Enablers of Patient Knowledge Empowerment for Self-Management of Chronic Disease: An Integrative Review

[Current state of patient knowledge regarding the preoperative impact and causes of anemia]

BACKGROUND

Despite being treatable, the prevalence of anemia is relatively high, affecting up to 30% of the general population and 35% of patients undergoing surgery. Symptoms are often misinterpreted and patients frequently do not recognize anemia as a disease. As a result, it is often not discussed during medical consultations. Additionally, the limited time between diagnosis and surgery makes preoperative anemia management challenging.

OBJECTIVE

The aim of the present study was to assess the state of knowledge about anemia and to identify areas of deficits to develop a strategy for future improvement.

MATERIAL AND METHODS

Patients undergoing surgery with a transfusion probability of > 10% were interviewed at the department for anesthesiology, intensive care medicine and pain therapy of the University Hospital Frankfurt in May and October 2023.

RESULTS

A total of 196 completed questionnaires were evaluated. Most correct answers were given in the category "treatment of anemia" with 54.3% (n = 426/784), followed by 50.1% (n = 393/784) correct answers in the category "diagnosis of anemia", 48.8% (n = 478/980) in the category "perioperative influence of anemia" and 44.6% (n = 350/784) correct answers in the category "influence of nutrition". The patients showed the greatest knowledge deficits in the category "symptoms of anemia" with 38.1% (n = 598/1568) correct answers and "causes of anemia" with 36.1% (n = 354/980). Only 3% (n = 5/196) of the participants rated their knowledge as "good", 16% (n = 31/196) as "fairly good", 48% (n = 94/196) as "fairly poor" and 29% (n = 56/196) as "poor". There is a weak to medium positive linear correlation between the self-assessment and the correct answers given (correlation coefficient 0.44). Approximately 70% of participants had a higher level of education, such as vocational training, a university degree or a high school diploma. There was no correlation between the number of correct answers given and the participants' level of education. The majority of the patients (71.4%; n = 140/195) expressed interest in learning more about anemia.

CONCLUSION

We identified a significant knowledge deficit, particularly regarding the causes and symptoms of anemia. It is likely that knowledge gaps persist and that anemia does not receive sufficient attention in everyday clinical practice. Educating and training patients about anemia is essential to further reduce its prevalence.

Development and validation of the health education demand scale for HPV infected patients based on KANO model

OBJECTIVE

The purpose of this study is to develop and validate the scale of health education demand of patients with HPV infection based on KANO model, so as to provide a tool for further exploring the types of health education demand and influencing factors of patients with HPV infection.

METHODS

This study is a scale development and validation study using a three-stage cross-sectional design. In stage 1, a preliminary item pool is formed using literature review, semi-structured interviews and the Delphi method. In stage 2, six experts were invited to assess content validity. A cross-sectional survey was conducted on 1169 patients with HPV infection, Questionnaire results from 583 patients were used for exploratory factor analysis. In stage 3, the remaining 586 patients to validate the factor structure through confirmatory factor analysis.

RESULTS

In stage 1, an initial 35-item scale was developed and the items were transformed positive and reverse based on KANO model. In stage 2, Exploratory factor analysis formed a scale of 28 items in 5 factors: disease information demand, social support, emotional demand, family support and health education style demand. Cronbach's alpha was 0.940 for the entire scale and 0.763~0.908 for the five subscales in the positive items, 0.955 for the entire scale and 0.739~0.946 for the five subscales in reverse items. The content validity index of the scale: S-CVI/UA = 0.91, S-CVI/Ave = 0.98. In stage 3, the confirmatory factor analysis showed that the χ2/df, RMSEA, CFI and TLI of the positive items after four model modifications were 3.650, 0.067, 0.901, 0.888, and the SRMR value was < 0.001. The fitting of the five-factor model was good.

CONCLUSION

The KANO model based questionnaire on health education demand of HPV infected patients has good reliability and validity, and is suitable for the investigation of health education demand of HPV infected patients.

Empowerment in Adolescent Patients with a Disability/Chronic Condition: A Scoping Review

BACKGROUND/OBJECTIVES

Empowerment has been associated with several positive outcomes in healthcare; however, there is limited insight on empowerment levels within the adolescent population of those with a chronic condition/disability. The aim of this scoping review was to identify gaps in the existing literature on empowerment levels within this population.

METHODS

Five databases (MEDLINE [Ovid], EMBASE [Ovid], PsycINFO [Ebsco], CINHAL [Ebsco] and Web of Science [UBC]) and grey literature were searched.

RESULTS

A total of 67 studies were included and used for data extraction including descriptive numerical analysis followed by a narrative review. Extracted data were divided into demographic characteristics (e.g., ethnicity/ancestry), type of disability/condition (e.g., type 1 diabetes), interventions used to increase empowerment or empowerment-adjacent elements, quantitative and qualitative tools used to measure empowerment (e.g., questionnaires and/or interviews), domains/outcomes associated with empowerment (e.g., self-control), and review articles. Several interventions were shown to have positive effects on empowerment levels in adolescents with a chronic condition/disability.

CONCLUSIONS

Gaps were identified in the consideration of ethnicity/ancestry and socioeconomic status, demonstrating a need for future research in this space to focus on the intersection of disability, ethnicity/ancestry, and socio-economic status and the implementation of interventions promoting empowerment.

Tailoring nursing interventions to empower patients: personal coping strategies and self-management in type 2 diabetes care

BACKGROUND

Diabetes is one of the most common chronic diseases that severely reduce a patient's quality of life. Effective self-care and management are critical for maintaining blood glucose levels and preventing complications.

AIM

This study evaluates the effectiveness of a structured diabetes self-management education program on patients' self-management behaviors, empowerment, and activation levels.

METHODS

This study employed a quasi-experimental design involving 100 participants aged 30-65 to improve diabetes self-management and empowerment. Over 16 weeks, the program included three phases: a two-week pre-test phase for recruitment and baseline assessments using the Diabetes Self-Management Questionnaire (DSMQ), Diabetes Empowerment Scale (DES), and Patient Activation Measure (PAM); a 12-week intervention phase featuring weekly 90-minute educational sessions on topics such as diet, exercise, medication adherence, stress management, and self-empowerment; and a two-week post-test phase for follow-up assessments using the same tools. Data were analyzed using descriptive statistics, chi-square tests for PAM levels, and paired t-tests for DSMQ and DES scores, with statistical significance set at p < 0.05.

RESULTS

The study demonstrated significant improvements in participants' self-management, empowerment, and activation levels after the intervention. DSMQ scores increased from 64.5 to 68.6 (p < 0.001), DES scores rose from 65.4 to 70.0 (p = 0.001), and the number of participants at the highest PAM activation level (Level 4) grew from 30 to 50 (p = 0.016). Positive correlations among DSMQ, DES, and PAM scores suggest these improvements are interrelated.

CONCLUSION

The structured diabetes self-management education programme significantly impacted participants' self-management behaviors, empowerment, and activation levels. The findings underscore healthcare professionals' need to implement targeted interventions that facilitate patient engagement in diabetes care.

RECOMMENDATION

Future interventions should be designed to address the specific needs of diverse populations, paying attention to those facing socio-economic challenges. It is vital to facilitate greater access to diabetes self-management education to enhance health outcomes for these demographic groups.

The Prevention of Maternal Phenylketonuria (PKU) Syndrome: The Development and Evaluation of a Specific Training Program

BACKGROUND

Maternal phenylketonuria (PKU) syndrome, leading to severe psychomotor retardation, microcephaly, cardiac defects and undergrowth, affects the unborn children of mothers with PKU with insufficient metabolic control during pregnancy. To improve long-term outcomes, a specific prevention program was developed.

METHODS

We designed a group training program for young women with PKU (>14 years) and their partners. Knowledge regarding PKU therapy and pregnancy was evaluated by a specifically developed multiple-choice questionnaire. In addition, scores of anxiety and depression were evaluated.

RESULTS

Patients (n = 20) and their partners (n = 13) significantly improved their knowledge after participation (correct answers: patients-86% vs. 90%, p = 0.003; partners-78% vs. 89%, p = 0.012). Females significantly improved their knowledge about diet (90% vs. 100%, p = 0.035) and metabolism (91% vs. 100%, p = 0.016), but not concerning gynecological topics. Patients' median depression scores were within the normative range, with a slight decrease over time (6 points vs. 4 points, p = 0.836). Patients' anxiety score remained stable over time (5.5 vs. 5, p = 0.247). Of trained mothers with PKU, four pregnancies with ideal metabolic control and healthy offspring could be observed.

CONCLUSION

We suggest the inclusion of specific training programs in the standard care of female young adults with PKU, including for their partners.

Evaluation of Hypertension-Related Knowledge, Medication Adherence, and Associated Factors Among Hypertensive Patients in the Aljouf Region, Saudi Arabia: A Cross-Sectional Study

Background and Objectives: Hypertensive patients' knowledge and adherence to prescribed medicines are critical in managing their condition, as poor adherence may lead to adverse cardiac and cerebrovascular events. The present study assessed hypertension-related knowledge and medication adherence among hypertensive patients attending primary health centers (PHCs) in the Aljouf Province, Saudi Arabia. Materials and Methods: Using a cross-sectional design, we conducted this survey on 390 patients. Self-reported hypertension knowledge was assessed using the Hypertension Knowledge Level Scale (HK-LS), and medication adherence was determined using the Hill-Bone Medication Adherence Scale. We used binomial regression analysis (adjusted with other variables) to find the associated factors of medication adherence. Results: This study found that nearly half (49.2%) of the participants had inadequate knowledge, and poor medication adherence was noted in 40.8% of the participants. We found a positive correlation between HK-LS and the Hill-Bone Medication Adherence Scale scores (Spearman's rho = 0.312, p = 0.002). Medication adherence was significantly associated with job status (private sector (ref: public sector, adjusted odds ratio [AOR] = 2.02, 95% CI = 1.18-3.62, p = 0.005)), living in an urban region (ref: rural, AOR = 3.61, 95% CI = 1.85-5.72, p = 0.002), and duration since diagnosis of more than 5 years (ref: ≤1 year, AOR = 3.53, 95% CI = 2.36-4.95, p = 0.001). Conclusions: The present study findings indicate that there is still a critical gap in managing hypertension at the PHCs in this region, and this may lead to poor health outcomes among the patients and burden the healthcare system. Hence, continuous patient education and targeted counseling are recommended for those with poor medication adherence.

Engaging patients through education: a modified-Delphi consultation to develop recommendations for patient education interventions in the management of subacromial pain syndrome in physical therapy

PURPOSE

To develop recommendations to support the range of patient education interventions relevant in the management of patients with subacromial pain syndrome (SAPS) in physical therapy.

MATERIALS AND METHODS

A 3-round modified Delphi consultation was used to obtain consensus agreement on the relevance of 12 preliminary recommendations. These were developed from a literature review and an expert consultation on general educational strategies and specific patient education interventions for the management of SAPS. The analysis assessed the rate of consensus on the relevance of these recommendations. Delphi panelists were rehabilitation professionals including physical (n = 21) and occupational therapists (n = 1) with SAPS experience, and patient-partners (n = 2) presenting shoulder pain.

RESULTS

The Delphi consultation resulted in 13 revised consensus recommendations. Six consensus recommendations addressed general educational strategies to facilitate patient education, including teaching methods and materials, and seven addressed specific educational interventions, including teaching symptom self-management and tailoring activities and participation. These recommendations were incorporated into a clinical decision-making tool to support the selection of the most relevant patient education interventions.

CONCLUSION

The recommendations developed in this study are relevant to guide physical therapist's clinical decisions making regarding interventions using patient education for SAPS. They promote active engagement and empowerment of individuals with SAPS.

Effects of self-management education on clinical outcomes of adults with rheumatic heart disease: A quasi-experimental study

As the burden of rheumatic heart disease (RHD) increases in Ethiopia, there is a growing need for low-cost interventions to mitigate its impact. This study aimed to assess the effectiveness of chronic disease self-management education (CDSME) on clinical outcomes, depression, and anxiety among patients with RHD. A quasi-experimental study was deployed among 166 patients with RHD at Jimma Medical Center between April and July 2024. A multi-component CDSME was endured for four consecutive months. Data were analyzed using SPSS version 25.0. Systolic blood pressure decreased from 131.31 mmHg (SD±15.68) at pre-education to 113.77 mmHg (SD±20.98) at post-education (t- 12.251, p<0.001). Diastolic blood pressure decreased from 94.87 mmHg (SD±19.41) pre-education to 79.28 mmHg (SD±9.33) post-education (t-12.306, p<0.001). Hemoglobin level changed from 11.97 g/dl (SD±1.99) to 13.84 g/dl (SD±1.37) after the intervention (t -11.96, p < 0.001). Similarly, hospital depression subscale decreased from 11.93 (SD±3.43) to 9.48 (SD±3.67) (t - 8.37, p < 0.001) post intervention. Regarding the hospital anxiety subscale, the mean score before education program was 8.59 (SD±2.91) and decreased to 7.30 (SD±1.97) (t -6.44, p < 0.001) after education. This intervention is simple, cost-effective, and has the potential to be scaled up and implemented in the current healthcare system in Ethiopia.

The effect of training to diabetes patients according to planned behavior theory on self-efficacy and patient empowerment: A randomized study

AIM

To examine the effect of training provided to type 2 diabetes patients according to the theory of planned behavior on self-efficacy and patient empowerment.

METHODS

This study, pre-test-post-test active control group single-blind experimental design, was conducted in the internal medicine outpatient clinic of a state hospital between April and October 2023. Participants were randomly assigned to the intervention group (IG; n = 45) and control group (CG; n = 47). The intervention group received a theory-based training program consisting of 5 sessions lasting approximately 40 min. each. Diabetes Management Self-Efficacy Scale, Patient Empowerment Scale and the patient's laboratory results were used for data collection.

RESULTS

In the study, while the posttest self-efficacy and patient empowerment scores of the intervention group increased compared to the pretest, there was an decrease in HbA1C level. On the post-test measurements between groups, self-efficacy and patient empowerment scores were higher and effect sizes were higher in the intervention group, while no difference was found in HbA1C values.

CONCLUSION

The training program provided according to the theory of planned behavior in diabetes patients provides positive contributions to disease management.

The Power of Thought: The Role of Psychological Attentiveness and Emotional Support in Patient Trajectories

In modern healthcare, the influence of a patient's mindset on health outcomes is an often neglected yet vital component of holistic care. This review explores the significant impact of positive and negative mindsets on disease progression and recovery, emphasizing the need to integrate mental wellness practices into conventional medical care. Drawing from a wide array of studies, it demonstrates how fostering a positive mindset can enhance patient trajectories across various medical specialties. The article advocates for training healthcare providers to adopt a more empathetic and patient-centered approach, bridging the gap between mind and body. By presenting compelling evidence on the correlation between patient mindset and health outcomes, this review highlights the potential benefits of incorporating psychological support and holistic strategies into standard care protocols. Practical strategies for implementing mindset-focused interventions are also proposed, including training programs for healthcare professionals and the development of interdisciplinary treatment plans. Ultimately, this article underscores the need for a paradigm shift in medical practice, advocating for a comprehensive approach that recognizes the power of thought in promoting patient wellness.

Using primary healthcare facilities and patients' expectations about triage system: Patients' perspective from multisite Jordanian hospitals

BACKGROUND

Using primary healthcare facilities can decrease the tension and workload in emergency departments (EDs). This study aim to examine the patient's use of primary healthcare facilities before EDs visits and their expectations about the triage.

METHODS

A cross-sectional design was utilized in at various EDs in different hospitals. A convenience sample of 726 patients were enrolled and completed a self-administrated questionnaire.

RESULTS

The mean age of the participants was 38.1 (SD = 12.9). Most participants (68.2 %) did not have primary care physicians and did not want to know how long other patients waited (61.4 %). There are significant relationships between participants' desired to know how long other patients have been waiting and their age (X2 = 4.02, P < .05), education level (X2 = 13.5, P < .001), and current job (X2 = 9.90, p < .05). Also, periodic updates from EDs staff about the delays were significantly related to participants' age (X2 = 3.29), current job (X2 = 28.4), marital status (X2 = 8.93), and residency place (X2 = 9.94).

CONCLUSION

Educating patients about the triage system and the importance of using primary healthcare facilities is recommended to reduce ED waiting times and overload.

Socio economic factors and adherence to home based exercise in people with epilepsy

Exercise is a well-established component in the management of chronic illness both as a primary prevention and secondary intervention. The assumption that in otherwise healthy individuals, higher socioeconomic status (SES) is positively associated with physical activity (PA) has been debated. We report the influence of SES on adherence to home-based exercise program in people with epilepsy (PWE) from a developing country. Participants' response to self-reported Social Needs Screening Tool of the American Academy of Family Physicians was collected. The current study is a secondary follow-up and post-hoc analysis of data from patients we have previous published. The average age of the study population was 26.93 ± 10.20 years with 57.8 % men. Among the 116 study participants, 31 (26.72 %) were adherent to the exercise program. Unemployment (14.1 % vs. 0.0 %; p = 0.034) was higher, fewer people had least high school education (76.6 % vs 93.5 %; p = 0.050) in PWE who did not adhere to exercise program. A significantly higher number of PWE who were not adherent to exercise reported that their family members or anyone else never physically hurt them (97.6 % vs 80.6 %; p = 0.05), never threaten (94.1 % vs 74.2 %; p = 0.007) and/or never scream at them (90.6 % vs 74.2 %; p = 0.011). In PWE education and employment are associated with adherence to home-based exercise programs. The role of family support and personal safety in adherence to exercise should be evaluated in detail.

Process evaluation of the implementation of the assessment of burden of chronic conditions tool in Dutch primary care - lessons from a qualitative implementation study

BACKGROUND

The Assessment of Burden of Chronic Conditions (ABCC-)tool is developed to facilitate a personalized approach to care in the patient-healthcare provider (HCP) conversation based on shared decision-making and individualized care plans. An effectiveness study highlighted its effect on the perceived quality of care and patient activation. Successful implementation of novel interventions necessitates an understanding of the user's actual application, user experiences and an evaluation of implementation outcomes. This study aims to evaluate the implementation of the ABCC-tool by HCPs in Dutch primary care.

METHODS

This study is the process evaluation of a larger type 1 effectiveness-implementation hybrid trial. Semi-structured interviews with HCPs, who were interventionists in the hybrid trial, were held at three and twelve months after they started using the ABCC-tool. The Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework was used to evaluate implementation outcomes. The Implementation domain was further strengthened with an evaluation of implementation fidelity using Carroll's framework. Inductive coding and thematic analysis were applied to identify relevant participant experiences and implementation outcomes within the RE-AIM framework.

RESULTS

Seventeen HCPs (1 general practitioner, 16 practice nurses) participated in the study, representing 39% of potentially eligible participants. Most HCPs applied the tool after finishing their own routines instead of how it is intended to be used, namely from the beginning of the consultation. HCPs reached 2-6 patients. The ABCC-tool was initially adopted, but twelve HCPs stopped using the tool due to COVID-19 related cancellation of consultations. High fidelity was found for applying the questionnaire and visualization. Low fidelity was present for applying shared decision-making, formulating care goals and monitoring progress. HCPs indicated that maintaning the ABCC-tool depended on accompanying training and implementation support.

CONCLUSIONS

HCPs applied the ABCC-tool critically different from intended, potentially diminishing its benefits and ease of use. This evaluation stresses the need for a tailored implementation plan that includes more detailed training and guidance on how and when to use the ABCC-tool.

Developing an Online Health Community Platform for Facilitating Empowerment in Chronic Disease Prevention and Health Promotion

This study aimed to develop an online health community platform for facilitating the empowerment of people with chronic diseases dwelling in the community regarding disease prevention and health promotion. The user-centered design approach included four main steps: (1) identifying the health problems and needs of target users, (2) developing the content of the platform, (3) constructing the platform, and (4) pilot testing, refinement, and finalization. An online health community platform available both in a mobile application and a Web-enabled application has been launched to facilitate empowerment and self-management by people with chronic conditions. The main components of the application comprised (1) screening for chronic diseases and health problems, (2) setting personal goals for health promotion and action planning to achieve the goals themselves, (3) offering an online health community with shared group goals that help users engage with their peers to attain their goals, and (4) creating one's own online health community and inviting others to participate. The platform has the potential to encourage people with chronic conditions to proactively engage in their own health promotion. Future studies are needed to determine the impact of the application on self-management and empowerment for its users.

Exploring the determinants of risk behavior for transfusion transmissible infections among first-time blood donors in Mandalay General Hospital, Myanmar

INTRODUCTION

Blood donation is vital to healthcare, but it must be kept safe by mitigating the risk of transfusion transmissible infections (TTIs). The objective of this study was to investigate the factors that influence risk behavior for transfusion transmissible infections among first-time blood donors at Mandalay General Hospital, Myanmar.

METHODS

This study utilized a cross-sectional study design using secondary data. Mandalay city and Mandalay Blood Bank in Mandalay General Hospital were purposely selected and a total of 406 first-time blood donors participated. A structured questionnaire administered by an interviewer was used. The questionnaire contained background characteristics, knowledge on TTIs, attitude toward TTIs, and TTIs risk behaviors. To examine the determinants (background characteristics, knowledge, and attitude) that affect risk behavior, inferential statistics techniques that included the chi-squared test, bivariable logistic regression, and multivariable logistic regression were applied. A p-value of less than 0.05 signified statistical significance.

RESULTS

Among 406 first-time blood donors, 52.9% were under 20 years old, and 53.7% were male. Most had undergraduate education (77.6%), were married (84.2%), and were students (55.7%). Additionally, 76.8% hadn't received the hepatitis B vaccine. Blood groups were distributed as follows: B (40.0%), O (33.8%), A (23.4%), AB (8.9%). About 15.8% showed high knowledge level, and 63.6% had high attitude. Notably, 29.3% exhibited high-risk behavior for TTIs. Age was associated with lower risk behavior (OR = 1.54, 95% CI: 0.99, 2.38, p = 0.049), but lost significance in multivariable regression (p = 0.214). Knowledge on TTIs didn't show significance. However, high attitudes were significantly associated with lower risk behavior (OR = 11.4, 95% CI: 1.25, 103.83, p = 0.017, retained in multivariable regression, p = 0.012).

CONCLUSION

Findings of this study contribute in the development of programs that ensure a safe and reliable blood supply chain. To improve blood safety standards among first-time blood donors, this study highlights the value of targeted education and screening processes, placing particular emphasis on acquiring knowledge and positive attitude toward blood donation and risk behavior.

Determinants associated with activation in patients with oral anticoagulant treatment: A cross-sectional study

AIMS

The terms "patient activation" and "patient empowerment" are used to describe the extent to which individuals are able to manage their own healthcare. Health outcomes and quality of life improve in patients who are more active in health care. The aim of this study was to identify sociodemographic, clinical, sociological and psychological determinants associated with activation in a group of chronically anticoagulated patients.

METHODS

Cross-sectional study of patients treated with oral antivitamin-k drugs attended at a specialized outpatient anticoagulant unit between November 2021 and June 2022. The main dependent variable was the level of patient activation according to the 13-item Patient Activation Measure (PAM-13). Simple and multiple linear regression models were conducted to identify the determinants associated with PAM-13 score.

RESULTS

A total of 137 patients who met all the inclusion criteria were recruited for the study. The mean age was 59.6 years (SD 13.8; range 22-86) and 60.6% were male. Sixty per cent presented a level IV of activation according to the PAM-13 scale. Mean patient activation score was 73.9 (SD 15.4). The factors independently associated with significantly lower activation were: emergency department visits in the past 12 months, intermediate social risk, anxiety symptoms, stress symptoms and low self-efficacy.

CONCLUSIONS

Five determinants were found to be associated with activation. Knowing the factors that modify the level of activation can help to identify subgroups of chronic anticoagulated patients who are less likely to engage in self-management and are therefore candidates for tailored educational interventions.

Work participation, social roles, and empowerment of Q-fever fatigue syndrome patients ≥10 years after infection

OBJECTIVE

To determine work participation, social roles, and empowerment of QFS patients ≥10-year after infection.

METHODS

QFS patients ≥10-year after acute infection, who were of working age, participated in a cross-sectional survey study. Work participation, fulfilment of social roles, and empowerment outcomes were studied for the total population, as well as for subgroups based on employment type and current work status. Associations between empowerment, work and social roles were examined.

RESULTS

291 participants were included. Of the 250 participants who had paid work before Q-fever, 80.4% stopped working or worked less hours due to QFS. For each social role, more than half of the participants (56.6-87.8%) spent less time on the role compared to before Q-fever. The median empowerment score was 41.0 (IQR: 37.0-44.0) out of 60. A higher empowerment score was significantly associated with lower odds of performing all social roles less due to QFS (OR = 0.871-0.933; p<0.001-0.026), except for parenting and informal care provision (p = 0.070-0.460). No associations were found between empowerment and current work status.

CONCLUSION

Work participation and fulfilment of social roles is generally low in QFS patients. Many of the participants stopped working or are working less hours due to QFS, and most spent less time on social roles compared to before Q-fever. Minor variation was seen in total empowerment scores of participants; however, these slight differences were associated with the fulfilment of social roles, but not work participation. This new insight should be further explored in future studies.

Prevalence and predictors of arthritis among adults in a rural set-up in Kenya: a cross-sectional study

Introduction

arthritis is a significant public health problem affecting many people globally. Exposure to various risk factors puts individuals at risk of developing arthritis. Therefore, this study aimed to assess the prevalence and predictors of arthritis among residents of a rural set-up in Nyamira County, Kenya.

Methods

a community-based cross-sectional study design was employed. Simple random sampling was utilized to select households from a household list. All the residents of the sampled household above 40 years were included. Descriptive analysis was done to describe the study population. Bivariate and multivariate analysis was also done to identify statistically significant arthritis-related variables.

Results

the prevalence of arthritis was 44.6%. Previous joint injury/infection [AOR=2.74; 95%CI=1.59-4.77; p<0.001], being unemployed [AOR=2.77; 95%CI=1.50-5.21; p=0.001], age above 51 years, and hypertension [AOR=1.90; 95%CI=1.03-3.53, p=0.040] were associated with an increased risk of arthritis. Conversely, being male [AOR=0.42; 95% CI=0.22-0.75; p=0.005], standing for > 2 hours [AOR=0.48; 95%CI=0.29-0.81; p=0.006], and constant shifting from sit to stand positions [AOR=0.45; 95% CI=0.26-0.76; p=0.003] were associated with a lower risk of arthritis. Most participants (75%) had an arthritis knowledge score of more than 66%.

Conclusion

the study found a high prevalence of arthritis in the community. Arthritis was strongly associated with various risk factors under study. Therefore, there is a need to take preventive measures for modifiable factors to enhance a reduced prevalence of arthritis.

The dynamics of knowledge sharing in chronically ill patient-led online health communities

Patient-led online health communities (OHCs) provide an accessible way for patients to share their knowledge without the constraints of time and distance. By sharing knowledge, patients receive information from other members of the community that expands their knowledge. In this way, knowledge 'grows' and enhances the ability of patients in the community to adequately self-care in everyday life, that is, patient empowerment. This paper aims to understand the dynamics of knowledge sharing in patient-led OHCs. In search of an answer to the research question, the virtual ethnography research design was applied using an observational data collection method. The observational research was conducted in five patient-led OHCs of chronically ill patients on the Lithuanian version of the Facebook Platform. The results of the study provided insight into the dynamics of knowledge sharing by detailing the design of the discussions that took place in the studied communities and by characterising the path of knowledge sharing.

Assessing the clinical benefit, safety, and patient-reported outcomes with the use of the PAHcare™ digital platform in pulmonary arterial hypertension: a pilot study

Introduction

Digital health interventions, particularly mobile health platforms, have shown promise in supporting patients with respiratory conditions, but their application in pulmonary arterial hypertension (PAH) remains limited. We aimed to assess the feasibility, acceptability, and potential clinical benefit of the novel PAHcare™ digital platform as a patient-centred intervention for PAH management through a prospective, single-arm, multicenter pilot study conducted on 53 patients diagnosed with PAH who used the platform for 6 months.

Methods

The primary objective was to assess the impact on Health-Related Quality of Life (HRQoL) through questionnaires. Secondary objectives included evaluating clinical outcomes, including disease progression, PAH signs and symptoms, the 6-min walking test, and the patient's symptom perception. Additionally, we assessed patient satisfaction and engagement with the PAHcare™ platform, interaction with health coaches, retention, costs and healthcare resource utilisation (HCRU), and safety through monitoring device incidents.

Results

Minimal changes in HRQoL and clinical outcomes were observed over 6 months. A noteworthy 92.4% of patients actively used the platform in the first month, maintaining high usage throughout the study. Patient satisfaction was substantial, with more than half of the patients expressing excellence in service quality, willingness to reuse the platform, and fulfilment of their needs. Health coach interaction was high, with 76% of patients initiating contact within the first week. User retention rates were 70%, with prevalent ongoing usage and interaction with healthcare professionals even after the study. In terms of HCRU and costs, the study showed no significant changes in PAH-related hospital admissions, clinical visits, or tests. Finally, the low number of device-related incidents indicated platform safety.

Conclusion

This pilot study provides compelling evidence supporting the feasibility and acceptability of the PAHcare™ digital platform to empower patients to manage their disease and significantly enhance their overall experience with PAH.

Development and Evaluation of a Patient Cirrhosis Knowledge Assessment

BACKGROUND AND AIMS

Self-management skills improve outcomes for patients with cirrhosis. While education programs exist to teach these skills, there are limited patient assessments to evaluate their efficacy. We aimed to develop and evaluate cirrhosis knowledge assessments for patients with compensated and decompensated cirrhosis.

METHODS

Across two institutions, a 4-stage process was undertaken: first, we developed a comprehensive set of questions regarding cirrhosis self-management. Second, the questions underwent critical review by patients and hepatology providers. Third, patients with cirrhosis answered these questions before and after a written educational tool. Questions were updated based on results. Fourth, patients answered the updated questions before and after a video educational tool. Binomial test or paired sample t-test was used to compare pre- and post-tests depending on question type.

RESULTS

In phase 3, 134 patients completed pre- and post-tests. 44% were decompensated, 81% were diagnosed with cirrhosis at least 3 years, and 52% were 60-75 years. 95% of single-answer questions were answered correctly by at least 70% of patients in the pre-test. None of the answers improved significantly with education. After phase 3, 6 questions were removed and 6 questions were edited to increase challenge. In phase 4, 96 patients (42 compensated, 54 decompensated) completed pre- and post-tests. In the compensated assessment, 3 questions improved after education and the summative score increased (7.9 to 9.0, P < 0.001). In the decompensated assessment, 4 questions improved after education and the summative score increased (7.0 to 7.7, P = 0.004).

CONCLUSION

Through a rigorous process, we created and evaluated cirrhosis knowledge assessments for patients with compensated and decompensated cirrhosis. Further validation is required and then these assessments can be used to improve patient education.

Multi-professional development of a competency framework for patients with a Port-a-Cath (PAC)

PURPOSE

In France, 40,000 Port-a-Cath (PAC) are inserted each year. These medical devices are prone to complications during their insertion or use. The education of patients wearing these devices could be a lever to reduce the risk of complications. The objective of this work was to develop, in a multi-professional and consensual manner, a unique and specific skills reference framework for patients with PAC and to propose it as a reference tool for health professionals.

METHODS

A multidisciplinary working group was set up to draw up this reference framework of skills. The first stage of the work consisted of a reflection leading to an exhaustive list of competencies necessary for the patient. These skills were then classified according to three different fields of knowledge (theoretical, know-how and attitudes). Finally, the working group identified priority competencies and established a grid that can be used to evaluate the level of acquisition of these competencies.

RESULTS

Fifteen competencies were identified: five relating to theoretical knowledge, six relating to know-how and four relating to attitudes. These competencies were broken down into sub-competences. Seven competencies or sub-competencies were selected to constitute the list of priority competencies.

DISCUSSION

This competency framework provides a reference framework for the education of patients with PAC and will help to harmonise practices within the different teams that care for patients with PAC.

Social Media-Delivered Lifestyle Interventions Among Individuals Living with Diabetes and Prediabetes: A Scoping Review

PURPOSE OF REVIEW

There is a lack of synthesized evidence on social media-delivered lifestyle interventions for managing and preventing diabetes. This scoping review aims to evaluate recently reported lifestyle interventions delivered on social media for individuals with diabetes and prediabetes.

RECENT FINDINGS

Twelve studies were included in this review. A team of multidisciplinary healthcare professionals coordinated most interventions, half of which lasted for 6 months, and used a combination of videos, texts, images or audio to deliver the educational materials. The glycosylated hemoglobin (HbA1c) level improved in most of the studies, followed by diabetes self-care and fasting plasma glucose. The dietary intakes were only assessed in two interventions among the individuals with prediabetes and showed promising improvements. This scoping review provides a holistic overview of the recent designs of lifestyle interventions for diabetes management and prevention on social media. This is essential for various healthcare professionals and stakeholders to formulate and implement population-based, cost-effective interventions in combating diabetes using social media.

Empowerment of the older adults in the context of Chinese culture: an evolutionary concept analysis

Background

With the increasing focus on addressing the challenges of aging, researchers have begun to recognize the potential impact of empowering older individuals in addressing retirement issues. However, within different cultural contexts, there still needs to be a more precise analysis regarding the definition of empowering older individuals.

Objective

To define and analyze the concept of empowering older individuals within the cultural context of China.

Method

Using Rodgers' concept analysis approach, a search was conducted in five databases (PubMed, Web of Science, China National Knowledge Infrastructure, Wan fang Data, and VIP Chinese Journal Platform) for studies on empowering older individuals from the time the databases were established until February 2023. The main disciplines involved in the search included nursing, medicine, and public health.

Results

Out of the 7,028 studies, 50 articles met the inclusion criteria. The identified attributes are as follows: support system, belief change, and behavioral autonomy. The antecedents were grouped into four categories: physical obstacles, psychological concerns, personal needs and external challenges. The consequences were determined to be improved quality of life, reduced burden of old-age care, gain respect, and self-actualization.

Conclusion

Empowering older individuals is a dynamic and evolving concept that involves aligning personal aspirations with appropriate external resources and expressing a certain degree of belief and behavioral change. This study deepens our understanding of empowering older individuals through comprehensive concept analysis, and the identified attributes, antecedents, and consequences of empowering older individuals can be utilized in practice, education, and research.

Unveiling the Enigma: Exploring the Intricate Link Between Coronary Microvascular Dysfunction and Takotsubo Cardiomyopathy

This review article delves into the intricate and evolving relationship between coronary microvascular dysfunction (CMD) and takotsubo cardiomyopathy (TCM), two intriguing cardiovascular conditions increasingly recognised for their potential interplay. We examine their characteristics, shared pathophysiological mechanisms, diagnostic challenges, and management strategies. Emerging evidence suggests a link between microvascular dysfunction and the development of TCM, leading to a deeper exploration of their connection. Accurate diagnosis of both conditions becomes essential, as microvascular dysfunction may modify TCM outcomes. We underscore the significance of understanding this connection for improved patient care, emphasising the need for tailored interventions when CMD and TCM coexist. Collaborative research and heightened clinical awareness are advocated to advance our comprehension of this relationship. Through interdisciplinary efforts, we aim to refine diagnostic precision, develop targeted therapies, and enhance patient outcomes in cardiovascular medicine.

Efficacy of a multidimensional self-management intervention on low-education women with metabolic syndrome: a cluster randomized controlled trial

Low-education women, a substantially older population, are subject to increased risks of metabolic syndrome and consequent cardiometabolic diseases; early detection and effective management were urgently needed. Ninety-nine women with metabolic syndrome, age 61 and education ≤ 6 years, from four community units were randomly assigned to either a self-management intervention (n = 51) or a control arm (n = 48). The intervention consisted of five dimensions, physical activity and diet modifications (daily exercise classes and two nutrition courses), goal setting, coaching and peer support, problem-solving, and self-monitoring. The control arm received an education leaflet. Assessments were performed at baseline, six months, and 18 months. Compared with the control, the intervention participants improved the overall rate of meeting the recommended servings for six health foods, including vegetables, dairy products, and nuts (except whole grains, fruits, and protein); the rate of meeting regular leisure-time physical activity; and criteria biomarkers-waist circumference, fasting blood glucose, high-density lipoprotein cholesterol (except blood pressure and triglycerides); as well as body weight and body mass index; consequently decreased the number of risk factors and rate of metabolic syndrome. In conclusion, the multidimensional self-management intervention improved physical activity, healthy eating, and metabolic syndrome risks among low-education women with metabolic syndrome.

Effects of empowerment education on patients after percutaneous coronary intervention: A meta-analysis and systematic review

BACKGROUND

Empowerment education is a new nursing education model with great significance in the process of chronic disease rehabilitation, and a number of studies have found that it has good benefits for patients after percutaneous coronary intervention (PCI). But there is no meta-analysis on how empowerment education influence the life of patients after PCI.

AIMS

Our study intends to evaluate the impact of empowerment education on the quality of life, cognitive level, anxiety and depression level of patients after PCI.

DESIGN

Systematic review and meta-analysis, following PRISMA guidelines.

METHODS

RevMan5.4 software and R software were used for statistical analysis. Mean difference or standard mean difference was used as effect analysis statistic for continuous variables with 95% confidence intervals.

RESULTS

Six studies met the inclusion criteria, including 641 patients. The Exercise of Self-Care Agency Scale score of the experimental group was higher than that of the control group, with statistically significant difference. Empowerment education could increase the knowledge of coronary heart disease in patients after PCI, but the difference was not statistically significant.

CONCLUSION

Significant effects of empowerment have been found in improving patients' quality of life and self-care ability. Empowerment education could be a safe exercise option in PCI rehabilitation. However, the effect of empowerment on cognitive level for coronary heart disease and the depression needs to carry out more large-sample, multi-center clinical trials.

PATIENT OR PUBLIC CONTRIBUTION

A data-analysis researcher and 3 clinicians are responsible for the writing, and no patients participated in the writing of this paper.

Providing Diabetes Education through Phone Calls Assisted in the Better Control of Hyperglycemia and Improved the Knowledge of Patients on Diabetes Management

Purpose: A recent single-arm pilot study from our group showed a significant decrease in HbA1C in Type-2 diabetes individuals provided with SMS and phone call-based education on glycemic control. Considering the preference of participants to phone call-based education, a randomized control trial (RCT) with parallel design was conducted to determine the impact of phone call-based diabetes educational intervention on the control of hyperglycemia and improvement in the knowledge about diabetes management. Objectives: To determine the impact of phone call-based educational intervention on the control of hyperglycemia and improvement in the knowledge about diabetes management. Methodology: The study was conducted for a period of 12 months on a total of 273 Type-2 diabetic patients (interventional group (n = 135); non-interventional group (n = 138)) who had provided consent to participate. Subjects in the case group received weekly phone calls on diabetes education; whereas the control group received no education. HbA1C investigations were carried out at baseline and at every fourth month until the completion of the study period for the subjects in both the groups. The impact of phone call-based education was measured by comparing HbA1C values as well as by measuring the questionnaire-based knowledge scores on diabetes management. Results: At the end of the study period, there was a significant reduction in HbA1C in 58.8% participants (n = 65) and a manifold (2-5-fold) increase in knowledge on diabetes management among participants in the case group (n = 110). However, no significant difference in HbA1C and knowledge score was observed in participants from the control group (n = 115). Conclusion: Phone call-based diabetes education is a viable option to empower patients for better management of Type-2 diabetes.

Effectiveness of health literacy interventions on anxious and depressive symptomatology in primary health care: A systematic review and meta-analysis

Background

Affective disorders are a debilitating and very prevalent problem throughout the world. Often these are associated with the onset of comorbidities or a consequence of chronic diseases. Anxiety and depression are associated with poor social and personal relationships, compromised health. We aimed to synthesize evidence from studies measuring the impact of a health literacy (HL) intervention on the improvement of affective disorders.

Methods

For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, Web of Science, Ibecs, Cuiden, Scielo, Science Direct and Dialnet for exclusively randomized controlled trial studies (RCTs) published between 1 Jan 2011, and 31 May 2022. The search terms employed were "health literacy," "health knowledge," "anxiety," "anxiety disorder," "depression," "depressive disorder," and "adult." The risk of bias assessment was performed using the Cochrane Collaboration Revised Risk of Bias tool (RoB2). We conducted random-effects meta-analyses and explored heterogeneity using meta-regression and a stratified survey.

Results

Of 2,863 citations found through the initial screening, 350 records were screened by the title and abstract for their themes and relevance. Finally, nine studies complied with the inclusion criteria for the meta-analysis. 66.66% of studies (n = 6) were rated as having a low risk of bias and 33.33% (n = 3) were judged to raise some concerns. The health literacy interventions were associated with -1.378 reduction in depression and anxiety questionnaires scores [95% CI (-1.850, -0.906)]. Low mood disorder scores are associated with better mental health and wellbeing.

Conclusion

Our findings demonstrate that an HL intervention in relation to the symptoms associated with affective disorders improves the emotional state of patients in PHC, with a moderately positive effect in reducing depression and anxiety.

Foresight study on online health community: The perspective of knowledge empowerment for patients with chronic diseases

Patient empowerment is an indispensable precondition for patients to self-manage their disease. The article takes the position that patients are empowered for disease self-management through patient knowledge empowerment when sharing knowledge. One of the most important instruments to successfully empower a patient to manage a chronic disease and maintain social relations, which are also a precondition for the prevention of chronic illnesses, is the possibility to access online health communities (OHCs) and participate in them. The aim of the article is to model possible development scenarios of OHCs as enablers of patient knowledge in relation to other digital health technologies (DHTs). A foresight methodology was used to achieve the goal, employing a technology scanning approach after selecting 10 foresight studies, which resulted in four future scenario models for the empowerment of patients wcith chronic diseases through digital health communities. They reveal options for the future interoperability of OHCs with other DHTs and highlight their importance and significance for the healthcare system as a technology for balancing patient self-efficacy and social relations as well as the need to maintain and develop them.

Interaction between self-perceived disease control and self-management behaviours among Chinese middle-aged and older hypertensive patients: the role of subjective life expectancy

Background

One of the effective ways to control hypertension is long-term self-management, which is difficult to maintain. Therefore, understanding how people engage in the process of self-management behaviour change is necessary. In this study, we aimed to examine the dynamic relationship between self-perceived disease control and self-management behaviours in Chinese middle-aged and older hypertensive patients, namely, medication use, self-monitoring, physical activity, tobacco and alcohol avoidance, and to explore the mediating role of subjective life expectancy (SLE) on this relationship.

Methods

Data were obtained from a nationally representative sample of 508 middle-aged and older hypertensive patients (aged 45+) from the 2013, 2015, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. A cross-lagged panel model combined with mediation analysis was used to determine the dynamic relationship between self-perceived disease control and self-management behaviours and to clarify the mediating effect of SLE on this ascertained relationship.

Results

Good self-perceived disease control subsequently predicted good medication use, self-monitoring and physical activity, and vice versa. Subjective life expectancy (SLE) partially mediated the prospective reciprocal relationships between self-perceived disease control and these self-management behaviours, which accounted for 37.11, 25.88, and 19.39% of the total effect of self-perceived disease control on medication use, self-monitoring and physical activity, respectively. These self-management behaviours had a significant and positive feedback effect on self-perceived disease control. However, neither the direct and indirect effects (via SLE) of self-perceived disease control on tobacco and alcohol avoidance were revealed.

Conclusions

Positive feedback loops of present self-perceived disease control, future SLE and self-management behaviours (medication use, self-monitoring, and physical activity) help middle-aged and older hypertensive patients adhere to these behaviours but are useless for the avoidance of addictive behaviours. Interventions aimed at enhancing the effect perception of general self-management behaviours (e.g., medication use, self-monitoring and physical activity) on the present disease control perspective, and future lifespan perspective would be beneficial for the consistent self-management behaviours of middle-aged and older hypertensive patients. The utility of present disease control perception to these self-management behaviours was much higher than the utility of future expectations. Alternative stress relief strategies may be conducive to long-term changes in addictive behaviours.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12990-8.

From physician’s authority to patient expertise: the effects of e-health technology use on patient’s behavior and physician-patient relationship

Purpose

This paper aims to examine the health technology use in health information seeking, communication and personal health information management, as well as in the effects they may have on his relationship with the physician and on the consumption of medical resources.

Design/methodology/approach

An online survey was conducted. The questionnaires were distributed via online health discussion forums using Google's survey software with a summary presentation of the study’s objective. The final selection of 362 individuals was made using social media, direct email and collaboration with community groups. The empirical validation of the causal model was conducted using the partial least square approach.

Findings

The results show that the use of e-health strengthens the quality of the patient–physician relationship and patient empowerment while increasing the consumption of medical resources.

Originality/value

The results of this research indicate that the internet has transformed the relationship of patients to health, to their doctors and to the health-care system. In this new context, a reconsideration of the status of the patient must be considered by health service providers.

Empowering Patients in the Therapeutic Decision-Making Process: A Glance Into Behçet's Syndrome

Behçet's syndrome (BS) represents a challenging condition, characterized by a variable spectrum of disease profile and associated with a significant limitation of the daily activities as well as a potential negative impact on relationships and psychological status. Considering also the complexity of the therapeutic management of BS, that often includes biological off-label treatments, the participation in the therapeutic decision-making process of the BS patients is essential to ensure the integration of the care process into the life of the patient. For this reason, the empowerment of BS patients represents a crucial need and the present work is aimed at fully exploring all the potential variables implicated in the BS patient empowerment, also highlighting major points to consider and concrete actions to be planned in the immediate future in order to implement a pragmatic facilitation of the patients' empowerment.