Predicting health-promoting self-care behaviors in people with pre-diabetes by applying Bandura social learning theory.

AIMS: The aim of this study was to apply Bandura social learning theory in a model for identifying personal and environmental factors that predict health-promoting self-care behaviors in people with pre-diabetes. BACKGROUND: The theoretical basis of health-promoting self-care behaviors must be examined to obtain evidence-based knowledge that can help improve the effectiveness of pre-diabetes care. However, such behaviors are rarely studied in people with pre-diabetes. METHODS: This quantitative, cross-sectional survey study was performed in a convenience sample of two hospitals in southern Taiwan. Two hundred people diagnosed with pre-diabetes at a single health examination center were recruited. A questionnaire survey was performed to collect data regarding personal factors (i.e., participant characteristics, pre-diabetes knowledge, and self-efficacy) and data regarding environmental factors (i.e., social support and perceptions of empowerment process) that may have associations with health-promoting self-care behaviors in people with pre-diabetes. RESULTS: Multiple linear regression showed that the factors that had the largest influence on the practice of health-promoting self-care behaviors were self-efficacy, diabetes history, perceptions of empowerment process, and pre-diabetes knowledge. These factors explained 59.3% of the variance in health-promoting self-care behaviors. CONCLUSIONS: To prevent the development of diabetes in people with pre-diabetes, healthcare professionals should consider both the personal and the environmental factors identified in this study when assessing health promoting self-care behaviors in patients with pre-diabetes and when selecting the appropriate interventions.

Psychometric analysis of the Short-Form Chinese Health and Safety Executive's Management Standards Indicator Tool among nurses in Taiwan.

The purpose of the study was to develop a Short-Form Chinese version of the Health and Safety Executive's Management Standards Indicator Tool that can be used to measure work-related stress among nurses in Taiwan. Three subscales (supportive climate, role perception, and workload) were developed from an exploratory factor analysis. The three-factor confirmatory factor analysis indicated that the model fit the data well. The evidence based on convergent validity was supported by a significant correlation between the Short-Form Chinese version of the Health and Safety Executive's Management Standards Indicator Tool and the job satisfaction subscale of the Chinese Patient Safety Attitude Questionnaire. Cronbach's α values demonstrated internal item consistency for the Short-Form Chinese version of the Health and Safety Executive's Management Standards Indicator Tool.

The psychometric testing of the diabetes health promotion self-care scale.

BACKGROUND: Health-promoting behavior is an important strategy to maintain and enhance health of patients with Type 2 diabetes. Few instruments have been developed to measure health promotion self-care behavior of patients with Type 2 diabetes. PURPOSE: Developing and psychometric testing of the Chinese version of the Diabetes Health Promotion Self-Care Scale (DHPSC) for patients with Type 2 diabetes. METHODS: Four hundred and eighty-nine patients with Type 2 diabetes were recruited from endocrine clinics in four hospitals in Kaohsiung City in southern Taiwan. Exploratory and confirmatory factor analyses were used to assess the construct validity of the scale. Correlations between the DHPSC and the satisfaction subscale of Diabetes Quality of Life, Diabetes Empowerment Scale, and HbA1c were calculated to evaluate concurrent validity. Internal consistency and test-retest reliability were used to assess the reliability of the scale. The study was conducted in 2007 and 2008. RESULTS: A proposed second-order factor model with seven subscales and 26 items fit the data well. The seven subscales were interpersonal relationships, diet, blood glucose self-monitoring, personal health responsibility, exercise, adherence to the recommended regimens, and foot care. The DHPSC statistically significantly correlated with the satisfaction subscale of Diabetes Quality of Life and the Diabetes Empowerment Scale. HbA1c only statistically significantly correlated with the subscale of health responsibility. Reliability was supported by acceptable Cronbach's alpha (range, .78-.94) and test-retest reliability (range, .76-.95). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The DHPSC has satisfactory reliability and validity. Healthcare providers can use the DHPSC to comprehensively assess the health promotion self-care behaviors of patients with Type 2 diabetes.

[Caregiving burden and associated factors among caregivers of terminally ill gastrointestinal cancer patients].

BACKGROUND: Heavy caregiving burdens can harm the physical and mental health of primary caregivers and reduce patient care quality. Understanding caregiving burden and its associated factors among primary caregivers of terminally ill patients with gastrointestinal cancer can help improve holistic terminal healthcare quality. PURPOSE: The authors explore in this paper the relationship between caregiving burden and terminally ill gastrointestinal cancer patient disease characteristics, demographic backgrounds, level of social support, self-care efficacy, fear of death and self-perceived symptom distress in both patients and primary caregivers. METHODS: This was a cross-sectional, descriptive, and correlational study that used convenience sampling and structured questionnaires. Data were collected from 178 family caregivers of terminally ill patients with gastrointestinal cancer in the Tainan and Chiayi areas of Southern Taiwan. RESULTS: The caregiving burden of caregivers of terminally ill gastrointestinal cancer patients in hospice homecare was significantly higher than that of those recruited from outpatient departments. Caregiving burden for liver and pancreatic cancer patients was significantly higher than for colorectal cancer patients. The caregiving burden of spousal caregivers was significantly higher than that of lineal blood relatives. The caregiving burden of caregivers with worse self-perceived health status was significantly higher than that of those with better self-perceived health status. The most important explanatory factors of caregiving burden among primary caregivers terminally ill gastrointestinal cancer patients were (in descending order) social support, self-perceived symptom distress in patient, self-perceived health status, location of study subject recruitment, fear of death, and relationship with patient; these factors explained 63.8% of the total variation. Social support was the most important explanatory factor, explaining 37.2% of total variance. CONCLUSIONS: We recommend that terminal health care teams better assess the social support given primary caregivers of terminally ill gastrointestinal cancer patients, that assistance be provided to caregivers with less social support, that caregiver life-and-death education be improved, and that primary caregivers be taught how to accept and positively handle the death of the loved one in their care. More attention should be paid to controlling symptoms of terminal stage cancer patients in order to reduce caregiver self-perceived symptom distress. Evaluation of caregiving burden is especially important for those primary caregivers who are hospice homecare workers, spouses, and of lower self-perceived health status.

The relationship between selected developmental assets and health-promoting behaviours of adolescents in Southern Taiwan.

AIMS AND OBJECTIVES: To examine the relationship between selected developmental assets and health-promoting behaviours of adolescents. BACKGROUND: Developmental assets can be considered as potential health assets for adolescents. Understanding the relationship between developmental assets and health-promoting behaviours among adolescents could provide nurses with a new approach to design intervention programmes for adolescent health-promoting behaviours. DESIGN: A cross-sectional study design. METHODS: Anonymous questionnaires were administered to 453 adolescents aged between 13-16 years. Canonical correlation analysis was used to examine the relationship between selected developmental assets and health-promoting behaviours. RESULTS: Canonical correlation analysis indicated two significantly meaningful variate pairs between selected developmental assets and health-promoting behaviour sets. The first pair variate accounted for 51.3% of the total variance, which showed that adolescents who had better self-esteem, future aspirations, responsible choices, family communication, non-parental adult role models, peer role models and community involvement had better behaviours of life appreciation, health responsibility, social support, stress management, nutrition and exercise. The second pair variate accounted for 9.6% of the total variance, which showed that adolescents who had better responsible choices had better stress management behaviours. CONCLUSION: Developmental assets are important to adolescents' health-promoting behaviours. Interventions focusing on strengthening developmental assets can potentially provide an innovative approach for nurses to improve health-promoting behaviours of adolescents. RELEVANCE TO CLINICAL PRACTICE: Strengthening developmental assets can potentially improve the health-promoting behaviours of adolescents. Individual and sociopolitical domains should be incorporated into programmes for enhancement of developmental assets. School nurses can cooperate with family and community and provide environments improving adolescents' developmental assets. Nurses should actively engage in developmental asset programmes for adolescents. The tools for measuring developmental assets modified and developed in this study were valid and reliable. They can be used for further examination of the developmental assets for adolescents in various subset populations.

Voices from the frontline: Perceptions and needs of nurses involved in a nosocomial cluster of tuberculosis infection.

Little is known about the psychological aspects of health care workers who contract tuberculosis (TB). This study explored the perceptions and the needs of nurses who were involved in a nosocomial cluster of TB infection in Taiwan. Using a phenomenological research design, we conducted semistructured interviews with nine participants. The data management was processed by Colaizzi's method. The result reveals that nursing staff members who occupationally contracted TB undergo two phases. From the detection of their infection to recovery, they experienced different perceptions and needs. The hospital should be mandated to accommodate nurses' varying needs accordingly. Clinical-implication-related infection control strategies, grouped into three levels of prevention, are discussed.

Predictors of sexual abstinence behaviour in Taiwanese adolescents: a longitudinal application of the transtheoretical model.

AIMS AND OBJECTIVES: To understand (1) the change of stage of changes, self-efficacy, decisional balance and processes of change for sexual abstinence behaviour across a 15-month interval, (2) relations of baseline stage of changes, self-efficacy, decisional balance and processes of change to follow-up stage of changes for sexual abstinence and (3) the important predictors of follow-up stage of changes and transition of stage of changes for sexual abstinence behaviour. BACKGROUND: Examining factors of sexual abstinence behaviour among adolescents can provide useful information in designing sexual abstinence intervention programmes. DESIGN: This study applied a transtheoretical model and used a longitudinal design. METHOD: Anonymous questionnaires were administered to 281 participants at baseline and 15-month follow-up. RESULTS: In summary, 46.3% (n = 130) of the participants were in the same stage, 30.2% (n = 85) regressed and 23.5% (n = 66) progressed their stage from baseline to follow-up. Baseline self-efficacy, decisional balance and processes of change are related to follow-up stage of changes for sexual abstinence. Participants with higher baseline self-efficacy, lower decrease of self-efficacy from baseline to follow-up and lower decrease of decisional balance from baseline to follow-up were more in the definite group (preparation and action stage) at follow-up. Participants with higher baseline decisional balance, lower decrease of decisional balance from baseline to follow-up and lower decrease of self-efficacy from baseline to follow-up were more in the advancement transition group at follow-up. CONCLUSIONS: Focus of interventions could differ according to intervention purpose. Reducing the decrease of self-efficacy and decisional balance across time is important to enable adolescents to be in or progress to better stages across time. RELEVANCE TO CLINICAL PRACTICE: To make adolescents be in later stages at follow-up, increasing baseline self-efficacy is important. If the purpose is to progress the stages, baseline decisional balance should be emphasised. Health care providers should continually boost the self-efficacy and decisional balance of adolescents across time.

A causal model of contraceptive intention and its gender comparison among Taiwanese sexually inexperienced adolescents.

AIMS AND OBJECTIVES: To test latent constructs of social influences, contraceptive attitude and self-efficacy for contraception as a causal model of contraceptive intention among adolescents and to search for possible gender differences in the causal model of contraceptive intention. BACKGROUND: A greater understanding of the causal model of contraceptive intention among sexually inexperienced adolescents will help nurses design contraceptive programmes to improve adolescent contraceptive use when they have sex. Design. This was a cross-sectional study; 770 boys and 685 girls that self-reported not being sexually experienced were selected for this study. METHODS: An anonymous questionnaire was used to collect data. By structural equation modelling using the eqs 6.1 software, a hypothesized structural model of contraceptive intention was tested. FINDINGS: For both genders, social influences affected contraceptive intention indirectly through the contraceptive attitude and self-efficacy for contraception. Contraceptive attitude and self-efficacy for contraception affected contraceptive intention directly. Contraceptive attitude also affected contraceptive intention indirectly through the mediation of self-efficacy for contraception. There were gender differences in the variances of contraceptive intention explained by contraceptive attitude, self-efficacy for contraception and social influences. Nevertheless, the data explain only a low proportion of the variability in contraceptive intention. More causal constructs influencing contraceptive intention should be explored in future. CONCLUSIONS: Personal factors and social influences operate interdependently to influence contraceptive intention among sexually inexperienced adolescents. Gender is a moderator that can modify the influential level of social influences, contraceptive attitude and self-efficacy for contraception on contraceptive intention. RELEVANCE TO CLINICAL PRACTICE: Nurses should operate personal factors and social influences interdependently when they are designing intervention programmes for sexually inexperienced adolescents. To make intervention more effective, nurses also need to provide gender-specific intervention programmes for sexually inexperienced adolescents.

Testing a model of contraception use behavior among sexually active female adolescents in Taiwan.

The purpose of this cross-sectional study was to test a model of contraception use among sexually active Taiwanese female adolescents, using structural equation modeling. Anonymous questionnaires were distributed to 404 female adolescents who had had sexual intercourse in the previous 3 months. A model was produced in which past contraception use, self-efficacy for contraception use, and decisional balance for using contraception had significant direct effects on current contraception use. Social influences had not only significant direct effects on self-efficacy and on decisional balance, but also a significant indirect effect on current contraception use. These findings provide a reference for the development of contraceptive intervention programs for sexually active female adolescents in Taiwan.

Factors related to avoidance of environmental tobacco smoke among adolescents in southern Taiwan.

This study employed the PRECEDE model to investigate the correlates of behavior to avoid environmental tobacco smoke (ETS) in adolescents. A total of 208 adolescents who were non-smoking and aged between 15 and 19 years old enrolled in junior programs in technical colleges in southern Taiwan were selected as participants. An anonymous questionnaire including demographic data, ETS avoidance scale, knowledge of ETS scale, attitude toward avoiding ETS scale, self-efficacy of avoiding ETS scale, perceptions of health resources for avoiding ETS in school scale, perceptions of ETS avoidance in families, perceptions of ETS avoidance in peers scale, whether the family smoke, and whether close friends smoke were used to collect data. The results showed: (1) behavior to avoid ETS for female adolescents was better than that of male adolescents; (2) attitude toward avoiding ETS, self-efficacy of avoiding ETS, perception of ETS avoidance in families, and perception of ETS avoidance in peers were significantly positive related to behaviors of avoiding ETS; (3) adolescents with close friends not smoking had a better behavior to avoid ETS; and (4) hierarchical regression analysis shows that gender, attitude toward avoiding ETS, perception of ETS avoidance in peers, and perceptions of ETS avoidance in families were the significant predictors, and could explain 54.5% of the total variance in behaviors to avoid ETS. Results of this study can serve as a reference on improving ETS avoidance among adolescents.

Relationship between perceived empowerment care and quality of life among elderly residents within nursing homes in Taiwan: a questionnaire survey.

BACKGROUND: It is essential for nurses to have a solid understanding of what may influence the quality of life (QOL) among elderly residents within nursing homes. Although many factors have been demonstrated to be related to the QOL among elderly people, the relationship between perceived empowerment care and QOL among elderly residents within nursing homes has not been investigated thoroughly. OBJECTIVES: The aim of this study is to explore how demographic characteristics, perceived empowerment care and functional status affect perceived QOL among the elderly residents who reside in nursing homes. DESIGN: This study employed a cross-sectional design. SETTINGS: Eight nursing homes throughout southern Taiwan were recruited into this study. PARTICIPANTS: One hundred and two residents aged 65 years or older residing in nursing homes for at least 6 months, who did not have moderate to severe obstacles in cognitive ability, were recruited as participants. METHODS: A questionnaire including demographic data, a physical function scale, an activity of daily living (ADL) scale, a patient empowerment scale, and a QOL index was used in this study. RESULTS: The results showed a medium rating level of QOL among elderly residents. Elderly residents did not feel excessively disempowered care. Perceived empowering care, ADLs and marital status were significant predictors of QOL, which explained 45.3% of the total amount of variance in QOL. Perceived empowering care was the most important predictor of QOL. CONCLUSIONS: Nurses should pay attention to the effect of empowering care on QOL of elderly residents within nursing homes. Empowering care should be considered as a strategy of nursing care in nursing homes.

Prebirth psychosocial factors as predictors of consistency in contraceptive use among Taiwanese adolescent mothers at 6 months postpartum.

OBJECTIVE: To assess contraceptive behavior and whether pre-birth psychosocial factors could predict consistency in contraceptive use among adolescent mothers at six-month postpartum. DESIGN: Prospective study. SAMPLE: 104 Taiwanese adolescent mothers. MEASUREMENTS: Participants completed a contraception questionnaire in their third trimester and a postpartum contraception questionnaire at six-month postpartum. RESULTS: Prior to giving birth, the adolescent mothers most commonly answered that condom use (39.8%) was the contraceptive method they planned to use after delivery. It was also more commonly reported in the postpartum to be the method they actually were using (54.3%). Stepwise logistic regression analysis further showed that a more positive contraceptive attitude (odds ratio=1.104) and a higher self-efficacy (odds ratio=1.068) in contraceptive use in the pre-birth period increased the probability that a participant would report that she always used contraceptives in the postpartum period. Nevertheless, a higher score in the pre-birth period in the area of subjective contraceptive norms (odds ratio=0.978) decreased this probability. The final regression model could correctly classify 81.7% of the participants. CONCLUSIONS: Health care professionals should provide adolescent mothers with the information they need to improve their attitude and self-efficacy toward contraception before they enter the postpartum period.

Factors associated with adolescent pregnancy- a sample of Taiwanese female adolescents.

This study was designed to explore the factors that differentiate sexually experienced teenagers who become pregnant from those who do not. The study examined the differences between pregnant and never-pregnant female adolescents in personal background characteristics, family characteristics, substance use, contraceptive attitude, contraceptive knowledge, contraceptive self-efficacy, sexual history, and effective contraceptive use. Sexually experienced but never-pregnant female adolescents were selected from two vocational high schools. Pregnant adolescents were recruited by convenience sampling from obstetric clinics and health stations in Tainan City, Taiwan. Multiple logistic regression analysis identified six factors associated with pregnancy: poor contraceptive knowledge, poor contraceptive self-efficacy, low socioeconomic status, low effective contraceptive use scores, more frequent sexual intercourse, and older age. The results of this study provide health professionals with information to develop more-effective prevention and intervention programs to reduce adolescent pregnancy. The results also could be used as a reference for related research and policy development in other countries.