Perceptions about eating experiences of low-literate older adults with heart disease: a qualitative study

Scoping review of the preferences of older adults for patient education materials

OBJECTIVE

To provide an overview of studies that describe the preferred mode and format of delivery of patient education materials to older adults.

METHODS

A scoping review was used to identify relevant literature published between January 2010 and June 2021, with specific attention given to studies conducted in high income countries with similar health systems.

RESULTS

A total of 3245 titles were identified, and 20 met the inclusion criteria and were included in this scoping review. Older adults preferred written information that could be accessed via health professionals or downloaded online. Other key features were identified including logical layout, signposted information, larger text size, labelled visual aids, and use of images appropriate and relevant to the target group were preferred. Audio visual resources were also considered valuable when well designed. Formats for patient education such as apps, group classes and online courses were less popular with older adults.

CONCLUSIONS

Patient education materials for older adults should be carefully designed, with attention to layout and content. Older adults indicated a preference for hard copy handouts or in a format that can be downloaded.

PRACTICE IMPLICATIONS

Regular engagement with older consumers about their preferences is important as technology for delivery of patient education materials evolve. Key features for specific attention during the design process include a logical layout (tested with consumers), signposted information, text size, labelled visual aids and appropriate images. The perspectives of other key groups of older adults such as those from minority populations or other disadvantaged groups are largely unexplored.

Physical resilience as a moderator of the relationship between frailty and disability in older adults with osteoarthritis

AIMS

Frailty is a leading cause of deteriorating physical function of older adults with osteoarthritis. This study examined a model of frailty with the goals of (1) exploring the direct effect of osteoarthritic symptoms on disability and the mediating effect of frailty on disability and (2) determining whether both effects are moderated by physical resilience.

DESIGN

A cross-sectional descriptive study.

METHODS

Data collection was conducted among patients 65-92 years of age (N = 235) who visited primary medical centres for the management of chronic arthritic pain between July and December 2019. Participants completed a questionnaire measuring osteoarthritic symptoms, frailty, physical resilience, and disability. SPSS 25.0 was used to analyse the conditional process model. This study was reported following the STROBE guidelines.

RESULTS

Frailty was shown to be a mediator between osteoarthritic symptoms and disability. Furthermore, physical resilience played a role as a moderator in both the direct and indirect pathways of this mediating relationship.

CONCLUSION

The findings emphasize the detrimental effects of osteoarthritic symptoms on disability through frailty, and the moderated mediation results suggest that these effects were conditional on physical resilience, which is a modifiable internal resource of individuals. When planning nursing interventions for older adults with osteoarthritis, nurses need to consider physical resilience as a moderator to prevent frailty and disability.

Expectations of an Online-Self-Management Program for Rheumatoid Arthritis

This qualitative descriptive study aimed to explore expectations of patients and healthcare experts for an online self-management program for rheumatoid arthritis. Participants were recruited from rheumatology clinics, medical centers, and universities in Taiwan. Individual face-to-face, semi-structured interviews were conducted with patients (n = 16) and healthcare experts (n = 7). Content analysis of the interview data resulted in five subthemes for expectations of an online self-management program: information about how the disease trajectory would impact future health status, availability of opportunities for self-monitoring, opportunities to interact with fellow patients and healthcare providers, simplicity and ease-of-use of the program, and methods to facilitate patient-motivation. These subthemes formulated two overarching themes: content and format. An online self-management program for patients with rheumatoid arthritis should provide evidence-based information about disease variables and behaviors aligned with the specific needs of the individual and adopt strategies that encourage and increase motivation and confidence.

Barreras estructurales en la atención nutricia a personas con enfermedad renal crónica en México

Resumen Este trabajo se propone describir las barreras estructurales que el personal de salud identifica para brindar atención nutricia a personas con enfermedad renal crónica (ERC). Se llevó a cabo un estudio cualitativo en la ciudad de San Luis Potosí, México. Se entrevistó a 21 profesionales de salud (nutriólogos, enfermeras y nefrólogos) que trabajan en unidades de hemodiálisis. Se realizó un análisis crítico del discurso. Los participantes del estudio señalan diversas barreras estructurales que obstaculizan la inclusión de la terapia nutricional en el tratamiento de la ERC: la falta de cobertura universal de salud en México, lo que genera que no todas las personas con ERC accedan a un tratamiento nutricio; la infraestructura inadecuada en las unidades de hemodiálisis, donde los nutriólogos carecen de un espacio físico para dar consulta o asesoría; la ausencia de normativa y protocolos para la atención nutricia y; la falta de recursos humanos en nutrición especializados en ERC. Como conclusión, se destaca que la atención nutricia para los enfermos renales en México es incipiente y poco sistematizada. Se requiere instituir una atención universal, así como modificar la normativa nacional para incluir al personal de nutrición especializado en el tratamiento interdisciplinar en beneficio de quienes padecen dicha enfermedad.

Who did it better? Gender differences in effects of a dietary self-management intervention for older community-dwelling adults

This study aimed to determine whether there were gender differences in the effectiveness of a 12-week dietary self-management program for older community-dwelling adults in northeast Taiwan. This was a secondary analysis of a previous study; participants (N = 58) were purposively sampled from two public health centers. Non-parametric models examined differences in outcome measures because of the small sample size; 20 males and 38 females completed the study. The results showed males scored significantly better than females for nutritional status, internal health locus of control, and responsibility for food preparation, which may have implications for older female adults' nutritional health.

Identification of risk factors for enteral feeding intolerance screening in critically ill patients

Objectives:

To identify risk factors for enteral feeding intolerance screening in critically ill patients, thereby, provide some reference for healthcare staff to assess the risk of feeding intolerance, and lay the foundation for future scale development.

Methods:

This study used a mixed methodology, including a literature review, semi-structured interviews, the Delphi technique, and the analytic hierarchy process. We used the literature review and semi-structured interviews (n=22) to draft a preliminarily item pool for feeding intolerance, Delphi technique (n=30) to screen and determine the items, and the analytic hierarchy process to calculate the weight of each item. The study was conducted between June 2014 and September 2015 in Daping Hospital, Third Military Medical University, Chongqing, China.

Results:

Twenty-three risk factors were selected for the scale, including 5 dimensions. We assigned a weight to each item according to their impact on the feeding intolerance, with a higher score indicating a greater impact. The weight of each dimension was decreasing as follows: patient conditions, weight score equals 42; general conditions, weight score equals 23; gastrointestinal functions, weight score equals 15; biochemical indexes, weight score equals 14; and treatment measures, weight score equals 6.

Conclusion:

Developed list of risk factors based on literature review, survey among health care professionals and expert consensus should provide a basis for future studies assessing the risk of feeding intolerance in critically ill patients.

Perceptions and experiences of nutritional care following the overwhelming experience of lower extremity amputation: A qualitative study

INTRODUCTION

Good nutritional care of people following major lower extremity amputation is essential as poor nutritional status can lead to delayed wound healing. Working with patients to identify their perspectives on food, views on nutritional care and the need for dietary counselling enables the development of optimised nutritional care.

AIMS AND OBJECTIVES

To explore hospital patients' perspectives on food, dietary counselling and their experiences of nutritional care following lower extremity amputation.

DESIGN

A qualitative, explorative study design was employed.

METHOD

An inductive content analysis of semi-structured interviews with a purposive sample of 17 people over 50 years of age, who had recently undergone major lower extremity amputation, was undertaken. The study was reported according to the consolidated criteria for reporting qualitative research guideline.

FINDINGS

Three themes emerged: responsible for own dietary intake, diet based on preferences and experiences with dietary counselling and feeling overwhelmed. The participants expressed motivation to ensure their nutritional needs were met but described feeling emotionally overwhelmed by the experience of amputation. They appeared not to expect nursing staff to focus on nutritional issues as they expressed belief that they themselves were solely responsible for their dietary intake. They described being motivated to receive nutritional counselling but indicated advice should be compatible with their lifestyle and eating habits.

CONCLUSION

Lower extremity amputation can be an overwhelming experience which affects nutritional intake. People appear to consider themselves responsible for their nutritional care and describe not experiencing or expecting nursing staff to engage in this aspect of care. Dietary counselling by nurses who respect and incorporate patient preferences and experiences following amputation has the potential to enhance nutritional care.

RELEVANCE TO CLINICAL PRACTICE

This study illustrates that nurses caring for people who undergo lower extremity amputation need to recognise that nutritional care is an essential component of nursing and should focus on working in partnership with the patient.

Development and evaluation of a dietary self-management programme for older adults with low literacy and heart disease: pilot study of feasibility and acceptability

AIMS

To develop a dietary self-management programme for salt-, fluid-, fat- and cholesterol-intake behaviours for older adults with low literacy and heart disease and evaluate the feasibility and acceptability of the programme.

BACKGROUND

Eating behaviours such as fluid, salt, fat and cholesterol intake are an important factor related to heart disease outcomes. People with low literacy have difficulty following recommended health behaviours, but limited research has investigated intervention programmes for this population.

DESIGN

Programme development and pilot testing its feasibility and acceptability. Recommendations were also collected from participants and the research assistant for future large-scale interventions.

METHODS

The study had two phases. Phase I consisted of programme development based on previous qualitative findings, a systematic review of the literature, clinical practice experience and expert opinion. In Phase II, we pilot tested the programme from January - June 2014 in a convenience sample of 10 older adults with low literacy, heart disease and recruited from a medical centre in northern Taiwan.

RESULTS

Pilot testing showed that our programme was feasible and acceptable to older adults with low literacy and heart disease. Moreover, the final version of the programme was revised based on participants' and the research assistant's recommendations.

CONCLUSION

Our study results suggest that with guidance and assistance, older adults with low literacy and heart disease can be motivated to take action for their health and are empowered by learning how to self-manage their heart-healthy eating behaviours.