Predictors of Self-care Among Chinese Patients With Chronic Heart Failure: A Situation-Specific Theory-Guided Structural Equation Model Analysis.

BACKGROUND: Self-care is important for improving the health outcomes of individuals with chronic heart failure (CHF). However, predictors of self-care behaviors remain unclear in Chinese society. OBJECTIVE: The aims of this study were to explore predictors of self-care in Chinese patients with CHF and clarify the complex relationships between predictors and self-care behaviors guided by the Situation-Specific Theory of Heart Failure Self-Care. METHODS: A cross-sectional study was conducted among individuals hospitalized with CHF in China. Person, problem, and environmental factors pertaining to self-care were collected by a questionnaire survey. Self-care was assessed by the Self-Care of Heart Failure Index version 6. Direct and indirect relationships between factors and self-care behaviors and the mediating role of self-care confidence were analyzed by the structural equation model. RESULTS: In total, 204 participants were involved in this study. The Situation-Specific Theory of Heart Failure Self-Care model demonstrated a good fit (root mean square error of approximation, 0.046; goodness of fit index, 0.966; normed fit index, 0.914; comparative fit index, 0.971). Inadequate self-care capabilities were common among Chinese patients with CHF. Person-related factors (female gender, higher monthly income and educational level), problem-related factors (severe New York Heart Association function class and better instrumental activities of daily living), and environmental factors (better social support and living in more developed areas) were significant predictors of better self-care behaviors ( P < .05). These associations were partly or fully mediated by self-care confidence. CONCLUSION: The Situation-Specific Theory of Heart Failure Self-Care can be used to guide research and practice in patients with CHF. Interventions and policies on promoting self-care in Chinese population living with CHF are encouraged, particularly for underserved populations.

Knowledge and Attitudes toward Dementia among Undergraduate Health Professional Students in China: A Cross-Sectional Survey.

PhenomenonDementia is a huge burden to the economic and health care system in China. As the next generation of health care providers, undergraduate health professional students play a pivotal role in caring for dementia patients during their clinical placements and in independent practice. Nevertheless, they may not be adequately prepared to care for patients with dementia by their undergraduate programs. Measuring the knowledge and attitudes of health professional students could be an important step in providing evidence regarding the need to enhance dementia care training in the curriculum. Approach: Responses from 325 Chinese health professional (nursing, medical, and public health) students were included in the analyses. After providing informed consent, students answered questionnaires including a demographic data questionnaire, the Alzheimer's Disease Knowledge Scale (ADKS) and the Dementia Attitudes Scale (DAS). Univariate analyses were performed to test the association between outcomes and potential explanatory variables. Multiple linear regression analysis was used to determine the predictive factors for knowledge and attitudes toward dementia. Findings: Chinese health professional students had a mean ADKS score of 18.92 (SD = 3.20). Better knowledge was associated with advanced education, having family members with medical knowledge, having heard of dementia, and having interest in learning about dementia. Students had a mean DAS score of 89.10 (SD = 8.93), and their attitudes were significantly associated with majoring in public health and having heard of dementia. Students' knowledge was positively, but weakly related with attitudes (r = 0.122, P = 0.028). Insights: Chinese undergraduate health professional students demonstrate insufficient knowledge and less positive attitudes toward dementia than their counterparts in developed countries. Enhanced dementia care-specific curriculum and training are urgently needed in China to meet the growing demand for dementia care services.

Health-Related Quality of Life Among Chinese Patients With Rheumatoid Arthritis: The Predictive Roles of Fatigue, Functional Disability, Self-Efficacy, and Social Support.

BACKGROUND: Health-related quality of life (HRQoL) is an important outcome measure in chronic diseases like rheumatoid arthritis (RA). However, there is a paucity of literature from mainland China on HRQoL and factors that influence it in people with RA. OBJECTIVES: The aim of this study was to assess HRQoL and to determine which factors, based on the Wilson and Cleary model, contribute to the prediction of HRQoL among persons with RA in mainland China. METHODS: A cross-sectional design was used. Persons with RA (N = 207) were recruited from the outpatient clinics of a university-affiliated hospital in central China. Participants responded to a demographic data questionnaire, the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), the Multidimensional Fatigue Inventory, the Health Assessment Questionnaire-Disability Index, the eight-item Arthritis Self-Efficacy Scale, and the Medical Outcomes Study Social Support Survey. Structural equation modeling was used to estimate the effects of factors from the Wilson and Cleary model on HRQoL. RESULTS: Scores on all SF-36 subscales were significantly lower in patients with RA compared with a general Chinese sample. Lower self-efficacy, greater fatigue, greater functional disability, lower social support, being unemployed, higher disease activity, more comorbidities, lower income level, being female, living in rural settings, and being older were directly or indirectly significantly and negatively associated with HRQoL; 67% of the total variance of HRQoL scores was explained. DISCUSSION: Patients with RA in mainland China experience impaired physical and mental health. Targeted and culturally sensitive interventions should be strengthened to improve the HRQoL of this population. Essentials in improving the HRQoL are enhancing self-efficacy, relieving fatigue, delaying the onset of disabilities, increasing social support, and controlling disease activity.

Medication adherence and predictive factors among patients with rheumatoid arthritis: A COM-B model guided structural equation modeling analysis.

OBJECTIVE: To assess medication adherence of patients with rheumatoid arthritis (RA) and explore predictive factors under the guidance of the Capability, Opportunity and Motivation to Behavior (COM-B) model. METHODS: A cross-sectional study was conducted among 221 RA patients conveniently recruited from rheumatology outpatient clinics of a university-affiliated hospital in China. Data about patients' sociodemographic and disease characteristics, medication adherence, functional disability, social support, beliefs about medicines, self-efficacy, and depression were collected via self-administered questionnaires. The influence of factors within the COM-B model on medication adherence were analyzed by the structural equation model. RESULTS: The mean score of medication adherence was 63.19 (SD 8.83), and 214 participants (96.8%) were considered non-adherent to their medication regime. Greater functional disability, higher social support, more positive beliefs about medicines, higher self-efficacy, and lower depression were significantly positively associated directly or indirectly with medication adherence, explaining 66% of the total variance. CONCLUSION: Patients with RA demonstrate poor medication adherence. Essentials in improving medication adherence are delaying the occurrence of disability, promoting social support, shaping beliefs about medicines, enhancing self-efficacy, and relieving depression. PRACTICE IMPLICATIONS: The value of integrated interventions targeting the drivers and barriers to medication adherence identified in this study should be further explored.

Pain experiences and self-management strategies among middle-aged and older adults with arthritis.

AIMS AND OBJECTIVES: The purposes were (1) to explore pain experiences and the use and perceived effectiveness of pain self-management methods among middle-aged and older adults with osteoarthritis or rheumatoid arthritis in mainland China and (2) to compare those with diagnoses of osteoarthritis and rheumatoid arthritis. BACKGROUND: Prior research has suggested that pain is a major concern for people with arthritis. However, studies systematically investigating pain experiences and self-management status of arthritis patients are scarce in mainland China. DESIGN: Descriptive survey. METHODS: Participants (n = 197) aged 45 and over, diagnosed with either osteoarthritis or rheumatoid arthritis, and experiencing persistent pain were administered three self-report questionnaires: the Demographic Data Questionnaire, the Brief Pain Inventory and the Pain Management Inventory. RESULTS: The mean of the overall pain intensity was 5.6 (SD = 1.3). The median of number of pain sites was 7.0 (QR = 7.0) and the overall pain interference was 6.0 (QR = 2.6). Most participants experienced moderate to severe pain and interference. The current methods used for managing pain were perceived as only moderately effective. The sample used a median of 4.0 (QR = 3.0) self-management methods. Most often used were prescribed medicine, massage, heat and activity pacing. Methods perceived as most helpful included prescribed medicine, over-the-counter medicine, hot baths and heat. Persons with rheumatoid arthritis had significantly more pain sites, higher pain intensity and greater number of pain management methods used compared to those with osteoarthritis. CONCLUSIONS: Pain management is a significant problem in this population. The findings highlight the importance of helping the individual to identify and appropriately use a variety of self-management methods, selecting the appropriate method(s) at any one time. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers are urged to develop appropriate interventions on pain management tailored to arthritis patients in mainland China.

Health-related quality of life among pregnant women with and without depression in Hubei, China.

The role of prenatal depression on physical and mental health among women in mainland China has not been previously investigated. The aim of this research was to (a) calculate the prevalence of depression during pregnancy, (b) explore the relationship between depression sample characteristics and quality of life and (c) identify predictors of physical and mental health among pregnant women. This study was designed as a cross-sectional and exploratory survey. A total of 454 pregnant women participated in the study between December 2009 and June 2010 in central China. The data was collected using the Medical Outcomes Study short form 36 v2 and the Edinburgh Postnatal Depression Scale. Participants were recruited at outpatient departments of obstetrics and gynecology. Findings show that almost 40% of pregnant women experience prenatal depression. Depression was significantly associated with physical and mental health-related quality of life (HRQoL). Depression, increased age, higher gestational age, being employed and married were significant predictors of lower physical HRQoL. Depression, lower BMI and having an unintended pregnancy were significant predictors of lower mental HRQoL. Prenatal depression is very common in women from mainland China. Depressed women suffer from impaired physical and mental health; prenatal depression has a negative impact on women's HRQoL. We recommend that antenatal services integrate screening for depression into routine antenatal care.