1
|
Yap XY, Tam WSW, Tan YQ, Dong Y, Loh LX, Tan PC, Gan P, Zhang D, Wu XV. Path analysis of self-care amongst community-dwelling pre-ageing and older adults with chronic diseases: A salutogenic model. Geriatr Nurs 2024; 59:516-525. [PMID: 39146642 DOI: 10.1016/j.gerinurse.2024.07.034] [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: 02/20/2024] [Revised: 07/05/2024] [Accepted: 07/30/2024] [Indexed: 08/17/2024]
Abstract
With the trend towards ageing population globally, the salutogenic model can be integrated in interventions for pre-ageing and older adults to better support healthy ageing. However, there is limited research examining the salutogenic model's pathway amongst pre-ageing and older adults. Hence, this study aims to investigate pathways of the salutogenic model amongst pre-ageing and older adults with chronic diseases. Two hundred and eight pre-ageing and older adults were recruited from 11 Senior Activity Centres in Singapore. Data was collected using a self-reported questionnaire and analysed using path analyses. The indirect pathway from Subjective Cognitive Complaints to self-care abilities via sense of coherence and health practices were significant. Participants with higher sense of coherence may have increased capacities to execute more complex forms of self-care. Future interventions integrating the salutogenic model could enhance pre-ageing and older adults' self-care abilities to cope with chronic diseases and contribute to healthy ageing.
Collapse
Affiliation(s)
- Xin Yi Yap
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore Level 5, Centre for Translational Medicine, Block MD6, 14 Medical Drive, Singapore 117599
| | - Wai San Wilson Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore Level 5, Centre for Translational Medicine, Block MD6, 14 Medical Drive, Singapore 117599
| | - Yue Qian Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore Level 5, Centre for Translational Medicine, Block MD6, 14 Medical Drive, Singapore 117599
| | - Yanhong Dong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore Level 5, Centre for Translational Medicine, Block MD6, 14 Medical Drive, Singapore 117599
| | - Le Xuan Loh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore Level 5, Centre for Translational Medicine, Block MD6, 14 Medical Drive, Singapore 117599
| | - Poh Choo Tan
- Community Nursing Department, Changi General Hospital, 2 Simei Street 3, Singapore, 529889
| | - Peiying Gan
- Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886
| | - Di Zhang
- Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore Level 5, Centre for Translational Medicine, Block MD6, 14 Medical Drive, Singapore 117599; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore.
| |
Collapse
|
2
|
Maria MD, Saurini M, Erba I, Vellone E, Riegel B, Ausili D, Matarese M. Generic and disease-specific self-care instruments in older patients affected by multiple chronic conditions: A descriptive study. J Clin Nurs 2024. [PMID: 39101399 DOI: 10.1111/jocn.17397] [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: 12/22/2023] [Revised: 03/18/2024] [Accepted: 07/04/2024] [Indexed: 08/06/2024]
Abstract
AIMS To describe and compare generic and disease-specific self-care measures in patients with multiple chronic conditions (MCCs) in the three dimensions of self-care maintenance, monitoring, and management. DESIGN Multicentre cross-sectional study. METHODS Patients aged 65 and over with MCCs. We used Self-Care of Chronic Illness Inventory to measure generic self-care, Self-care of Diabetes Inventory to measure self-care in diabetes mellitus, Self-Care of Heart Failure (HF) Index to measure self-care in HF, and Self-Care of Chronic Obstructive Pulmonary Disease Inventory to measure self-care in chronic lung diseases. RESULTS We recruited 896 patients. Multimorbid patients with diabetes had lower scores on the self-care maintenance scale, and diabetic patients in insulin treatment on the generic management scale than on the disease-specific instrument. Multimorbid patients with HF or chronic lung diseases scored higher on generic self-care maintenance and monitoring scales than disease-specific ones. There was a partial consistency between the generic and disease-specific self-care maintenance and management. Inadequate behaviours were recorded in disease-specific self-care monitoring rather than generic ones. CONCLUSIONS Older patients affected by MCCs scored differently in the generic and disease-specific instruments, showing inadequate self-care in some of the three self-care dimensions. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The choice between generic and disease-specific instruments to use in clinical practice and research should be made considering the specific aims, settings, patients characteristics, and knowledge of the different performance of the instruments by users. IMPACT No study has described and compared generic and specific self-care measures in patients affected by MCCs. Knowing these differences can help nurses choose the most suitable measure for their aims, context, and patients and plan generic and disease-specific self-care educational interventions for those behaviours in which MCCs patients perform poorly. PATIENT CONTRIBUTION Patients were informed about the study, provided informed consent, and answered questionnaires through interviews.
Collapse
Affiliation(s)
- Maddalena De Maria
- Department of Life Health Sciences and Health Professions, Link Campus University, Rome, Italy
| | - Manuela Saurini
- Department of Biomedicine and Prevention, University of Rome tor Vergata, Rome, Italy
| | - Ilaria Erba
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome tor Vergata, Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Matarese
- Research Unit of Nursing Sciences, Department of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| |
Collapse
|
3
|
Erba I, De Maria M, Saurini M, Ausili D, Matarese M, Vellone E. Generic and disease-specific caregiver contribution to self-care in a population with multiple chronic conditions: A comparative study. J Clin Nurs 2024. [PMID: 38951119 DOI: 10.1111/jocn.17334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024]
Abstract
AIM Describe and compare generic and disease-specific caregiver contribution (CC) to self-care behaviours in the dimensions of self-care maintenance, self-care monitoring and self-care management in multiple chronic conditions (MCCs). DESIGN Multicentre cross-sectional study. METHODS We enrolled caregivers of patients with MCC, from April 2017 to November 2022, if they were (a) 18 years of age or older and (b) identified by the patient as the principal unpaid informal caregiver. The Caregiver Contribution to Self-Care of Chronic Illness Inventory, Caregiver Contribution to Self-Care of Heart Failure Index, Caregiver Contribution to Self-Care of COPD Inventory and Caregiver Contribution to Self-care of Diabetes Inventory were used to measure generic and disease-specific contribution to patient self-care. Descriptive statistics, Student's t-tests and Pearson's correlation coefficients were used. RESULTS We found adequate generic CC for self-care monitoring but inadequate CC in self-care maintenance and management. All CC to disease-specific self-care maintenance, monitoring and management scales' scores were inadequate, except for caregivers of diabetic patients in which we observed an adequate score in the CC to self-care maintenance and self-care management scales in those practice insulin therapy. CONCLUSION Caregivers experience difficulties in performing behaviours of contribution to their patients affected by chronic conditions. Caregivers of patients with MCCs contribute more to self-care in aspects related to provider prescriptions and less to lifestyle changes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Healthcare professionals have to know in which behaviours caregivers show gaps and reflect on the reasons for poor CC to self-care to develop interventions to enhance these behaviours. IMPACT This study underlines the importance of choosing the most appropriate instrument for measuring CC to self-care, considering the caregiver's characteristics. REPORTING METHOD We adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION Caregivers of patients affected by MCCs were enrolled.
Collapse
Affiliation(s)
- Ilaria Erba
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Maddalena De Maria
- Department of Life Health Sciences and Health Professions, Link Campus University, Rome, Italy
| | - Manuela Saurini
- Department of Biomedicine and Prevention, University of Rome tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Matarese
- Research Unit of Nursing Sciences, Campus Bio-Medico of Rome University, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome tor Vergata, Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
4
|
Estrada YVR, Esteban ANP, Aldana MSCD, Niño EYD, Contreras JSR, Galvis MDPC, Pinzón VA, Arenas SAG. Efficacy of a Hospital Discharge Transition Plan in the care competence of patients with chronic conditions and their family caregivers: a clinical trial. Rev Lat Am Enfermagem 2024; 32:e4104. [PMID: 38655933 DOI: 10.1590/1518-8345.6620.4104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 10/07/2023] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE to assess the efficacy of a Hospital Discharge Transition Plan in the care competence and in adherence to the therapy of dyads comprised by patients with non-communicable chronic diseases and their caregivers. METHOD a controlled and randomized clinical trial; the sample was comprised by 80 dyads of patients with chronic conditions and their caregivers, randomly allocated as follows: 40 to the control group and another 40 to the intervention group. The instruments to characterize the patient-caregiver dyad, the patients' and caregivers' care competence and the patients' adherence to the treatment scale were applied. The " CUIDEMOS educational intervention" was applied to the intervention group; in turn, the control group was provided usual care with the aid of a booklet, with phone follow-up via at month 1. RESULTS 52.5% of the patients and 81.3% of the caregivers were women. The patients' and caregivers' mean ages were 69.5±12.6 and 47.5±13.1 years old, respectively. The Hospital Discharge Transition Plan increased the scores in the "knowledge", "uniqueness", "instrumental", "enjoying", "anticipation" and "social relations" dimensions, as well as the global care competence of the patients and family caregivers; in addition to the following factors: medications, diet, stimulants control, weight control, stress management, and global adherence to the therapy by the patient. There were no statistically significant differences between the control and intervention groups. CONCLUSION the Hospital Discharge Transition Plan increased the patients' and family caregivers' care competence after the intervention, as well as the patients' adherence to the treatment. However, there were no differences between the control and intervention groups, possibly due to the similarity of the activities.
Collapse
Affiliation(s)
- Yuliana Valentina Rincón Estrada
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Astrid Nathalia Páez Esteban
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Maria Stella Campos de Aldana
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Erika Yurley Durán Niño
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Juan Sebastian Rincón Contreras
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Maria Del Pilar Castillo Galvis
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Valeria Arias Pinzón
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Sergio Andrés García Arenas
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| |
Collapse
|
5
|
Wang W, Wang X, Vellone E, Zhang Z. Effectiveness of a smartphone-enabled dyadic self-care programme (SDSCP) for stroke survivors and caregivers: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e073016. [PMID: 37666544 PMCID: PMC10481751 DOI: 10.1136/bmjopen-2023-073016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION The promotion of self-care has begun to serve as a central response strategy to the rising burden of stroke. In fact, stroke self-care can be recognised to be a dyad phenomenon having an effect on the health of stroke survivors and their caregivers. While studies have confirmed the effectiveness of smartphone-based interventions in improving self-care among stroke survivors, there remains a lack of evidence specifically regarding dyadic self-care interventions for both patients and caregivers. AIM The present single-blinded, two-arm, randomised controlled trial aims to verify the effectiveness of a smartphone-enabled dyadic self-care programme (SDSCP) for stroke survivors and their caregivers. METHODS AND ANALYSIS The estimated sample size is 152 stroke survivor-caregiver dyads. The participants will be randomly classified (1:1) into either a control (N=76) or an experimental group (N=76) through block randomisation. The participants classified into the experimental group will be provided with SDSCP, and during the initial home visit, the research team members will provide instructions to all patients and caregivers on how to download and use the smartphone application. While the participants in the control group will be given the existing stroke standard care. The main outcome measures of stroke survivors will consist of the Self-Care of Stroke Inventory and a short version of the Stroke Specific Quality of Life Scale. The outcome measures of stroke caregivers will primarily cover the Caregiver Contribution to Self-Care of Stroke Inventory and Zarit burden interview. The data of this study will be collected at three time points, including baseline, 1 month and 6 months from the baseline. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Zhengzhou University (ZZUIRB 2021-115) in January 2021. The results achieved in this study will facilitate the clinical practice to improve self-care of stroke survivors and promote dyadic health outcomes for stroke patients and caregivers. TRIAL REGISTRATION NUMBER The study was registered with the Chinese Clinical Trial Registry and the registration number is ChiCTR2100053591.
Collapse
Affiliation(s)
- Wenna Wang
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoxuan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Ercole Vellone
- Department of Biomedicine and Prevention, Universita degli Studi di Roma Tor Vergata, Roma, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
6
|
Matarese M, Pendoni R, Ausili D, Vellone E, De Maria M. Validity and Reliability of Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease Inventory and Caregiver Self-Efficacy in Contributing to Self-Care Scale. Eval Health Prof 2023; 46:255-269. [PMID: 36266087 DOI: 10.1177/01632787221134712] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study tested the construct validity and reliability of the Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease (COPD) Inventory and the Caregiver Self-Efficacy in Contributing to Self-Care of COPD Scale. The two instruments were developed by modifying the Self-Care of COPD Inventory and Self-Care Self-Efficacy Scale in COPD into caregiver versions. The psychometric properties were tested in a convenience sample of 261 informal caregivers of COPD patients recruited in Italy in two cross-sectional studies. Structural validity was tested by confirmatory factor analysis, construct validity by posing several hypotheses, and internal consistency through factor score determinacy and global reliability index for multidimensional scales. In confirmatory factor analysis, the caregiver contribution to self-care maintenance, monitoring and management scales, composing the Caregiver Contribution to Self-Care of COPD Inventory, presented good fit indices. Global reliability indices ranged 0.75-0.88. The caregiver self-efficacy scale presented a comparative fit index of 0.96 and a global reliability index of 0.82. The caregiver contribution to self-care and the caregiver self-efficacy scales correlated moderately among themselves and with the patient versions of the scales, and scores were higher with caregiver-oriented dyadic care types and female caregivers. Our study provides evidence of the two instruments' construct validity and internal consistency.
Collapse
Affiliation(s)
- Maria Matarese
- Research Unit of Nursing Sciences, Department of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Roberta Pendoni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
7
|
De Maria M, Erba I, Ferro F, Ausili D, Matarese M, Vellone E. The influence of dyad sex combination on patient self-care and caregiver contribution to self-care in multiple chronic conditions: An observational study. J Nurs Scholarsh 2023; 55:1008-1019. [PMID: 37721456 DOI: 10.1111/jnu.12895] [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: 11/17/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION We know that patient and caregiver sex influence patient self-care and caregiver contribution to self-care in multiple chronic conditions. However, the role of dyad sex combination (e.g., male patient and female caregiver, female patient and male caregiver, male patient and caregiver, and female patient and caregiver) in influencing patient self-care and caregiver contribution to self-care remains unexplored. Our aim was to investigate the relationship between patient and caregiver sex combination and patient self-care and caregiver contribution to self-care in multiple chronic conditions. DESIGN Multicentre cross-sectional study. METHODS We enrolled patients with multiple chronic conditions and caregiver dyads in outpatient and community settings from April 2017 to December 2019. We used the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory that measure, from the patient and caregiver perspective, self-care maintenance (i.e., behaviors to maintain illness stability), self-care monitoring (i.e., monitoring of illness signs and symptoms), and self-care management (i.e., behaviors to manage signs and symptoms). We used multivariate analysis of covariance to evaluate the association between sex and self-care and caregiver contribution to self-care. RESULTS We recruited 540 patient-caregiver dyads. Male patients cared by female caregivers performed higher self-care maintenance compared to female patients cared by female caregivers. Female caregivers caring for female patients performed higher caregiver contribution to self-care monitoring compared to male caregivers caring for female or male patients. CONCLUSIONS Clinicians should consider the influence of patient and caregiver sex combination on self-care and caregiver contribution to self-care in multiple chronic conditions to provide tailored interventions. CLINICAL RELEVANCE Healthcare professionals should consider the patient and caregiver sex combination in the dyad to tailor better interventions aimed at improving patient self-care and caregiver contribution to self-care in multiple chronic conditions.
Collapse
Affiliation(s)
- Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Erba
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federico Ferro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Matarese
- School of Nursing, Campus Bio-Medico of Rome University, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
8
|
De Maria M, Lee CS, Matarese M, Vellone E, Lorini S, Ausili D. Dyadic Archetypes of Patient Self-Care and Caregiver Contribution to Self-Care in Dyads With Multiple Chronic Conditions: An Observational Study. J Appl Gerontol 2023; 42:1809-1819. [PMID: 36826408 DOI: 10.1177/07334648231159980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Self-care of multiple chronic conditions (MCCs) and caregiver contribution to self-care have been theorized as dyadic. However, the different dyadic archetypes are still unknown. This cross-sectional study aimed to identify dyadic archetypes related to how in patient-caregiver dyads manage the patient's MCCs and to describe other ways in which the dyadic archetypes differ. A sample of 340 MCCs patient-caregiver dyads was enrolled in outpatient and community settings. Patients had a mean age of 76.7 (±7.3) years and were mostly female (54.5%). Caregivers had a mean age of 54.6 (±15.1) years and were mostly female (71.5%). Four dyadic archetypes were observed: "autonomous," "compensatory," "balanced," and "complementary" care. Clinical programs should consider the different characteristics of dyads to support self-care.
Collapse
Affiliation(s)
- Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Christopher S Lee
- School of Nursing, Boston College William F. Connell, Boston, MA, USA
| | - Maria Matarese
- School of Nursing, Campus Bio-Medico of Rome University, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Lorini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
9
|
Vellone E, Rebora P, Iovino P, Ghizzardi G, Baricchi M, Alvaro R, Sili A, Barello S, Ausili D, Trenta AM, Pedroni C, Dellafiore F, Arrigoni C, Riegel B, Caruso R. Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial. Res Nurs Health 2023; 46:190-202. [PMID: 36566360 DOI: 10.1002/nur.22289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/26/2022]
Abstract
In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely.
Collapse
Affiliation(s)
- Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- School of Nursing, Midwifery and Paramedicine Faculty of Health Science, Australian Catholic University, Melbourne, Australia
| | | | - Marina Baricchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Serena Barello
- Department of Psychology, EngageMinds Hub-Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alessia M Trenta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Cardiology Center Monzino IRCCS, University of Milan-Bicocca, Milan, Italy
| | | | - Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Mary MacKillop Institute for Health Research, Australian Catholic University, North Sydney, Australia
- International Center for Self-Care Research
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| |
Collapse
|
10
|
Arapi A, Vellone E, Ivziku D, Duka B, Taci D, Notarnicola I, Stievano A, Prendi E, Rocco G, De Maria M. Psychometric Characteristics of the Self-Care of Chronic Illness Inventory in Older Adults Living in a Middle-Income Country. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4714. [PMID: 36981630 PMCID: PMC10048512 DOI: 10.3390/ijerph20064714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Chronic illness requires numerous treatments and self-care is essential in the care process. Evaluation of self-care behaviors facilitates the identification of patients' needs and optimizes education and care processes. This study aimed to test the psychometric characteristics (validity, reliability, and measurement error) of the Albanian version of the Self-Care of Chronic Illness Inventory (SC-CII). Patients with multiple chronic conditions and caregivers were recruited in outpatient clinics in Albania. The patients completed the SC-CII, which includes three scales: self-care maintenance, self-care monitoring, and self-care management. Factorial validity was tested for each scale, with confirmatory factor analysis. Reliability was evaluated with the composite coefficient, Cronbach's alpha, and the global reliability index for multidimensional scales. The construct validity was tested using hypothesis testing and known differences between groups. The measurement error was tested to assess responsiveness to changes. The self-care maintenance and self-care monitoring scales showed a unidimensional factorial structure, while the self-care management scale showed a bidimensional structure. Reliability estimates were adequate for all reliability coefficients. Construct validity was supported. The measurement error was adequate. The Albanian version of the SC-CII shows good psychometric properties in the Albanian sample.
Collapse
Affiliation(s)
- Alta Arapi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Dhurata Ivziku
- Degree Course in Nursing, UniCamillus International Medical University, 00131 Rome, Italy
- Department of Healthcare Professions, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy
| | - Blerina Duka
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Dasilva Taci
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Ippolito Notarnicola
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Alessandro Stievano
- Centre of Excellence for Nursing Scholarship, Order of Nurses of Rome, 00173 Rome, Italy
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Emanuela Prendi
- Department of Biomedical Sciences, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Gennaro Rocco
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
- Centre of Excellence for Nursing Scholarship, Order of Nurses of Rome, 00173 Rome, Italy
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| |
Collapse
|
11
|
Simonelli N, Bolgeo T, Iovino P, Di Matteo R, Maconi A, Vellone E. Self-care in coronary heart disease patient and caregiver dyads (HEARTS-IN-DYADS)-Protocol of a multicenter longitudinal study. Res Nurs Health 2023; 46:37-47. [PMID: 36538334 DOI: 10.1002/nur.22286] [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: 02/14/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
Self-care performed by patients and the caregiver contribution to this self-care are essential for improving cardiovascular outcomes; however, so far, no studies have sufficiently investigated this field in Italy. This paper describes a research protocol of a multi-center longitudinal study designed to investigate the self-care of patients affected by coronary heart disease (CHD), the caregiver's contribution to this self-care, the predictors of patient and caregiver self-care, the mediating role of self-efficacy, and the self-care outcomes. Data collection will be performed across seven Italian inpatient settings at baseline and 3 and 6 months from enrollment. Multilevel modeling and actor partner interdependence models will be implemented on a sample of 330 patient-caregiver dyads to adjust for the interdependence of measurements. The study received approval from an ethics committee in Italy and was financed in January 2021 by a grant from the Solidal Foundation in Alessandria. This research will advance the knowledge about the self-care process in CHD. The results will guide research and clinical practice by identifying variables sensitive to educational interventions.
Collapse
Affiliation(s)
- Niccolò Simonelli
- SC Cardiology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Tatiana Bolgeo
- Research Training Innovation Infrastructure - Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,School of Nursing Midwifery and Paramedicin Australian Catholic University, Melbourne, Victoria, Australia
| | - Roberta Di Matteo
- Research Training Innovation Infrastructure - Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Maconi
- Research Training Innovation Infrastructure - Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
12
|
De Maria M, Ausili D, Lorini S, Vellone E, Riegel B, Matarese M. Patient Self-Care and Caregiver Contribution to Patient Self-Care of Chronic Conditions: What Is Dyadic and What It Is Not. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1165-1173. [PMID: 35337754 DOI: 10.1016/j.jval.2022.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/01/2021] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Self-care of chronic conditions involves both patients and their informal caregivers and therefore might be considered as a dyadic phenomenon. Nevertheless, empirical evidence supporting a dyadic construct is unavailable. This study aimed to explore the existence of a dyadic construct in self-care maintenance, monitoring, and management in patients affected by chronic conditions and their informal caregivers. METHODS This study used a cross-sectional design. We used the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory, which measure patient self-care and informal caregivers' contribution to self-care maintenance, monitoring and management. Exploratory Structural Equation Modeling was performed to verify the existence of dyadic latent constructs in each scale in patients and informal caregivers. RESULTS A convenience sample of 493 patients and informal caregivers, with a mean age of 76.47 and 52.76 years, respectively, was studied. In the self-care maintenance scales, 2 correlated factors (r = 0.34, P < .001) were identified, indicating the presence of a dyadic second-order construct. In addition, 2 factors that were not correlated (r = 0.11, P = .064) were identified in the self-care monitoring scales, indicating the absence of a dyadic construct. Finally, we found a 3-factor model in the self-care management scales composed of both patient and caregiver items, indicating a dyadic first-order construct. CONCLUSIONS Knowing which care behaviors are dyadic in chronic conditions is important for tailoring interventions to improve self-care. Self-care maintenance and management would benefit from dyadic interventions, while self-care monitoring would not. The results of this study may illuminate future theoretical and scientific developments in dyadic care of chronic illness.
Collapse
Affiliation(s)
- Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Silvia Lorini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria Matarese
- Research Unit of Nursing Science, University Campus Bio-Medico of Rome, Rome, Italy
| |
Collapse
|
13
|
Riegel B, De Maria M, Barbaranelli C, Matarese M, Ausili D, Stromberg A, Vellone E, Jaarsma T. Symptom Recognition as a Mediator in the Self-Care of Chronic Illness. Front Public Health 2022; 10:883299. [PMID: 35655456 PMCID: PMC9152258 DOI: 10.3389/fpubh.2022.883299] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background The recognition of a symptom is needed to initiate a decision to engage in a behavior to ameliorate the symptom. Yet, a surprising number of individuals fail to detect symptoms and delay in addressing early warnings of a health problem. Purpose The aim of this study was to test the hypothesis that symptom recognition mediates the relationship between monitoring for and management of symptoms of a chronic illness. Methods A secondary analysis of existing cross-sectional data. A sample of 1,629 patients diagnosed with one or more chronic conditions was enrolled in the United States (US) (n = 407), Italy (n = 784) and Sweden (n = 438) between March 2015 and May 2019. Data on self-care monitoring, symptom recognition, and self-care management was assessed using the Self-Care of Chronic Illness Inventory. After confirming metric invariance in cultural assessment, we used structural equation modeling to test a mediation model where symptom recognition was conceptualized as the mediator linking self-care monitoring and self-care management with autonomous (e.g., Change your activity level) and consulting behaviors (e.g., Call your healthcare provider for guidance). Results Symptom recognition mediated the relation between self-care monitoring and autonomous self-care management behaviors (β = 0.098, β = 0.122, β = 0.081, p < 0.001 for US, Italy, and Sweden, respectively). No mediation effect was found for consulting self-care management behaviors. Conclusion Our findings suggests that symptom recognition promotes autonomous self-care behaviors in people with a chronic condition. Self-care monitoring directly affects consulting self-care management behaviors but not through symptom recognition. Further research is needed to fully understand the role of symptom recognition in the self-care process.
Collapse
Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Barbaranelli
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Matarese
- Research Unit of Nursing Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, Department of Cardiology, Linkoping University, Linköping, Sweden
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden
| |
Collapse
|
14
|
Iovino P, Nolan A, De Maria M, Ausili D, Matarese M, Vellone E, Riegel B. The influence of social support on self-care is mediated by self-efficacy and depression in chronic illness: key findings from the 'SODALITY' observational study. Aging Ment Health 2022; 27:820-828. [PMID: 35416091 DOI: 10.1080/13607863.2022.2056877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives: Family is a major source of support for older chronically-ill patients and known to be associated with better self-care. Depression and self-care self-efficacy are associated with healthy behaviors and thus may serve as mechanisms by which family support influences self-care.We explored depression and self-care self-efficacy as mediators of the relationship between perceived family support and self-care.Methods: Five hundred forty-one older adults with multiple chronic illnesses were recruited from outpatients and community settings. Three structural equation models (SEM) were fit on cross-sectional data. We measured perceived family support (subscale of the Multidimensional Scale of Perceived Social Support, scores range 1-7), depression (Patient Health Questionnaire, scores range 0-27), selfcare self-efficacy (Self-Care Self Efficacy Scale, standardized scores range 0-100), and self-care maintenance, monitoring, and management (Self-care of Chronic Illness Inventory, standardized scores range 0-100).Results: Participants (mean age = 76.6±7.3 yrs) were predominantly females (55.6%). In the full sample, depression and self-care self-efficacy mediated the relationship between perceived family support and self-care; in the gender-stratified SEM, men's depression was no longer a significant mediator. Depression and self-care self-efficacy were significant mediators of the relation between perceived family support and self-care.Conclusion: In older chronically-ill patients, interventions addressing perceived family support may facilitate a rapid improvement in self-care self-efficacy and a decrease in depressive symptoms, particularly among women.
Collapse
Affiliation(s)
- Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,School of Nursing, Midwifery and Paramedicine Faculty of Health Science, Australian Catholic University, Melbourne, Australia
| | - Amy Nolan
- University of Pennsylvania, Philadelphia, PA, USA
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | |
Collapse
|
15
|
Biagioli V, Spitaletta G, Kania V, Mascolo R, Gawronski O, Liburdi A, Manzi G, Salata M, Vellone E, Tiozzo E, Dall'Oglio I. Instruments Measuring Self-Care in Children and Young Adults With Chronic Conditions: A Systematic Review. Front Pediatr 2022; 10:832453. [PMID: 35419323 PMCID: PMC8995847 DOI: 10.3389/fped.2022.832453] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Children and young adults (CYAs) with chronic conditions need to engage in self-care to improve their quality of life. This study aimed to retrieve the literature on instruments to assess self-care in CYAs living with chronic conditions and evaluate the psychometric proprieties of the instruments retrieved. A systematic literature review was conducted on six databases to identify peer-reviewed papers that described or used an evaluation instrument of self-care in CYAs with chronic conditions. Twenty-three articles describing 11 instruments of self-care were identified. Five instruments (45.45%) were developed for specific diseases, while six (54.54%) for various chronic illnesses. Most of the instruments were focused on treatment adherence within self-care maintenance (i.e., behaviors to maintain illness stability), excluding the monitoring of clinical parameters or the management of exacerbations. This review provides an overview of available instruments that measure self-care in CYAs with chronic conditions, which health professionals could use for patient education.
Collapse
Affiliation(s)
- Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giuseppina Spitaletta
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valeria Kania
- Department of Paediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rachele Mascolo
- Pediatric Semi-Intensive Care Area/Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annachiara Liburdi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Manzi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michele Salata
- Rheumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
16
|
Self-care interventions in stroke survivor–caregiver dyads: a protocol for systematic review and meta-analysis. BMJ Open 2021. [PMCID: PMC8719191 DOI: 10.1136/bmjopen-2021-051860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Stroke is known as one of the leading causes of mortality and disability worldwide. Self-care plays a significant role in improving the quality of life, self-efficacy and many other outcomes of stroke survivors. However, it is a dyadic phenomenon where patient self-care and the caregiver contribution to self-care are inter-related in terms of predictors and outcomes. Currently, there is still no systematic assessment conducted to examine the overall effectiveness of self-care interventions carried out in stroke survivor–caregiver dyads and explore the effect on stroke survivor and/or caregiver outcomes. Methods We plan to conduct a systematic review and meta-analysis of the evidence regarding the self-care interventions carried out in stroke survivor–caregiver dyads. We will undertake a systematic search of multiple databases including PubMed, Web of Science, CINAHL, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials and four Chinese databases (CNKI, CBM, WANFANG and VIP) from inception to July 2021 for the purpose of collecting the relevant articles. The eligible studies are defined as those original researches, written in English or Chinese, on self-care interventions in stroke survivor–caregiver dyad samples. Two independent researchers will be deployed to identify the eligible trials according to the selection criteria and extract the relevant data. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist has been used for this protocol. We will use the Cochrane Risk for Bias tool to assess the risk of bias for randomised controlled trials. Ethics and dissemination In our review, any identifiable patient data will be excluded, which removes the need for ethical approval and participant consent. The final results of our study will be published in an open-access peer-reviewed journal, and abstract will be presented at suitable national/international conferences. PROSPERO registration number CRD42021239824.
Collapse
|
17
|
De Maria M, Ferro F, Vellone E, Ausili D, Luciani M, Matarese M. Self-care of patients with multiple chronic conditions and their caregivers during the COVID-19 pandemic: A qualitative descriptive study. J Adv Nurs 2021; 78:1431-1447. [PMID: 34846083 DOI: 10.1111/jan.15115] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 12/23/2022]
Abstract
AIMS Explore the self-care experiences of patients with multiple chronic conditions (MCCs) and caregivers' contributions to patient self-care during COVID-19 pandemic. DESIGN A descriptive qualitative design was used. The COREQ checklist was used for study reporting. METHODS Individual semi-structured interviews were used to collect data from patients with MCCs and caregivers selected from the dataset of an ongoing longitudinal study. Data analysis was performed through deductive thematic analysis. The middle-range theory of self-care of chronic illness, which entails the three dimensions of self-care maintenance, monitoring and management, was used as a theoretical framework to guide data collection and analysis. RESULTS A total of 16 patients and 25 caregivers were interviewed from May to June 2020. The participants were mainly women, with a mean age for patients of 76.25 years and caregivers of 45.76 years; the caregivers were mainly the patients' children (72%). During the pandemic, some patients reported remaining unchanged in their self-care maintenance, monitoring and management behaviours, others intensified their behaviours, and others decreased them. Caregivers played an important role in protecting patients from the risk of contagion COVID-19 and in ensuring patients' self-care of chronic diseases through direct and indirect interventions. CONCLUSIONS Critical events can modify the self-care experiences of chronically ill patients and caregivers' contributions, leading to maintenance, increase or decrease of self-care and contributions to self-care behaviours. IMPACT Patients with MCCs and their caregivers can react in different ways in their performances of self-care and contribution to patients' self-care behaviours when ordinary daily life is disrupted; therefore, nurses should assess such performances during critical events to identify the individuals at risk of reduced self-care and promote the most suitable healthcare services (e.g. eHealth) to implement individualised interventions.
Collapse
Affiliation(s)
- Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federico Ferro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Michela Luciani
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Maria Matarese
- Research Unit of Nursing Science, Campus Bio-medico University of Rome, Rome, Italy
| |
Collapse
|
18
|
De Maria M, Iovino P, Lorini S, Ausili D, Matarese M, Vellone E. Development and Psychometric Testing of the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1407-1415. [PMID: 34593163 DOI: 10.1016/j.jval.2021.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Caregiver self-efficacy-a caregiver's belief in his/her ability to contribute to patient self-care-is associated with better patient and caregiver outcomes in single chronic conditions. It is, however, unknown if caregiver self-efficacy improves patient and caregiver outcomes in multiple chronic conditions (MCCs) because there is no instrument to measure this variable. We developed the 10-item Caregiver Self-Efficacy in Contributing to patient Self-Care (CSE-CSC) scale for that purpose, and we tested its psychometric characteristics in caregivers of patients with MCCs. METHODS In this cross-sectional multisite study, we tested the structural validity of the CSE-CSC scale with exploratory and confirmatory factor analysis, and we tested construct validity by correlating CSE-CSC scores with those of the Caregiver Contributions to Self-Care of Chronic Illness Inventory. We also tested reliability, and precision of the CSE-CSC scale. RESULTS The 358 enrolled caregivers (mean age 54.6 years; 71.5% female) cared for patients with an average of 3.2 chronic conditions. Structural validity was good, and it showed 2 factors within the scale. Construct validity showed significant correlations between scores of the CSE-CSC scale and the Caregiver Contributions to Self-Care of Chronic Illness Inventory. Reliability coefficients were between 0.90 and 0.97. Measurement error yielded satisfactory results. CONCLUSIONS The CSE-CSC scale is valid, reliable, and precise in measuring caregiver self-efficacy in contributing to patient self-care in MCCs. Because caregiver self-efficacy is a modifiable variable, the CSE-CSC scale can be used in clinical practice and research to improve patient and caregiver outcomes.
Collapse
Affiliation(s)
- Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Lorini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Maria Matarese
- Research Unit of Nursing Science, Campus Bio-medico University of Rome, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
19
|
De Maria M, Ferro F, Ausili D, Buck HG, Vellone E, Matarese M. Characteristics of dyadic care types among patients living with multiple chronic conditions and their informal caregivers. J Adv Nurs 2021; 77:4768-4781. [PMID: 34487558 DOI: 10.1111/jan.15033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/07/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
AIMS To examine the distribution of dyadic care types in multiple chronic conditions, compare self-care and caregiver contributions to patients' self-care in each care type and identify the patient and caregiver characteristics associated with each care type. DESIGN Secondary analysis of a multicentre, cross-sectional study. METHODS Patient-caregiver dyads were enrolled from outpatient clinics and community settings. The Dyadic Symptom Management Type Scale was used to categorize dyads by type. Self-care, self-efficacy, comorbidities and cognitive impairment were measured in patients, whereas caregiver contributions to patient self-care, self-efficacy, caregiver burden and hours of caregiving were measured in caregivers. Sociodemographic characteristics perceived social support and mutuality were measured in both patients and caregivers. Univariate and multivariate analyses were performed. RESULTS A sample of 541 patient-caregiver dyads was examined. The most frequent dyadic care type was the collaborative-oriented (63%). In the patient-oriented type, patients scored higher on self-care compared with caregivers; in the caregiver-oriented and collaborative types, caregivers scored higher than patients supporting the typology. The patient-oriented type was associated with younger, healthier male patients with better cognitive status, who scored higher for mutuality and whose caregivers scored lower for burden. The caregiver-oriented type was associated with older, less educated patients, with caregivers experiencing higher burden and unemployment. The collaborative type was associated with sicker patients, with the caregiver more probably to be female and employed, with higher perceived social support, mutuality and burden. The incongruent dyadic care type was associated with lower caregiver mutuality. IMPACT In the context of multiple chronic conditions, clinicians should consider targeting any educational interventions aimed at improving patient self-care and caregiver contributions to self-care by dyadic care types.
Collapse
Affiliation(s)
- Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federico Ferro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Harleah G Buck
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Maria Matarese
- Research Unit of Nursing Science, Campus Bio-Medico University of Rome, Rome, Italy
| |
Collapse
|
20
|
Giordano V, Iovino P, Corvese F, Vellone E, Alvaro R, Villa G. Caregiver contribution to self-care and its associated variables among caregivers of ostomy patients: Results of a cross-sectional study. J Clin Nurs 2021; 31:99-110. [PMID: 34121255 DOI: 10.1111/jocn.15851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/02/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe caregiver contribution (CC) to ostomy self-care and identify its associated variables among caregivers of ostomy patients. BACKGROUND Self-care is essential for ostomy patients, but it can be difficult to perform. In these cases, caregivers play a key role in promoting self-care behaviours. So far, the CC to ostomy self-care has not been investigated thoroughly. DESIGN This is a cross-sectional and multicentre study conducted at seven outpatient clinics of two Italian regions. METHODS We recruited 252 caregivers between February 2017-May 2018. The Caregiver Contribution to Ostomy Self-Care Index (CC-OSCI) was used to measure CC to ostomy self-care. Three multivariable linear regression models were fitted to identify variables associated with CC dimensions (maintenance, monitoring and management). The STROBE checklist was used to report the present study. RESULTS The sample (mean age = 58.73, SD = 13.98) was mostly female (80.60%), unemployed (58.70%) and resided with the patient (81.00%). Caregivers being employed and those declaring more hours of contribution per week were associated with a significantly lower contribution to self-care maintenance. Caregivers with lower levels of education and those residing with the patient were less likely to contribute to CC to self-care monitoring. Spousal caregivers and those with higher preparedness contributed significantly lower to CC to self-care management. CONCLUSIONS We found a variety of sociodemographic factors associated with CC to ostomy self-care. RELEVANCE TO CLINICAL PRACTICE Sociodemographic variables associated with CC to ostomy self-care can help clinicians develop more tailored educational interventions for caregivers who find their contribution challenging.
Collapse
Affiliation(s)
- Vittoria Giordano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,School of Nursing, Midwifery and Paramedicine Faculty of Health Science, Australian Catholic University, Melbourne, Australia
| | - Francesco Corvese
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
21
|
Yu DSF, De Maria M, Barbaranelli C, Vellone E, Matarese M, Ausili D, Rejane RSE, Osokpo OH, Riegel B. Cross-cultural applicability of the Self-Care Self-Efficacy Scale in a multi-national study. J Adv Nurs 2020; 77:681-692. [PMID: 33295675 DOI: 10.1111/jan.14617] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/24/2020] [Accepted: 10/08/2020] [Indexed: 12/15/2022]
Abstract
AIM The Self-Care Self-Efficacy Scale (SCSES) was newly developed as a self-report measure for self-care self-efficacy for chronic illness. This study investigated its measurement equivalence (ME) in different cultural groups, including United States, China (Hong Kong), Italy, and Brazil. DESIGN A multi-national study for cross-cultural validation of the Scale. METHODS From January 2015 - December 2018, investigators recruited 957 patients (United State: 200; Hong Kong: 300; Italy: 285; and Brazil: 142) with chronic illness from inpatient and outpatient settings. The SCSES was administered and clinical and demographic data were collected from participants. Based on the Meredith framework, multi-group confirmatory factor analysis evaluated the configural, metric, scalar, and strict invariance of the scale across the four populations through a series of nested models, with evaluation of reliability and coherence of the factor solution. RESULTS The mean ages of the groups ranged from 65-77 years, 56.4% was male. The Cronbach's alpha coefficients of the single-factor SCSES were 0.93, 0.89, 0.92, and 0.90 for the United States, China (Hong Kong), Italy, and Brazil, respectively. Three of the four levels of ME were partially or totally supported. The highest level achieved was partial scalar invariance level (χ2 [52] = 313.4, p < 0.001; RMSEA = 0.067; 95% CI = 0.056-0.077; CFI = 0.966; TLI = 0.960, SRMR = 0.080). CONCLUSION Patients from the four countries shared the same philosophical orientation towards scale items, although some of the items contributed differently to represent the concept and participants shared the same schemata for score interpretation. IMPACT Self-efficacy is important in producing effective and sustainable self-care behavioural changes. Cultural ideation shapes the ways individuals interpret and report their self-care self-efficacy. The study findings support cross-cultural and cross-national utility of the SCSES for research on self-care across United States, China (Hong Kong), Italy, and Brazil.
Collapse
Affiliation(s)
- Doris Sau-Fung Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulum, Hong Kong
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Barbaranelli
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Maria Matarese
- Research Unit of Nursing Science, Campus Bio-medico University of Rome, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milano, Italy
| | | | | | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.,Australian Catholic University, Mary Mackillop Institute for Health Research, Melbourne, Vic, Australia
| |
Collapse
|
22
|
Vellone E, Lorini S, Ausili D, Alvaro R, Di Mauro S, De Marinis MG, Matarese M, De Maria M. Psychometric characteristics of the caregiver contribution to self-care of chronic illness inventory. J Adv Nurs 2020; 76:2434-2445. [PMID: 32538503 DOI: 10.1111/jan.14448] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/23/2020] [Accepted: 06/02/2020] [Indexed: 11/27/2022]
Abstract
AIM The purpose of the this study was to test the factorial structure, internal consistency reliability and concurrent validity of the Caregiver Contribution to Self-Care Chronic Illness Inventory. BACKGROUND Existing measures of caregiver contribution to self-care are disease-specific or behaviour-specific; no generic measures exist. DESIGN A cross-sectional study. METHOD Between April 2017 - December 2018, we enrolled a convenience sample of 358 patients with chronic illnesses and their caregivers. Patients completed the Self-Care of Chronic Illness Inventory while caregivers completed the Caregiver Contribution to Self-Care of Chronic Illness Inventory, a modification of the Self-Care of Chronic Illness Inventory, which includes three scales as follows: the Caregiver Contribution to Self-Care Maintenance, the Caregiver Contribution to Self-Care Monitoring and the Caregiver Contribution to Self-Care Management. Of each scale, we tested the factorial structure with confirmatory factor analysis and reliability with the factor score determinacy coefficient, the global reliability index for multidimensional scale and Cronbach's alpha. Also, we used Pearson's correlations for concurrent validity purposes. RESULTS Confirmatory factor analysis supported the two-factor structure of the Caregiver Contribution to Self-Care Maintenance and Management scales and the one-factor structure of the Caregiver Contribution to Self-Care Monitoring scale. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model (Comparative Fit Index = 0.933). Reliability estimates ranged between 0.701 and 0.961 across the three scales. Concurrent validity of Caregiver Contribution to Self-Care of Chronic Illness Inventory with the Self-Care of Chronic Illness Inventory was not sufficiently supported since weak correlations were found. CONCLUSION The Caregiver Contribution to Self-Care of Chronic Illness Inventory is valid and reliable and can be used in clinical practice and research. IMPACT The Caregiver Contribution to Self-Care of Chronic Illness Inventory is an useful instrument to evaluate the extent to which caregivers contribute to patient self-care in chronic illnesses.
Collapse
Affiliation(s)
- Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Lorini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Stefania Di Mauro
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | | | - Maria Matarese
- School of Nursing, University Campus Bio-Medico, Rome, Italy
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
23
|
Iovino P, De Maria M, Matarese M, Vellone E, Ausili D, Riegel B. Depression and self-care in older adults with multiple chronic conditions: A multivariate analysis. J Adv Nurs 2020; 76:1668-1678. [PMID: 32281683 DOI: 10.1111/jan.14385] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
AIMS To investigate the relationship between depression and self-care behaviours in older individuals with multimorbidity. DESIGN Cross-sectional study. Data were collected between April 2017 - June 2019. METHODS Patients were enrolled from community and outpatient settings and included if they were ≥65 years, affected by heart failure, diabetes mellitus or chronic obstructive pulmonary disease and at least another chronic condition. They were excluded if they had dementia and/or cancer. Patient Health Questionnaire-9 was used to measure depression and Self-Care of Chronic Illness Inventory was used to measure self-care maintenance, monitoring, and management. The relationship between depression and self-care was evaluated by performing two sets of univariate analyses, followed by multivariate and step-down analyses. The second set was performed to control for the number of chronic conditions, age, and cognitive function. RESULTS The sample (N = 366) was mostly female (54.2%), with a mean age of 76.4 years. Most participants (65.6%) had mild to very severe depressive symptoms. Preliminary analysis indicated a significant negative association between depression and self-care maintenance and monitoring and a significant negative association between depression and multivariate self-care. Step-down analysis showed that self-care maintenance was the only dimension negatively associated with depression, even after controlling for the number of chronic conditions, age, and cognitive function. CONCLUSION In multimorbid populations, depression is more likely to be associated with self-care maintenance than the other self-care dimensions. Therefore, self-care maintenance behaviours (e.g., physical activity and medication adherence) should be prioritized in assessment and focused on when developing interventions targeting depressed older adults with multimorbidity. IMPACT The results of this study may help guide clinical practice. In patients with depressive symptoms, self-care maintenance behaviours should be assessed first, as a potential first indicator of poor self-care.
Collapse
Affiliation(s)
- Paolo Iovino
- University of Rome Tor Vergata, Rome, Italy.,Australian Catholic University, Melbourne, Australia
| | | | | | | | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | | |
Collapse
|
24
|
Iovino P, Lyons KS, De Maria M, Vellone E, Ausili D, Lee CS, Riegel B, Matarese M. Patient and caregiver contributions to self-care in multiple chronic conditions: A multilevel modelling analysis. Int J Nurs Stud 2020; 116:103574. [PMID: 32276720 DOI: 10.1016/j.ijnurstu.2020.103574] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/22/2020] [Accepted: 03/07/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Multiple chronic conditions (MCC) are highly prevalent worldwide, especially among older populations. Patient self-care and care partner (or caregiver) contributions to self-care are recommended to reduce the impact of MCC and improve patients' outcomes. OBJECTIVES To describe patient self-care and care partner contributions to self-care and to identify determinants of patient self-care and care partner contributions to self-care at the patient and care partner level. DESIGN Multicentre cross-sectional study. SETTING Outpatient and community settings in Italy. PARTICIPANTS A sample of 340 patients with MCC and care partner dyads was recruited between 2017 and 2018. METHODS We measured patient's self-care and care partner contributions to self-care in dyads using the Self-care of Chronic Illness Inventory and the Caregiver Contribution to Self-care of Chronic Illness Inventory. To control for dyadic interdependence, we performed a multilevel modelling analysis. RESULTS Patients' and care partners' mean ages were 76.65 (± 7.27) and 54.32 (± 15.25), respectively. Most care partners were female and adult children or grandchildren. The most prevalent chronic conditions in patients were diabetes (74%) and heart failure (34%). Patients and care partners reported higher levels of self-care monitoring than self-care maintenance and management behaviours. Important patient clinical determinants of self-care included cognitive status, number of medications and type of chronic condition. Care partner determinants of self-care contributions included age, gender, education, perceived income, care partner burden, caregiving hours per week and the presence of a secondary care partner. CONCLUSIONS Our findings support the importance of taking a dyadic approach when focusing on patients with MCC and their care partners. More dyadic longitudinal research is recommended to reveal the modifiable determinants of self-care and the complex relationships between patients and care partners in the context of MCC.
Collapse
Affiliation(s)
- Paolo Iovino
- University of Rome "Tor Vergata", Rome, Italy; Australian Catholic University, Melbourne, Australia.
| | | | | | | | | | | | - Barbara Riegel
- University of Pennsylvania, Philadelphia, United States.
| | | |
Collapse
|
25
|
Cross-cultural assessment of the Self-Care of Chronic Illness Inventory: A psychometric evaluation. Int J Nurs Stud 2019; 116:103422. [PMID: 31791631 DOI: 10.1016/j.ijnurstu.2019.103422] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Self-care refers to behaviors that individuals adopt to prevent or maintain the stability of an illness (self-care maintenance), to monitor signs and symptoms (self-care monitoring), and to respond to signs and symptoms of an illness exacerbation (self-care management). A generic measure of self-care, the Self-Care of Chronic Illness Inventory, based on the Theory of Self-Care of Chronic Illness, was developed for use in individuals with any number and type of chronic conditions. OBJECTIVE The current study investigated the measurement equivalence of the Self-Care of Chronic Illness Inventory in individuals from three different cultural groups. We were interested in determining if Italians, Swedes, and Americans interpret the measure in a conceptually similar way. METHODS This cross-sectional study enrolled 1629 patients, 784 recruited in Italy, 438 in Sweden and 407 in the United States. Self-care (self-care maintenance, self-care monitoring and self-care management) was measured with the Self-Care of Chronic Illness Inventory. A multi-group confirmatory factor analytic approach was used to assess the equivalence of the measures across the three countries. Configural, metric, scalar and strict invariance were tested through a series of nested models where increasingly stringent equality constraints were posited. RESULTS Participants were mostly males (56.3%), older adults (69.8%) and had at least two chronic conditions. Results indicated that three out of four measurement equivalence levels were partially or totally supported in all three of the Self-Care of Chronic Illness Inventory scales. The partial scalar invariance level was reached for self-care maintenance [χ2(50) = 63.495, p = 0.095; RMSEA = 0.022, p = 0.999, 90% CI = 0.000 0.038; CFI = 0.981; TLI = 0.977; SRMR = 0.036], self-care monitoring [χ2(22) = 28.770, p = 0.095; RMSEA = 0.024, p = 0.978, 90% CI = 0.000 0.046; CFI = 0.996; TLI = 0.995; SRMR = 0.054], and self-care management [χ2(51) = 91.334, p = 0.001; RMSEA = 0.048, p = 0.576, 90% CI = 0.031 0.063; CFI = 0.949; TLI = 0.937; SRMR = 0.047] scales. CONCLUSIONS These findings suggest that patients in the three countries used an identical cognitive framework or mental model when responding and used the 1-5 Likert response scale in an almost identical way, almost without bias. In spite of sociocultural differences, patients in these countries seem to share the same fundamental view of self-care. The results of the Self-Care of Chronic Illness Inventory will be comparable in these countries.
Collapse
|