Self-care agency in two groups of pregnant women

Researchers' perspectives of self-agency within a context of violence and harm in maternity care

PROBLEM

There is an increasing awareness of the prevalence of obstetric violence within maternity care and that some women and birthing people are at greater risk of experiencing violence and harm.

BACKGROUND

Supporting self-agency for women and birthing people in maternity care may be a way of addressing the disparities in vulnerability to violence and harm.

AIM

To explore researchers' perspectives of self-agency for women from different backgrounds, what inhibits and prevents self-agency, and how self-agency can be enabled.

METHODS

A qualitative research design was undertaken underpinned by a reproductive justice framework. Group interviews were held with researchers working with perinatal women/birthing people with histories and experiences of violence and abuse. Reflexive thematic analysis using Bronfenbrenner's ecological systems theory was undertaken.

FINDINGS

12 participants took part in two group interviews. Two themes were developed: 'defining self-agency' and 'ecological influences on self-agency'.

DISCUSSION

The findings identify how self-agency should not be perceived as an intrinsic attribute, but rather is underpinned by exogenous and endogenous influences. Whether and how self-agency is enacted is determined by interacting factors that operate on a micro, meso and macro level perspective. Self-agency is undermined by factors including immigration policies and sociocultural perspectives that can lead to under-resourced and judgemental care, other intersectional factors can also lead to some individuals being more vulnerable to violence and harm.

CONCLUSION

Implications from this work include strategies that emphasise woman-centred care, staff training and meaningful organisational change to optimise positive health and wellbeing.

The relationship between self-care agency, disability levels and factors regarding these situations among patients with rheumatoid arthritis

AIMS AND OBJECTIVES

To assess the relationship between self-care agency scores, disability levels and factors regarding these situations among Turkish patients with rheumatoid arthritis.

BACKGROUND

Rheumatoid arthritis is characterised by severe to slight synovial joint inflammation that can lead to pain, stiffness and joint destruction with subsequent physical deformities, disabilities and reduced self-care. Self-care is an important component of comprehensive chronic disease management such as rheumatoid arthritis. If patients have high levels of self-care and adhere to rheumatoid arthritis treatment, it can be expected that they will have fewer symptoms and better functional capabilities.

DESIGN

A cross-sectional, design was used.

METHOD

This study was conducted with 467 rheumatoid arthritis patients who applied at the Rheumatology Outpatient Department of Gaziantep University between September 2008-February 2009. The data collection instruments used in this study were the Demographic Data Form, Health Assessment Questionnaire (including disability index and pain scale) and Self-as-Carer Inventory. The frequency, mean, Student's t-test, one-way anova, Kruskal-Wallis, chi-square, correlation and regression analysis were used; p < 0·05 was accepted as statistically significant.

RESULTS

For patients the self-care agency classification of 13·7% and 86·3% were 'moderate' and 'poor', respectively; while the disability levels of 12·2 51·2 and 36·6% were 'mild', 'moderate' and 'severe', respectively; and their pain average was 'moderate'. It was also determined that, as the patients' self-agency scores declined, their disability levels deteriorated even further and their pain levels increased even more.

CONCLUSIONS

In conclusion we found that in Turkish patients with Rheumatoid Arthritis, the higher disability and pain rate were, the lower self-care agency score was.

RELEVANCE TO CLINICAL PRACTICE

Nurses should strive to provide individuals with RA the knowledge, skills and resources necessary for active participation in self-care, as this might promote the capacity for self-care.

Reliability, validity and factor structure of the Appraisal of Self-Care Agency Scale-Revised (ASAS-R)

RATIONALE, AIMS AND OBJECTIVES

Self-care agency is a fundamental concept in nursing and health care research. Having self-care agency enhances an individual's health-promoting behaviours and/or specific capabilities for chronic disease self-management. The purpose of this study was to continue the development and psychometric testing of the Appraisal of Self-Care Agency - Revised (ASAS-R).

METHODS

A cross-sectional methodological design was used to examine the reliability, validity and factor structure of the ASAS-R among individuals from the general population. The sample consisted of 629 adults who were randomly selected to conduct an exploratory factor analysis (EFA; n=240) and a confirmatory factor analysis (CFA; n=389) of the scale. A demographic questionnaire, the ASAS-R and the Health-Promoting Lifestyle Profile (HPLP-II) were the measures used to collect the data.

RESULTS

The final 15-item three-factor ASAS-R had an overall Cronbach's alpha (α) of 0.89. The three factors extracted, rotated and scored in this study were labelled: having power for self-care, developing power for self-care and lacking power for self-care. All inter-items and item-to-total correlations met recommended criteria of r=0.30 to r=0.70, except for one of the items that had an item-to-total correlation of 0.71, slightly exceeding the maximum recommended item-to-total correlation. The three factors had Cronbach's alphas of 0.86, 0.83 and 0.79, respectively. The three factors together explained 61.7% of the scale items variance. Each item of the scale had a strong factor loading ranging from 0.52 to 0.81. All measures of model fit exceeded the recommended criteria, indicating that the 15-item ASAS-R had a very good fit (χ(2) /d.f.=1.97, GFI=0.94, AGFI=0.92, CFI=0.96, TLI=0.95, RMSEA=0.05, RMR=0.05 and the PCLOSE=0.48).

CONCLUSIONS

The 15-item three-factor ASAS-R is a short, reliable and valid instrument to measure self-care agency among individuals from the general population, but further psychometric evaluation is needed among individuals with chronic diseases, especially those with diabetes mellitus.

[Applications of Orem's Theory in addressing interventions during pregnancy and climateric]

The aim of this paper is to develop applications of Orem's Theory of Self Care in order to address nursing interventions during pregnancy and menopause, and to determine its usefulness as a theoretical framework for addressing self care during stages of development. It is concluded that the application by nurses and midwives of this theoretical framework, in assisting women during pregnancy and menopause, contributes to identifying the requirements of self care, the required interventions, necessity of self care and the methods of assistance that women require with special emphasis on training and development of self care procedures.

The relationship between disability and self-care agency of Turkish people with rheumatoid arthritis

AIM

This study aims to determine the relationship between disability levels and self care agency scores in Turkish patients with rheumatoid arthritis and to investigate the factors affecting them.

BACKGROUND

Self-care agency is the complex acquired ability to meet one's constant requirements for care that regulates life processes, maintains or promotes the integrity of human structure, functioning and development, and promotes well-being.

DESIGN AND METHODS

Forty-three consecutive patients with Rheumatoid Arthritis (M/F: 11/32; mean age 49.53 +/- 13.37 years; disease duration 118.32 +/- 76.55 months), being followed up by Ege University Rheumatology Outpatient Department and all fulfilling ACR 1987 criteria were included in this study. Data collection instruments used in this study were Informative-Demographic Data Form, Health Assessment Questionnaire (including disability index and pain scale) and Self-as-Carer Inventory.

RESULTS

The mean disability index, the mean pain score and the mean self-care agency score of patients were 0.53 (SD 0.45), 1.48 (SD 0.74) and 80.95 (SD 27.80) were respectively. Self-care agency of patients found moderate level. It was found that a positive correlation between the disability index and the self-care agency scores (r = 0.488; p < 0.01). It was found that in male (t = 0.907; p = 0.000), in patients graduate from university (F = 0.271; p = 0.001), the self-care agency was better than other patients.

CONCLUSION

In conclusion we found that in Turkish patients with Rheumatoid Arthritis, the higher the disability rate was, the lower the self-care agency score was.

RELEVANCE TO CLINICAL PRACTICE

Disability, pain and their impact on self-care agency should be focused on in everyday care for Rheumatoid Arthritis patients. These areas are most important in nursing care and should be considered while organizing the medical treatment and rehabilitation programme.

Relationships among self-care agency, self-efficacy, self-care, and glycemic control

Costly complications of diabetes often arise from poor glycemic control. Appropriate diabetes self-care management may improve control. This study examined whether self-care management affects glycemic control and mediates relationships between self-efficacy and self-care agency with glycemic control. In a cross-sectional correlational design, data from a prior study of 141 insulin-requiring adults with type 1 or type 2 diabetes were examined using descriptive statistics, Pearson's correlation, and multiple hierarchical regression. Findings indicated that greater self-care agency and self-efficacy lead to greater self-care management, in turn leading to better glycemic control. Self-care management did not mediate between self-efficacy or self-care agency and glycemic control. Thus, beliefs or capabilities for self-care are insufficient to improve glycemic control; doing so requires self-care management.

Self-care in adults with sickle cell disease

This article summarizes the psychometric evaluation of the Chronic Illness Assessment Interview for Sickle Cell Disease (CIAI-SCD), an instrument based on a model of self-care for adult patients with chronic medical conditions. The CIAI-SCD was administered to 104 adults with sickle cell disease. A factor analysis identified three factors that reflected the psychological constructs of Personal Satisfaction and Perceived Control (Factor 1), Feeling Concerned and Worried (Factor 2), and Feeling Supported (Factor 3). Preliminary evidence for the internal consistency, test-retest reliability content validity, and construct validity of the CIAI-SCD was obtained. After further refinement and validation, the CIAI-SCD may be a useful tool for assessing factors related to self-care skills among adults with sickle cell disease.