Role of the Lebanese family caregivers in cardiac self-care: a collective approach

"It is something you live with, like an organ in your body" a qualitative study on the lived experiences of people suffering from chronic low back pain in Lebanon

PURPOSE

This paper aims to understand the distinctive biopsychosocial aspects and patient perspectives on chronic low back pain in Lebanon, an Arab country with a unique and rich cultural heritage.

METHOD

Qualitative, semi-structured interviews with 12 Lebanese patients purposefully sampled from various governorates. The interviews included participants from different geographic areas and religions. The data underwent analysis through an inductive thematic approach guided by a bounded relativist ontology, a subjectivist epistemology, and a descriptive phenomenological framework. The coding process was managed by computer-assisted qualitative data analysis software (QSR NVivo version 12.0).

RESULTS

The researchers identified and constructed two themes: (1) Chronic low back pain: understanding the impact, coping strategies, and communication patterns in lived experiences within the Lebanese context. This theme sheds light on the complexities of pain management and societal influences in Lebanon. (2) Explanatory model of patients living with chronic low back pain in Lebanon. This theme allowed an exploration of the multifaceted narratives of chronic low back pain.

CONCLUSION

This study found that Lebanese individuals attribute chronic low back pain to biomedical factors despite some recognizing psychosocial elements. It emphasizes the need to educate patients on the biopsychosocial model, facilitate better care, and dispel misconceptions.

Perceived Therapeutic Self-Care Ability of Patients in Surgical Units: A Multisite Survey

Assessing patients' therapeutic self-care ability allows nurses to initialize care and implement interventions to enhance their self-care abilities. However, sociocultural beliefs and determinants can affect patients' self-care practices. This study determined perceived therapeutic self-care ability of patients in surgical units in Pakistan. A survey was conducted using a purposive sample 511 patients admitted to surgical units for at least 24 hours. Data were collected using the Urdu version of Therapeutic Self-Care Measure. The mean self-care ability score was 20.05 ± 4.3. Patients felt more prepared to take their medications, but less prepared to respond to any unforeseeable physical changes. Significant difference was found between self-care ability of male (20.68 ± 4.15) and female (19.18 ± 4.27) (p < .001) patients. A weak negative correlation was found between patient age and self-care ability (r = -0.15, p = .001). Self-care ability assessment should be included in routine discharge planning, and nurses should provide more tailored self-care discharge education to surgical patients.

Why do they care? A qualitative systematic review and meta-synthesis of personal and relational motivations for providing informal care

Informal caregiving is crucial to the sustainability of health and social care systems globally. With ageing populations and a rising prevalence of acute and chronic health conditions, the need for informal care is growing, making it important to understand what motivates individuals to care and to continue caring. This paper reports findings of a systematic review which examined determinants of motivations and willingness to provide informal care. A systematic search was conducted using six electronic databases and a wide range of additional sources. 105 qualitative studies published before August 2019 were included with 103 of them reporting on personal and relational motivations, and the contextual factors underpinning these. Grounded theory-based, thematic synthesis was applied to synthesise the literature. This meta-synthesis reports on findings from across the world spanning three decades, with data from over 2500 caregivers across a range of health conditions. This paper presents the relational, personal and contextual themes. It highlights the significance of reciprocity, affection, family values and caregiving obligations. Personal characteristics, finding meaning, illness perceptions, situational and temporal aspects of caregiving are also identified as important in shaping motivations and willingness to care and to continue caring. Implications for theory, research, policy and practice are discussed.

Predictors of Effective Self-care Interventions Among Jordanians With Heart Failure

Jordan has dramatic increases in the prevalence of risk factors for heart failure. However, there are few studies addressing heart failure self-care in Jordan. Identifying predictors of heart failure self-care among Jordanian patients is crucial in providing comprehensive care including addressing risk factors. The study aimed to identify predictors of self-care behaviors among Jordanians with heart failure. A cross sectional study with a convenience sample of 300 Jordanian patients was performed in an educational hospital in the north of Jordan. Differences in the level of self-care between selected sociodemographic and clinical variables were identified using univariate statistics, and multiple regression was used to adjust estimates for covariates. The predictors of self-care were insomnia (p ≤ .001) and marital status (p = .018). Identifying factors influencing self-care can assist with addressing the causes of insomnia to ensure effective treatment, providing patients with social support, and eventually promoting heart failure self-care.

Cultural and societal motivations for being informal caregivers: a qualitative systematic review and meta-synthesis

Informal caregiving constitutes the mainstay of a society's care supply. Motivations for caring and continuing to provide care are crucial to understanding the nature of caregiver experiences and their relationship with the person/people they support. This systematic review of qualitative evidence examines determinants of motivations and willingness to provide informal care. 105 qualitative studies published before August 2019 and fitting the inclusion criteria were identified, 84 of them pertaining to cultural and societal motivations for caregiving. Grounded theory-based, thematic synthesis was conducted. Cultural and societal factors strongly underpinned motivations and willingness for informal caregiving. The main cultural motives for caregiving were cultural values and beliefs encompassing the ethnocultural context of the caregiving role, culture-specific norms, cultural and spiritual beliefs, illness beliefs and socialisation. Societal norms and perceived expectations, such as gendered roles, norms and expectations of caregiving, and perceptions of health and social care services further shaped caregiver motivations and willingness to provide care. These meta-synthesis findings contribute towards novel understandings about the cultural and societal aspects shaping informal care provision. These findings bear important implications for theory, research, policy and practice; all of which contributing to the issue of the sustainability of informal care from a 'macro' perspective.

Exploring Factors Associated With Depressive Symptoms Among Patients With Chronic Pain: A Cross-Sectional Multicenter Study

ABSTRACT

This cross-sectional study examined the factors associated with depression among people with chronic pain (PwCP) attending specialized pain clinics in Muscat, Oman. Two-hundred eighty-seven participants were recruited for the study, and univariate analyses were used to investigate the difference between individuals who scored above/below the cutoff points for depressive symptoms. A multiple regression analysis was used to detect the independent predictors. Twenty-six percent of participants scored above the cutoff point. Further analysis indicated that unstable family relationships pre-existing depressive symptoms (odds ratio [OR], 2.86; p = 0.044), a family history of depression (OR, 4.75; p = 0.019), severe pain (OR, 4.21; p < 0.006), having fibromyalgia (OR, 28.29; p = 0.005), and lumbago/truck (OR, 2.41; p = 0.039) were independent predictors of depressive symptoms. This study indicates that one in four patients with chronic pain also presents with depressive symptoms. However, the role of culture needs to be taken into consideration when interpreting these findings and when building on these data.

Awareness and attitudes towards advance care planning in primary care: role of demographic, socioeconomic and religiosity factors in a cross-sectional Lebanese study

OBJECTIVE

To assess awareness and attitudes towards engaging in advance care planning (ACP) and their relationship with demographic, socioeconomic and religiosity factors among Lebanese middle-aged to older-aged adults in primary care.

DESIGN

A cross-sectional survey study.

SETTING

Tertiary referral hospital in Beirut, Lebanon.

PARTICIPANTS

A total of 215 middle-aged to older-aged adults.

RESULTS

Out of 215 participants, 18.6% of participants knew about ACP; 94% favoured truth-telling; 87.4% favoured healthcare autonomy; 77.2% favoured documenting their own health values and preferences; and 29.3% were willing to undergo life-prolonging interventions. Among participants who were aware of ACP, 67.5% preferred ACP documentation and 85% had negative attitudes towards life-sustaining interventions. Women were more aware about ACP than men. Those who were willing to undergo life-prolonging interventions were found to be men and had higher religiosity scores.

CONCLUSION

Large deficit in ACP awareness was evident despite the high preference for healthcare autonomy. Medical and public health efforts should strive to enhance patients' ACP awareness and engagement in ACP while considering factors relevant to gender, culture and religiosity.

Getting back or giving back: understanding caregiver motivations and willingness to provide informal care

Background: Informal caregivers are those providing care, which exceeds that which is typically provided, to a relative or friend with care needs. Informal caregiving constitutes the backbone of a society’s care supply and with ageing populations the need for informal care is growing. We know little as to why caregivers start caring and continue doing so, yet understanding of motivations and willingness to provide care is important if informal caregivers are to be supported. However, both motivations and willingness are inconsistently defined making it difficult to compare the empirical findings that do exist.

Methods: This paper reviews and synthesises thinking about the theoretical constructs of motivations to provide care and willingness to perform informal care, and presents those in relation to existing theoretical and empirical literature.

Results and Conclusions: Theoretical reflections based on various motivational frameworks and available empirical data are presented to illustrate that: caregiving motivations should be conceptualised as multifaceted and multiply determined; intrinsic and extrinsic motivations should not be treated as antagonistic and can occur simultaneously; the commonly applied model of extrinsic/intrinsic motivations is oversimplified and omits consideration of the diversity of caregiver motives; other motivational models can be discerned in the context of the empirical research; there are differences between motivations and willingness to provide care with the latter being more consequent to the motives; both should be considered dynamic in nature; and finally, that the two constructs may not inevitably lead to actual caregiver behaviour. The implications of these theoretical reflections for methodology and research as well as their relevance for practice and policy are indicated.

A single educational intervention on heart failure self-care: Extended follow-up from a multisite randomized controlled trial

BACKGROUND

Heart failure outcomes remain poor, and little is known about the causes and predictors of these outcomes in Lebanon.

AIM

The purpose of this article is to report the causes and predictors of the 6- and 12-month readmission and mortality of previously recruited patients to the Family focused Approach to iMprove Heart Failure care In LebanonQualitY intervention (FAMILY) study.

METHODS

A multi-site block randomized controlled trial in three tertiary medical centers in Beirut. Initially, participants were randomized to either the control or the intervention group. The latter group, with their family caregivers, received heart failure self-care resources and an educational intervention on self-care and symptom management during their index admission. Participants from the FAMILY study were followed up with through phone calls for readmission and mortality at 6 and 12 months following their hospital discharge.

RESULTS

A total of 218 (85%) patients were followed up with for this evaluation. There was a significant difference between the intervention group and the control group in terms of mortality at 6 months (n=18 (16%) versus n=36 (33%); p<0.05) and 12 months (n=29 (26%) versus n=45 (42%); p<0.05) post the index discharge. Mortality at 6 and 12 months was associated with aging, lower body mass index scores and readmission at 30 days post the index admission. Results of a logistic regression for mortality at 6 months showed hypertensive etiology of heart failure and 30-day readmission to be the only significant predictors.

CONCLUSION

A single session intervention was associated with lower mortality, even after an extended period of time, possibly mediated by other variables. Future studies should be powered for such outcomes while also addressing the cultural needs and literacy levels of the patients using multi-session trials and more frequent follow-ups.

Determinants of Self-Care in Patients With Heart Failure: Observations From a Developing Country in the Middle East

Introduction: Self-care is recognized as a means for improving outcomes of heart failure (HF), yet studies have not addressed what predicts successful self-care in collectivist cultures like Lebanon. Methodology: Self-care was measured, using the Arabic Self-Care of HF index, in 100 participants with HF (76% males; mean age 67.59) recruited from a tertiary medical center. Results: Self-care was suboptimal, with mean scores of 67.26, 66.96, and 69.5 for self-care maintenance, management, and confidence. Better HF knowledge, social support, and self-care confidence and lower New York Heart Association score predicted better self-care maintenance. Better knowledge, social support, and self-care maintenance, no recent hospitalization, and being unemployed predicted better self-care confidence. Better self-care confidence, maintenance, and HF knowledge predicted better self-care management. Discussion: HF self-care in Lebanon is suboptimal. Nurses need to identify facilitators of and barriers to self-care particular to this population. Interventions targeting HF knowledge, confidence, and caregiver support are expected to improve self-care in Lebanese patients.

Perspectives on barriers and facilitators to self-care in Lebanese cardiac patients: A qualitative descriptive study

BACKGROUND

Cardiovascular disease is the leading cause of mortality worldwide. Cardiac self-care practices are essential for managing cardiac illness and improving quality of life. However, these practices may be affected by factors that may hinder or facilitate self-care especially in countries that experience political and economic instabilities.

OBJECTIVES

The purpose of this study was to explore self-care practices among Lebanese cardiac patients. Another aim was to reveal factors that might influence these self-care practices.

DESIGN

This is a qualitative descriptive study.

SETTING

Participants were recruited from a referral medical center in Beirut, Lebanon and interviews took place in their homes.

PARTICIPANTS

Purposive sample of 15 adult participants, seven females and eight males, diagnosed with coronary artery disease at least a year ago and not in critical condition recruited from the cardiology clinics of the medical center.

METHODS

Data were collected through semi-structured audio-recorded interviews that took place in their places of residents.

RESULTS

Three themes emerged from the data: I. The behaviors of cardiac patients demonstrated selected self-care practices; II. Patients identified barriers to self-care reflective of the Lebanese political and socio-economic situation; and, III. Patients described facilitators to self-care consistent with the Lebanese socio-cultural values and norms. The most common self-care practices included taking medications and eating properly. Participants emphasized avoiding stress and being upset as a self-protective measure for cardiac health. Health care costs, family responsibilities, psychological factors and the country's political situation impeded self-care practices whereas family support facilitated them.

CONCLUSION

Lebanese patients reported select self-care practices in dealing with their cardiac illness. Barriers and facilitators to their self-care behaviors reflected the Lebanese context and culture. Thus health care providers must assess their patients' practices within their sociocultural context so that interventions to promote self-care are tailored accordingly.