Validation of a dutch self-efficacy scale for adherence to fluid allowance among patients on haemodialysis.

Many haemodialysis patients have problems limiting their fluid intake, and this might be influenced by their self-efficacy. Thus interventions to improve patients' self-efficacy might lead to an improvement in their adherence to fluid restriction. The fluid intake appraisal inventory (FIAI) evaluates patients' self-efficacy with regard to fluid intake. The aim of this study was to translate and validate the FIAI for use in the Netherlands. Four translators, seven experts, and four haemodialysis patients participated in the translation part of the study. Thirty-three patients from one dialysis centre in the Netherlands completed the Dutch FIAI. The instrument had good content validity (interdialytic weight gain was found to be negatively correlated with self-efficacy), internal consistency (Cronbach's alpha = 0.982), and stability (Spearman's rho = 0.823). These findings indicate that the Dutch FIAI can be used in clinical practice as a self-efficacy screening instrument for adult haemodialysis patients on fluid restriction.

The effect of self-efficacy on cardiovascular lifestyle.

BACKGROUND: It is important that patients with vascular diseases adopt a healthy lifestyle so as to reduce vascular risk. Since self-efficacy is an important precondition for health behavior change in patients with chronic disease, we investigated whether self-efficacy was associated with cardiovascular lifestyle in patients with clinical manifestations of vascular diseases. METHODS AND DESIGN: In this observational cohort study, 125 patients who had recently been referred for cerebrovascular disease, coronary heart disease, or peripheral arterial disease participated in a 1-year self-management intervention. They completed a self-efficacy questionnaire and questions about their cardiovascular lifestyle at baseline and after 1 year. Logistic regression analyses were performed to quantify the impact of change in self-efficacy on physical activity, smoking behavior, alcohol consumption, and food choices. RESULTS: Improved self-efficacy was associated with improved adherence to guidelines for physical activity (OR 3.5, 95%CI 1.0-11.0) and food choices (B 0.15, 95%CI 0.00-0.31). No such improvement was seen regarding adherence to guidelines for smoking or alcohol intake. CONCLUSION: In patients with vascular diseases, improvements in self-efficacy are associated with an improvement in cardiovascular lifestyle, namely, more exercise and better food choices.

The effect of a self-management intervention to reduce vascular risk factors in patients with manifestations of vascular diseases.

BACKGROUND: Self-management can improve health behaviors and influence reduction of vascular risk. We developed a 1-year self-management intervention and investigated its effect on vascular risk factors and quality of life in patients with different vascular diseases. DESIGN AND METHODS: This observational cohort study involved 223 patients (self-management group, n=125; usual care group n=98) with at least two modifiable vascular risk factors. RESULTS: Patients in the self-management group achieved treatment goals for LDL-cholesterol (difference 13%; 95%CI 1-26) and HDL-cholesterol (difference 9% 95%CI 0-19) significantly more often than did patients in the usual care group. Mean systolic blood pressure decreased significantly by 5mm Hg (95%CI -9 to 0) in the self-management group and mean BMI increased significantly by 0.4 kg/m(2) (95%CI -0.8 to -0.1) in the usual care group. No significant differences were seen in waist circumference, smoking, or triglycerides. General health (RAND36) improved more in the self-management group (by 8 points 95%CI 3-12) than in the usual care group. CONCLUSION: After 1 year, the self-management intervention was more effective than usual care on several important vascular risk factors in patients with vascular diseases. PRACTICE IMPLICATIONS: This self-management intervention used in a hospital population may be applicable in different care settings.

Social support and change in vascular risk factors in patients with clinical manifestations of vascular diseases.

BACKGROUND AND AIMS: Vascular risk can be reduced by adequate medical treatment of vascular risk factors and by adopting a healthy lifestyle, a behavioral change that is influenced by social support. We investigated whether social support is associated with change in vascular risk factors in patients with vascular diseases during 1 year. METHODS: 140 patients who had 2 modifiable vascular risk factors participated. Social support was measured with a questionnaire about the patient's perception of active involvement, protective buffering, and overprotection. RESULTS: Most types of social support were not associated with a change in vascular risk factors over 1 year. Having a partner was associated with a reduction in BMI of 1.4 kg/m2 (95%CI -2.2 to -0.5), less protective buffering was associated with a decrease in blood glucose of 0.47 mmol/l (95%CI 0.09-0.84), and less active involvement was associated with an increase in BMI of 0.42 kg/m2) (95%CI 0.05-0.78). CONCLUSION: Having a partner and active involvement are only associated with a decrease in BMI but not with changes in other vascular risk factors. Protective buffering is only associated with blood glucose whereas overprotection is not associated with changes in vascular risk factors.

The role of self-efficacy in vascular risk factor management: a randomized controlled trial.

OBJECTIVE: Given the large number of patients at high risk of vascular events, new strategies are needed to reduce vascular risk. We investigated whether self-efficacy promotion could change self-efficacy levels in patients with vascular diseases and whether baseline self-efficacy and changes in self-efficacy were related to changes in vascular risk factors. METHODS: One hundred fifty-three recently referred patients with symptomatic vascular diseases (cerebrovascular, abdominal, or peripheral arterial) participated in a randomized trial investigating the effect of nursing care, as compared with usual care, on vascular risk factors. Nursing care consisted of self-efficacy promotion and medical treatment of vascular risk factors. Self-efficacy and vascular risk factors (smoking, BMI, waist, blood pressure, lipid, and glucose levels) were measured at baseline and after 1 year. RESULTS: While total self-efficacy did not change over the 1-year intervention period in either treatment group, self-efficacy in choosing healthy food (mean +0.4+/-1.4, p-value 0.01) and in doing extra exercise (mean +0.3+/-1.3, p-value 0.03) increased in the intervention group. No relation was seen between baseline total self-efficacy or change in composite self-efficacy and change in vascular risk factors. CONCLUSION: The nursing intervention did not influence total self-efficacy but did improve self-efficacy in choosing healthy food and doing extra exercise. Change in composite self-efficacy was not related to change in vascular risk factors in patients at high risk of developing (new) cardiovascular diseases. PRACTICE IMPLICATIONS: Influencing self-efficacy in choosing healthy food and doing extra exercise could be incorporated in vascular risk reduction programs in addition to medical treatment of vascular risk factors.

A randomized, controlled trial for risk factor reduction in patients with symptomatic vascular disease: the multidisciplinary Vascular Prevention by Nurses Study (VENUS).

BACKGROUND: Patients with manifest vascular disease are at high risk of a new vascular event or death. Modification of classical risk factors is often not successful. We determined whether the extra care of a nurse practitioner could be beneficial to the cardiovascular risk profile of high-risk patients. DESIGN: We conducted a randomized, controlled trial based on the Zelen design. METHODS: Two hundred and thirty-six patients with manifestations of a vascular disease and who had two or more modifiable vascular risk factors were pre-randomized to receive treatment by a nurse practitioner plus usual care or usual care alone. After 1 year, risk factors were remeasured. The primary endpoint was achievement of treatment goals for blood pressure, lipid, glucose and homocysteine levels, body mass index, and smoking. RESULTS: Of the pre-randomized patients, 95 of 119 (80%) in the intervention group and 80 of 117 (68%) in the control group participated in the study. After a mean follow-up of 14 months, the patients in the intervention group achieved significantly more treatment goals than did the patients in the control group (systolic blood pressure 63 versus 37%, total cholesterol 79 versus 61%, low density lipoprotein-cholesterol 88 versus 67%, and body mass index 38 versus 24%). Medication use was increased in both groups and no differences were found in patients' quality of life (SF-36) at follow-up. CONCLUSION: Treatment delivered by nurse practitioners, in addition to a vascular risk factor screening and prevention program, resulted in a better management of vascular risk factors than usual care alone in vascular patients after 1-year follow-up.

Self-efficacy in patients with clinical manifestations of vascular diseases.

OBJECTIVE: Patients with established cardiovascular disease are at high risk of developing new vascular events or death. This risk can be reduced by lifelong treatment of risk factors and by permanent changes in lifestyle. Self-efficacy is important for achieving behavior change by self-management. The self-efficacy of different vascular risk factors subgroups in patients with clinical manifestations of atherosclerotic vascular diseases was investigated. METHODS: From January 2001 to September 2003, 192 patients with recently established clinically manifest atherosclerotic disease with > or = 2 modifiable vascular risk factors were selected for the study. The mean self-efficacy scores were calculated for vascular risk factors (age, sex, vascular disease, weight, diabetes mellitus, smoking behavior, hypercholesterolemia, hypertension, and hyperhomocysteinemia). RESULTS: Diabetes, overweight, and smoking, but none of the other risk factors, were significantly associated with the level of self-efficacy in these patients. CONCLUSIONS: Patients with vascular diseases appear to have high levels of self-efficacy regarding medication use, exercise, and controlling weight. In patients with diabetes, overweight, and in smokers, self-efficacy levels were lower. PRACTICE IMPLICATIONS: In nursing care and research on developing self-efficacy based interventions, lower self-efficacy levels can be taken into account for specific vascular patient groups.

Vascular risk management through nurse-led self-management programs.

In current clinical practice, adequate cardiovascular risk reduction is difficult to achieve. Treatment is primarily focused on clinical vascular disease and not on long-term risk reduction. Pertinent to success in vascular risk reduction are proper medication use, weight control, healthy food choices, smoking cessation, and physical exercise. Atherosclerotic vascular disease and its risk constitute a chronic condition, which poses specific requirements on affected patients and caregivers who should be aware of the chronicity. In patients with vascular disease, there is lack of awareness of their chronic condition because of the invisibility of most risk factors. In other patient groups with chronic illness, self-management programs were successful in achieving behavioral change. This strategy can also be useful for patients with vascular disease to adapt and adhere to an improved lifestyle. Self-management refers to the individual's ability to manage both physical and psychosocial consequences including lifestyle changes inherent to living with a chronic condition. Interventions that promote self-management are based on enhancing self-efficacy. In self-management, attention can be given to what is important and motivational to the individual patient. In this article the challenge of nursing care promoting self-management for patients with vascular risk and how this care can be applied will be explained. Nurses can play a central role in vascular risk management with a self-management approach for patients with chronic vascular disease. In vascular prevention clinics, nursing care can be delivered that includes medical treatment of vascular risks (hypertension, hypercholesterolemia, hyperglycemia, and hyperhomocystinemia) and counseling on promoting self-management (changes in diet, body weight, smoking habits, and level of exercise). Nursing interventions based on self-management promotion can provide a new and promising approach to actually achieve vascular risk reduction.