Determinants of Self-Care and Home-Based Management of Hypertension: An Integrative Review.

Introduction: Patients with hypertension should perform diverse self-care activities that incorporate medication adherence and lifestyle modification, such as no smoking or alcohol, weight reduction, a low-salt diet, increased physical activity, increased self-monitoring, and stress reduction, for effective management at home. Aim: This systematic review assessed and synthesized the factors that are associated with self-care and home-based management of hypertension. Methods: The search of the articles incorporated the population, intervention, comparison, and outcome (PICO) framework. The literature was searched in four databases (PubMed, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, and Web of Science) until 2022. The articles retrieved and searched from the reference list (531) were transported to EndNote version 20, and duplicates (19) were identified and removed to produce 512 titles. Following the eventual title, abstracts, and full-text screening, 13 articles were appropriate for this study. The narrative and thematic data analysis were used to analyze and integrate the data. Results: The analysis showed five themes were associated with home-based self-care and blood pressure (BP) control among patients diagnosed with hypertension. These themes that emerged were (1) the prevalence of control of BP, (2) sociodemographic factors, (3) treatment-related factors, (4) knowledge of management, and (5) knowledge of the prevention of risk factors of hypertension. The demographic factors influencing home-based self-care for hypertension were gender, age, and socioeconomic status. In contrast, the treatment factors were duration of hypertension treatment, medication burden, and medication adherence. Other factors that influenced self-care were inadequate knowledge of BP management, follow-up care, and risk factors of hypertension. Conclusion: Hypertension self-care interventions must incorporate individual, societal, and cultural perspectives in increasing knowledge and improving home-based hypertension management. Therefore, well-designed clinical and community-dwelling interventions should integrate personal, social, and cultural perspectives to improve behavior in the home management of hypertension by increasing knowledge and self-efficacy.

Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review.

BACKGROUND: Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. METHODS: We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS: Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. CONCLUSION: This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities.

Mapping evidence on knowledge of breast cancer screening and its uptake among women in Ghana: a scoping review.

INTRODUCTION: Female breast cancer is currently the most commonly diagnosed cancer globally with an estimated 2.3 million new cases in 2020. Due to its rising frequency and high mortality rate in both high- and low-income countries, breast cancer has become a global public health issue. This review sought to map literature to present evidence on knowledge of breast cancer screening and its uptake among women in Ghana. METHODS: Five databases (PubMed, CINAHL, PsycINFO, Web of Science, and EMBASE) were searched to identify relevant published studies between January 2012 and August 2021 on knowledge of breast cancer screening and its uptake among women. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and the six-stage model by Arksey and O'Malley were used to select and report findings. RESULTS: Of the 65 articles retrieved, 14 records were included for synthesis. The review revealed varied knowledge levels and practices of breast cancer screening among women across a few regions in Ghana. The knowledge level of women on breast cancer screening was high, especially in breast cancer screening practice. Breast cancer screening practice among women was observed to be low and the most identified barriers were lack of technique to practice breast self-examination, having no breast problem, lack of awareness of breast cancer screening, and not having breast cancer risk. The results further showed that good knowledge of breast cancer screening, higher educational level, increasing age, physician recommendation, and household monthly income were enabling factors for breast cancer screening uptake. CONCLUSION: This review showed varied discrepancies in breast cancer screening uptake across the regions in Ghana. Despite the benefits of breast cancer screening, the utilization of the screening methods across the regions is very low due to some varied barriers from the different regions. To increase the uptake of breast cancer screening, health workers could employ various strategies such as community education and sensitization on the importance of breast cancer screening.

Comparing the effectiveness of three pain relief methods for inserting a needle into the implanted venous access chemoport: A randomized controlled trial.

AIMS: Effective methods for relieving pain in inserting a needle for chemotherapy in cancer patients have been studied. This study examined the pain relief effects during needle insertion into the implanted venous access chemoport by comparing three methods. METHODS: This randomized controlled trial included 120 cancer patients who were randomly assigned. The experimental groups received applications of lidocaine cream (n = 30), cryotherapy (n = 30) and cutaneous stimulation therapy (n = 30); the control group (n = 30) received routine care. Premeasurements and postmeasurements were evaluated using a visual analogue pain scale and nurses' careful observations of patients' pain behaviour checklists during needle insertion. RESULTS: Pain levels were reduced by all three interventions, with the level of relief depending on the type of application. All experimental groups showed significant reduction in pain compared with the control group. Lidocaine cream had the strongest effect, followed by cryotherapy and then cutaneous stimulation. CONCLUSION: Lidocaine cream, cryotherapy and cutaneous stimulation therapy all reduced cancer patients' pain levels during insertion of an implanted central venous access chemoport needle. Nurses can apply cryotherapy and cutaneous stimulation therapy independently to reduce the pain associated with this procedure. Future studies should consider using these methods to control for any individual differences that may exist.

Health promotion interventions for the control of hypertension in Africa, a systematic scoping review from 2011 to 2021.

BACKGROUND: A proportion of hypertension patients live in developing countries with low awareness, poor control capabilities, and limited health resources. Prevention and control of hypertension can be achieved by applying both targeted and population-based health promotion interventions. This study synthesised the health promotion interventions for the control of hypertension in Africa. METHODS: An in-depth search of PubMed, CINAHL, EMBASE, Cochrane library, web of science, google scholar yielded 646 titles and 615 after duplicates were removed. Full text (112) was screened, and ten articles were selected. The data analysis method was thematic analysis through the incorporation of convergent synthesis. The major sub-themes that were identified were reduction in the prevalence of hypertension, increase in knowledge, impact and feasibility, role in the reduction of risk factors, and the cost associated with health promotion interventions. RESULTS: Health promotion interventions led to a remarkable decrease in the prevalence of hypertension, increased knowledge and awareness in the intervention compared to the control groups. Community-based interventions were noted to have a positive impact on people's adoption of measures to reduce risk or identify early symptoms of hypertension. There was a significant relationship for the reduction in salt consumption, smoking, alcohol use, and increased physical activity after the administration of an intervention. Interventions using community health workers were cost-effective. CONCLUSION: To sustain health promotion interventions and achieve control of hypertension especially in the long term, interventions must be culturally friendly and incorporate locally available resources in Africa.