An Educational Intervention for Coronary Heart Disease Patients With Type D Personality: A Randomized Controlled Trial.

BACKGROUND: Type D personality, a newly specified personality type defined as the interaction of high levels of negative affectivity and social inhibition, is associated with poor health outcomes. Few interventional studies have been performed to improve health outcomes in this subpopulation. PURPOSE: This study was developed to examine the effects of an educational intervention on psychological health, health-promoting behaviors, and quality of life in coronary heart disease (CHD) patients with type D personality in China. METHODS: A randomized controlled trial was adopted. One hundred twenty-eight patients with CHD and type D personality were randomly assigned. The intervention group received the 12-week educational intervention in addition to usual care, whereas the control group received usual care only. Data on anxiety and depression, health-promoting behaviors, and quality of life were collected at baseline and at 1 and 3 months after enrollment. After controlling for the covariates, the generalized estimating equation model was used to examine the intervention effects. RESULTS: The mean age of the participants was 61.02 years, and more than 70% were male. Results of the generalized estimating equation analysis showed significantly greater improvements in anxiety, depression, and health-promoting behaviors in the intervention group than in the control group. In addition, quality of life, the domains of angina limitation, angina stability, and treatment satisfaction were found to have improved more significantly in the intervention group than the control group, whereas the posttest changes in angina frequency and disease perception were found to be similar in both groups. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The educational intervention was shown to be effective in improving psychological health, health-promoting behaviors, and certain domains of quality of life in patients with CHD and type D personality. Nurses should identify patients with this personality type and provide tailored care to improve their health outcomes in clinical practice.

The effects of an integrated exercise and cardiovascular health education programme on community-dwelling older adults at risk of atherosclerotic cardiovascular diseases: A study protocol for a randomised controlled trial.

BACKGROUND: Although older adults are at an increased risk of atherosclerotic cardiovascular disease (ASCVD), the effect of an integrated exercise and cardiovascular health education programme based on self-efficacy theory has not been well investigated among older adults. This study aims at examining the effect of this programme on community-dwelling older adults at risk of ASCVD concerning physical activity level, exercise self-efficacy and ASCVD risk profile. METHODS: A parallel two-arm randomised controlled trial with pretest-posttest design will be performed among 190 Chinese community-dwelling adults aged 60 or above in elderly community centres of the Guangdong-Hong Kong-Macao Greater Bay Area. Eligible participants will be randomised by computerised generation. Experimental group will receive a 12-week integrated exercise and cardiovascular health education programme, which comprises a one-hour group-based health education talk conducted at Week 1, a booklet, a lecture video, a tailor-made exercise video, and a booster intervention by text messaging starting from Week 1 to Week 12. Control group will receive placebo intervention including a talk on basic health issues, a lecture video and corresponding leaflet. The outcomes will be investigated through self-report questionnaires and physiological evaluations at baseline, Week 12, Week 24, and Week 36. Physical activity level, exercise self-efficacy and ASCVD risk profile will be assessed, with physical activity level at Week 24 considered the primary outcome. The main intervention effect (group differences on continuous outcome variables) will be examined via Generalized Estimating Equations with identity link. DISCUSSION: This study findings will provide clues to the effect of the integrated exercise and cardiovascular health education programme, which is theoretically underpinned with self-efficacy theory, in older adults at risk of ASCVD. It will also enhance the quality of community health education by providing insight into the effective teaching strategies targeting older adults. TRIAL REGISTRATION: This study has been registered on ChinicalTrial.gov (Trial ID: NCT05434273).

The Effects of Educational Programs on Knowledge, International Normalized Ratio, Warfarin Adherence, and Warfarin-Related Complications in Patients Receiving Warfarin Therapy: An Integrative Review.

BACKGROUND: Education is considered a crucial element in anticoagulation management for patients with atrial fibrillation, valvular disease, ischemic heart disease, and venous thromboembolism. However, the effects of education on the patients prescribed warfarin are seldom investigated. OBJECTIVES: This integrative review was conducted to explore the effects of educational programs on patients prescribed warfarin for the aforementioned cardiovascular diseases and to identify the components of effective programs. METHODS: A systematic search of clinical trials was performed in 8 databases from inception to August 2020. Two reviewers performed the eligibility assessment, methodological evaluation, and data extraction. A total of 9 studies were included and analyzed via narrative synthesis. RESULTS: Nine studies involving a combined total of 1335 patients were included in the review. The findings suggest that educational programs have potential benefits related to international normalized ratio control and warfarin knowledge. However, their effects on major bleeding and thromboembolic events are unremarkable. Stronger evidence is recommended to confirm these findings, and the limited evidence examining the effects of education on warfarin adherence, minor bleeding, abnormal international normalized ratio, readmission rate, and warfarin-related mortality requires further exploration. Verbal education supported by written materials was the main educational delivery mode. A lecture length of approximately 45 minutes was likely appropriate. Notably, the integration of educational strategies, application of follow-up interventions and monitoring measures, adoption of psychological theories in program development, and inclusion of nurses or pharmacists in program conduction seemed to be effective program components. CONCLUSIONS: The effects of educational programs on patients prescribed warfarin mainly for atrial fibrillation, valvular disease, ischemic heart disease, and venous thromboembolism remain inconclusive. Further research using randomized controlled trials is warranted.

Effects of an African Circle Dance Programme on Internally Displaced Persons with Depressive Symptoms: A Quasi-Experimental Study.

Background: Internally Displaced Persons (IDPs) are people who have been forced to flee their homes due to disasters. Depressive symptoms, at over 31-67%, are prevalent in IDPs in Africa. Despite the evidence for the benefits of the promotion of dance interventions on psychological health, supporting information is needed to outline the benefits of an African Circle Dance (ACD) intervention for IDPs in Africa. Methods: A quasi-experimental design (pre-/post-test) was employed. Two IDP camps were randomized into the intervention group (psychoeducation and ACD intervention) and the control group (psychoeducation). Adults aged ≥18 years, living in an IDP camp, able to perform brisk walking, and who scored ≥10 on a depressive symptoms subscale were recruited. The intervention group received an 8-week ACD dance intervention and two 1-h psychoeducation sessions on stress management; the controls only received the psychoeducation sessions. Outcomes were depressive symptoms, stress, and anxiety. Data were collected at baseline (T0), immediately after the intervention at week 8 (T1), and at week 12 (T2) at the post-intervention and follow-up session. A generalized estimating equation was used to test the effects of the ACD intervention, with a 0.05 significance level. Results: 198 IDPs completed the study (ncontrol = 98; nintervention = 100). The intervention group reported significantly greater improvements in depressive symptoms (v = 0.33, p < 0.001) and stress (v = 0.15, 0.008) than did the control group. Conclusions: ACD could be a valuable complementary intervention in health promotion but more research is needed.

Prospective Validation of the Chinese Version of the Self-Efficacy for Exercise Scale Among Middle-Aged Patients With Coronary Heart Disease.

PURPOSE: The aim of this study was to further evaluate the psychometric properties of the Chinese version of the Self-Efficacy for Exercise Scale (SEE-C) among middle-aged outpatients with coronary heart disease (CHD). DESIGN: Psychometric evaluation design. METHODS: A convenience sample of 355 CHD patients was recruited and followed up at 3 and 6 months. Cronbach's alpha, construct validity (exploratory factor analysis), and concurrent and predictive validity were examined. FINDINGS: The SEE-C had a single-factor structure that was stable over time and had high internal consistency. Baseline SEE-C scores were significantly and positively associated with quality of life and total exercise time per week and significantly and negatively associated with anxiety and depression. They also significantly predicted total exercise per week at the 3- and 6-month follow-ups. CONCLUSIONS: The SEE-C is a robust, reliable, and valid measure of exercise self-efficacy for middle-aged Chinese CHD outpatients. CLINICAL RELEVANCE: The SEE-C can assess patients' exercise self-efficacy, so that appropriate interventions to improve exercise self-efficacy can be provided.

Effects of Promotional Materials on Attitudes and Fear towards Colorectal Cancer Screening among Chinese Older Adults: An Experimental Study.

Colorectal cancer (CRC) screening is a cost-effective prevention and control strategy. However, the promotion of CRC screening for older adults may be difficult because reading CRC prevention information may evoke embarrassment, fear, and anxiety towards the screening procedure and cancer diagnosis. This study aims to (1) examine the effects of three promotional materials for CRC screening on the attitudes toward CRC screening tests (screening interest, screening effectiveness, and trust in the screening results) and cancer fear, and (2) to explore the interaction effect of cancer fear with screening effectiveness and trust in the screening results on screening interest of the three screening tests (fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy) among Chinese older adults. A total of 114 community-dwelling older adults were asked to look at the corresponding promotional materials (pamphlet, cartoon, and video) of one of the three study groups. The pamphlet and video represent convention strategies and the cartoon represents an innovative strategy. No significant difference was observed in the screening interest and cancer fear across groups. FOBT was the most preferred screening modality. The video group has a large proportion agreed screening effectiveness of flexible sigmoidoscopy than pamphlet and cartoon groups and trusted in the screening results for FOBT and flexible sigmoidoscopy than the pamphlet group. Logistic regression results showed that the effect of trust in the screening results on screening interest for colonoscopy was greater among participants with higher cancer fear than those with lower cancer fear level. In conclusion, the three promotional groups had produced similar results in their attitudes toward CRC screening and cancer fear. The use of cartoons may be a comparable approach with conventional methods in the promotion of CRC screening. Additional components that can arouse fear and boost response efficacy simultaneously might also be useful for the effective promotion of colonoscopy among Chinese older adults.

Promoting Holistic Well-Being in Chronic Stroke Patients Through Leisure Art-Based Creative Engagement.

PURPOSE: To examine the potential value of a creative art-based activity as a caring modality for promoting holistic well-being among chronic stroke patients, and to explore the feelings and meanings that stroke patients derived from their experience in leisure art-based creative engagement (LACE). DESIGN: Qualitative design. METHOD: Participants were recruited through purposive and snowball sampling. Individual semi-structured interviews were conducted. Qualitative content analysis was performed. The design and implementation of LACE was guided by Watson's theory of caring. FINDINGS: Twenty-four participants completed the study. Four themes emerged from participants' account of experiences with the LACE: (1) appreciation of opportunities, (2) appreciation of self, (3) appreciation of others, and (4) appreciation of life. CONCLUSION: From the perspective of the participants, engaging in LACE enhances their sense of enjoyment and self-expression. Furthermore, they perceived LACE as an affirmation of life and an empowering process strengthening their connection and appreciation with the self and others. CLINICAL RELEVANCE: This study adds evidence to existing literature on Watson's theory-guided design and implementation of caring initiatives for community rehabilitation and has laid the groundwork for developing further evidencebased research in leisure art-based caring occasions for promoting holistic well-being in stroke rehabilitation.

Cancer-Related Information Seeking and Scanning Behaviors among Older Chinese Adults: Examining the Roles of Fatalistic Beliefs and Fear.

Effective communication in health information plays an important role in health promotion and cancer prevention. Cancer-related information acquisition can happen via active and purposeful seeking, but may also happen less purposely via the routine use of media and interactions with other people (called scanning). We examined seeking and scanning behaviors regarding cancer prevention in older Chinese adults, identified commonly used sources of information of such behaviors, and examined their associations with fatalistic beliefs and cancer fear. A convenience sample of 224 community-dwelling adults aged ≥60 were recruited between May and July in 2013 in Hong Kong. Results suggested that cancer information scanning (79.5%) was more common than information seeking (30.4%) among our participants. Health professional was the most popular source for both scanning (78.7%) and seeking (58.8%) behaviors regarding cancer information. Fatalistic beliefs was significantly and negatively associated with seeking behaviors (OR = 0.50) but not scanning behaviors, and cancer fear showed no relationship with either behavior. This study shows that the cancer information seeking and scanning behaviors were still suboptimal in this age group and adds to the knowledge regarding the associations between fatalistic beliefs and fear with cancer information seeking and scanning behaviors among older Chinese adults.

Evaluation of the Effectiveness of Tai Chi versus Brisk Walking in Reducing Cardiovascular Risk Factors: Protocol for a Ranomized Controlled Trial.

Physical inactivity is one of the major modifiable lifestyle risk factors for cardiovascular disease (CVD). This protocol aims to evaluate the effectiveness of Tai Chi versus brisk walking in reducing CVD risk factors. This is a randomized controlled trial with three arms, namely, Tai Chi group, walking group, and control group. The Tai Chi group will receive Tai Chi training, which consists of two 60-min sessions each week for three months, and self-practice for 30 min every day. The walking group will perform brisk walking for 30 min every day. The control group will receive their usual care. 246 subjects with CVD risk factors will be recruited from two outpatient clinics. The primary outcome is blood pressure. Secondary outcomes include fasting blood for lipid profile, sugar and glycated haemoglobin (HbA1c); body mass index, waist circumference, body fat percentage; perceived stress level and quality of life. Data collections will be conducted at baseline, 3-month, 6-month and 9-month. Generalized estimating equations model will be used to compare the changes in outcomes across time between groups. It is expected that both the Tai Chi and walking groups could maintain better health and have improved quality of life, and that Tai Chi will be more effective than brisk walking in reducing CVD risk factors.

Interventions for Cardiovascular Patients with Type D Personality: A Systematic Review.

BACKGROUND: Cardiovasculardisease (CVD) is a major cause of death worldwide. Type D personality, a newly identified risk factor for cardiac outcomes, can deteriorate the health outcomes of CVD patients. Several interventional studies have been conducted on CVD patients with type D personality. AIM: To provide the best available evidence of the effects and characteristics of interventions applied to cardiac patients with type D personality. METHODS: Experimental studies on the effects of interventions for cardiac patients with type D personality were reviewed. English and Chinese electronic databases were searched from inception to December 2014. The eligibility and quality of each article were reviewed by two independent reviewers. The outcomes of interest included psychological health (anxiety & depression), physical functioning, and quality of life. Data were synthesized in a narrative form rather than meta-analysis because of the heterogeneity of studies and the insufficient data for statistical pooling. RESULTS: Four studies (one randomized controlled trial and three single-group pre- and posttests) involving 967 cardiac patients were identified. The quality of included studies was moderate, with three studies rated as fair and one study rated as poor. Cardiac rehabilitation programs were the interventions identified in all the included studies, with main components of physical exercise, patient education, psychological intervention, and individual counseling. The findings of this review indicated that cardiac rehabilitation can significantly reduce anxiety and depression, improve physical functioning, and quality of life in cardiac patients with type D personality. The evidence of optimal duration, frequency of interventions, and length of each session was not established. LINKING EVIDENCE TO ACTION: This review provides preliminary evidence for the use of cardiac rehabilitation as an effective intervention to improve health outcomes in cardiac patients with type D personality. The optimal delivery format of the intervention for cardiac patients with type D personality needs to be explored.

Determinants of participation in colorectal cancer screening among community-dwelling Chinese older people: Testing a comprehensive model using a descriptive correlational study.

PURPOSE: The prevalence of colorectal cancer (CRC) among older people is high. Screening for CRC presents a cost-effective secondary prevention and control strategy which results in a significant reduction in mortality. This study aims to describe the prevalence of CRC screening and examine its risk factors among Chinese community-dwelling older people guided by a comprehensive model combining Health Belief Model and Extended Parallel Processing Model. METHODS: A descriptive correlational study was conducted. A convenience sample of 240 community-dwelling adults aged ≥60 was recruited in May-July in 2012 in Hong Kong. Participants were asked to complete a questionnaire which collected information on demographic variables, CRC-related psychosocial variables and whether they had a CRC screening in the past 10 years. RESULTS: Among the participants, 25.4% reported having a CRC screening test. Results of logistic regression analyses indicated that participants with a higher level in cue to action, and lower perceived knowledge barriers and severity-fear were significantly associated with participation in CRC screening. But there were no significant associations between fatalism and cancer fear with screening. CONCLUSIONS: The prevalence of CRC screening was low in Hong Kong Chinese community-dwelling elders. A number of modifiable factors associated with CRC screening were identified which provides specific targets for interventions. This study also adds to the knowledge regarding the associations between fatalism and fear with CRC screening behaviors among Chinese older people.

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.

Psychometric properties of a Chinese version of the Colorectal Cancer Perceptions Scale in a sample of older Chinese people.

BACKGROUND: Older adults are more susceptible to colorectal cancer (CRC). Psychosocial constructs in the Health Belief Model are targets for interventional studies. No tool to measure these beliefs of older Chinese people has been validated. OBJECTIVE: The present study aimed to examine the preliminary psychometric properties of the Chinese version of the Colorectal Cancer Perceptions Scale (CRCPS). METHODS: The CRCPS was translated to Chinese language, validated by an expert panel, and tested. Interviewer-administered surveys were carried out with a convenience sample of 219 community-dwelling Chinese adults 60 years or older and were included in the analysis. RESULTS: Six factors were retained, with items on susceptibility and benefits remaining as designed, whereas those on severity formed 2 factors, labeled severity-fear and severity-life impact, and those on barriers again formed 2 factors, labeled psychological barriers and knowledge barriers. Cronbach's α values ranged from .74 to .88, and test-retest reliability correlations ranged from .38 for psychological barriers to .69 for knowledge barriers. Respondents who had undergone CRC screening had significantly lower mean scores on severity-fear, severity-life impact, psychological barriers, and knowledge barriers compared with those who had not. CONCLUSIONS: The results provide preliminary support for the reliability and validity of the Chinese version of the CRCPS. Further psychometric testing is recommended. IMPLICATIONS FOR PRACTICE: The survey provides a useful tool to assess CRC health beliefs, which interventions should address to improve screening rates among older Chinese adults.

Adapting Champion's Breast Cancer Fear Scale to colorectal cancer: psychometric testing in a sample of older Chinese adults.

PURPOSE: Colorectal cancer (CRC) is the most common type of cancer in both men and women, and older adults are more susceptible to this disease. Previous studies suggest that cancer fear may be a key predictor of participation in cancer screening. Yet there is a lack of validated measuring tools of fear relating to CRC for the Chinese older adult population. This study aims to test the psychometric properties of the Chinese version of the Colorectal Cancer Fear Scale (CRCFS), adapting from the Champion's Breast Cancer Fear Scale. METHODS: The CRCFS was developed by altering the wording 'breast cancer' to 'colorectal cancer'. Interviewer-administered surveys were carried out with a convenience sample of 250 community-dwelling adults aged at least 60 years old without a history of cancer. A subsample of 40 participants completed the scale again at one-month. RESULTS: Confirmatory factor analysis revealed that the one-factor model provided excellent fits to the overall data, and two randomly split samples. Cronbach's alpha of the scale was 0.95 and test-retest reliability was 0.52. Positive and significant correlations of CRC Cancer Fear with CRC-related susceptibility, severity and barriers were observed. A non-linear relationship with benefits was found. CONCLUSIONS: The findings provide support for the psychometric properties of a Chinese version of the Champion Cancer Fear with an adaption to CRC in a sample of community dwelling older Chinese adults. The scale provides a useful tool to assess CRC-related fear, which interventions should address in order to improve screening rates among older Chinese adults.