Exploring the sources of cervical cancer screening self-efficacy among rural females: A qualitative study.

AIM: Evidence showed self-efficacy was relevant to rural females' cervical cancer screening behaviour. However, little is known about sources of self-efficacy in cervical cancer screening among rural females. This study aimed to explore sources of self-efficacy in cervical cancer screening among rural females. DESIGN: A qualitative descriptive study was conducted. Both users and providers of cervical cancer screening services in rural areas of China were recruited through maximum variation sampling. METHODS: Individual semi-structured interviews through telephone calls were conducted. Data were analysed via six main stages of the framework method, with the social cognitive theory as a reference. RESULTS: Four main sources were identified, including personal screening experience, hearing about other women's screening experiences, professional health education and consultation, and emotional status. Personal screening experience included enactive mastery of completing the screening behaviour and cognitive mastery of internalisation of the screening. Only the experience of completing cervical cancer screening behaviour was not strong enough to improve self-efficacy. Cognitive mastery showed more critical influence. CONCLUSION: These four sources of rural females' cervical cancer screening self-efficacy matched with the major sources of self-efficacy of the social cognitive theory. Cognition was critical to influencing the screening self-efficacy. Intervention strategies aimed at enhancing rural females' cervical cancer screening self-efficacy can be developed from these four major sources. PUBLIC CONTRIBUTION: A registered nurse with rich experience in cervical cancer-related research and qualitative study was the interviewer of this study. Rural females and cervical cancer screening services providers (healthcare professionals and village staff) were recruited as interviewees. The interview guides were developed by the research team and evaluated by an expert panel including two nurse leaders of gynaecological cancer, one doctor specialised in cervical cancer, and one medical director in a local rural hospital.

Psychometric Evaluation of the Chinese Version of Hypertension Self-care Profile.

BACKGROUND: Valid and reliable assessment of the multidimensional self-care of patients with hypertension is important to tailor individualized care. The Hypertension Self-care Profile (HBP SCP), which comprises behavior, motivation, and self-efficacy scales, has been widely tested in various settings. OBJECTIVE: The aims of this study were to translate the HBP SCP into a Chinese version (HBP SCP-C) and evaluate its psychometric properties among Chinese adults with hypertension. METHODS: The HBP SCP was translated to Chinese using Cha's combined translation technique, and its content validity was examined by a panel of 7 experts. The psychometric properties of HBP SCP-C were tested in 200 Chinese patients with hypertension. Reliability tests included internal consistency and test-retest reliability. Exploratory factor analysis was performed to explore the structure of HBP SCP-C. Discriminative validity was examined by the known-group approach. RESULTS: The HBP SCP-C demonstrated satisfactory content validity. The 2-factor structures of the behavior ("health promotion" and "habit modification") and self-efficacy ("intake management" and "health maintenance") scales and 1-factor structure of the motivation scale were determined. The behavior, motivation, and self-efficacy scales had Cronbach α coefficients of 0.86, 0.94, and 0.93, respectively, and test-retest reliabilities were 0.82 to 0.98, 0.90 to 0.98, and 0.81 to 0.95, respectively. Significant differences between patients with or without comorbidities in behavior (t = 2.55, P = .011), motivation (t = 3.25, P = .001), and self-efficacy (t = 3.02, P = .003) supported the discriminative validity of HBP SCP-C. CONCLUSIONS: The HBP SCP-C could be a reliable and valid instrument for evaluating hypertension self-care in Chinese patients.

Effects of a Web-Based Educational Support Intervention on Total Exercise and Cardiovascular Risk Markers in Adults With Coronary Heart Disease.

BACKGROUND: eHealth educational programs have proven to be an effective means for health promotion, yet limited studies have been conducted for coronary heart disease (CHD) patients to improve their total physical exercise, self-efficacy for exercise, and cardiovascular risk factor profile. METHOD: A prospective randomized controlled trial (RCT) was conducted in two cardiac clinics in Hong Kong. Four hundred thirty-eight eligible CHD clients were randomly assigned to either the control or the intervention group. All of the participants received standard care, which consisted of regular medical and nursing care in the cardiac clinic. The intervention group received an additional web-based educational support intervention (eHES), which consisted of a 20-minute individual educational session on the use of the eHES web link. The eHES web link contains a health information platform related to CHD care and an individual member area with records of health measures and physical exercise data for six months. Data were collected at baseline, at three-month and six-month intervals at the cardiac clinic. The primary outcome was the total amount of physical exercise, measured by the Godin-Shephard Leisure-Time Physical Activity Questionnaire. The secondary outcomes were self-efficacy for exercise and cardiovascular disease (CVD) risk markers (body weight, blood pressure, lipid profile). The data were analyzed using a generalized estimating equations model. RESULTS: The intervention group reported a statistically higher amount of physical exercise and a higher HDL-C at 3 and 6 months, respectively. There were no statistical differences between the groups in self-efficacy for exercise and other CVD risk markers. LINKING EVIDENCE TO ACTION: The study demonstrated the effectiveness of the eHES in meeting the challenge of boosting the amount of physical exercise and increase HDL-C among CHD patients who engaged for over three months. The results provide insight for eHealth development to support and promote exercise among CHD patients in the community.

Malnutrition risks and their associated factors among home-living older Chinese adults in Hong Kong: hidden problems in an affluent Chinese community.

BACKGROUND: Although China is undergoing rapid economic development, it is facing an ageing population. No data exists on malnutrition risks of older adults in an affluent Chinese society. The aim of this study is to examine these risks and identify their associated factors among home-living older Chinese adults in Hong Kong. METHODS: This is a cross-sectional study, to which home-living subjects aged 60 or above were recruited, between May and September 2017, from a non-governmental community organisation located in three different districts of Hong Kong. Nutritional status was assessed by the Mini Nutritional Assessment (MNA), and its associated factors examined included socio-demographic characteristics, lifestyle, health status and diet. Multivariable logistic regression analysis was performed to identify factors associated with malnutrition risks (MNA < 24). RESULTS: Six hundred thirteen subjects (mean age: 78.5 ± 7.4; 54.0% females) completed the survey. Nearly 30% (n = 179) were at risk of malnutrition. By multivariable logistic regression, subjects (1) whose vision was only fair or unclear, (2) with poor usual appetite and (3) with main meal skipping behaviour had significantly higher malnutrition risk (all p < 0.05). CONCLUSIONS: In this affluent Chinese society, the malnutrition risk in older adults is close to the global average, which is a matter for much concern. Interventions are therefore warranted that target vulnerable groups with poor vision, appetite, and meal skipping behaviour. TRIAL REGISTRATION: Not applicable.

The influence of Chinese culture on family caregivers of stroke survivors: A qualitative study.

AIMS AND OBJECTIVES: To explore and describe the caregiving experiences of Chinese stroke caregivers. BACKGROUND: Previous research has indicated that culture can have a significant impact on the stroke caregiving experience. Moreover, scant research exists on stroke caregivers' experience within the Chinese culture. DESIGN: A qualitative descriptive design was used. METHODS: In-depth, semistructured interviews were conducted with 25 family caregivers of stroke survivors. The interviews were audiotaped, transcribed and analysed. Content analysis was also performed. FINDINGS: Twenty-five family caregivers of stroke survivors were recruited for the study. On average, respondents were 66 years old (range 45-82 years). Of 25 interviewees, 76% were female, 64% were spouse-caregivers and 36% were children-caregivers. Three themes reflecting the influence of Chinese culture on stroke caregiving emerged from the interviews. (i) Caregiving role perception. Informants accepted caregiving for the sick family member as an expected part of life, a culturally prescribed obligation and an expression of reciprocal love. (ii) Coping strategies. Connecting with family resources and connecting with inner strength were frequently reported coping strategies. (iii) Self-sacrifice. Informants identified self-reliance and feeling of restraint in their utilisation or access of formal caregiving service. Chinese caregivers sacrifice themselves for the care recipients regardless of the hardships and the neglect of their own health. CONCLUSION: Our findings provide a comprehensive and culturally sensitive perspective in understanding the experience of stroke caregivers in Chinese communities. Cultural and religious backgrounds were found to influence Chinese stroke caregivers' experience, coping strategies and self-sacrifice behaviour in idiosyncratic ways. RELEVANCE TO CLINICAL PRACTICE: Research on the practice of culture can serve as a basis for the formulation of specific policies and effective interventions for supporting stroke caregivers of different cultural backgrounds.

A qualitative insight into self-management experience among Chinese breast cancer survivors.

BACKGROUND: With increasing awareness in the chronic nature of cancer, promoting the engagement of breast cancer survivors in self-management has become a priority of cancer care reform initiatives. This study aimed to reveal Chinese breast cancer survivors' views and experiences of self-management in extended survivorship. METHODS: Archived interview transcripts from 19 breast cancer survivors (<5 years since diagnosis) were subjected to a secondary analysis. Each transcript was re-examined through qualitative content analysis. RESULTS: Three categories were established to represent the perceptions of the participants on their self-management tasks related to health and well-being, emotions, and roles and relationships. Managing health and well-being covers modifying lifestyle, taking traditional Chinese medicine, attending regular follow-ups, managing symptoms, and adhering to hormonal therapy. Managing emotions involves maintaining a positive attitude and utilizing supportive resources. Managing roles and relationships comprises adjusting to life as cancer survivors, maintaining marital relationships, and performing familial and other social roles. CONCLUSIONS: Most participants actively participated in various self-management tasks and behaviors that can help improve their health and prevent cancer recurrence. They may exhibit optimal self-management in their emotions and most health aspects but may exert limited efforts in managing their different roles during survivorship.

Effectiveness of Interactive Self-Management Interventions in Individuals With Poorly Controlled Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials.

AIMS: To identify, assess, and summarize available scientific evidence on the effectiveness of interactive self-management interventions on glycemic control and patient-centered outcomes in individuals with poorly controlled type 2 diabetes. METHODS: Major English and Chinese electronic databases including Medline, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and WanFang Data were searched to identify randomized controlled trials that reported the effectiveness of interactive self-management interventions in individuals with poorly controlled type 2 diabetes (glycated hemoglobin [HbA1c] ≥ 7.5% or 58 mmol/mol), from inception to June 2015. Data extraction and risk-of-bias assessment were performed by two reviewers independently. Meta-analysis was performed using Review Manager 5.3. RESULTS: A total of 16 trials with 3,545 participants were included in the meta-analysis. Interactive self-management interventions could have a beneficial effect in individuals with poorly controlled type 2 diabetes in reducing HbA1c (mean difference: -0.43%, 95% CI: -0.67% to -0.18%), improving diabetes knowledge (standardized mean difference [SMD]: 0.30, 95% CI: 0.03 to 0.58), enhancing self-efficacy (SMD: 0.29, 95% CI: 0.14 to 0.44), and reducing diabetes-related distress (SMD: -0.21, 95% CI: -0.39 to -0.04). Self-management interventions supported with theory and structured curriculum showed desirable results in glycemic control. The behavioral change techniques, including providing feedback on performance, problem-solving, and action planning, were associated with a significant reduction in HbA1c. LINKING EVIDENCE TO ACTION: Individuals with poorly controlled type 2 diabetes could benefit from interactive self-management interventions. Interventions targeting patients with poorly controlled diabetes, those who are at the greatest risk of developing complications, should be prioritized. Our findings indicate that providing feedback on performance, problem-solving, and action planning are promising behavioral change techniques specifically for individuals with poor glycemic control.

Negative and positive life changes following treatment completion: Chinese breast cancer survivors' perspectives.

PURPOSE: Although we acknowledge the negative and positive aspects of the cancer survivorship experience, we have little information on this issue from the perspective of Chinese breast cancer survivors. This study aimed to explore the perceptions of negative and positive life changes following treatment completion among this population. METHODS: Using purposive sampling, 29 breast cancer survivors were selected from the attendees of a local cancer self-help organization in middle China and proceeded with semi-structured in-depth interviews. Each interview was transcribed verbatim and analyzed using directed content analysis. RESULTS: Two predetermined categories were identified to represent participant perception of the breast cancer survivorship experience, namely, negative life changes and positive life changes. The first category included fear of recurrence, symptom experience, poor body image, altered sexuality and intimacy, and financial burden. The second category consisted of new life perspective, personal growth, and enhanced relationships with family. CONCLUSIONS: Our findings contribute to the emerging evidence on the duality of breast cancer survivorship. This enhanced understanding of the specific negative and positive changes experienced by Chinese breast cancer survivors can assist health professionals in addressing survivorship issues by designing appropriate interventions to minimize negative consequences and enhance positive growth.

Attitude toward the out-patient cardiac rehabilitation program and facilitators for maintenance of exercise behavior.

OBJECTIVE: This study examined the attitudes of Chinese patients with coronary heart disease (CHD) toward the outpatient cardiac rehabilitation program (OCRP), as well as their exercise behavior, intention, maintenance and related factors. METHOD: A qualitative descriptive study design was used, and 22 CHD patients were recruited in Hong Kong in 2014. In-depth interviews and content analyses were conducted. The tripartite model of attitudes was adopted as research framework. RESULT: Two themes were identified: (1) informant attitude (perception, affection, and practice) toward the OCRP and (2) Exercise Behavior - intention, maintenance and its related factors. Most informants showed positive perception and affection regarding the outpatient rehabilitation program, leading to regular practice of exercise in the program and at home. Peer, group dynamic, social support and Chinese culture influences on exercise behavior may serve as major facilitators to maintain exercise behavior. CONCLUSION: Positive attitude toward the OCRP enhanced the participation rate, whereas peer and social support from the family and workplace were useful to improve the maintenance of exercise behavior. Overall, this study provides insights into strategic planning for the OCRP and continual support for CHD patients in the community.

A mixed-methods exploration of the quality of life of Chinese breast cancer survivors.

Quality of life (QOL) in cancer survivorship is a multidimensional and subjective concept, which represents the personal sense of the physical, psychological, social, and spiritual consequences of cancer diagnosis and its treatment. This mixed method study aimed to explore the QOL of Chinese breast cancer survivors. Participants were recruited from a cancer self-help organization in the central area of China. QOL was assessed using the QOL-Cancer Survivor Scale and subsequently elicited by in-depth interviews. Results showed that participants had good overall QOL but with unfavorable aspects in psychological and social well-being. Interview data revealed that participants seldom attended spiritual activities. Instead, they actively reconnected with their "self" to create a positive meaning from their cancer experience. Understanding how Chinese breast cancer survivors perceive QOL is important for health professionals to address survivorship in this population.

Environmental Factors Associated with Altered Gut Microbiota in Children with Eczema: A Systematic Review.

Eczema is a common skin condition that impairs children's daily life activities and quality of life. Previous research shows that gut microbiome composition plays an important role in the development of eczema. The present review summarizes evidence on environmental factors related to altered gut microbiota in children with eczema. We searched Medline, PubMed, Embase, and the Cochrane database of Systematic Reviews through October 2015. The search strategy focused on articles published in peer-reviewed, English-language journals with no publication year limit. Only original studies and review articles that reported environmental factors on gut microbiome specific to eczema were included in this review. We selected six studies (total 1990 participants) for full review and identified that the composition of gut microbiota specific to eczema could be influenced by the following environmental factors: length of gestation, mode of delivery, type of feeding, method of treatment, number of older siblings, and other lifestyle factors. There has been inconsistent empirical evidence as to the modulatory effects of gut microbiota on immunological functions in children with eczema. Further research on the environmental-host-microbial interaction is needed to develop a strong base of knowledge for the development and implementation of prevention strategies and policies for eczema.

The Association Between Self-Management Barriers and Self-Efficacy in Chinese Patients with Type 2 Diabetes: The Mediating Role of Appraisal.

BACKGROUND: Patients with higher levels of self-management barriers are more likely to exhibit a lower level of self-efficacy. However, the theoretically meaningful mechanisms underlying the association between the two variables have not yet been established. AIMS: Informed by the Transactional Model of Stress and Coping, this study aimed to examine the potential role of diabetes appraisal on the association of self-management barriers and self-efficacy in patients with type 2 diabetes mellitus. METHODS: This article presents the secondary data analyses of a multicenter, cross-sectional study. A sample of 346 adults with type 2 diabetes was interviewed, using the Personal Diabetes Questionnaire, the Appraisal of Diabetes scale, the Diabetes Empowerment Scale-Short Form, and the Summary of Diabetes Self-Care Activities. Structure equation modeling was performed with 10,000 bootstrap samples using Mplus 7. RESULTS: The hypothesized model provided a good fit to the data (χ2 = 22.975, df = 33; p = .1144; CFI = 0.989; SRMR = 0.036; RMSEA = 0.042). The mediating effect of diabetes appraisal on the association of self-management barriers and self-efficacy was significant (ß = -0.521; 95% CI: -0.865, -0.283), explaining 44.82% of the total effect of barriers on self-efficacy. Significant associations were also detected between diet knowledge and diabetes appraisal (ß = 0.148, p = .047). LINKING EVIDENCE TO ACTION: Diabetes appraisal plays a mediating role in the association between self-management barriers and self-efficacy in patients with type 2 diabetes. Reflecting on patients' appraisal of diabetes can help to develop evidence-based and patient-centered interventions. Interventions that enhance individuals' positive appraisal of diabetes have the potential to buffer the negative effects of self-management barriers on self-efficacy.

A controlled trial of a nurse follow-up dietary intervention on maintaining a heart-healthy dietary pattern among patients after myocardial infarction.

BACKGROUND AND RESEARCH OBJECTIVE: Post-myocardial infarction (MI) survivors are at a higher risk of coronary events. Therapeutic lifestyle changes, including dietary modification, have been emphasized as the cornerstone of secondary prevention. This study aimed to examine the effectiveness of a nurse follow-up dietary intervention (NFDI) on post-MI patients' dietary behavioral change (primary outcome) and blood lipid levels (secondary outcome). SUBJECTS AND METHODS: A total of 82 post-MI subjects with borderline dyslipidemia were recruited and randomly allocated to a control group or an intervention group (IG) (n = 41/group). The control group received conventional care and attended a heart health dietary class. The IG received, in addition, a structured 8-week NFDI (including a face-to-face consultation session, a take-home self-management workbook, and fortnightly telephone follow-ups). Data were collected at 3 time points: baseline (T0), 1-week posttest (T1), 3-month posttest (T2). The effect of the intervention was assessed by a self-report questionnaire and blood tests. T test and time-by-group analysis of variance with repeated-measures analysis of variance were used. An intention-to-treat analysis was conducted. RESULTS: Significant positive dietary changes were found among participants of the IG in reduced intake of saturated fat (F = 22.48, P < .001) and salted/preserved food (F = 13.58, P < .001) and increased intake of heart-healthy food (vegetables, fruit, nuts, and whole grains) (F = 40.88, P < .001). Although the results of secondary outcomes, triglyceride, and total cholesterol were not statistically significant, the high-density lipoprotein trend was in the expected direction for the IG (F = 8.982, P = .001). CONCLUSION: This study found positive changes in dietary behavior and an increase in high-density lipoprotein level from participants who undertook the NFDI for self-management in dietary modification.

Evaluation of the sustaining effects of Tai Chi Qigong in the sixth month in promoting psychosocial health in COPD patients: a single-blind, randomized controlled trial.

OBJECTIVES: To evaluate the sustaining effects of Tai Chi Qigong (TCQ) in improving the psychosocial health in chronic obstructive pulmonary disease (COPD) patients in the sixth month. BACKGROUND: COPD affects both physical and emotional aspects of life. Measures to minimize patients' suffering need to be implemented. METHODS: 206 COPD patients were randomly assigned into three groups: TCQ group, exercise group, and control group. The TCQ group completed a three-month TCQ program, the exercise group practiced breathing and walking exercise, and the control group received usual care. RESULTS: Significant group-by-time interactions in quality of life (QOL) using St. George's respiratory questionnaire (P = 0.002) and the perceived social support from friends using multidimensional scale of perceived social support (P = 0.04) were noted. Improvements were observed in the TCQ group only. CONCLUSIONS: TCQ has sustaining effects in improving psychosocial health; it is also a useful and appropriate exercise for COPD patients.

Comparison of health-related quality of life and emotional distress among Chinese cancer survivors.

The purpose of this study is to compare health-related quality of life (HRQoL) and emotional distress among diverse cancer survivors who had completed all treatment within the previous year. A convenience sample of 353 cancers survivors (lung, head and neck, breast and prostate cancers) were recruited to complete a survey, which consisted of (i) Hospital Anxiety and Depression Scales; (ii) Chinese version of the Functional Assessment of Cancer Therapy-General version; and (iii) demographic and clinical data. The HRQoL scores were similar among the four types of survivors. Mild anxiety and depression levels were reported, but no significant difference was noted. Younger females with financial burdens and uncertain prognosis were particularly associated with HRQoL and emotional distress. Further studies are essential to identify specific problems that cancer patients experience after cancer diagnosis that might lead to the early detection of those most at risk of ongoing problems.

A theory-driven, culture-tailored educational intervention for cervical cancer screening among rural Chinese females: A feasibility and pilot study.

Objective: This study aimed to evaluate the feasibility and preliminarily estimate the effects of a theory-driven, culture-tailored, community-based educational intervention promoting cervical cancer screening among rural females. Methods: An experimental study with the two-arm parallel, nonrandomized control trial design was implemented, followed by individual semi-structured interviews. Thirty rural females between 26 and 64 were recruited, with 15 in each group. Both groups were exposed to the usual care about cervical cancer screening promotion from the local clinics, while participants in the intervention group additionally received five educational sessions in 5 weeks. Data were collected at baseline and immediately postintervention. Results: All participants completed the study, and the retention rate was 100%. Participants in the intervention group had more significant increments in cervical cancer screening-related self-efficacy (P â€‹< â€‹0.001), knowledge (P â€‹< â€‹0.001), and intention levels (P â€‹= â€‹0.003) than those in the control group. Most participants showed acceptance and satisfaction with this educational intervention. Conclusions: This study revealed that the theory-driven, culture-tailored, community-based educational intervention was feasible among the rural populations to promote cervical cancer screening. A large-scale interventional study with a prolonged follow-up duration is warranted to explore this educational intervention's effectiveness further.

Measuring poststroke fatigue: The psychometric properties of the Chinese version of multidimensional fatigue inventory.

OBJECTIVE: Poststroke fatigue (PSF) is a common and debilitating problem among stroke patients. Multidimensional fatigue inventory (MFI) has been recommended to assess fatigue related to acquired brain injury. This study aimed to examine the psychometric properties of the Chinese version of MFI among stroke patients. METHODS: The study recruited 252 stroke patients in China. The internal consistency of the Chinese-version MFI was evaluated using Cronbach's α coefficients. The test-retest reliability was measured over a 5-day interval with intraclass correlation coefficient. Exploratory factor analysis was conducted to analyze the construct validity. The concurrent validity of MFI was examined by calculating the Pearson's correlation coefficient between the scores of MFI and the fatigue assessment scale (FAS). RESULTS: The exploratory factor analysis of the Chinese-version of MFI showed that it captured three dimensions of PSF, namely, physical fatigue, mental fatigue, and level of activity. The Chinese-version MFI demonstrated satisfactory internal consistency with Cronbach's α ranging from 0.83 (mental fatigue) to 0.91 (total scale). The Chinese-version MFI showed adequate test-retest reliability with intraclass correlation coefficients of 0.70 for the total scale, 0.69 for physical fatigue, 0.66 for mental fatigue, and 0.62 for level of activity. The concurrent validity of the Chinese-version MFI was demonstrated by a significant positive correlation (r=0.49, p <0.001) with FAS. CONCLUSION: This study findings showed that Chinese-version MFI has adequate internal consistency and test-retest reliability, and demonstrated its concurrent validity with FAS. The findings provide preliminary evidence of the three-factor structure of Chinese-version MFI by exploratory factor analysis.

Educational Interventions to Promote Cervical Cancer Screening among Rural Populations: A Systematic Review.

The urban-rural gap in cervical cancer screening uptake is a significant public health consideration. Educational interventions are commonly adopted to promote cervical cancer screening among females in rural areas; however, the characteristics and effectiveness of these educational interventions remain unclear. In this review, we aimed to identify the characteristics of educational interventions used in rural populations and to evaluate the effects of these interventions on cervical cancer screening-related outcomes. Seven English databases were searched in January 2022. Randomized controlled trials (RCTs) and quasi-experimental studies were included. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials and the JBI Critical Appraisal Checklist for Quasi-Experimental Studies were used for quality appraisal. RevMan 5.4 software was used for the meta-analysis. A narrative synthesis was conducted in instances where a meta-analysis was inappropriate. Three RCTs and seven quasi-experimental studies conducted in six countries were included. A social cognitive theory-based framework, the community setting, group sessions, healthcare professional-led approaches, and culture-tailored materials were implemented in the educational interventions for cervical cancer screening. The educational content mainly included basic information on cervical cancer screening, psychological issues, barriers and strategies to overcome them, and locally available resources. Educational interventions increased the knowledge and uptake of cervical cancer screening in the rural population. However, the studies only evaluated the short-term effects of these educational interventions, with the cervical screening behavior only being assessed in one instance for each participant. Educational interventions promote cervical cancer screening among females in rural areas. Theory-driven, community-involved, group-based, and healthcare professional-led approaches should be prioritized in the application of educational interventions in rural populations. Both the short- and long-term, influences of educational interventions on the cervical cancer screening behavior of females in rural areas need to be recognized.

The effects of a smartphone-enhanced nurse-facilitated self-care intervention for Chinese hypertensive patients: A randomised controlled trial.

BACKGROUND: For hypertensive patients, self-care is of the utmost importance in disease management and health maintenance. However, due to inadequate motivation and self-efficacy in performing self-care behaviours, satisfactory self-care is difficult to initiate and maintain. Smartphone-based interventions with support from nurses may be an alternative way to improve self-care behaviours and blood pressure control. Therefore, a randomised controlled trial was conducted to test the effects of a smartphone-enhanced nurse-facilitated self-care intervention for hypertensive people. OBJECTIVE: To examine the effects of a smartphone-enhanced nurse-facilitated self-care intervention on improving blood pressure control, anthropometric parameters, and self-care amongst Chinese hypertensive patients from two community health service centres. DESIGN: This study was a single-blinded, two-arm randomised controlled trial with a repeated-measures design. SETTINGS: Participants were recruited from two community health service centres in China from March 2018 to June 2018. PARTICIPANTS: A total of 210 patients with hypertension were randomly allocated to either the intervention or control group (n = 105 per group). METHODS: Participants in the intervention group received six individual weekly education and consultation sessions provided by a nurse in the first 6 weeks and a researcher-developed smartphone application for 12 weeks. The sessions consisted of health education, individual self-care planning, daily records of physical health status and lifestyle behaviour, and an automated weekly health report. Data on systolic blood pressure, diastolic blood pressure, body weight, waist circumference, and self-care (behaviour, motivation, and self-efficacy) were collected at baseline, the 6th week, and 12th week after joining the study. A generalised estimating equation model was used to analyse the outcome. RESULTS: A total of 191 patients (91%) completed outcome measurements at the three time points. Compared with the control group at the 6th and 12th week follow-ups, the intervention group exhibited significant reductions in systolic blood pressure (T1: ß = -7.29, T2: ß = -11.07), diastolic blood pressure (T1: ß = -4.80, T2: ß = -7.50), body weight, body mass index, and waist circumference, and a significant improvement in self-care (behaviour, motivation, and self-efficacy). At the 12th week follow-up, the proportion of participants with BP < 140/90 mmHg in the intervention group (31%) was significantly higher than that in the control group (9%, p = 0.003). CONCLUSION: The smartphone-enhanced nurse-facilitated self-care intervention could improve blood pressure, anthropometric parameters, and self-care amongst Chinese hypertensive people in two communities. Its long-term effects amongst diverse hypertensive patient populations can be examined in a future study. TWEETABLE ABSTRACT: The smartphone-enhanced nurse-facilitated self-care intervention improved BP control and self-care, which is an effective alternative to hypertension management. REGISTRATION NUMBER: This study was registered at the Chinese Clinical Trial Registry (ChiCTR-IOR-17014227).