A Theory-Based Self-Management Training Program for Older Adult Peer Leaders with Diabetes: A Feasibility Assessment.

OBJECTIVE: To improve the quality of peer leader training, this study developed a theory-based self-management training program for older adult peer leaders with diabetes and assessed its feasibility. BACKGROUND: Current self-management programs are designed mainly to be implemented by healthcare professionals, but healthcare staff may not fully perceive the needs and obstacles of older adults in disease management due to a lack of similar illness experience. To target this problem, peer leaders with successful self-management experiences, similar cultural backgrounds and languages, and related illness experiences are trained to guide and mentor peer patients in self-management programs. STUDY DESIGN AND METHODS: This study was conducted in two stages. In stage 1, a peer leader training program was developed based on experiential learning theory as the framework and self-regulation theory as the activity design strategy. In stage 2, program feasibility was assessed via participants' feedback toward the training program by three indicators: attendance, future willingness to lead the peer-led self-management program, and leadership skills evaluated by a peer leader training assessment tool. RESULTS: In this study, peer leaders demonstrated good leadership skills by expressing active willingness to lead self-management programs in the community. Peer leaders' feedback indicated that the program's training content was helpful in preparing peer leaders to guide older adults in learning self-management skills and in improving the abilities and confidence of peer leaders in mentoring self-management. CONCLUSION: Findings in this study showed that peer leader training can impact the effectiveness and success of self-management in older adults with diabetes. Even in a small-scale study, the impact was evident, which demonstrated the feasibility of the program. More large-scale studies on the effectiveness of various peer leader training programs in diverse disciplines are recommended. CLINICAL TRIALS REGISTRY: ClinicalTrials.gov Identifier: NCT04298424 (the Peer-Led Self-Management Program).

Planning mass eradication of Helicobacter pylori infection for indigenous Taiwanese peoples to reduce gastric cancer.

BACKGROUND AND AIM: The aim of this study is to identify gastric cancer burden in Indigenous Taiwanese peoples and conduct a project to evaluate how to reduce the disparities most effectively in Indigenous communities. METHODS: First, we quantified the health disparities in gastric cancer in Indigenous peoples using data from the cancer registries during the period of 2006-2014. Second, we identified parameters that might be associated with Helicobacter pylori infection or help identify a good eradication strategy. RESULTS: Gastric cancer incidence (24.4 vs 12.3 per 100 000 person-years) and mortality rates (15.8 vs 6.8 per 100 000 person-years) were higher in Indigenous than in non-Indigenous, with 2.19-fold (95% confidence interval [CI]: 2.06-2.33) and 2.47-fold (2.28-2.67) increased risk, respectively. In Indigenous communities, H. pylori infection was more prevalent in Indigenous than in non-Indigenous (59.4% vs 31.5%, P < 0.01). Regression analyses consistently showed that either the mountain or plain Indigenous had 1.89-fold (95% CI: 1.34-2.66) and 1.73-fold (95% CI: 1.24-2.41) increased risk for H. pylori infection, respectively, as compared with non-Indigenous, adjusting for other baseline characteristics. The high infection rates were similarly seen in young, middle-aged, and older adults. Program eradication rates using clarithromycin-based triple therapy were suboptimal (73.7%, 95% CI: 70.0-77.4%); the habits of smoking (1.70-fold, 95% CI: 1.01-2.39) and betel nut chewing (1.54-fold, 95% CI: 0.93-2.16) were associated with the higher risk of treatment failure. CONCLUSION: Gastric cancer burden is higher in Indigenous Taiwanese peoples than in their non-Indigenous counterparts. Eliminating the prevalent risk factor of H. pylori infection is a top priority to reduce this health disparity.

Current Status and Policy Planning for Promoting Age-Friendly Cities in Taitung County: Dialogue Between Older Adults and Service Providers.

The World Health Organization has promoted age-friendly city (AFC) projects in response to the aging population. Taiwan has also promoted AFC policies. This study was conducted in Taitung County, where 15.37% of the population is older adults in Taiwan. The aim was to understand the perceptions of older adults and service providers with regard to the current status of AFC policies to influence future policies. The participants of this study were older adults and service providers in various regions of Taitung. Quantitative questionnaires were completed by older adults and qualitative interviews were held with focus groups. The older adults were the most satisfied with the AFC domains of "respect and social inclusion" and "community and health services", and the least satisfied with "transportation" and "civic participation and employment". Homogeneity existed between the older adults' satisfaction levels in different regions and the service providers' opinions; however, there were notable differences between them. Both economic development and the ethnicity of groups in different regions are influential factors that determine the success of government policies. In promoting AFC policies, local governments should consider their applicability based on local conditions and resources to meet the needs of the aging population in rural areas.

A "Sit Less, Walk More" Workplace Intervention for Office Workers: Long-Term Efficacy of a Quasi-Experimental Study.

OBJECTIVE: This study tested the maintenance outcomes of a 3-month Sit Less, Walk More (SLWM) workplace intervention for office workers compared with usual care at 12 months from the baseline. METHOD: A quasi-experimental study was conducted in two workplaces. The intervention group (n = 51) received multi-component intervention and the comparison group (n = 50) received newsletters only. The outcomes of the study (self-reported psychosocial, physical activity, sitting, and lost productivity; objectively measured cardiometabolic biomarkers) were compared at baseline, 3, and 12 months. RESULTS: Generalized estimating equations analyses found that the intervention group had significant improvements in self-regulation for sitting less and moving more (P = 0.017), walking (P = 0.003), weight (P = 0.013), waist circumference (P = 0.002), and insulin (P = 0.000) at 12 months compared with the comparison group. CONCLUSION: The SLWM intervention was effective in improving self-regulation, walking, and some cardiometabolic biomarkers in office workers.

A Preliminary Study of the Effects of a Multitheory-Driven Intervention in Adults With Prediabetes Mellitus.

BACKGROUND: Prediabetes mellitus (pre-DM) is an important predictive indicator of Type 2 diabetes. A person with pre-DM is eight times more likely to develop diabetes than a person without pre-DM. Prior research suggests that proactive interventions may delay the progression of this disease and reduce the rate of disease development. PURPOSE: The purposes of this preliminary study were to develop a multitheory-driven lifestyle intervention protocol for adults with pre-DM and to evaluate its feasibility and impacts on knowledge regarding pre-DM, dietary behaviors, and physical activity (primary outcomes) as well as to describe the disease progression indicators (secondary outcomes). METHODS: A single-group, longitudinal study design was used. Thirty-nine participants were included in the analysis. A generalized estimating equation model was used to determine the trends in changes in the outcomes. All of the participants underwent testing at baseline (T0) and at 3 (T1), 6 (T2), and 12 (T3) months after the 4-week lifestyle intervention. RESULTS: There were significantly increasing trends for each study parameter (Pre-DM Knowledge Assessment Form-12, p < .01; Dietary Behavior Scale, p < .01) and significantly positive changes in body weight (p < .01), body mass index (p < .01), fasting glucose level (p < .01), and glycated hemoglobin level (p < .01) over the 12-month study period. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study supports the feasibility of the developed multitheory-driven lifestyle intervention protocol and suggests that its application may improve the effectiveness of diabetes prevention programs in clinical settings. Further randomized controlled trials are needed.

The predictors of adopting a health-promoting lifestyle among work site adults with prediabetes.

AIM AND OBJECTIVE: To examine how prediabetes knowledge, health beliefs and self-efficacy of health behaviour contribute to work site adults adopting a health-promoting lifestyle and to analyse these three factors as independent variables to identify key predictors of adopting health-promoting lifestyles. BACKGROUND: Health providers use health-promoting lifestyle interventions as the primary approach in preventing diabetes. However, many influential factors make it difficult for individuals to adopt a health-promoting lifestyle. Furthermore, no previous study has examined prediabetes knowledge, health beliefs, self-efficacy of health behaviour and health-promoting lifestyle in work site adults with prediabetes, especially among Asians. DESIGN: This was a cross-sectional study of 260 adults at four work sites in southern Taiwan. METHOD: Patients with prediabetes were given a cross-sectional questionnaire about prediabetes knowledge, health beliefs, self-efficacy of health behaviour and health-promoting lifestyle. Multiple stepwise regression analysis was used to determine predictors of implementing health-promoting lifestyles. RESULTS: In general, this study found that over age 45 and a BMI above 25 kg/m(2) are risk factors for prediabetes. A 47.5% variance in implementing health-promoting lifestyle was explained by a model that included self-efficacy of health behaviour (beta = 0.519, p < 0.001), perceived action barrier (beta = -0.207, p = 0.001) and perceived action benefits (beta = 0.129, p = 0.023). CONCLUSIONS: Work site health care units should identify prediabetes cases and teach diet control strategies for reducing body weight. By designing behaviour self-regulation protocol to promote self-management for prediabetic individuals, organisations could enhance self-efficacy and delay further development of diabetes. RELEVANCE TO CLINICAL PRACTICE: Findings guide the clinical assessment (e.g. self-efficacy) of prediabetic adults regarding their health-promoting lifestyles and provide effective guidelines for designing lifestyle interventions to prevent prediabetes in high-risk groups.

[Risk assessment: a concept analysis].

Risk assessments are conducted to assess the negative influences and potential losses related to a prospective goal or decision. The main practical purpose of risk assessment is to provide information, which can then be used to manage identified potential risks to avoid their occurrence or minimize their influence. To date, the risk assessments have primarily been applied to finance, environmental pollution and employment. Risk assessment has been applied only in a limited manner in the fields of medical treatment and nursing. Literature on risk assessment lack analysis that is systematic and complete. This article applies the methodology of Walker and Avant (2005) to analyze the concept of risk assessment. Steps include a review of the literature on conceptual definitions of risk assessment, determining the defining attributes of risk assessment, model construction, defining parameters and related cases, and identifying antecedents and consequences. Once completed, empirical references of risk assessment were explored. The authors hope that this analysis can assist nursing stuff to gain a better understanding of risk assessment concepts in order to apply knowledge gained to clinical practice. As such, nursing stuff will be able to apply the concept of risk assessment to identify risk, control risk, and reduce the occurrence and loss of accidents.

The fatigue experience of haemodialysis patients in Taiwan.

AIMS AND OBJECTIVES: To expand the theoretical understanding of fatigue, this study used in-depth interview to explore the fatigue experience from haemodialysis patients' perspectives. BACKGROUND: Fatigue is a common symptom experienced by the people with chronic diseases including those with renal failure requiring haemodialysis. METHODS: Data were collected in a haemodialysis unit of a hospital in South Taiwan. Purposive samples of 14 participants were interviewed in-depth. Colaizzi's methods were used to analyse transcripts of the interviews. RESULTS: Ten themes were delineated and classified into three domains. The first domain 'physical fatigue' consists of four themes: (1) habitual fatigue, (2) experiencing the uraemic symptoms (3) suffering from sleeping disturbance, (4) insufficient physical energy. The second domain 'affective fatigue' contains three themes: (5) detesting long-term treatment, (6) perceiving depression (7) and feeling exhausted. The third domain 'cognitive fatigue' includes three themes: (8) regretting lost cognition, (9) intentional isolation and (10) coping with fatigue. CONCLUSIONS: The findings identify that fatigue is a multi-dimensional concept. By understanding the various aspects of fatigue, nurses may be better able to plan and provide fatigue-relieving strategies for haemodialysis patients. RELEVANCE TO CLINICAL PRACTICE: The results can provide a direction for interventional studies designed to reduce the patients' fatigue.