Exploring self-efficacy as a predictor of disease management

Social Cognitive Predictors of Health Promotion Self-Efficacy Among Older Adults During the COVID-19 Pandemic

PURPOSE

To examine the relative importance of social cognitive predictors (ie, performance accomplishment, vicarious learning, verbal persuasion, affective state) on health promotion self-efficacy among older adults during COVID-19.

DESIGN

Cross-sectional.

SETTING

Data collected online from participants in British Columbia (BC), Canada.

SUBJECTS

Seventy-five adults (n = 75) aged ≥65 years.

MEASURES

Health promotion self-efficacy was measured using the Self-Rated Abilities for Health Practices Scale. Performance accomplishment was assessed using the health directed behavior subscale of the Health Education Impact Questionnaire; vicarious learning was measured using the positive social interaction subscale of the Medical Outcomes Survey - Social Support Scale (MOS-SSS); verbal persuasion was assessed using the informational support subscale from the MOS-SSS; and affective state was assessed using the depression subscale from the Depression Anxiety Stress Scale (DASS-21).

ANALYSIS

Multiple linear regression was used to investigate the relative importance of each social cognitive predictor on self-efficacy, after controlling for age.

RESULTS

Our analyses revealed statistically significant associations between self-efficacy and performance accomplishment (health-directed behavior; β = .20), verbal persuasion (informational support; β = .41), and affective state (depressive symptoms; β = -.44) at P < .05. Vicarious learning (β = -.15) did not significantly predict self-efficacy. The model was statistically significant (P < .001) explaining 43% of the self-efficacy variance.

CONCLUSION

Performance accomplishment experiences, verbal persuasion strategies, and affective states may be the target of interventions to modify health promotion self-efficacy among older adults, in environments that require physical and social distancing.

Mechanism study of social media overload on health self-efficacy and anxiety

Previous studies have found that people's excessive use of social media may have a negative impact on their crisis coping skills. This study focuses on the effects of social media overload (information overload, communication overload and social overload) on anxiety and health self-efficacy during the COVID-19 pandemic. The study used an online questionnaire and partial least squares structural equation modeling (PLS-SEM) to obtain data (816 valid samples), analyze the data and validate the model. The findings revealed that social media overload (information overload, communication overload and social overload) triggers increased social media fatigue, which in turn leads to the development of anxiety and the consequence of diminished health self-efficacy; social media fatigue plays a partially mediating role between social media and health self-efficacy and a fully mediating role between communication overload and health self-efficacy. The results of this study can inform the development of crisis communication strategies during public health emergencies.

Mindsets and self-efficacy beliefs among individuals with type 2 diabetes

Growth mindsets and self-efficacy beliefs have been known to predict and promote resilience, challenge seeking, and improved outcomes in areas such as education and intelligence. However, little is known about the role of these two potentially influential beliefs in the context of type 2 diabetes (T2D), specifically in terms of whether and in which domains (i.e., beliefs toward general life, general health, or condition-specific domains) these beliefs-or lack thereof-is prevalent among individuals with T2D. Given the lifelong challenges that individuals with diabetes often encounter with managing their disease, many may slip into a conceding negative belief that their diabetes is "too difficult to control" or simply "out of their hands," inhibiting proactive self-management efforts. Results from our study (n = 893) revealed that individuals with T2D had a significantly lower growth mindset towards their blood glucose level and lower self-efficacy towards their general health, blood glucose, and cholesterol levels compared to those without T2D. Among participants with T2D, further analyses showed a pattern of higher HbA1c among those with lower growth mindsets and self-efficacy toward their general health or blood glucose level. These findings identify the belief-domains that may pose barriers to necessary self-care behaviors, informing future interventions to promote improved diabetes care and management.

The construct validity of an abridged version of the general self-efficacy scale for adults with attention-deficit/hyperactivity disorder

Objectives

The General Self-Efficacy (GSE) scale is a validated self-rated questionnaire increasingly used in mental health research. However, despite several psychometric advantages of the GSE scale, its validity in those diagnosed with attention-deficit/hyperactivity disorder (ADHD) has not yet been examined. Moreover, a shorter version of the GSE scale would contribute to a more rational use of resources in extensive multivariate studies. Therefore, as self-rated scales to measure self-efficacy in this population are lacking, the current study aims to develop a condensed version of the GSE for adults with ADHD.

Methods

A group of patient collaborators (user representatives) from an ADHD organization and health professionals shortened the original 10-item GSE scale to six items and evaluated the content validity of the revised scale. Second, 525 potential participants were invited to participate in a cross-sectional study conducted in 2021 (between January 19th and February 7th). Of them, 403 filled out the GSE-6 for ADHD and two scales measuring psychological well-being and mental health (the five-item World Health Organization Well-Being Index, WHO-5, and the four-item Patient Health Questionnaire, PHQ-4). The psychometric properties of the new scale were examined, testing a priori formulated hypotheses.

Results

The brief GSE-6 for ADHD displayed good internal consistency with a Cronbach's α of 0.907. No floor or ceiling effect was detected. Exploratory and confirmatory factor analyses supported a one-factor structure. The GSE-6 also showed a moderate positive correlation with the WHO-5 (rs = 0.578) and a moderate negative correlation with the depression and anxiety rating scale PHQ-4 (rs = -0.595).

Conclusion

The 6-item GSE for ADHD was evaluated to have good content validity. The scale demonstrated good psychometric properties. The results indicate that the GSE-6 may help assess self-efficacy in adults with ADHD.

Expected increase in health competence improves over modules of an unguided internet-based cognitive-behavioural therapy for obsessive-compulsive disorder

Internet-based cognitive-behavioural interventions (iCBT) are a valuable alternative to face-to-face psychotherapy. An unguided iCBT program has shown to be efficacious for patients with obsessive-compulsive disorder (OCD). However, the modules' mode of action is not well understood, which is the objective of the present study. Twenty-five patients with OCD who participated at the iCBT program for 8 weeks answered a questionnaire on their self-efficacy, motivation, expected increase in health competence and experiential avoidance before and after each module and were included in the present analyses. Linear mixed-effects models demonstrated that patients' expected increase in health competence improved over the course of the treatment. No within-module-specific effect was found. The iCBT program was able to improve patients' expected health competence. However, all other variables did not change. The iCBT program should be revised by focusing more strongly on the integration of the content to reduce experiential avoidance and to improve motivation.

A multi-country survey of the socio-demographic factors associated with adherence to COVID-19 preventive measures during the first wave of the COVID-19 pandemic

BACKGROUND

Health behaviours are influenced by individual characteristics including age, gender, education and economic level. This study aimed to assess the associations between individual-level determinants and adherence to COVID-19 preventive measures.

METHODS

We performed secondary analyses of international data collected using an online survey during the first wave of the COVID-19 pandemic between June and December 2020. The dependent variables were self-reported adherence to COVID-19 preventive measures (wearing of face masks, frequent washing/sanitizing of hands, physical distancing, working remotely). The independent variables were age, sex at birth (female vs male), having a chronic disease related elevated risk for severe COVID-19 (none/little, might be at increased risk, at increased risk), educational level completed (no formal education, primary, secondary vs college/university) and employment status (retiree, students, not employed vs employed). Four multivariate logistic regression analyses were conducted to determine the associations between the dependent variables and independent variables. Interaction terms with country-income level were tested in regressions to explore its moderating effect.

RESULTS

Out of 16,866 respondents, 12,634 (74.9%) wore masks or face coverings, 12,336 (73.1%) washed or sanitized their hands frequently, 11,464 (68.0%) reported adherence to physical distancing and 5,646 (33.5%) worked remotely. In adjusted analyses, increased age, college/university education, employment, and having risks for severe COVID-19 were associated with significantly higher odds of adhering to COVID-19 preventive measures. Retirees and students had lower odds of adhering to COVID-19 prevention measures than employed individuals. Males had significantly lower odds of wearing face masks (AOR: 0.901), frequent washing/sanitizing hands (AOR: 0.774) and working remotely (AOR: 0.875) compared to females. Country-income level generally moderated the above relationships such that the associations disappeared in lower income countries.

CONCLUSION

The study findings suggest that the individual socio-demographic factors-age, sex, employment status, education status and having a chronic disease - influence adherence to COVID-19 preventive measures. Findings further reiterate the need for health education and health promotion campaigns on preventive health measures to focus on subpopulations, such as younger males, students and retirees, that require targeted or unique messaging.

Waist-What? Can a single sensor positioned at the waist detect parameters of gait at a speed and distance reflective of older adults' activity?

One of the problems facing an ageing population is functional decline associated with reduced levels of physical activity (PA). Traditionally researcher or clinician input is necessary to capture parameters of gait or PA. Enabling older adults to monitor their activity independently could raise their awareness of their activitiy levels, promote self-care and potentially mitigate the risks associated with ageing. The ankle is accepted as the optimum position for sensor placement to capture parameters of gait however, the waist is proposed as a more accessible body-location for older adults. This study aimed to compare step-count measurements obtained from a single inertial sensor positioned at the ankle and at the waist to that of a criterion measure of step-count, and to compare gait parameters obtained from the sensors positioned at the two different body-locations. Step-count from the waist-mounted inertial sensor was compared with that from the ankle-mounted sensor, and with a criterion measure of direct observation in healthy young and healthy older adults during a three-minute treadmill walk test. Parameters of gait obtained from the sensors at both body-locations were also compared. Results indicated there was a strong positive correlation between step-count measured by both the ankle and waist sensors and the criterion measure, and between ankle and waist sensor step-count, mean step time and mean stride time (r = .802-1.0). There was a moderate correlation between the step time variability measures at the waist and ankle (r = .405). This study demonstrates that a single sensor positioned at the waist is an appropriate method for the capture of important measures of gait and physical activity among older adults.

Translation and Psychometric Properties of the Strategies Used by People to Promote a Health Instrument for the Assessment of Self-Care Self-Efficacy among Patients Undergoing Hemodialysis in Vietnam

Self-care and self-efficacy play an important role in predicting quality of life among patients undergoing hemodialysis, but there currently is a lack of an instrument in the Vietnamese language for assessing self-care and self-efficacy. This limits the ability of researchers to explore and determine the confidence patients have in their ability to perform relevant self-care activities. The purpose of this investigation was to assess the validity and reliability of the Strategies Used by People to Promote Health questionnaire-Vietnamese version. This cross-sectional study involved translation, validation, and cultural adaptation of the questionnaire into Vietnamese and a trial with 127 patients undergoing hemodialysis in Bach Mai Hospital (Hanoi, Vietnam). The questionnaire was translated by bilingual translators and validated by three experts. Internal consistency and confirmatory factor analysis were applied. This questionnaire demonstrated good content validity and a Cronbach's alpha of 0.95 for the total scale. Confirmatory factor analysis of the three-factor model showed moderate model fit (comparative fit index = 0.84, Tucker-Lewis coefficient = 0.82, root mean square error of approximation = 0.09). Overall, this questionnaire exhibited acceptable validity and reliability for measuring self-care and self-efficacy among patients undergoing hemodialysis.

A better self-efficacy is predictive of better health-related quality of life (HRQoL) in patients with systemic lupus erythematosus: data from the Almenara Lupus Cohort

OBJECTIVE

To determine the possible predictive value of self-efficacy on health-related quality of life (HRQoL) in patients with SLE.

METHODS

Patients with SLE from the Almenara Lupus Cohort were included. Self-efficacy was ascertained with the six domains from the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy for managing chronic conditions. For PROMIS domains, a score of 50 is the average for a clinical population (people with a chronic condition), a higher score indicates that the respondent has greater self-efficacy. HRQoL was ascertained with the physical and mental component summary (PCS and MCS) measures of the Short-Form 36 (SF-36). Generalised estimating equations were performed, using as outcome the PCS or MCS in the subsequent visit, and the self-efficacy domain in the previous visit; multivariable models were adjusted for possible confounders. The confounders were measured in the same visit as the self-efficacy domain.

RESULTS

Two-hundred and nine patients for a total of 564 visits were included; 194 (92.8%) patients were women and mean age at diagnosis was 36.4 (14.0) years. In the multivariable models, a better PCS was predicted by a better self-efficacy for managing symptoms, managing medications and treatments and managing social interactions and general self-efficacy; a better MCS was predicted by a better self-efficacy for managing daily activities, managing symptoms, managing medications and treatments and managing social interactions.

CONCLUSION

A better self-efficacy is predictive of subsequent better HRQoL, even after adjustment for possible confounders. These results should encourage clinicians to develop strategies to improve self-efficacy in patients with SLE.

Facing Pain Together: A Randomized Controlled Trial of the Effects of Facebook Support Groups on Adults With Chronic Pain

Despite the popularity and affordances of social media groups for people with chronic conditions, there have been few controlled tests of the effects of these groups. This randomized controlled superiority trial examined the effects of Facebook groups on pain-related outcomes and tested whether a professional-led group leads to greater effects than a support group alone. We randomly assigned 119 adults with chronic pain to one of two Facebook group conditions: a standard condition (n = 60) in which participants were instructed to offer mutual support, or a professional-led condition (n = 59) in which the investigators disseminated empirically-supported, socially-oriented psychological interventions. Four groups were run (2 standard, 2 professional-led), each lasting 4 weeks and containing approximately 30 participants. Measures were administered at baseline, post-intervention, and 1-month follow-up. Across conditions, participants improved significantly in primary outcomes (pain severity and interference; medium-large effects) and a secondary outcome (depressive symptoms; small-medium effect), and they retained their outcomes 1 month after the groups ended. The 2 conditions did not differ on improvements. Overall, this study supports the use of social media groups as an additional tool to improve chronic pain-related outcomes. Our findings suggest that professional intervention may not have added value in these groups and that peer support alone may be driving improvements. Alternatively, the psychosocial intervention components used in the current study might have been ineffective, or more therapist direction may be warranted. Future research should examine when and how such guidance could enhance outcomes. PERSPECTIVE: Findings from this randomized trial support the use of both standard and professional-led Facebook groups as an accessible tool to enhance the lives of adults with chronic pain. This article provides direction for how to improve social media groups to optimize outcomes and satisfaction for more users.

The impact of online health community engagement on lifestyle changes: A serially mediated model

Background

Due to reduced physical labor and increased food availability, making healthy lifestyle changes is becoming increasingly challenging. Prior studies have suggested that strong ties (such as friends or family members) help promote positive lifestyle behavior changes while weak ties like online friends hardly make a difference in activating healthy lifestyle changes. More recent studies have found evidence of positive lifestyle changes brought about by health APPs. Yet, the process through which online health community (OHC) engagement is related to healthy lifestyle changes has not been fully explored.

Methods

Drawing on social network theory and the self-efficacy literature, we argued that the information and emotional support which users obtained from OHCs is positively associated with health self-efficacy, which in turn is positively associated with lifestyle changes. Then we constructed a serially mediated model between OHC engagement and healthy lifestyle changes and collected 320 valid questionnaires through an online survey. We tested the model by applying structural equation modeling via Mplus 8.3, which uses bootstrapping (5,000 samples) to test the significance of the mediated paths.

Results

This study demonstrated that the informational and emotional support that users receive from OHC engagement positively affects healthy lifestyle changes via the mediating role of health self-efficacy. We also found that healthy lifestyle changes are an outcome of enhanced health self-efficacy through the effect of informational and emotional support from OHC engagement.

Conclusions

Our findings help explain how OHC users make healthy lifestyle changes by utilizing the informational and emotional support to develop health self-efficacy. The results also highlight the value of informational and emotional support as important resources which users acquire from OHC engagement. Thus, we suggest that OHC users utilize the informational and emotional support to enhance health self-efficacy and facilitate healthy lifestyle changes. Future research could explore the dynamic process through which OHC engagement influences lifestyle changes by designing longitudinal research and addressing the limitations of the present study.

Is Teleaudiology Achieving Person-Centered Care: A Review

Digital health and person-centered care are unquestionably linked in today’s Australian healthcare landscape. Teleaudiology is the application of digital health in the field of audiology, and it has become a popular component of standard audiological care. Behavior modification is essential in audiology intervention. Guidance on achieving behavior change, which is dependent on digitally enabled intervention, is a valuable resource when used in tandem to achieve person-centered care. The aim of this review is to determine whether teleaudiology achieves person-centered care. A qualitative review was conducted, followed by mapping and analysis. Analysis identified evidence of teleaudiology use, and ascertained guiding principles are appropriate to behavior change dependent digital intervention supported or enabled person-centered care. In conclusion, teleaudiology will continue to be a promising technology for promoting relatedness, a positive user experience, confidence and capability, and appropriate levels of autonomy for the user to choose from among the person-centered care options available.

Health information seeking and sharing behavior of young adults on social media in Pakistan

Social media such as Facebook, YouTube, WhatsApp, and Twitter have radically enhanced the public access to health information. Still, studies have unexplored the factors that contribute toward such behaviors especially in developing countries. Therefore, this study identifies the factors that contribute to the likelihood of young adults’ health information seeking and sharing on social media. Specifically, drawing upon health belief model (HBM), the study attempts to understand how health belief and e-Health literacy affects health information seeking and sharing on social media. The study collected data from 413 young adults through Google Forms on a random basis. The results generated applying structural equation modeling confirmed that HBM related factors such as perceived susceptibility, perceived severity and perceived benefits positively while perceived barriers negatively influence young adults’ health information seeking and sharing intentions on social media. Furthermore, e-Health literacy was positively associated with health information seeking and sharing intentions on social media. This study is amongst a first few studies in the context of developing world to investigate the young adults’ intentions of seeking and sharing health information on social media based on HBM.

Grouping Together to Fight Cancer: The Role of WeChat Groups on the Social Support and Self-Efficacy

With the increasing number of cancer survivors, the question of how to coexist with cancer has become more and more pressing. This research uses a mutual help WeChat group organized by cancer patients as the research field to observe the daily interactions of cancer patients, so as to improve understanding of how social media technology can help cancer patients in the treatment and recovery process. The study found that the WeChat group is the main source of health knowledge for the participating cancer patients, and that when compared to traditional web-based patient mutual aid communities, the WeChat group is a more timely, popular, continuous, and accurate source of information. Patients in the group can listen and respond to each other's questions and worries, providing both an outlet for patients to vent their emotions and concerns and a source of recognition and encouragement. In addition, this study found that the WeChat mutual aid group improves patients' self-efficacy of disease on four levels: successful experience in curing patients, imitating patients' behavior, verbal persuasion, and emotional support.

Internet+Continuing Nursing (ICN) Program Promotes Motor Function Rehabilitation of Patients With Ischemic Stroke

BACKGROUND AND PURPOSE

Ischemic stroke is a severe disorder with high rates of death and recurrence that causes disability in patients and for which there is currently no effective treatment. Internet-based rehabilitation helps patients with disability recover at home with the help of their household or family members in a nonclinical setting. However, the effects of the internet+continuing nursing (ICN) program on the recovery of patients after ischemic stroke remains unknown.

METHODS

In the present study, patients were treated with an ICN-based rehabilitation training program; subsequently, the Self-efficacy Scale for Chronic Disease, Questionnaire of Exercise Adherence, Motor Assessment Scale, Activities of Daily Living, and Stroke-specific Quality of Life were performed to evaluate the effects of the ICN program on patient self-confidence to persist with rehabilitation, functional exercise compliance, motor function, ability to live independently and quality of life following ischemic stroke.

RESULTS

We observed that, after the ICN intervention for 6 weeks and 3 months, the scores of Self-efficacy Scale for Chronic Disease, Questionnaire of Exercise Adherence, Motor Assessment Scale, Activities of Daily Living, and Stroke-specific Quality of Life in the ICN-treated group were significantly higher compared with those in the control group.

CONCLUSION

These results suggested that the ICN program may promote the recovery of patients after ischemic stroke.

Biopsychosocial Profiles of Patients With Cardiac Disease in Remote Rehabilitation Processes: Mixed Methods Grounded Theory Approach

Background

Digital development has caused rehabilitation services and rehabilitees to become increasingly interested in using technology as a part of rehabilitation. This study was based on a previously published study that categorized 4 groups of patients with cardiac disease based on different experiences and attitudes toward technology (e-usage groups): feeling outsider, being uninterested, reflecting benefit, and enthusiastic using.

Objective

This study identifies differences in the biopsychosocial profiles of patients with cardiac disease in e-usage groups and deepen the understanding of these profiles in cardiac rehabilitation.

Methods

Focus group interviews and measurements were conducted with 39 patients with coronary heart disease, and the mean age was 54.8 (SD 9.4, range 34-77) years. Quantitative data were gathered during a 12-month rehabilitation period. First, we used analysis of variance and Tukey honestly significant difference test, a t test, or nonparametric tests—Mann–Whitney and Kruskal–Wallis tests—to compare the 4 e-usage groups—feeling outsider, being uninterested, reflecting benefit, and enthusiastic using—in biopsychosocial variables. Second, we compared the results of the 4 e-groups in terms of recommended and reference values. This analysis contained 13 variables related to biomedical, psychological, and social functioning. Finally, we formed biopsychosocial profiles based on the integration of the findings by constant comparative analysis phases through classic grounded theory.

Results

The biomedical variables were larger for waistline (mean difference [MD] 14.2; 95% CI 1.0-27.5; P=.03) and lower for physical fitness (MD −0.72; 95% CI −1.4 to −0.06; P=.03) in the being uninterested group than in the enthusiastic using group. The feeling outsider group had lower physical fitness (MD −55.8; 95% CI −110.7 to −0.92; P=.047) than the enthusiastic using group. For psychosocial variables, such as the degree of self-determination in exercise (MD −7.3; 95% CI −13.5 to −1.1; P=.02), the being uninterested group had lower values than the enthusiastic using group. Social variables such as performing guided tasks in the program (P=.03) and communicating via messages (P=.03) were lower in the feeling outsider group than in the enthusiastic using group. The feeling outsider and being uninterested groups had high-risk lifestyle behaviors, and adherence to the web-based program was low. In contrast, members of the being uninterested group were interested in tracking their physical activity. The reflecting benefit and enthusiastic using groups had low-risk lifestyle behavior and good adherence to web-based interventions; however, the enthusiastic using group had low self-efficacy in exercise. These profiles showed how individuals reflected their lifestyle risk factors differently. We renamed the 4 groups as building self-awareness, increasing engagement, maintaining a healthy lifestyle balance, and strengthening self-confidence.

Conclusions

The results facilitate more effective and meaningful personalization guidance and inform the remote rehabilitation. Professionals can tailor individual web-based lifestyle risk interventions using these biopsychosocial profiles.

Users' Intention to Continue Using Online Mental Health Communities: Empowerment Theory Perspective

INTRODUCTION

Online mental health communities may provide new opportunities for rehabilitation for people with mental illness, so it is important to understand the factors that influence the continued use of online mental health communities by people with mental illness.

METHODS

From the perspective of empowerment, based on the theory of health self-efficacy and expectation confirmation, this study explored the mediating role of health self-efficacy and expectation confirmation in the empowerment process of patients in online mental health communities and users' intention to continue using online mental health communities. To verify this model, we obtained 272 valid questionnaires. The SmartPLS 3.0 software was selected for model construction and empirical analysis.

RESULTS

Health self-efficacy completely mediates the relationship between the empowerment process (i.e., emotional support, information support, helping others and sharing experiences) and users' intention to continue using an online mental health community. Expectation confirmation partially mediates the relationship between the empowerment process (i.e., information support and finding recognition) and users' intention to continue using an online mental health community.

CONCLUSION

The empowerment process is the main predictor of user health self-efficacy and expectation confirmation. This study has certain theoretical and practical significance for online mental health community research.

Psychosocial Impact of COVID-19 Pandemic in Libya: A Cross-Sectional Study

Background: Since the outbreak of COVID-19 were announced in Wuhan, China, the virus has spread in most countries. After one year of restrictive measures applied by governments, it is unclear how this prolonged social distancing has affected the mental health of individuals in Libya. Therefore, the present study aims to assess the levels of perceived stress, depression, sleep disturbance, and self-efficacy associated with the pandemic in Libya and their association with the demographic factors. Methods: A cross-sectional study was conducted between October 10 and November 10, 2020 in 21 cities in Libya using an online survey. The survey collected socio-demographic variables and other important psychological variables using valid scales: namely, the Perceived Stress scale, the PROMIS Depression scale, the PROMIS Sleep Disturbance scale, and self-efficacy 6-item scale. Additionally, data were collected regarding eating and smoking habits, housing and living situations, and the preparedness of the public to manage the upcoming waves of the pandemic. Results: The questionnaire was accessed 746 times, and a total of 683 completed questionnaires were analyzed (response rate of 91.6%), with ages ranging from 18 to 94 years (Mean ± SD = 27.09 ± 10.57). Among the respondents, 58.4% were females and 77% were from the age group 18-29 years. The perceived stress, depression, and sleep disturbance symptoms were high in overall population. For stress, 52.7 and 17.1% of respondents reported moderate and high stress, and for sleep quality 28.8 and 8.1% reported moderate and high sleep disturbance, respectively. For depression, the overall median score was 20 (out of 40). The perceived stress, depression, and sleep disturbance were more prevalent among females and the younger age groups (18-29 years old). The overall self-efficacy median total score was 6.67 (out of 10), with a significantly higher median total score for males than females (7 vs. 6.33, p = 0.001). About 14.5% of the respondents were regular cigarette smokers, and most of them (79.8%) described their smoking habits during the previous month as more than typical. In addition, the reported eating habits of almost half of the respondents (43%) had changed, with about one-third (29.6%) reporting that their eating habits had become less healthy during the pandemic. Conclusion: The findings of this research suggest increased levels of stress, depression, and sleep disturbances as well as COVID-19-related fear during the pandemic, especially among young females. This alarming finding urgently calls for safe and low-barrier interventions to help mentally burdened individuals. This study makes a significant contribution in providing essential data on the psychological and social impacts on the Libyan population due to the COVID-19 pandemic.

The influence of opioid-taking self-efficacy and social support on pain management satisfaction in outpatients with cancer pain

PURPOSE

The purpose of this study was to explore the correlations between patients' opioid-taking self-efficacy, social support, and their pain management satisfaction, and to evaluate the effect of social support and opioid-taking self-efficacy in explaining the variance in pain management satisfaction.

METHODS

We used a cross-sectional and correlational research design and recruited 123 cancer patients via convenience sampling. We used the following instruments: the Opioid-Taking Self-Efficacy Scale, the Inventory of Socially Supportive Behavior, and the Chinese version of the Pain Treatment Satisfaction Scale.

RESULTS

There were significant and negative correlations between opioid-taking self-efficacy and pain management satisfaction (r =  - .43, p < .001) and between social support and pain management satisfaction (r =  - .47, p < .001). Using a hierarchical regression analysis, social support and opioid-taking self-efficacy explained 17.20% and 5.20%, respectively, of the variance in pain management satisfaction.

CONCLUSIONS

The results of this study confirm the importance of social support and opioid-taking self-efficacy in influencing pain management satisfaction. We recommend that professional care providers develop relevant intervention aimed at improving patients' pain management satisfaction.

Factors affecting individual online rumor sharing behavior in the COVID-19 pandemic

With the outbreak of COVID-19, online sharing of rumors about the disease is of growing concern worldwide. Drawing on the stimulus–organism–response (S–O-R) framework, this study aims to explore the impacts of peer condition and peer communication on fear of COVID-19, and the impact of fear of COVID-19 on online rumor sharing behavior, by considering the contingency effect of health self-efficacy. Data from 1167 respondents to an online survey in China were adopted to test our research model. The results indicate that peer communication and peer condition induce fear of COVID-19, and fear of COVID-19 results in online rumor sharing. Fear of COVID-19 mediates the effects of peer communication and peer condition on online rumor sharing. Health self-efficacy alleviates the positive effect of peer communication on fear of COVID-19, and the positive effect of fear of COVID-19 on online rumor sharing. This study advances the literature on online rumor sharing and S–O-R, and provides practical implications to social media users and governments.

Implementing information and communication technology education on food allergy and anaphylaxis in the school setting

Introduction

Every year, 1/10,000 children experiences a food‐anaphylactic reaction. Most of these events, including attack‐related deaths, may happen during the school hours. In the current study, we assessed the influence of information and communication technologies (ICT) in the school‐staff's education on food allergy and anaphylaxis (FAA).

Methods

The target population of this intervention was non‐university teaching centers from the local Regional Education Council, including both state and private institutions. The digital intervention was supported by the free‐of‐charge and open‐source learning‐management Aulatic Educational Platform. Structured questionnaires were developed to evaluate the educators' knowledge, feelings, and self‐efficacy on FAA, in addition to a satisfaction and quality survey of the training program.

Results

A total of 1748 school‐educators were virtually enrolled from May 2016 to June 2020 in one of the 8‐week course editions, with 80.6% of attendees successfully completing the full training. All scores concerning school‐staff's basic knowledge and self‐efficacy on FAA significantly improved after the educational intervention, reaching a high level of satisfaction among participants (98.5%) over the 4‐year educational program.

Conclusion

Our results highlighted the effectiveness of a focused e‐learning activity to improve teachers and school caretakers in the management of food allergic scholars and anaphylactic reactions during the school hours. The use of ICTs tools should become an integrated part of curricular frameworks in non‐university education, leading to a better care of FAA school children.

General self-efficacy in individuals with visual impairment compared with the general population

BACKGROUND

Knowledge about self-efficacy and its significance for the quality of life of people with visual impairment is lacking. The aims of the study were to compare general self-efficacy in individuals with visual impairment with the general population, and to investigate the association between self-efficacy and life satisfaction.

METHODS

A telephone-based cross-sectional survey was conducted between January and May 2017 in a probability sample of adults who were members of the Norwegian Association of the Blind and Partially Sighted. Participants were asked questions about their sociodemographic characteristics, characteristics of vision loss, general self-efficacy (General Self-efficacy Scale), and life satisfaction (Cantril's Ladder of Life Satisfaction). We obtained norm data from a representative survey of the general Norwegian population (N = 1792; mean age 53.2 years; 52.5% females).

RESULTS

People with visual impairment had higher levels of general self-efficacy than people in the general population (Mean: 31.5 versus 29.0, p < .001). Results from linear regression analyses of the visual impairment population showed that higher education and residential in an urban municipality were associated with higher self-efficacy. Having additional impairments and a previous history of physical or sexual assaults were associated with lower self-efficacy. A linear dose-response relationship was found between self-efficacy and life satisfaction, in the visual impairment population as well as in the general population.

CONCLUSIONS

People with visual impairment have higher self-efficacy than people in the general population, possibly due to extensive mastery experience in how to handle life as visually impaired. Self-efficacy seems to be important in achieving the best possible life.

Developing a cognitive behavioral therapy for hypersomnia using telehealth: a feasibility study

STUDY OBJECTIVES

The purpose of this study was to evaluate the feasibility and acceptability of a novel cognitive behavioral therapy for hypersomnia (CBT-H) in people with central disorders of hypersomnolence and co-occurring depressive symptoms using a telehealth model for delivery and assessment.

METHODS

Thirty-five adults with narcolepsy or idiopathic hypersomnia received a 6-session CBT-H delivered individually or in small groups using videoconferencing. The clinical impact of CBT-H was evaluated using the Patient Health Questionnaire, Patient-Reported Outcomes Measurement Information System measures, Epworth Sleepiness Scale, and other patient-reported outcomes collected online at baseline and posttreatment. Feasibility and acceptability of the intervention and telehealth model was also evaluated using qualitative data collected from exit interviews conducted through videoconferencing.

RESULTS

Forty percent of the sample achieved a clinically significant baseline to posttreatment change in depressive symptoms (decrease in Patient Health Questionnaire ≥ 5), which is below the prespecified efficacy benchmark (50% of the sample). The prespecified benchmark for a minimal clinically important difference (Cohen's d > 0.5) on other psychosocial measures was met only on the Patient-Reported Outcomes Measurement Information System global self-efficacy (d = 0.62) in the total sample. Qualitative data revealed enthusiasm for the accessibility of telehealth delivery and the usefulness of several cognitive and behavioral modules but also revealed opportunities to refine the CBT-H program.

CONCLUSIONS

These findings indicate that this new CBT-H program can potentially reduce depressive symptoms and improve self-efficacy in people with central disorders of hypersomnolence. Furthermore, telehealth is a promising model for remote delivery and data collection to enhance participant accessibility and engagement.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Psychosocial Adjunctive Treatment for Hypersomnia (PATH); URL: https://clinicaltrials.gov/ct2/show/NCT03904238; Identifier: NCT03904238.

Evaluating Self-Efficacy among Patients Undergoing Dialysis Therapy

(1) Background: Perceived disease-related self-efficacy is considered a fundamental component of the successful self-management of chronic diseases. Prior studies have found that self-efficacy is associated with improvements in health behaviors and health status among people with chronic kidney disease (CKD). However, few studies have evaluated self-efficacy among patients undergoing dialysis. (2) Methods: This study was performed to evaluate CKD patients’ self-efficacy and to determine the factors that significantly affect self-efficacy among dialysis patients. This was a cross-sectional study using a convenience sample of 190 patients undergoing dialysis. The patients’ self-efficacy was measured using the CKD Self-Efficacy Scale. Inferential statistics were used to analyze the data. (3) Results: The mean age of the participants was 49.24 ± 13.15 years. Almost half of them were males (48.4%), and 75.3% were married. The majority of the patients (83%) were undergoing hemodialysis. The total score for self-efficacy was 192.57 ± 39.23. Only occupational status and the type of dialysis were significantly and positively correlated with patients’ perceived self-efficacy scores. (4) Conclusions: This study provides primary evidence of the perceived self-efficacy among CKD patients who are on dialysis. The results of this cross-sectional study showed that greater self-efficacy was associated with employment and peritoneal dialysis. Strategies to enhance self-efficacy among dialysis patients, especially those on hemodialysis, are needed.

Perceptions and experiences of lifestyle interventions in women with polycystic ovary syndrome (PCOS), as a management strategy for symptoms of PCOS

Background

The international clinical practice guidelines for PCOS emphasize diet and exercise as first-line management of clinical signs and symptoms. This study aimed to describe the patterns, perceptions and experiences of lifestyle interventions for women in the community with PCOS.

Method

An electronic survey of 493 members of two PCOS consumer support groups, collected by cloud-based Survey Monkey, described women’s types and patterns of diet and exercise, experiences and perceptions of effectiveness. Women were recruited from the Polycystic Ovary Association of Australia (POSAA) and from the Facebook group, PCOS University Research Group. Associations between participants perceptions of effectiveness, and diet types and exercise patterns were assessed using logistic regression. Response bias for the POSAA group was assessed with a continuum of resistance model.

Results

91% of POSAA members and 311 Facebook group members aged 16–50 years responded to the survey. Nearly all women reported adjusting their dietary and exercise practices with the aim to improve their health and/or PCOS (82% and 73% respectively), however less than 13% reported achievement of health goals (12.2% and 8.1% respectively). Low carbohydrate, high protein diets, and vigorous activity were associated with self-perceived effectiveness (r.0.16, p < 0.01; r.0.15 p < 0.01 and r.0.2 p < 0.01 respectively). Barriers for lifestyle interventions included psychosocial factors. Response bias was not assessed for the Facebook group, however self-reported PCOS aligned with prevalence of clinical phenotypes and suggests results are generalizable to clinical populations of women with PCOS, who are responsible for self-directing and administering lifestyle interventions to manage their PCOS.

Conclusions

Perceptions of effectiveness for lifestyle interventions by women with PCOS may be complicated by a lack of rigorous evidence. The strength of recommendations in clinical practice guidelines may be enhanced by clinical trials investigating flexible and feasible lifestyle interventions for women in the community with PCOS.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01252-1.

Symptom Experience and Related Predictors in Liver Transplantation Recipients

PURPOSE

Symptom experience after liver transplantation (LT) provides healthcare professionals with important information about the benefits and limitations of LT from patients' perspective. This study aims to explore the multidimensional symptom experience and analyze related predictive factors in LT recipients.

METHODS

This cross-sectional study evaluated the occurrence, frequency, intensity, and level of distress of 40 symptoms in 265 LT recipients. Stepwise multiple regression analysis was performed to analyze the influencing factors of symptom experience.

RESULTS

The analysis of patient-reported data indicated that the ten most common symptoms were fatigue (42.3%), frequent sleep interruptions (38.9%), difficulty falling asleep (35.9%), decreased memory (34.0%), dreaminess (29.8%), itch (28.7%), muscular weakness (26.4%), shortness of breath (25.3%), anxiety (24.5%), and hand tremor (21.9%). Patients were classified into four groups according to survival time (1-month, 2-6-month, 7-12-month, and >1-year groups) after LT, and the most common symptom was fatigue in the one-month and 2-6-month groups, difficulty falling asleep in the 7-12-month group, and decreased memory in the >1-year group. Type of the primary caregiver, complications, concerns about the decreased ability to perform household and outdoor activities, and concerns about being a burden to the family were predictors of symptoms burden.

CONCLUSION

LT recipients experienced complicated symptoms. In clinical practice, it is critical to integrate physicians, nurses, and social workers as a medical team to help LT recipients develop suitable coping strategies that can potentially address patients' concerns, increase the sense of confidence, and improve symptom outcomes.

Validity and reliability study of the Turkish version of the self-efficacy for managing chronic disease 6-item scale

Background/aim

The measurement of self-efficacy is an important step toward improving chronic disease management, enhancing adherence to treatment, and assessing patients with chronic diseases. The purpose of this study was to assess the validity and reliability of the Turkish version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale.

Materials and methods

In this methodological study, the sample consisted of 211 patients receiving chronic disease care in 2 family health centers in İstanbul, Turkey. Data were analyzed with descriptive statistics, exploratory and confirmatory factor analyses, concurrent validity, Cronbach’s alpha, item-total correlation, and test-retest reliability.

Results

Most of the sample were women (72%), primary school graduates (41.7%), hypertensive (68.7%), and had comorbidities (68.2%). The mean age of the sample was 60.5 ± 10.9. The scale mean was 5.66 ± 2.28. Cronbach’s alpha reliability was 0.90. Item-total correlations were between 0.64–0.85 and test-retest reliability was high (R = 0.95, P < 0.001). A positive, significant correlation was found in concurrent validity. According to the results of factor analysis, the scale had a 2-dimensional structure.

Conclusion

The Turkish version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale is a valid and reliable instrument to assess perceived the self-efficacy level of patient with chronic disease.

Cross-Cultural Reliability of an Arabic Version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale in Arab Patients with Diabetes mellitus

INTRODUCTION

Arab nations have the second highest diabetes mellitus (DM) prevalence in the world. There is a growing interest in self-management programs that emphasize patient's central role in managing type 2 DM.

AIM OF THE STUDY

To validate an Arabic version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEM6S) among Arab type 2 DM patients and to explore factors associated with self-efficacy measured with the SEM6S.

METHODS

Cross-sectional study on 302 Arab patients with T2DM of three different nationalities (Egyptian, Saudi, Kuwaiti).The SEM6S was translated using forward-backward method, and its reliability was determined by calculating Cronbach's alpha. A regression model was used to examine variables associated with self-efficacy in Arab patients with T2DM.

RESULTS

Questionnaire was successfully translated without language or content-related problem. The mean age of participants was 47.71±14.7 years with equally represented sexes. The mean total score of the SEM6S was 5.99±1.86. The scale psychometric properties was reproducible (ICC=0.61-0.71) with good reliability (Cronbach's alpha=0.79). Statistically significant increase in self-efficacy was observed in patients <30 years, uncomplicated DM, DM with hypertension, and in patients who had physical activity > 60min per day. Also, a bimodal increase in self-efficacy was detected in patients with DM<5 years and 10.1-15 years. After regression analysis, physical activity was significantly positively correlated with self-efficacy (β=0.8, P=0.01), and duration of diabetes was significantly negatively correlated with self-efficacy (β = -0.23, P=0.03).

CONCLUSION

Arabic SEM6S is acceptable, reliable and repeatable metric for self-efficacy.

Self-estimation of phenylketonuria patients on therapeutic diet. Psychological support

Objectives Self-esteem is the degree to which the qualities and characteristics contained in one's self-concept are perceived to be positive. The aim of this study was to evaluate the self-esteem scores in phenylketonuria (PKU) patients on "strict", "loos" and "off diet". Sixty PKU patients were divided in three equal groups. Methods Group a: "on strict", group b: "on loos" and group c: "off diet". A special questionnaire for self-esteem scores was created for these patients. Results Before psychological support, group a patients demonstrated 6/20 (30%) very high self-esteem, 9/20 (45%) high and 5/25 (25%) moderate. After support 14/20 (70%) were turned to very high, 5/20 (25%) represented high except one whose degrees remained an altered. group b 4/20 (20%) were very high, 7/20 (35%) were high, 3/20 (15%) moderate and the rest of them showed low self-esteem degrees, after support, 10/20 (50%) showed very high, 5/20 (25%) became high, 3/20 (15%) turned to moderate and 2/20 (10%) remained unaltered. Group c, 1/20 (5%) were very high self-esteemed, 7/20 (35%) were high, 6/20 (30%) were moderate and 6/20 (30%) with low self-esteemed, at the end of support, 6/20 (30%) become very high, 8/20 (40%) with high, 4/20 (20.0%), moderate self-esteem whereas the rest were unaltered. Conclusions Very high and high self-esteem degrees were demonstrated in patients who follow their PKU diet. Moderate and low self-esteem degrees were predominantly found in patients on loos and or off diet. Psychological supports commonly result in amelioration of self-esteem degrees.

Self-estimation of phenylketonuria patients on therapeutic diet. Psychological support

Objectives Self-esteem is the degree to which the qualities and characteristics contained in one's self-concept are perceived to be positive. The aim of this study was to evaluate the self-esteem scores in phenylketonuria (PKU) patients on "strict", "loos" and "off diet". Sixty PKU patients were divided in three equal groups. Methods Group a: "on strict", group b: "on loos" and group c: "off diet". A special questionnaire for self-esteem scores was created for these patients. Results Before psychological support, group a patients demonstrated 6/20 (30%) very high self-esteem, 9/20 (45%) high and 5/25 (25%) moderate. After support 14/20 (70%) were turned to very high, 5/20 (25%) represented high except one whose degrees remained an altered. group b 4/20 (20%) were very high, 7/20 (35%) were high, 3/20 (15%) moderate and the rest of them showed low self-esteem degrees, after support, 10/20 (50%) showed very high, 5/20 (25%) became high, 3/20 (15%) turned to moderate and 2/20 (10%) remained unaltered. Group c, 1/20 (5%) were very high self-esteemed, 7/20 (35%) were high, 6/20 (30%) were moderate and 6/20 (30%) with low self-esteemed, at the end of support, 6/20 (30%) become very high, 8/20 (40%) with high, 4/20 (20.0%), moderate self-esteem whereas the rest were unaltered. Conclusions Very high and high self-esteem degrees were demonstrated in patients who follow their PKU diet. Moderate and low self-esteem degrees were predominantly found in patients on loos and or off diet. Psychological supports commonly result in amelioration of self-esteem degrees.

An examination of the relationship of patient modifiable and non-modifiable characteristics with fear of cancer recurrence among colorectal cancer survivors

PURPOSE

Fear of cancer recurrence (FCR) is one of the most common and distressing issues affecting cancer survivors. This study examined (1) the association between modifiable cognitive, behavioral, and social characteristics and FCR, (2) the association between non-modifiable characteristics and FCR, and (3) the relative contributions of modifiable and non-modifiable characteristics to FCR.

METHODS

Participants (n = 120) had been diagnosed with colorectal cancer and completed cancer treatment in the past 6 to 36 months. Participants completed self-report measures of modifiable cognitive (e.g., beliefs about worry), behavioral (e.g., health-related reassurance seeking), and social (e.g., social constraints) characteristics. Non-modifiable characteristics (e.g., age, disease severity) were assessed via self-report and medical record review.

FINDINGS

Modifiable (i.e., perceived risk, self-efficacy, positive beliefs about worry, negative beliefs about worry, intolerance of uncertainty, rumination, reassurance seeking, health-related reassurance seeking, social constraints) and non-modifiable (i.e., age, gender, disease severity, neuroticism, conscientiousness) characteristics were associated with FCR (p's < .05). Hierarchical linear regression analyses demonstrated that modifiable characteristics accounted for an additional 15% of the variance (p < .001) beyond that accounted for by non-modifiable characteristics (R² = .45, p < .001), with perceived risk (B = .35) and health-related reassurance seeking (B = .22) emerging as significant predictors of FCR (p's < .05).

IMPLICATIONS

Results identify non-modifiable characteristics that may serve as risk factors for greater FCR and identify specific modifiable characteristics (i.e., perceived risk, health-related reassurance seeking) to be targeted by interventions to reduce FCR among cancer survivors.

The potency of education programs for management of blood pressure through increasing self-efficacy of hypertensive patients: A systematic review and meta-analysis

OBJECTIVE

To identify the effect of self-management education programs on the changes of self-efficacy and the management of blood pressure (BP) in hypertensive patients.

METHODS

PubMed, Google Scholar, Scopus, Trip database, Proquest, and Embase were searched. Trials that had examined the effect of self-management education programs on self-efficacy, systolic BP (SBP) and diastolic BP (DBP) in hypertensive patients were selected.

RESULTS

Fourteen studies with 2239 participants were analyzed. Self-management education programs led to a statistically-significant increase in the self-efficacy of the participants (SMD: 0.71; 95% CI: 0.34-1.07; I² = 94%; P < 0.001), as well as significant decrease in SBP (MD: -5.37 mmHg; 95% CI: -8.53 to -2.22; P < 0.001) and DBP (MD: -3.87 mmHg, 95% CI: -5.84 to -1.90; P < 0.001) compared to control groups.

CONCLUSION

The findings indicated that self-management education programs can promote self-efficacy in hypertensive patients, possibly contributing to better management of BP.

PRACTICE IMPLICATIONS

Adoption of the self-management education program provides a basic concept to improve both quality and efficacy of strategies related to BP management. Policy makers should focus on improving self-efficacy via the implementation of policies useful for better educational outcomes concerning new technologies as well as appropriate theoretical methods.

Development of a transition program for adolescents with congenital heart disease

Thanks to advances in care, most children with congenital heart disease nowadays survive into adulthood. The majority of patients remain at high risk for future complications. Hence, life-long follow-up is mandatory. Care needs of patients evolve, especially when reaching adulthood. A structured transition period to adult care is advocated. Currently, a fully detailed and structured transition program is not available for patients with congenital heart disease. The aim is to describe the development and design of a multicomponent transition program for adolescents with congenital heart disease, called "Transition with a heart." Transition with a heart was developed based on the Dutch program "On your own feet," starting at the age of 12 years and continuing after transfer. The most vital core components include a general and individualized flowchart, adolescent-centered communication, a joined transfer consultation, and an appointed transition coordinator. Adolescents are gradually informed about their condition and potential late consequences in adult life and stimulated to take medical care in their own hands.Conclusion: Transition with a heart is a practical, multicomponent, comprehensive transition program developed to cover the essential aspects of transitional care for adolescents with congenital heart disease (i.e., continuity of care, disease knowledge, and self-management skills). Interventions were selected from the highest sources of scientific evidence currently available.Clinical trial registration: Not applicableWhat is Known:• Transition towards adult life and health care is a complex process, requiring careful patients' guidance. Various task forces have described the need and potential benefits of transition programs in young people with chronic conditions. Details about the practical development and content of such programs in congenital heart disease are, however, currently lacking.What is New:• This method paper presents the development and design of a person-centered multicomponent transition program for adolescents with congenital heart disease comprising interventional components covering the most important aspects of transitional care: promoting autonomy, disease knowledge, and continuity of care.

Accuracy of Prescription Claims Data in Identifying Truly Nonadherent Patients

BACKGROUND

Administrative claims data are increasingly used to identify nonadherent patients. This necessitates a comprehensive review and assessment of their accuracy in identifying nonadherent patients.

OBJECTIVES

To (a) compare administrative claims-based measures of adherence with nonadherence verified by patient interview; (b) determine if and to what extent patients classified as nonadherent based on prescription claims differ from patients classified as nonadherent based on interventions designed to gather multiple types of medication lists to compare against the prescription fill history; and (c) assess the various patient-reported reasons for nonadherence.

METHODS

A cross-sectional study was used to identify patients from the Southern Piedmont Community Care Network of North Carolina who were enrolled with Medicaid between January 1, 2012, and May 31, 2013, and were using prescription medications for 1 or more chronic conditions. Patients with more than a 30-day gap in refill history were identified using prescription claims and were interviewed by pharmacists to assess the reasons for nonadherence. Based on the patient-reported reasons for a gap in refill, patients were classified as interview-verified nonadherent patients or interview-verified adherent patients. The positive predictive value of prescription claims in identifying nonadherent patients was calculated, and descriptive statistics were reported. Characteristics of interview-verified nonadherent patients were compared with adherent patients using t-tests and chi-square statistics.

RESULTS

1,425 patients representing 2,936 patient-class of medication combinations were included in the final analysis. 824 (28.07%) of the 2,936 records that were flagged as nonadherent using claims analysis were confirmed as adherent during patient interviews. The positive predictive value of claims records in identifying nonadherent patients was 0.72. The 2 most common reasons for patients to be misclassified as nonadherent in claims data following self-report were discontinuation of medication on prescribers' directions (21.93%) and having an alternate channel for receiving the medication (6.13%). Among interview-verified nonadherent patients, side effects, patient beliefs, education, and socioeconomic barriers were the most common patient-reported reasons for gaps in refill.

CONCLUSIONS

Prescription claims may underestimate adherence in patients. When interviewed directly by a pharmacist, most patients reported discontinuation of medication as per prescribers' directions. To determine the overall validity of prescription claims data, further analysis is required to assess its accuracy in identifying truly nonadherent patients among those who are identified as nonadherent by claims data.

DISCLOSURES

No outside funding supported this study. Glassberg and Wei were employees at Community Care of North Carolina when this research was conducted. Trygstad is an employee of Community Care of North Carolina; Robinson is an employee of Community Care of Southern Piedmont, a subsidiary of Community Care of North Carolina. The geographies, health care professionals, and subjects involved in the study were related to the care coordination work that Community Care of North Carolina was charged with implementing through its informatics and subject matter expertise assistance provided to these local entities to augment primary care activities. Farley has received funding from the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, American College of Clinical Pharmacy, the National Institutes of Health, and Community Care of North Carolina and has also received consulting funds from UCB. The other authors have nothing additional to report.

The Effects of Amplification on Listening Self-Efficacy in Adults With Sensorineural Hearing Loss

Objectives The aim of this study was to evaluate listening self-efficacy ratings between aided and unaided conditions in different communication environments and to determine what patient- and device-centered variables were associated with individual differences. Method An observational, cross-sectional study design was used to evaluate 165 older adults with mild to moderately severe sensorineural hearing loss who wore hearing aids at least 8 hr per week. Listening self-efficacy for both unaided and aided listening was measured using the Listening Self-Efficacy Questionnaire (LSEQ; Smith, Pichora-Fuller, Watts, & La More, 2011), consisting of a global score and subscales of Dialogue in Quiet, Directed Listening, and Complex Listening. Metrics to explain variability in the degree of improvement in LSEQ ratings with aided listening included patient-centered variables of age, pure-tone average, and personality and device-centered variables of hearing aid use, speech intelligibility index, directionality, and noise reduction. The NEO Five-Factor Inventory (Costa & McCrae, 1985) was used to measure 5 personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness). Associations were evaluated between LSEQ ratings and patient- and device-centered variables using a linear mixed-model analysis. Results Statistically significant improvements in LSEQ ratings were found for aided conditions (relative to unaided conditions), easier listening environments, lower pure-tone averages, and lower levels of neuroticism. Furthermore, the improvement in listening self-efficacy with hearing aids did not depend on the listening environment but did alter with severity of hearing loss, length of hearing aid use, and levels of conscientiousness. Conclusions Results of this study suggest that wearing hearing aids is associated with improved listening self-efficacy in a variety of communication environments. Aural rehabilitation and counseling may focus on improving listening self-efficacy to address the challenges of consistent hearing aid use and reduced quality of life related to hearing loss.

A bidirectional path analysis model of smoking cessation self-efficacy and concurrent smoking status: impact on abstinence outcomes

Self-efficacy is routinely associated with abstinence in the addictions literature, and is a major component relapse-prevention models. The magnitude of this relationship has been brought into question following equivocal results in studies controlling for concurrent smoking status. The aim of our study was to clarify the relationship between cessation self-efficacy, smoking status, and cessation outcomes in a cohort of treatment-seeking smokers. Smokers participating in the FLEX trial, a randomized trial investigating the efficacy of three pharmacologic treatments for smoking cessation, completed questionnaires assessing cessation self-efficacy at baseline and at weeks 1, 3, 5 and 10 post-target quit date; smoking status was verified using expired carbon monoxide. Structural models were fit in order to ascertain the relationship between cessation self-efficacy and concurrent smoking at each time-point, and to assess the association between cessation self-efficacy, smoking and seven-day point prevalence smoking status at week 10. A total of 737 treatment-seeking smokers participated. In our path model, self-efficacy and smoking status at all time points were associated with week 10 abstinence (except week 3 self-efficacy), after controlling these values' previous time-points. All direct pathways between cessation self-efficacy and smoking were also significant, supporting a bidirectional relationship. Our results support a bidirectional and reciprocal relationship between cessation self-efficacy and concurrent smoking behavior; participants with higher confidence were more likely to be smoke-free, and concurrent smoking status predicted levels of confidence over the ensuing weeks. Both measures were associated with week 10 abstinence. Our results indicate that while correlated, both cessation self-efficacy and current smoking behavior during a cessation attempt are important independent markers of ultimate cessation success.

Comparative study of PROMISⓇ self-efficacy for managing chronic conditions across chronic neurologic disorders

PURPOSE

Self-efficacy (SE) for managing chronic conditions is the belief that one can carry out behaviors to reach health goals. The study objective is to investigate (1) SE for managing chronic conditions across diverse neurologic conditions, (2) demographic and disease determinants of SE, and (3) SE as a predictor of health and disability.

METHODS

Patients with chronic neurologic conditions (epilepsy, multiple sclerosis, neuropathy, Parkinson disease, stroke; n = 834) completed five SE for Managing Chronic Conditions instruments (Patient-Reported Outcomes Measurement Information System®; PROMIS®). Other assessments included PROMIS depression, fatigue, physical function, and global health.

RESULTS

Two of the five SE domains showed differences across the five disorders (ANOVA; SE for Managing Daily Activities p < .001 and Managing Symptoms p < .01). The three domains with no differences were Managing Medications/Treatments, Emotions, and Social Interactions. Lowest SE was in neuropathy, and highest in epilepsy (Managing Activities) and stroke (Managing Symptoms). Multivariate regression showed SE measures to be better predictors of mental health, global health, and disability than either disease severity or diagnosis.

CONCLUSIONS

SE for managing chronic conditions differs across neurologic disorders, with lowest SE for managing activities and symptoms in neuropathy, and highest in patients with epilepsy and stroke. PROMIS SE measures are better predictors of mental health, disability, and quality of life than disease severity or diagnosis.

Identifying modifiable factors associated with health optimism in older adults

OBJECTIVE

Despite the documented importance of health optimism for enhancing health outcomes, very little work has been done to examine who experiences health optimism and under what conditions. The present study sought to identify modifiable factors associated with health optimism that could constitute the focus of future intervention efforts designed to promote health optimism among older people.

DESIGN

Participants were 453 (44% males) community-based Western Australians aged 60+ years (M = 70.39 years, SD = 6.06). Participants completed questionnaires to assess sociodemographic characteristics and provided information relating to physical and psychological health status.

RESULTS

Almost a quarter of participants (24%; n = 108) were classified as health optimists. Results from a multivariate regression analysis found quality of life, psychological well-being, and age to be directly and positively associated with health optimism. A subsequent path analytic model found depression (negatively) and self-efficacy (positively) to be indirectly associated with health optimism via both psychological well-being and quality of life.

CONCLUSION

These findings extend the limited evidence on health optimism in older adults by identifying various modifiable factors that may constitute potential areas of focus for future interventions designed to enhance health outcomes via the fostering of health optimism.

Development And Preliminary Evaluation Of Psychometric Properties Of A Tuberculosis Self-Efficacy Scale (TBSES)

PURPOSE

No instrument exists for measuring TB patients' self-efficacy which is vital for choosing and insisting in benefit TB-management behaviors. Our study aimed to develop and test a new tuberculosis self-efficacy scale (TBSES).

PATIENTS AND METHODS

The TBSES was designed through literature review, individual interviews, Delphi surveys, and pilot testing. After that, 460 TB patients were recruited to validate TBSES. Exploratory and confirmatory factor analysis and correlation analysis were used to evaluate the scale reliability and validity. The cut-off point for TBSES was identified using receiver operating characteristic (ROC) analysis.

RESULTS

The final TBSES includes 21 items scored on a 5-point Likert scale, and these items are loaded in four distinct factors that explain 67.322% of the variance, both exploratory and confirmatory factor analysis proved that the scale had good construct validity. The scale had adequate internal consistency, split-half reliability, test-retest reliability, as well as demonstrated content, concurrent validity. The ROC analysis results showed the cut-off point was 86.5.

CONCLUSION

This 21-item TBSES demonstrated favorable psychometric properties. It provides an instrument for not only measuring specific self-efficacy in TB, but also identifying patients with low self-efficacy and determining the specific area toward designing interventions for enhance self-efficacy.

Diabetes-Related Behavior Change Knowledge Transfer to Primary Care Practitioners and Patients: Implementation and Evaluation of a Digital Health Platform

BACKGROUND

Behavioral science is now being integrated into diabetes self-management interventions. However, the challenge that presents itself is how to translate these knowledge resources during care so that primary care practitioners can use them to offer evidence-informed behavior change support and diabetes management recommendations to patients with diabetes.

OBJECTIVE

The aim of this study was to develop and evaluate a computerized decision support platform called "Diabetes Web-Centric Information and Support Environment" (DWISE) that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines-based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies.

METHODS

A health care knowledge management approach is used to implement DWISE so that it features the following functionalities: (1) assessment of primary care practitioners' readiness to administer validated behavior change interventions to patients with diabetes; (2) educational support for primary care practitioners to help them offer behavior change interventions to patients; (3) access to evidence-based material, such as the Canadian Diabetes Association's (CDA) clinical practice guidelines, to primary care practitioners; (4) development of personalized patient self-management programs to help patients with diabetes achieve healthy behaviors to meet CDA targets for managing type 2 diabetes; (5) educational support for patients to help them achieve behavior change; and (6) monitoring of the patients' progress to assess their adherence to the behavior change program and motivating them to ensure compliance with their program. DWISE offers these functionalities through an interactive Web-based interface to primary care practitioners, whereas the patient's self-management program and associated behavior interventions are delivered through a mobile patient diary via mobile phones and tablets. DWISE has been tested for its usability, functionality, usefulness, and acceptance through a series of qualitative studies.

RESULTS

For the primary care practitioner tool, most usability problems were associated with the navigation of the tool and the presentation, formatting, understandability, and suitability of the content. For the patient tool, most issues were related to the tool's screen layout, design features, understandability of the content, clarity of the labels used, and navigation across the tool. Facilitators and barriers to DWISE use in a shared decision-making environment have also been identified.

CONCLUSIONS

This work has provided a unique electronic health solution to translate complex health care knowledge in terms of easy-to-use, evidence-informed, point-of-care decision aids for primary care practitioners. Patients' feedback is now being used to make necessary modification to DWISE.

Cognitive-behavioural theories and adherence: Application and relevance in antiretroviral therapy

Background

Adherence in chronic disease conditions is described as the extent to which a person‘s behaviour corresponds to the prescribed medical advice of the healthcare provider. This is not limited to medication intake only but also includes acts such as following instructions regarding dietary or fluid restrictions and taking medicines at the prescribed times and intervals. Although adherence to antiretroviral therapy (ART) is a predictor of good clinical outcome among HIV-infected persons on ART, it is a major challenge and strict adherence is not very common. This article aims to examine the application and relevance of some cognitive-behavioural theories in antiretroviral therapy adherence

Methods

After doing a thorough literature review, contemporary theories of health behaviour at the individual and interpersonal levels referred to as cognitive-behavioural theories were explored. This review highlights some aspects of the cognitive perspective of health behaviour theories as a good theoretical framework that could be used for organising thoughts about adherence and other health behaviours among patients on lifelong treatment such as ART.

Results

Key concepts of these theories stipulate that behaviour is mediated by cognition i.e. knowledge and attitude affect the person’s action. In addition, cognitive-behavioural theories recognise knowledge alone as being insufficient to produce behavioural change; a person’s perception, motivation, skills and social environment are all influential in the process of behavioural change.

Conclusion

Prediction of medication adherence is complex, and health-related knowledge and beliefs alone are insufficient to achieve behaviour change, especially in chronic conditions such as HIV/AIDS. However, people can control or influence the events affecting their lives by integrating cognitive, social, and behavioural sub-skills related to beliefs of personal efficacy in performing these skills.

How Social Participation Benefits the Chronically Ill: Self-Management as a Mediating Pathway

Objective: Few studies have tested the purported causal mechanisms between social participation and health, especially among those in poor health. This study aimed to determine whether self-management of chronic disease operates as a pathway through which social participation affects health-related quality of life. Method: I utilized causal mediation analysis among 600 low-income older Singaporeans living with chronic conditions, to test whether self-management mediates the association between social participation and health-related quality of life. Results: Results show that self-management fully mediated the positive effect of informal social participation on health-related quality of life. Formal social participation was found to have a negative direct effect on health-related quality of life. Discussion: These findings reiterate the primacy of family and friends for older adults, but highlight that a better understanding of formal engagement with the low-income population is still needed.

Improving Hearing Aid Self-Efficacy and Utility Through Revising a Hearing Aid User Guide: A Pilot Study

PURPOSE

This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associated with improved hearing aid self-efficacy and utility performance.

METHOD

In Part 1, an HAUG was evaluated using the Suitability Assessment of Material (SAM) and readability formulas (Flesch Reading Ease [Flesch, 1943], Flesch-Kincaid Readability Formula [Kincaid, Fishburne, Rogers, & Chissom, 1957], and Simple Measure of Gobbledygook [McLaughlin, 1969]). The HAUG was revised using results from the SAM and best practice guidelines. The revision included generating a video. In Part 2, 30 adults with hearing impairment were randomly assigned to use either the original guide (N = 15) or the revised guide and video (N = 15) to perform a utility task. Participants' self-efficacy was measured using the Basic and Advanced Handling subscales of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids questionnaire. SAM and readability were compared between the original and revised guides (Doak, Doak, & Root, 1996).

RESULTS

SAM and readability were improved following the revision. Participants in the revised guide group performed significantly better on the utility task and on the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids subscales than participants in the original guide group.

CONCLUSIONS

These results are encouraging as they indicate that there is scope to influence self-efficacy and utility performance through the use of appropriate HAUGs.

Sex Differences in the Association of Perceived Ambiguity, Cancer Fatalism, and Health-Related Self-Efficacy with Fruit and Vegetable Consumption

Adequate fruit and vegetable (FV) consumption is promoted as a means of preventing chronic health conditions, such as cardiovascular disease and cancer. This study investigated whether perceived ambiguity about cancer prevention recommendations, fatalistic beliefs about cancer, and health-related self-efficacy were associated with FV consumption and whether sex moderated these associations. Data from the five most recent waves (spanning 2011 to 2017) of the nationally representative Health Information National Trends Survey (N = 16,965) were used. Participants reported levels of perceived ambiguity, cancer fatalism, health-related self-efficacy, and daily FV consumption. Perceived ambiguity and cancer fatalism were negatively associated with FV consumption, ps <.001, whereas health-related self-efficacy was positively associated with FV consumption, b = 0.34, p < .001. Sex moderated these associations, ps <.05. Perceived ambiguity and cancer fatalism were more strongly associated with less FV consumption for men, bs < -0.31, ps <.001, than women, bs < -0.14, ps <.01. In contrast, health-related self-efficacy was more strongly associated with more FV consumption for women, b = 0.43, p < .001, than men, b = 0.26, p < .001. These results suggest that tailoring health messaging to target sex-specific barriers may improve their effectiveness.