Self-care of patients with multiple chronic conditions and their caregivers during the COVID-19 pandemic: A qualitative descriptive study

Developing a narrative communication intervention in the context of HPV vaccination

Objective

We outline the development of a narrative intervention guided by the Common-Sense Model of Self-Regulation (CSM) to promote Human Papillomavirus (HPV) vaccination in a diverse college population.

Methods

We adapted the Obesity-Related Behavioral Intervention Trials (ORBIT) model to guide the development, evaluation, and refinement of a CSM-guided narrative video. First, content experts developed a video script containing information on HPV, HPV vaccines, and HPV-related cancers. The script and video contents were evaluated and refined, in succession, utilizing the think-aloud method, open-ended questions, and a brief survey during one-on-one interviews with university students.

Results

Script and video content analyses led to significant revisions that enhanced quality, informativeness, and relevance to the participants. We highlight the critical issues that were revealed and revised in the iterative process.

Conclusions

We developed and refined a CSM guided narrative video for diverse university students. This framework serves as a guide for developing health communication interventions for other populations and health behaviors.

Innovation

This project is the first to apply the ORBIT framework to HPV vaccination and describe a process to develop, evaluate, and refine comparable CSM guided narrative interventions that are tailored to specific audiences.

Descriptive qualitative study of breathlessness and its management of Turkish individuals with self-reported heart failure

AIMS

To explore the experiences of individuals with heart failure, with a specific focus on elucidating the full spectrum of symptoms experienced and their subjective descriptions of breathlessness and self-management strategies regarding socio-cultural-behavioural context.

DESIGN

Qualitative descriptive study underpinned by critical realism and situation-specific theory of heart failure self-care.

SETTING

Participants from various settings (hospitals and community) in Southeastern Türkiye.

PARTICIPANTS

Adults reporting heart failure and breathlessness.

METHODS

Semi-structured interviews were carried out with 20 individuals (11 women and 9 men). Data were audio-recorded and transcribed. Participants were asked to describe their symptoms, experiences with breathlessness, self-management strategies and health needs from their perspectives. The interview data were analysed using reflexive thematic analysis.

RESULTS

There were a range (31 physical and 7 psycho-social behavioural) of symptoms experienced by participants. This included fatigue, difficulty sleeping, pain (not including chest pain) and fear about death and dying. Based on reflexive thematic analysis of semi-structured interviews, six main themes were identified. First two themes (knowledge and misconception, and experience of breathlessness) were related to breathlessness experience and knowledge. The third theme (culture and religious consideration) highlighted the importance of cultural and religious perspectives in breathlessness regarding Turkish socio-cultural-behavioural context. Themes four (breathlessness self-management/physical) and five (breathlessness self-management/psychological) were identified as self-management strategies for breathlessness. The need for improved health behaviours (improved health behaviours) was also identified.

CONCLUSION

Breathlessness and self-management strategies are affected by individual perspectives in relation to their socio-cultural-behavioural context. Understanding individuals' unique breathlessness experiences regarding their socio-cultural-behavioural context assists in the identification of possible individualised-care strategies to improve their life and care quality in heart failure. We recommend creating a person-centred symptom assessment strategy with reference to culture or transculture guided by nurses. This will help to understand individuals' unique symptom profiles and tailor responses to their needs.

Evaluation of the relationship between self-care agency and quality of life in adolescents with type 1 diabetes mellitus during COVID-19 pandemic

PURPOSE

This study aims to explore the relationship between self-care agency and quality of life among adolescents with Type 1 Diabetes Mellitus (T1DM) during the pandemic.

DESIGN AND METHODS

The study was conducted with 186 adolescents aged 13-16 who have T1DM and attended a pediatric endocrinology clinic at a Training and Research Hospital in the capital city of Turkey between January 1, 2022, and December 31, 2022. Data from 118 adolescents who met the inclusion criteria and fully completed the survey were used in the analysis. Data were collected using the 'Participant Information Form', 'Self-Care Agency Scale', and 'Kiddo-KINDL Quality of Life Scale'.

RESULTS

The study found that adolescents with higher self-care agency reported significantly better quality of life. Additionally, significant correlations were observed between self-care agency and adherence to pandemic measures, dietary adjustments, hygiene practices, diabetes management challenges, family communication, sleep duration, dietary patterns, and exercise difficulties (p < 0.05).

CONCLUSION

During the COVID-19 pandemic, it was evident that the self-care agency and quality of life of adolescents with T1DM were impacted, with those possessing higher self-care agency experiencing better and more meaningful quality of life.

APPLICATION TO PRACTICE

T1DM affects all aspects of life, and quality of life is considered a critical outcome of diabetes care. It is essential for adolescents to adhere to practices such as regular nutrition, physical activity, blood sugar monitoring, and appropriate insulin intake to achieve optimal glycemic levels and the best possible quality of life. Adolescents should be trained on these issues by pediatric nurses.

Generic and disease-specific self-care instruments in older patients affected by multiple chronic conditions: A descriptive study

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.

Cross-cultural adaptation and validation of the caregiver self-efficacy in contributing to patient self-care scale in China

BACKGROUND

Caregiver self-efficacy is crucial in improving patient outcomes and caregiver well-being, but there is a lack of suitable scales to assess this concept within the context of Chinese culture. This study aimed to cross-culturally translate the Caregiver Self-Efficacy in Contributing to Patient Self-Care (CSE-CSC) Scale and evaluate its psychometric properties using classical test theory and item response theory.

METHODS

The CSE-CSC scale was adapted using Brislin's translation model after obtaining authorization from the original author. A multicenter, cross-sectional study was conducted to assess the psychometric properties of this scale. Classical test theory was used to evaluate reliability (internal consistency, test-retest reliability), validity (content validity, structural validity, convergent validity), and floor and ceiling effects. Item response theory was employed to assess the fit of the rating scale model, reliability, item difficulties, and measurement invariance.

RESULTS

The translation and cultural adaptation process was completed. Classical test theory demonstrated good internal consistency (Cronbach's α = 0.935) and test-retest reliability (ICC from 0.784 to 0.829, p<0.001). The I-CVI and K* of each item ranged from 0.875 to 1.00 and 0.871 to 1.00. The first-order 2-factor model fit well (χ2/df = 3.71, RMSEA = 0.082, SRMR = 0.032, CFI = 0.973, TLI = 0.60). Convergent validity showed that the CSE-CSC scores had a strong positive correlation with three separate scales of the CC-SC-CII. There was no floor and ceiling effect in this scale. Rasch analysis showed that the CSE-CSC scale demonstrated a good fit to the rating scale model and exhibited excellent reliability (person/item separation index>2, person/item reliability coefficients>0.8). The Wright map showed that item difficulty matched the respondents' measured abilities. The analysis of differential item functioning (DIF) showed that all items were comparable in gender.

CONCLUSIONS

This study indicated that the CSE-CSC scale had good reliability, validity, difficulty degree, and measurement invariance. The CSE-CSC scale can be used to measure caregiver self-efficacy of Chinese patients with multiple chronic conditions.

Impact of caregiver relationship on self-care in patients with Parkinson's disease: A cross-sectional study using Riegel's theory of self-care of chronic illness

AIMS

To explore how the characteristics of patients and caregivers affect self-care in patients with Parkinson's disease (PD).

DESIGN

A multicentre cross-sectional study.

METHOD

We followed the STROBE checklist. Parkinson's disease patients aged 50 years and older and their caregivers were recruited from two tertiary hospitals and the Korean Parkinson's Disease Association website. Patient characteristics, including social support, relationship quality with caregivers, self-care efficacy and self-care, were analysed. Caregiver characteristics were also evaluated, including caregiving duration, social support, relationship quality with patients, contribution to patients' self-care efficacy and contribution to patients' self-care.

RESULTS

The characteristics of patients and caregivers (103 pairs) were hierarchically regressed into patient self-care domains (maintenance, monitoring and management). Most patients and caregivers gave a self-care efficacy and self-care management rating of moderate. In three regression models, patient self-care efficacy was positively related to three domains of patient self-care. Self-care maintenance decreased as patients' disease duration increased. Self-care monitoring was positively related to the education level of patients and caregiving duration. Self-care management showed an inverse relationship with caregiving duration and a positive relationship with caregiver contribution.

CONCLUSION

Self-care efficacy was important in promoting PD patients' self-care maintenance, monitoring and management. The contributions of caregivers were also critical in increasing PD patients' self-care management.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

To increase patients' self-care efficacy and self-care, educational interventions containing information about the disease, symptom management, and problem-solving should be implemented. Since caregivers are deeply involved in patients' self-care, educational interventions for caregivers should also be provided.

IMPACT

This study closed the literature gap by examining the self-care efficacy and self-care of Korean PD patients. Findings demonstrated the importance of caregiver roles on patients' self-care and health.

PATIENT OR PUBLIC CONTRIBUTION

Two tertiary hospitals and the Korean Parkinson's Disease Association assisted during the recruitment process.

Spanish version of the Self-Care of Chronic Illness Inventory: A validation study amongst community-dwelling older adults with chronic multimorbidity

AIM

To psychometrically assess the Spanish version of the Self-Care of Chronic Illness Inventory (SC-CII-Sp) in community-dwelling older adults with chronic multimorbidity.

DESIGN

A methodological study.

METHOD

A total of 1260 older adults participated in the study between May 2020 and February 2022. The data were analysed using SPSS Statistics® 26 and AMOS® 24. The items' content validity index and the Fleiss' kappa were calculated to assess the SC-CII-Sp's content validity. Convergent validity was assessed by calculating the Pearson correlation coefficient between the participants' scores on the SC-CII-Sp and their scores on the Spanish Chronic Disease Self-Efficacy scale (SCD-SE). Construct validity was tested by performing a confirmatory factor analysis (CFA). The SC-CII-Sp's reliability was tested by computing the Cronbach's alpha.

RESULTS

The SC-CII-Sp showed good content and convergent validity. The CFA showed that the SC-CII-Sp has three sub-scales. The 8-item Self-Care Maintenance sub-scale has good internal consistency and is comprised of two dimensions: illness-related and health-promoting behaviour. The Self-Care Monitoring sub-scale had excellent internal consistency and its five loaded items belonged to a single dimension. The 6-item Self-Care Management sub-scale has adequate internal consistency and two dimensions: autonomous and consulting behaviour.

CONCLUSION

The Spanish version of SC-CII is a valid and reliable instrument to be used in the assessment of self-care behaviours amongst Spanish-speaking, community-dwelling older adults with chronic multimorbidity.

IMPLICATIONS FOR THE PROFESSION

Nurses need valid and reliable tools to assess self-care behaviours in Spanish-speaking community-dwelling older adults with chronic multimorbidity. This study provides a 19-item tool that allows for the comprehensive evaluation of self-care behaviours in healthy and ill states.

IMPACT

Using the SC-CII-Sp in clinical or research settings could help nurses to examine the effects of different interventions on self-care behaviours amongst Spanish-speaking, community-dwelling older adults with chronic multimorbidity.

PATIENT OR PUBLIC CONTRIBUTION

None to be reported.

Self-care behaviours of patients with left ventricular assist devices in Israel: changes during the COVID-19 pandemic

AIMS

Left ventricular assist devices (LVADs) support the hearts of patients with advanced heart failure. Following LVAD implantation, patients face a complex regimen of self-care behaviours including self-care maintenance, self-care monitoring and self-care management. However, during the COVID-19 pandemic, symptoms of anxiety and depression may have interfered with their self-care. Currently, little is known on how specific self-care behaviours of LVAD-implanted patients changed during the COVID-19 pandemic. We aim to describe the changes in self-care behaviours among patients with an implanted LVAD in Israel during the COVID-19 pandemic and explore the factors related to self-care behaviour change.

METHODS

A prospective observational cross-sectional study design. A convenience sample of 27 Israeli LVAD-implanted patients (mean age 62.4 ± 9, 86% male, 78.6% living with a partner) completed the LVAD Self-Care Behaviour Scale (1 = never to 5 = always) and Hospital Anxiety and Depression Scale (0 = not at all to 3 = most of the time). Data were collected before and after the onset of the COVID-19 pandemic in Israel. Statistical analyses included paired t-tests, Pearson's correlations, and one-way repeated measures ANOVAs.

RESULTS

During the COVID-19 pandemic, a significant decrease was found in patients' adherence to checking and recording their LVAD speed, flow, power and PI (Pulsatility Index) (P = 0.05), checking their INR (P = 0.01), and daily weighing (P < 0.01). The prevalence of some behaviours (e.g. regularly exercising) increased in some patients and decreased in others. Patients living without a partner worsened their adherence to some of the self-care behaviours (e.g. taking medicines as prescribed), compared with those living with a partner (M_b  = 5.0 ± 0 and M_d  = 5.0 ± 0, delta = 0 vs. M_b  = 5.0 ± 0 and M_d  = 4.6 ± 0.9, delta = -0.4, respectively; F = 4.9, P = 0.04). Women, and not men, tended to improve their adherence to the self-care behaviour such as avoiding kinking, pulling, or moving the LVAD driveline at the exit site (M_b  = 4.0 ± 1.0 and M_d  = 5.0 ± 0, delta = 1.0 vs. M_b  = 4.5 ± 0.9 and M_d  = 4.4 ± 1.2, delta = -0.1, F = 4.7, P = 0.04, respectively). In total, 41% (11) patients reported neither anxiety nor depression, 11% (3) reported anxiety, 15% (4) reported depression, and 44% (12) reported both anxiety and depression. No associations between anxiety and/or depression and self-care behaviours were found.

CONCLUSIONS

Priorities in self-care behaviours among patients with implanted LVAD changed after the onset of the COVID-19 pandemic. Factors that assisted with adherence to self-care behaviours included living with a partner and being female. The current results may guide further research on identifying behaviours that are at risk of not being maintained during a time of emergency.

"Be Your Own Doctor" Experiences of Patients With Transcatheter Aortic Valve Implantation During the Pandemic: A Qualitative Study

Background and Purpose: Although patients have had reduced access to healthcare institutions due to the COVID-19 pandemic and the related preventive measures, there is no current data on how the pandemic has affected patients who underwent transcatheter aortic valve implantation (TAVI), despite their need for close follow-up.This study investigated TAVI patients' experiences with self-care management during the pandemic. Methods: This study adopted a descriptive qualitative design. The sample consisted of 24 patients recruited using purposive sampling. Data were collected by telephone and analyzed using inductive content analysis. Results: The data were grouped under three themes: "vulnerability," "worsening of psychological condition," and "expectations." The most challenging self-care behaviors reported by TAVI patients were determined to be doing regular physical activity, managing their symptoms, complying with treatment, and attending regular check-ups. They also reported experiencing psychological problems such as fear, concern, and abandonment and stated a need for better communication and follow-up at home during the pandemic. Implications for Practice: The pandemic has more than ever demonstrated the importance of effective self-care for cardiovascular patients. Nurses should plan individualized interventions regarding the problems in self-care management that we identified in this study. In this regard, the use of secure digital applications such as telerehabilitation can be effective. Also, nurses should develop community-based and political initiatives to allow sustainable self-care management to be effectively implemented in special patient groups in extraordinary circumstances such as pandemics.

The Influence of COVID-19 Pandemic on the Health Seeking Behaviors of Adults Living With Chronic Conditions: A View Through the Health Belief Model

The COVID-19 pandemic resulted in disruption in every facet of life including health service delivery. This has threatened the attainment of global targets to improve health and wellbeing of all persons. In particular, for persons living with chronic diseases, who require consistent monitoring by health professionals and medication to enhance their health, understanding how the pandemic has disruption their access to health care delivery is critical for interventions aimed at improving health service delivery for all as well as preparedness for future pandemic. This study applied the constructs of the Health Belief Model, to explore the influences of the COVID-19 pandemic on the health seeking behaviors of persons living with chronic diseases. The design was exploratory descriptive. Semi-structured interviews were conducted to collect data among persons living with chronic diseases in the Cape Coast Metropolis of Ghana. Thematic analysis, both inductive and deductive, was conducted to unearth the findings. Awareness of increased susceptibility and risk of a more severe episode if they contracted COVID-19 as a result of the existing chronic diseases was identified. Lack of access to health professionals during the peak of the pandemic as well as the fear of contracting the virus while accessing their regular chronic disease clinic was the main barriers identified. Information in the media served as cues to action for adopting preventive health strategies. Behavior modifications; dietary and lifestyle, self-medication and adoption of COVID-19 related precautions were practiced. Susceptibility to contracting COVID-19 contributed to missed adherence to treatment appointment. The health belief model was a useful framework in exploring the health seeking behavior of the adults living with chronic conditions during the COVID-19 in this study setting. Intensifying targeted education for persons living with chronic diseases will contribute to the adoption of positive health seeking behaviors during future pandemic.

Self-Care Practices of Patients with Non-Communicable Diseases during the COVID-19 Pandemic: A Qualitative Study

Individuals with chronic non-communicable diseases (NCDs) have a higher risk of morbidity and mortality. This study explores the lived experience of patients with NCDs during the COVID-19 pandemic and the impact of COVID-19 on their self-care. An interpretive phenomenological analysis approach was used that involved in-depth interviews with patients who received medical services from a family medicine clinic, along with caregivers who responded on their behalf. An inductive thematic approach was utilized to analyze the data. Interview respondents included 17 patients with NCDs and four caregivers. The patients had a mean age of 65.7 ± 11.3 years and were diagnosed with an NCD, a mean of 4.8 ± 1.1 years previously. Self-care practices used during the pandemic were classified as therapeutic or preventive. Patients responded to changes in healthcare services by seeking in-person services for their acute illnesses and accepting remote services for underlying chronic conditions. The COVID-19 pandemic influenced the self-care practices of patients with NCDs. Most patients paid more attention to self-care during this time, while some became more concerned with other aspects of their life.

Nursing Research on Benign Prostatic Hyperplasia Based on Continuous Nursing Care

Purpose. To explore the nursing research of prostatic hyperplasia based on continuous nursing and based on the combination of medical care and nursing.Methods. A prospective study of 96 patients with benign prostatic hyperplasia admitted to our hospital from November 2019 to May 2021 was selected. According to the random number table method, they were divided into an observation group and a control group with 48 cases each. The control group used routine nursing and discharge guidance, and the observation group implemented continuous care based on the combination of medical care and nursing on the basis of the control group. The differences in the scores of quality of life, self-care ability, quality of life score, and sleep quality were compared between the two groups. Results. After 3 months of nursing, the quality of life scores (health status, psychology, social relationship, environment, physiology, and quality of life scores) of the observation group was higher than those of the control group ( $P<0.05$ ). After 3 months of nursing, the quality of life scores of disease, physiology, society, psychology, and satisfaction of the observation group was significantly higher than those of the control group, which was statistically significant ( $P<0.05$ ). After 3 months of nursing, the observation group’s sleep quality scores in all dimensions (time to fall asleep, sleep time, sleep quality, sleep efficiency, hypnotics, sleep disorders, and day disorders) were higher than those of the control group ( $P<0.05$ ). After 3 months of nursing, the observation group’s self-care skill score, self-responsibility score, health knowledge score, and self-concept score were better than those of the control group ( $P<0.05$ ). Conclusion. Continued nursing care based on the combination of medical and health care for prostate hyperplasia is beneficial to improve sleep quality and improve the patient’s quality of life score and self-care ability and provide certain references for clinical care of patients with benign prostatic hyperplasia.

Association between biopsychosocial factors and self-reported COVID-19 clinical complications in a Brazilian city

ABSTRACT Objective: This study aimed to analyze the existence of an association between the biopsychosocial profile of people affected and the number of self-reported clinical complications from COVID-19 in a Brazilian city. Methods: This is a cross-sectional (baseline) study, nested in a cohort study, carried out with 217 confirmed cases of COVID-19, interviewed from January to October 2021, during home visits, in a city in the south of Minas Gerais, Brazil. A structured questionnaire with the KoboToolbox resource was used. The independent variables were sociodemographic and clinical profile (comorbidities), quality of life, post-traumatic stress, anxiety, depression, and social support. The dependent variable was the number of self-reported clinical complications from COVID-19. The multivariate linear regression technique was adopted for the analyses. Results: The participants reported multiple clinical complications from COVID-19. There were “four or more” complications in 94.6% of the cases. Having a history of high blood pressure was associated with more complications post-SARS-CoV-2 infection, whereas having a caregiver and presenting with post-traumatic stress were associated with fewer COVID-19 complications. Conclusion: The multisystemic nature of the complications caused by COVID-19 and the associations identified emphasizes the need for an integrated approach to patients and for studies that monitor the effects of the disease on the demands placed on health systems, aiming to better understand and address them.

A bibliometric analysis on global eHealth

Background

The current coronavirus disease 2019 pandemic highlights the potential of eHealth. Drawing the knowledge map of eHealth research through data mining and visual analysis technology was helpful to systematically present the research status and future trends of global academic circles.

Methods

Based on the web of Science Core Collection (SCIE/SSCI) database, using bibliometric theory and visual analysis technology, this work analyzed the global eHealth research publications from 2000 to 2021, and introduced the interdisciplinary characteristics, hot topics and future trends in this field.

Results

A total of 10188 authors, 891 journals, 3586 institutions, 98 countries using 12 languages had conducted eHealth research in the world. The United States, the Netherlands, Australia and the United Kingdom were the main forces and international cooperation. However, the international co-operation between Eastern and Western countries was still relatively few. The frontier of global eHealth research mainly focused on #0eHealth innovation, #1physical activity, #2generalised anxiety disorder, #3lightweight authentication protocol, #4 eHealth information, #5technology readiness, #6 ehealth literacy scale, #7family carer, #8citance analysis, #9 guiding patient. Clusters #3 lightweight authentication protocol and #9 guiding patient were the latest clusters, indicating the research trend and direction of eHealth in the future.

Conclusions

Cooperation network framework at the regional, national and global levels and the cooperation of multidisciplinary teams with complementary backgrounds and expertise were needed to realize the in-depth popularization and application of eHealth knowledge. Interdisciplinary international cooperation should be the trend of eHealth research in the future.