceptions of patient participation in different phases of the myocardial infarction pathway. Four themes were identified: (a) variation between paternalism and autonomy in the acute phase; (b) individualization of dialogue and patient participation during treatment; (c) lack of coherence in the pathway hinders patient participation at discharge; and (d) cardiac rehabilitation promotes patients' autonomous decisions in lifestyle changes.
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Affiliation(s)
- Elise Kvalsund Bårdsgjerde
- Department of Health Sciences in ÅlesundFaculty of Medicine and Health SciencesNTNU – Norwegian University of Science and TechnologyÅlesundNorway
| | - Bodil J. Landstad
- Department of Health SciencesMid Sweden UniversitySundsvall and ÖstersundSweden
- Levanger HospitalNord‐Trøndelag Hospital TrustNord‐TrøndelagNorway
| | - Torstein Hole
- Clinic of Medicine and RehabilitationMøre og Romsdal Hospital TrustÅlesundNorway
- Department of Circulation and Medical ImagingFaculty of Medicine and Health SciencesNTNU – Norwegian University of Science and TechnologyTrondheimNorway
| | - Magne Nylenna
- Institute of Health and SocietyUniversity of OsloOsloNorway
- Norwegian Institute of Public HealthOsloNorway
| | - Kari Hanne Gjeilo
- Department of Cardiothoracic SurgerySt. Olavs HospitalTrondheim University HospitalTrondheimNorway
- Department of CardiologySt. Olavs HospitalTrondheim University HospitalTrondheimNorway
- Department of Public Health and NursingFaculty of Medicine and Health SciencesNTNU – Norwegian University of Science and TechnologyTrondheimNorway
| | - Marit Kvangarsnes
- Department of Health Sciences in ÅlesundFaculty of Medicine and Health SciencesNTNU – Norwegian University of Science and TechnologyÅlesundNorway
- Møre og Romsdal Hospital TrustÅlesundNorway
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17
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Li S, Tang Y. Structural Model for Estimating the Influence of Healthy Lifestyle on Episodic Memory in Adults with Subjective Memory Complaints. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8349819. [PMID: 32219143 PMCID: PMC7085832 DOI: 10.1155/2020/8349819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/28/2020] [Indexed: 12/16/2022]
Abstract
The aim of this study is to examine the relationships between a healthy lifestyle and episodic memory among adults with subjective memory complaints (SMCs). We proposed a structure equation model to study the association between a healthy lifestyle and episodic memory with an investigation covering 309 participants over 50 years old with SMCs. The model showed a good fit after being adjusted (p = 0.054, goodness of fit index = 0.981, adjusted goodness of fit index = 0.956, comparative fit index = 0.981, and root mean square error of approximation = 0.049): a healthy lifestyle has a direct positive effect on episodic memory among adults with SMCs (β = 0.60). The research model provides possible guidelines for medical staff to prevent the cognitive function decline in the risk population of Alzheimer's disease.
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Affiliation(s)
- Shijie Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yongchuan Tang
- School of Big Data and Software Engineering, Chongqing University, Chongqing 401331, China
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18
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New Educational Model to Promote Breast Cancer-Preventive Behaviors (ASSISTS): Development and First Evaluation. Cancer Nurs 2020; 42:E44-E51. [PMID: 29334521 DOI: 10.1097/ncc.0000000000000560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The prevalence of breast cancer in Iran has increased. An effective approach to decrease the burden of breast cancer is prevention. OBJECTIVE The aim of this study was to develop and evaluate an educational model, called the ASSISTS, for promoting breast cancer-preventive behaviors in women. METHODS A multiphase method was used to develop the model designed to promote breast cancer prevention behaviors. A conceptual model was generated based on a secondary analysis of qualitative data. Then, a structural equation model technique was used to test the relationships among the model constructs. RESULTS The analysis revealed that 7 constructs could be extracted, namely, perceived social support, attitude, motivation, self-efficacy, information seeking, stress management, and self-care. Based on these constructs, a conceptual model was built and tested using structural equation modeling. The model fit was good, and the model confirmed significant relationships among the 7 constructs of breast cancer prevention. CONCLUSION Findings revealed that self-care behavior and stress management are influenced directly by attitude, motivation, self-efficacy, information seeking, and social support. In addition, women seek more information when they are motivated, have more self-efficacy, have a more positive attitude toward breast cancer prevention, and experience more social support. IMPLICATION FOR PRACTICE Cancer nurses can be at the forefront of breast cancer prevention. Because they can play a pivotal role in providing information, they can reduce women's stress and increase their self-care behavior. In addition, their social support can positively influence Iranian women's attitude, motivation, and self-care behavior. Furthermore, implementing educational programs based on this model might encourage women to practice preventive behaviors.
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19
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Kähkönen O, Kankkunen P, Saaranen T, Miettinen H, Kyngäs H. Hypothetical model of perceived adherence to treatment among patients with coronary heart disease after a percutaneous coronary intervention. Nurs Open 2020; 7:246-255. [PMID: 31871708 PMCID: PMC6917951 DOI: 10.1002/nop2.381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/19/2022] Open
Abstract
Aim To test the hypothetical model of adherence to treatment among patients with coronary disease after percutaneous coronary intervention. Design A descriptive, explanatory, cross-sectional survey. Methods The study was conducted in 2013 with 416 patients in five hospitals in Finland. The adherence of patients with chronic disease instrument, the adherence visual analogue scale, the social support for people with coronary heart disease instrument, the EuroQoL five-dimensional scale and EuroQoL visual analogue scale were used. The data were analysed using descriptive statistic. The hypothetical model was tested using structural equation modelling. Results The hypothetical model explained 30% of perceived adherence to treatment. Structural equation modelling confirmed that motivation, support from physicians and next of kin had direct associations with adherence. Indirectly, informational support, results of care, perceived health, anxiety and depression were associated with adherence. The background variables associated with adherence were gender, relationship, physical activity, consumption of vegetables and consumption of alcohol.
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Affiliation(s)
- Outi Kähkönen
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
| | - Päivi Kankkunen
- Department of Nursing ScienceUniversity of Eastern FinlandKuopioFinland
| | - Terhi Saaranen
- Department of Nursing ScienceUniversity of Eastern FinlandKuopioFinland
| | | | - Helvi Kyngäs
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
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20
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Kähkönen O, Kyngäs H, Saaranen T, Kankkunen P, Miettinen H, Oikarinen A. Support from next of kin and nurses are significant predictors of long-term adherence to treatment in post-PCI patients. Eur J Cardiovasc Nurs 2019; 19:339-350. [PMID: 31744316 DOI: 10.1177/1474515119887851] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adherence to treatment is a crucial factor in preventing the progression of coronary heart disease. More evidence of the predictors of long-term adherence is needed. AIMS The purpose of this study was to identify the predictive factors of adherence to treatment six years after percutaneous coronary intervention. METHODS Baseline data (n=416) was collected in 2013 and follow-up data in 2019 (n=169) at two university hospitals and three central hospitals in Finland. The self-reported Adherence of Patients with Chronic Disease Instrument was used. Data were analysed using descriptive statistics and binary logistic regression analysis. RESULTS The respondents reported higher adherence to a healthy lifestyle six years after percutaneous coronary intervention in comparison to four months post-percutaneous coronary intervention; adherence was seen in their healthy behaviour, such as decreased smoking and reduced alcohol consumption. Participating in regular follow-up control predicted adherence. Support from next of kin predicted physical activity and normal cholesterol levels; this outcome was associated with close relationships, which also predicted willingness to be responsible for treatment adherence. Women perceived lower support from nurses and physicians, and they had more fear of complications. Fear was more common among respondents with a longer duration of coronary heart disease. Physical activity and male gender were associated with perceived results of care. CONCLUSION Support from next of kin, nurses and physicians, results of care, responsibility, fear of complication and continuum of care predicted adherence to treatment in long term. These issues should be emphasised among women, patients without a close relationship, physically inactive and those with a longer duration of coronary heart disease.
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Affiliation(s)
- Outi Kähkönen
- Research Unit of Nursing Science and Health Management, University of Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Finland
| | - Terhi Saaranen
- Department of Nursing Science, University of Eastern Finland, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, University of Eastern Finland, Finland
| | | | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Finland
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21
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Jiang W, Feng M, Gao C, Li J, Gao R, Wang W. Effect of a nurse-led individualized self-management program for Chinese patients with acute myocardial infarction undergoing percutaneous coronary intervention. Eur J Cardiovasc Nurs 2019; 19:320-329. [PMID: 31702385 DOI: 10.1177/1474515119889197] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The study of the development and evaluation of self-management intervention among patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) is lacking, especially in China. AIM To examine the effects of a nurse-led individualized self-management program (NISMP) on health behaviors, control of cardiac risk factors, and health-related quality of life (HRQoL) among patients with AMI undergoing PCI. METHODS The quasi-experimental design included a convenience sample of 112 participants recruited from a tertiary hospital in China. The participants were assigned to the control group (n = 56) or the intervention group (n = 56). The intervention group underwent the NISMP, which includes six group-based education sessions, a face-to-face individual consultation, and 12-month telephone follow-ups. Data were collected at baseline and at the end of the 12-month program using the Health Promotion Lifestyle Profile, the Risk Factors Assessment Form, and the Short Form 36-item Health Survey. RESULTS The baseline sociodemographic and clinical characteristics of the two groups were comparable (p > 0.05). After the 12-month intervention, the health behaviors and HRQoL of the participants in the intervention group had significantly improved (p < 0.05 for both) compared to those of the control group. Compared to the control group, the participants in the intervention group also reported significantly better control of cardiac risk factors including smoking (χ2 = 4.709, p = 0.030), low-density lipoprotein (χ2 = 4.160, p = 0.041), body mass index (χ2 = 3.886, p = 0.049) and exercise (χ2 = 10.096, p = 0.001). CONCLUSION The NISMP demonstrated positive effects on health behaviors, control of cardiac risk factors, and HRQoL among Chinese patients with AMI undergoing PCI.
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Affiliation(s)
- Wenhui Jiang
- Xi'an Jiaotong University Health Science Center, China
| | - Mei Feng
- Xi'an Jiaotong University Health Science Center, China.,West China Hospital, Sichuan University, China
| | - Chunyan Gao
- Cardiology Department, First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Juanli Li
- Cardiology Department, First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Rui Gao
- Xi'an Jiaotong University Health Science Center, China
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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22
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Adherence to Treatment of Female Patients With Coronary Heart Disease After a Percutaneous Coronary Intervention. J Cardiovasc Nurs 2019; 34:410-417. [PMID: 31365439 DOI: 10.1097/jcn.0000000000000592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherence to treatment is essential to prevent the progression of coronary heart disease (CHD), which is the most common cause of death among women. Coronary heart disease in women has special characteristics: the conventional risk factors are more harmful to women than men, accumulation of risk factors is common, and women have nontraditional risk factors such as gestational diabetes and preeclampsia. In addition, worse outcomes, higher incidence of death, and complications after percutaneous coronary intervention have been reported more often among females than among male patients. OBJECTIVE The aim of this study was to test a model of adherence to treatment among female patients with CHD after a percutaneous coronary intervention. METHODS A cross-sectional, descriptive, and explanatory survey was conducted in 2013 with 416 patients with CHD, of which the 102 female patients were included in this substudy. Self-reported instruments were used to assess female patient adherence to treatment. Data were analyzed using descriptive statistics and a structural equation model. RESULTS Motivation was the strongest predictor for female patients' perceived adherence to treatment. Informational support, physician support, perceived health, and physical activity were indirectly, but significantly, associated with perceived adherence to treatment via motivation. Furthermore, physical activity was positively associated with perceived health, whereas anxiety and depression were negatively associated with it. CONCLUSIONS Secondary prevention programs and patient education have to take into account individual or unique differences. It is important to pay attention to issues that are known to contribute to motivation rather than to reply on education alone to improve adherence.
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23
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Oliveira D, Aubeeluck A, Stupple E, Kim S, Orrell M. Factor and reliability analysis of a brief scale to measure motivation to change lifestyle for dementia risk reduction in the UK: the MOCHAD-10. Health Qual Life Outcomes 2019; 17:75. [PMID: 31046782 PMCID: PMC6498554 DOI: 10.1186/s12955-019-1143-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/11/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Modifying lifestyle risk factors for dementia is a public health priority. Motivation for change is integral to the modification of health-related risk behaviours. This study investigates the psychometric properties of the previously validated tool entitled 'Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction Scale' (MCLHB-DRR) for use in the UK. METHODS A sample of 3,948 individuals aged 50 and over completed the 27-item MCLHB-DRR online. The psychometric properties of the scale were explored via Exploratory Principal Axis Factoring (PAF) with Oblimin rotation. Confirmatory Factor Analysis (CFA) was used to confirm the factor structure using chi-square (χ2), the goodness-of-fit index (GFI), the comparative fit index (CFI), the root mean square error of approximation (RMSEA) and Root Mean Square Residual (RMR) as fit indices to evaluate the model fit. Internal consistency (Cronbach α) was measured for the final scale version. RESULTS Exploratory Factor Analysis (EFA) resulted in a parsimonious 10-item, two-factor structure (5 items each, factor loadings > 0.3) that explained 52.83% of total variance. Based on the Pattern Matrix, Factor 1 was labelled "Positive Cues to Action" and Factor 2 was labelled "Negative Cues to Action". After addressing some errors in covariances, CFA showed a good fit where all fit indices were larger than 0.90 (GFI = 0.968, CFI = 0.938) and smaller than 0.08 (RMSEA = 0.072, RMR = 0.041). The standardized coefficients of Factor 1 and Factor 2 ranged from 0.30 to 0.73 and were all statistically significant (p < 0.001). The final scale showed moderate to high reliability scores (Factor 1 α = 0.809; Factor 2 α = 0.701; Overall α = 0.785). CONCLUSIONS The new MOCHAD-10 (Motivation to Change Behaviour for Dementia Risk Reduction Scale) is a short, reliable and robust two-factor, 10-item clinical tool for use in preventative health care and research to evaluate motivation to change lifestyle for dementia risk reduction.
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Affiliation(s)
- Deborah Oliveira
- Department of Psychiatry, School of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Major Maragliano, 241 - Predio Academico - Vila Mariana Mariana, São Paulo - CEP: 04017-030, São Paulo, SP Brazil
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Aimee Aubeeluck
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Ed Stupple
- Human Sciences Research Centre, College of Life and Natural Sciences, University of Derby, Derby, UK
| | - Sarang Kim
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University, Canberra, Australia
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Martin Orrell
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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24
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Letzen JE, Seminowicz DA, Campbell CM, Finan PH. Exploring the potential role of mesocorticolimbic circuitry in motivation for and adherence to chronic pain self-management interventions. Neurosci Biobehav Rev 2019; 98:10-17. [PMID: 30543904 PMCID: PMC6401294 DOI: 10.1016/j.neubiorev.2018.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 12/28/2022]
Abstract
Adherence to pain self-management strategies is associated with favorable psychobehavioral outcomes among individuals with chronic pain. Substantive adherence to treatments teaching these adaptive skills often proves challenging, resulting in poor individual and societal outcomes. Evidence demonstrates motivation for behavior change as a key predictor of treatment adherence. Despite behavioral techniques that target motivation, however, nonadherence persists as a barrier to positive clinical outcomes in chronic pain. Understanding the neurobiological mechanisms underlying treatment motivation might highlight novel avenues for augmentative therapies. The purpose of this review is to present theory and evidence that the mesocorticolimbic system (i.e., brain circuitry associated with reward processing and motivation) contributes to treatment motivation among chronic pain patients, ultimately influencing adherence. We review evidence for motivation as a key adherence determinant, detail neuroimaging findings relating mesocorticolimbic circuitry and motivation, and discuss data supporting mesocorticolimbic dysfunction among chronic pain patients. We propose a neurobehavioral model for adherence to pain self-management interventions, listing testable hypotheses. Finally, we discuss potential research and intervention implications from the proposed model.
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Affiliation(s)
- Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 5510 Nathan Shock Drive, Suite 101, Baltimore, MD, USA.
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, 650 W. Baltimore St., Baltimore, MD, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 5510 Nathan Shock Drive, Suite 101, Baltimore, MD, USA
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 5510 Nathan Shock Drive, Suite 101, Baltimore, MD, USA
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Bårdsgjerde EK, Kvangarsnes M, Landstad B, Nylenna M, Hole T. Patients' narratives of their patient participation in the myocardial infarction pathway. J Adv Nurs 2018; 75:1063-1073. [PMID: 30549312 DOI: 10.1111/jan.13931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 10/18/2018] [Accepted: 11/13/2018] [Indexed: 11/29/2022]
Abstract
AIM To explore how patients in areas without local percutaneous coronary intervention (PCI) facilities experience patient participation in different phases of the myocardial infarction pathway. BACKGROUND Acute treatment of myocardial infarction often involves PCI. In Norway, this treatment is centralized at certain hospitals; thus, patients often require long-distance transportation and experience frequent hospital transfers. Short hospital stays, transfers between hospitals and the patient's emotional state pose challenges to promoting patient participation. DESIGN A qualitative design with a narrative approach. METHODS Participants were recruited through purposive sampling. Eight men and two women were interviewed in 2016. FINDINGS Four themes related to the patients' experiences at the beginning, middle and end of the pathway were identified: (a) Lack of verbal communication in the acute phase; (b) trust in healthcare professionals and treatment; (c) lack of participation and coordination at discharge; and (d) shared decision-making in rehabilitation. The findings showed how the patients moved from a low level of patient participation in the acute phase to a high level of patient participation in the rehabilitation phase. CONCLUSION This is the first study to explore patient participation in different phases of the myocardial infarction pathway. We argue that individual plans for information and patient participation are important to improve patient involvement in an earlier stage of the pathway. Further research from a healthcare professional perspective can be valuable to understand this topic. IMPACT This study gives new insight that can be valuable for healthcare professionals in implementing patient participation throughout the pathway.
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Affiliation(s)
- Elise Kvalsund Bårdsgjerde
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Marit Kvangarsnes
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway.,Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Bodil Landstad
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Magne Nylenna
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Torstein Hole
- Clinic of Medicine and Rehabilitation, Møre og Romsdal Hospital Trust, Ålesund, Norway.,Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Kähkönen O, Saaranen T, Kankkunen P, Lamidi ML, Kyngäs H, Miettinen H. Predictors of adherence to treatment by patients with coronary heart disease after percutaneous coronary intervention. J Clin Nurs 2018; 27:989-1003. [PMID: 29098747 DOI: 10.1111/jocn.14153] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To identify the predictors of adherence in patients with coronary heart disease after a percutaneous coronary intervention. BACKGROUND Adherence is a key factor in preventing the progression of coronary heart disease. DESIGN An analytical multihospital survey study. METHODS A survey of 416 postpercutaneous coronary intervention patients was conducted in 2013, using the Adherence of People with Chronic Disease Instrument. The instrument consists of 37 items measuring adherence and 18 items comprising sociodemographic, health behavioural and disease-specific factors. Adherence consisted of two mean sum variables: adherence to medication and a healthy lifestyle. Based on earlier studies, nine mean sum variables known to explain adherence were responsibility, cooperation, support from next of kin, sense of normality, motivation, results of care, support from nurses and physicians, and fear of complications. Frequencies and percentages were used to describe the data, cross-tabulation to find statistically significant background variables and multivariate logistic regression to confirm standardised predictors of adherence. RESULTS Patients reported good adherence. However, there was inconsistency between adherence to a healthy lifestyle and health behaviours. Gender, close personal relationship, length of education, physical activity, vegetable and alcohol consumption, LDL cholesterol and duration of coronary heart disease without previous percutaneous coronary intervention were predictors of adherence. CONCLUSIONS The predictive factors known to explain adherence to treatment were male gender, close personal relationship, longer education, lower LDL cholesterol and longer duration of coronary heart disease without previous percutaneous coronary intervention. RELEVANCE TO CLINICAL PRACTICE Because a healthy lifestyle predicted factors known to explain adherence, these issues should be emphasised particularly for female patients not in a close personal relationship, with low education and a shorter coronary heart disease duration with previous coronary intervention.
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Affiliation(s)
- Outi Kähkönen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Terhi Saaranen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Marja-Leena Lamidi
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Helvi Kyngäs
- Department of Health Science, University of Oulu, Oulu, Finland
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27
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Xiao L, Wang P, Fang Q, Zhao Q. Health-promoting Lifestyle in Patients after Percutaneous Coronary Intervention. Korean Circ J 2018; 48:507-515. [PMID: 29856145 PMCID: PMC5986750 DOI: 10.4070/kcj.2017.0312] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/25/2018] [Accepted: 02/22/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to determine the status of health-promoting behaviors in patients after percutaneous coronary intervention (PCI) and explore what factors affect healthy lifestyle behaviors. METHODS A total of 120 patients with coronary artery disease after PCI was included in this study. The Health Promoting Lifestyle Profile (HPLP) II was used to assess health-promoting lifestyle behavior. Data analysis was performed by t-test, analysis of variance, and multiple linear stepwise regression analyses. RESULTS The average age of the participants was 60.10±9.84 (range, 37-81) years old. Among the participants, 86.7% were men and 13.3% were women. In all, 24.2% of the patients had an excellent level of health-promoting lifestyle and 74.2% had a moderate level of health-promoting lifestyle. The spiritual growth scores were the highest, while stress management and physical activity scores were the lowest. The level of health-promoting lifestyle was higher for people with higher income and a diagnosis of stable angina. CONCLUSIONS Healthcare providers should focus on promoting physical exercise and stress management for patients after PCI. It is also necessary to keep an eye out for patients with low income and severe illness to encourage a health-promoting lifestyle in these subsets of patients.
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Affiliation(s)
- Ling Xiao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Pan Wang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Fang
- Department of Cardiovascular Internal Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Oikarinen A, Engblom J, Kyngäs H, Kääriäinen M. A study of the relationship between the quality of lifestyle counselling and later adherence to the lifestyle changes based on patients with stroke and TIA. Clin Rehabil 2017; 32:557-567. [DOI: 10.1177/0269215517733794] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Janne Engblom
- Turku School of Economics, University of Turku, Turku, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
- Northern Ostrobothnia Hospital District, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
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29
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Langdridge D. Recovery From Heart Attack, Biomedicalization, and the Production of a Contingent Health Citizenship. QUALITATIVE HEALTH RESEARCH 2017; 27:1391-1401. [PMID: 27634296 DOI: 10.1177/1049732316668818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this article, I explore the experience of recovery from a heart attack through an analytic autoethnography. I discuss the tensions inherent in biomedical subjectivities of health and ill-health during cardiac recovery through three key themes: (a) the transfer of responsibility and becoming a subject "at risk," (b) technologies of biomedicine and the disciplining of subjectivities, and (c) the transformation of a body toward a new pharmaceuticalized bodily normal. Through an analysis driven by the biomedicalization thesis of Clarke, alongside work on biopower and the governmentality of health by Foucault, Rose, and Rabinow, I seek to provide new insights into the process of cardiac recovery and the relationship between individual experience and broader socio-political processes. Key to this analysis is a focus on the contingent subjectivities brought into being through biomedicalization that constitute a new form of health citizenship that is otherwise not accounted for in narratives of recovery.
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30
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Mason Barber LA, Kimble LP, Sudia T, Taylor LF. Self-determination theory-based perceptions of community dwelling women with cardiovascular disease and prediction of perceived physical activity limitations. Appl Nurs Res 2017; 35:48-52. [PMID: 28532726 DOI: 10.1016/j.apnr.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/10/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Linda A Mason Barber
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30118, USA; University of West Georgia, Tanner Health System School of Nursing, 1601 Maple Street, Carrollton, GA 30118, USA.
| | - Laura P Kimble
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30118, USA.
| | - Tanya Sudia
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30118, USA; Baylor University, Louise Herrington School of Nursing, 3700 Worth Street, Dallas, TX 75246, USA.
| | - Leslie F Taylor
- Mercer University, College of Health Professions, 3001 Mercer University Drive, Atlanta, GA 30118, USA.
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Kangasniemi M, Hirjaba M, Kohonen K, Vellone E, Moilanen T, Pietilä AM. The cardiac patients' perceptions of their responsibilities in adherence to care: a qualitative interview study. J Clin Nurs 2017; 26:2583-2592. [PMID: 27862488 DOI: 10.1111/jocn.13642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe cardiac patients' perceptions of their responsibilities in adherence to care. BACKGROUND The responsibilities of cardiac patients' adherence to care is a topical issue because of the increasing prevalence of noncommunicable diseases in Western countries, including cardiovascular disease (CVD). Responsibilities for cardiac patients' care have been studied, but little is described about patients' perspectives in this study. DESIGN A qualitative, hermeneutic inquiry. METHODS We used face-to-face individual semistructured interviews with 21 cardiac patients (76% male) aged 58-86 in an urban area of Finland in winter 2013. The data were analysed hermeneutically with inductive content analysis. RESULTS Based on our results, patients with cardiac disease understood that autonomy provided a basis for their responsibility in adherence to care. It included being able to make independent decisions, in collaboration with health professionals, or even to entrust that responsibility to healthcare professionals. Responsibilities were understood to be an expression of adherence, perceived to benefit the patient and included the duty to adopt a healthy lifestyle and care for their own medical condition. The main factors that influenced patients' responsibilities around adherence to care were their individual resources and motivation, relationships with healthcare professionals and the resources of the healthcare system. CONCLUSION Autonomy is an inherent part of cardiac patients' adherence to care, but there has been little focus on their responsibilities in the literature. More attention needs to be paid to the healthcare providers' abilities to support patients' duties and responsibilities in clinical practice and to future research.
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Affiliation(s)
- Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Marina Hirjaba
- Department of Nursing, The School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Katja Kohonen
- Cardiac Surgical Intensive Care Unit M2A, HUS, Meilahti Tower Hospital, Helsinki, Finland
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Tanja Moilanen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Social and Health Care Services, Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Patwardhan AR, Lloyd LW. Decline in the Use of Medicalized Yoga Between 2002 and 2012 While the Overall Yoga Use Increased in the United States: A Conundrum. J Evid Based Complementary Altern Med 2017; 22:567-572. [PMID: 29228812 PMCID: PMC5871265 DOI: 10.1177/2156587216689183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We analyzed the National Health Institute Survey Alternative Medicine supplement yoga
data for 2002, 2007, and 2012 to answer the following questions: (1) Do the claims about
increase in the use of yoga hold true at the level of specific health problems? (2) Do
trends support a proposition that yoga is believed to be helpful in amelioration of
disease conditions? (3) Do the prescribing patterns of health care providers correspond
with the increasing popularity of yoga? Data were analyzed using SAS software, version
9.4. Response percentages were compared using chi-square test after adjusting for age.
Between 2002 and 2012, use of yoga increased but adherence failed to increase, and use for
specific health problems and for back pain declined; use of health care providers’
referral–driven yoga declined between 2007 and 2012. All results were statistically
significant. Our results suggest that the use of medicalized yoga declined between 2002
and 2012.
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