Public libraries to promote public health and wellbeing: a cross-sectional study of community-dwelling adults.

BACKGROUND: Libraries in the UK have evolved from traditional book-lending institutions into dynamic community hubs, This study aims to explore the potential of libraries to act as community hubs to promote mental and physical health and wellbeing of community-dwelling adults, drawing on insights from both library users and library staff in England. DESIGN: A mixed-method, cross-sectional study using online survey and interviews with community-dwelling adults and library staff. METHODS: We collected data using a 14-item electronic survey and interviews with library users and staff to gauge perceptions. Descriptive statistics and thematic analysis were used to identify key trends and emergent themes. RESULTS: We included 605 respondents from the survey and interviewed 12 library users and staff. Libraries remain popular and are considered a 'safe place by members of the community, regardless of their frequency of service usage irrespective of whether they are frequent users of services. However, a lack of awareness among library users about community-facing services could act as a hurdle to improving community health and wellbeing. Targeted engagement with residents is needed to increase awareness of libraries' services, including community interventions to help tackle loneliness and inequalities in digital and health literacy. Library staff often did not feel involved in important decision-making. Various barriers, drivers and practical recommendations were identified to leverage libraries as hubs to promote community health and wellbeing. CONCLUSION: Libraries already offer a variety of resources that directly or indirectly support the health and wellbeing of community-dwelling adults and young people. However, public awareness of these services is limited. As we navigate post-pandemic recovery, libraries can serve as platforms for community engagement, fostering resilience, mental health support and reducing social isolation. Recognising libraries' untapped potential can lead to healthier communities and improved wellbeing.

Assessment of Paracetamol Usage Practices and Perceptions among Caregivers for Children Post-COVID-19 in Saudi Arabia: A Cross-Sectional Analysis.

Caregivers often use paracetamol in the management of pediatric illnesses without a clear rationale. This study evaluated the perception and practices of caregivers regarding the use of paracetamol in children in Southwestern Saudi Arabia. This study involved a cross-sectional design involving 373 caregivers of children under twelve. The questionnaire elucidated the reasons, usage frequency, and safe usage practices. Data were analyzed using SPSS, applying Chi-square tests and logistic regression. Most caregivers were in the age range of 31-40 years, and with intermediate education. Paracetamol was mainly used for fever, generalized pain and, diarrhea, with fewer opting for other self-care measures. Caregivers with primary or less education were more likely to perceive paracetamol as safe (AOR = 2.98 (1.3-6.73), p = 0.009) and less inclined to check warning labels (AOR: 0.11 (0.05-0.25), p < 0.001) and expiry dates (AOR: 0.063 (0.027-0.14), p < 0.001). The caregiver's education level significantly influenced the determination of treatment duration (χ2 = 21.58 (4), p < 0.001), dosage (χ2 = 30.70 (4), p < 0.001), and frequency of administration (χ2 = 17.77 (4), p = 0.001). In conclusion, inadequate health literacy can result in a lack of attention towards crucial safety information about pediatric paracetamol use. Hence, counselling initiatives should be undertaken to ensure the safe and effective use of paracetamol in children.

Supporting patients with venous leg ulcers in self-care monitoring: an interview study with primary health care professionals.

OBJECTIVE: This study described the experiences and perceptions of how primary health care professionals (PHCPs) support patients with venous leg ulcers (VLUs) in self-care monitoring. DESIGN: A qualitative approach with reflexive thematic analysis was used, with 24 individual qualitative open interviews. SETTING: Primary health care clinics and community health care in four southern regions in Sweden. SUBJECTS: Registered nurses, district nurses and nurse assistants who had experience of caring for patients with VLUs. In total, 24 interviews were conducted with PHCPs in Sweden. RESULTS: PHCPs have a vital role in promoting patient independence and responsibility, identifying needs and adapting care strategies, while also recognising unmet needs in patients with VLUs. CONCLUSION: PHCPs actively monitor patients' self-care and establish caring relationships. They see a need for a structured primary health care work routine for ulcer management.

PHCPs described encouraging patients by identifying needs, adapting care and promoting self-care monitoring using various skills and strategies.PHCPs described unmet needs and insufficient care practices for patients with VLUs.PHCPs pointed out the importance of establishing caring relationships in order to involve patients in their VLU treatment.

Study Circles as a Possible Arena to Support Self-Care-A Swedish Pilot Study.

Today, issues related to people's mental health and well-being have been described as a challenge for society, globally as well as in Sweden. This calls for new approaches to mental health promotion. The aim was to evaluate the adequacy of its content and structure, describing experiences of study circles as a means of supporting participants' self-care and self-compassion. The overall design is a descriptive QUAL + quan design, where the quantitative and qualitative results are integrated. Five participants participated in a focus group interview, of whom four completed questionnaires. One individual interview was conducted with the study circle leader. Study circles can be an arena for mental health promotion, as learning and sharing of experience contributes to a sense of coherence, as well as self-compassion and a genuine concern for one's own and others' well-being, but are not considered an alternative to psychiatric care for those in need of professional services. Study circles can be a possible means to support self-care and thereby promote mental health in the general population and are a valuable contribution to public health. However, in addition to modifications of the content, further research is needed on the qualifications for study circle leaders, as well as the dissemination of study circles.

The Rising Challenge of Poor Health Literacy of Patients with Systemic Sclerosis: Preliminary Data Identify Important Unmet Needs in an Italian Cohort.

RATIONALE AND AIM: Health literacy (HL) is pivotal for the successful self-management of chronic diseases. Little HL information is currently available in SSc patients; therefore, the present study aims at evaluating the HL levels in an Italian cohort of SSc patients. METHODS: SSc patients were enrolled with the support of Italian patient associations, from September 2022 to March 2023. Health literacy characteristics were derived from the Health Literacy Scale European Questionnaire-16 (HLS-EU-Q16), consisting of 16 items designed on a four-point Likert scale ranging from "very difficult" to "very easy", and three HL levels were identified: inadequate HL (0-8 score); problematic HL (9-12 score); and sufficient HL (13-16 score). RESULTS: Enrolled patients (n = 57, mean age = 59 years, SD = 13.2) were mostly female (98.2%), partnered (73.7%), and unemployed or retired (67.9%). Almost half of SSc patients were diagnosed more than 10 years ago, with first symptoms appearing on average 19 years ago (SD 10.5). In 63% of the participants, the overall health literacy skills were inadequate, or problematic, especially in the health care and disease prevention domains. Indeed, 49.2% of the patients declared difficulty in finding information on treatments for illnesses and where to get professional help (42.1%), 47.6% found difficulty in retrieving information on how to manage mental health problems, and 40.4% declared difficulties in judging whether the information on health risks in the media was reliable. CONCLUSIONS: Our findings show that SSc patients have inadequate or problematic levels of HL, suggesting the need for periodic screenings to uncover poor health literacy skills and to provide tailored and understandable educational material. This study was not registered.

Assessment and Factors Contributing to the Quality of Life in Diabetes Mellitus Patients: A Cross-Sectional Single-Center Study.

Introduction Diabetes mellitus (DM) is one of the most common chronic illnesses worldwide, with its prevalence rising rapidly every year. This condition adversely affects vasculature, leading to several potentially devastating complications like cerebrovascular mishaps, myocardial infarction, retinal damage, and renal compromise. These sequelae could lead to serious disabilities and negatively impact quality of life (QoL). Objectives This study aims to assess the QoL of adult diabetic patients in Saudi Arabia and determine influencing socio-demographic factors. Methods This is a cross-sectional study targeting adult diabetic patients visiting the Imam Medical Center in Riyadh, Saudi Arabia, from October 2022 to June 2023. The study encompasses diabetic patients of both genders aged 18 or more but excludes those diagnosed recently, i.e., within less than one year. A validated Arabic questionnaire, available online, was used to assess the QoL of the diabetic patients enrolled in this study. The sample size was 244 adult diabetic patients recruited from the Imam Medical Center through their official social media sites. Results The cohort of 244 patients recruited in this study were mostly aged between 18 and 30 (44.7%), females (52.5%), and married (47.5%). Furthermore, 58.6% of the participants were found to hold a bachelor's degree, 48.8% were employed, and 36.1% earned less than 5000 Saudi riyals each month. Of the total patients, 36.5% were diagnosed with diabetes 1-5 years ago, while 30.5% were diagnosed 5-10 years ago. Type 1 diabetes afflicted 48.4% of participants, whereas 47.1% were affected by type 2 diabetes. It was also determined that type 2 diabetic patients have higher overall QoL scores than type 1 diabetic patients. QoL had a high mean score of 22.05±4.4. The psychological/spiritual domain has the greatest mean score of 24.06±5.4, while the social and economic domain has the lowest (20.58±4.6). The majority of participants (71.3%) did not have other chronic conditions, whereas hypertension (18%) is the prevalent comorbidity, followed by respiratory ailments (7.4%) and cardiovascular disease (3.3%). Furthermore, people with hypertension had a higher total QoL and four life domain scores than those with cardiovascular and respiratory disorders. Conclusion The relevance of the findings is that it could aid health practitioners in developing techniques to encourage patients to undertake self-care to improve physiological management of the condition and reduce complications.

Symptom characteristics, perceived causal attributions, and contextual factors influencing self-care behaviors: An ecological daily assessment study of adults with chronic illness.

OBJECTIVE: Insights into how symptoms influence self-care can guide patient education and improve symptom control. This study examined symptom characteristics, causal attributions, and contextual factors influencing self-care of adults with arthritis, asthma, chronic obstructive pulmonary disease, diabetes, or heart failure. METHODS: Adults (n = 81) with a symptomatic chronic illness participated in a longitudinal observational study. Using Ecological Daily Assessment, participants described one symptom twice daily for two weeks, rating its frequency, severity, bothersomeness, duration, causes, and self-care. RESULTS: The most frequent symptoms were fatigue and shortness of breath. Pain, fatigue, and joint stiffness were the most severe and bothersome. Most participants engaged in active self-care, but those with fatigue and pain engaged in passive self-care (i.e., rest or do nothing), especially when symptoms were infrequent, mild, somewhat bothersome, and fleeting. In people using passive self-care, thoughts, feelings, and the desire to conceal symptoms from others interfered with self-care. CONCLUSION: Most adults with a chronic illness take an active role in managing their symptoms but some conceal or ignore symptoms until the frequency, severity, bothersomeness, or duration increases. PRACTICE IMPLICATIONS: When patients report symptoms, asking about self-care behaviors may reveal inaction or ineffective approaches. A discussion of active self-care options may improve symptom control.

Healthy aging, self-care, and choice in India: Class-based engagements with globally circulating ideologies.

Euro-American notions of successful and healthy aging are taking root globally, shaped and inflected by local cultural and political contexts. India is one place where globally inflected discourses of healthy, active, and successful aging are on the rise. However, notions about just what constitutes healthy aging and how to achieve such a goal do not play out the same way across the globe. This article explores how older Indians of diverse social classes are thinking about their own lives in relation to broader discourses of healthy aging circulating within India and abroad. Analyses of in-depth interviews with 25 individuals (11 women and 14 men, ages 57 to 81, across a range of social classes) reveal that while many among the urban elite are enjoying participating in a globally informed healthy-aging culture, such trends are not at all widespread among the non-elite. Moreover, Indians across social classes tend to interpret their own "healthy aging" goals in ways at odds with their perceptions of Western paradigms of healthy and successful aging, sometimes incorporating critiques of the West into their own reflections about health and well-being in later life. By examining how healthy-successful aging ideologies play out across divergent national-cultural and social-class contexts, our aim is to challenge universalizing models and heighten understanding of social inequalities while opening up a wider set of possibilities for imagining what it is to live meaningfully in later life.

Individual and systems-related factors associated with heart failure self-care: a systematic review.

BACKGROUND: Heart failure (HF) is a prevalent condition worldwide. HF self-care is a set of behaviors necessary for improving patient outcomes. This study aims to review and summarize the individual and system-related factors associated with HF self-care published in the last seven years (Jan 2015 - Dec 2021) using the Socioecological Model as a review framework. METHODS: An experienced nursing librarian assisted authors in literature searches of CINAHL Plus with Full Text, Ovid Nursing, PsychINFO, and PubMed databases for peer-reviewed descriptive studies. Inclusion criteria were HF sample with self-care as the outcome variable, and a quantitative descriptive design describing individual and/or system-level factors associated with self-care. Exclusion criteria were interventional or qualitative studies, reviews, published before 2015, non-English, and only one self-care behavior as the outcome variable. The search yielded 1,649 articles. Duplicates were removed, 710 articles were screened, and 90 were included in the full-text review. RESULTS: A subset of 52 articles met inclusion and exclusion criteria. Study quality was evaluated using modified STROBE criteria. Study findings were quantitated and displayed based on socioecological levels. Self-care confidence, HF knowledge, education level, health literacy, social support, age, depressive symptoms, and cognitive dysfunction were the most frequently cited variables associated with self-care. Most factors measured were at the individual level of the Socioecological Model. There were some factors measured at the microsystem level and none measured at the exosystem or macrosystem level. CONCLUSION: Researchers need to balance the investigation of individual behaviors that are associated with HF self-care with system-level factors that may be associated with self-care to better address health disparities and inequity.

Assessment of knowledge, attitude, and practice on self-care with over-the-counter medicines among pregnant women.

Background: Self-care during pregnancy is a crucial topic to be discussed due to its effects on both the mother and fetus. In Sri Lanka, specifically regarding self-care with over-the-counter (OTC) medicines, usage among the pregnant population is scarce. Objective: This study assessed knowledge, attitudes, and practices (KAP) on self-care with OTC medicine usage among pregnant women attending maternity clinics in the Colombo Medical Officer of Health (MOH) areas, Sri Lanka. Method: A cross-sectional study was conducted among 399 pregnant women enrolled through simple random sampling using a self-administered questionnaire. Data were collected on knowledge, attitudes, practices, and sociodemographic characteristics. SPSS version 27 was used for descriptive statistical analysis. Results: There were satisfactory levels of KAP on self-care with OTC medicines identified among participants. The Mean ± SD for knowledge was 4.38 ± 0.873, and for attitude and practice, 27.56 ± 3.752 and 20.35 ± 4.235, respectively. Significant positive linear correlation between knowledge and attitude (r = 0.375, p < 0.001), attitude and practice (r = 0.518, p < 0.001), and knowledge and practice (r = 0.224, p < 0.001) were observed. It refers to participants with higher levels of knowledge being more likely to exhibit certain attitudes and engage in good practice regarding self-care. However, 93% of the participants had a wrong intention that any medicine could be used at any stage of pregnancy, and 26.3% of the participants didn't know that the medications taken during pregnancy could impact the fetus. Surprisingly, 87% had misperceived that antibiotics can be purchased as OTC medicines. Additionally, the majority of the participants (96%) believed that they could use old prescriptions to purchase medicines during pregnancy. Conclusion: Greater awareness regarding self-care with OTC medication usage is suggested to be provided during pregnancy.

Can Clinical Assessment of Postural Control Explain Locomotive Body Function, Mobility, Self-Care and Participation in Children with Cerebral Palsy?

Trunk control may influence self-care, mobility, and participation, as well as how children living with cerebral palsy (CP) move around. Mobility and Gross Motor performance are described over environmental factors, while locomotion can be understood as the intrinsic ontogenetic automatic postural function of the central nervous system, and could be the underlying element explaining the relationship between these factors. Our goal is to study the correlation among Trunk Control Measurement Scale (TCMS) and Pediatric Evaluation of Disability Inventory (PEDI) domains, as well as Locomotor Stages (LS). METHODS: A feasibility observational analysis was designed including 25 children with CP who were assessed with these scales. RESULTS: The strong correlation confirms higher levels of trunk control in children with better self-care, mobility and participation capacities. Strong correlations indicate also that higher LS show better levels of PEDI and TCMS domains. CONCLUSIONS: Our results suggest that more mature LS require higher levels of trunk control, benefitting self-care, mobility and social functions.

The ubiquity of 'self-care' in health: Why specificity matters.

Despite increased interest in self-care for health, little consensus exists around its definition and scope. The World Health Organization has published several definitions of self-care, including in a 2019 Global Guideline rooted in sexual and reproductive health and rights (SRHR), later expanded to encompass health more generally. To establish a robust understanding of self-care, this exploratory study inventorises, consolidates, presents and analyses definitions of self-care beyond the SRHR field. A pragmatic review identified definitions and conceptualisations of self-care from peer-reviewed and grey literature published between 2009 and 2021. The search identified 91 definitions of self-care from 116 relevant publications. Data extraction informed analysis to identify recurring themes and approaches, revealing three key areas of variation: self-care being: (1) defined directly or descriptively; (2) situated within individual, interpersonal or structural contexts; (3) defined broadly or topic-specifically. A multilevel conceptualisation can guide a more broadly applicable understanding of self-care: first, as an aspect of healthcare; second, as a concept operating at individual, interpersonal and institutional levels; third, as a concept that impacts specific health fields and contexts differently. A comprehensive but adaptable framework works in service of improving health and wellbeing for all, acknowledging the linkages between self-care and health-related human rights.

Translation, transcultural adaptation into Brazilian Portuguese and concurrent validity of the rheumatoid arthritis assessment scale (RAKAS-13/Brazil).

BACKGROUND: Knowledge of patients about Rheumatoid Arthritis (RA) is a necessary aspect to better approach self-management support in a patient-centered manner. The research instrument known as the Rheumatoid Arthritis Knowledge Assessment Scale (RAKAS), consisting of 13 items, is simple, reliable and reproducible, and can be applied in both clinical practice and research protocols. OBJECTIVE: This study aimed to translate and culturally adapt the RAKAS vocabulary into Brazilian Portuguese and to evaluate its concurrent validity. METHODS: The RAKAS was translated into Brazilian Portuguese and administered to 52 elderly women with RA recruited between May 2021 and May 2022. Concurrent validity was assessed using the Spearman's correlation coefficient between RAKAS and Patient Knowledge Questionnaire (PKQ). RESULTS: The participants considered RAKAS-13/BRAZIL easy to understand and did not report any doubts in answering the final version. Concurrent validity of the RAKAS-13/BRAZIL was low compared to the PKQ (ρ = 0.283, p = 0.038). CONCLUSION: The Brazilian Portuguese version of the RAKAS (RAKAS-13/BRASIL) proved to be a questionnaire that was easy and quick to administer to assess patient knowledge about Rheumatoid Arthritis, despite its low correlation with the PKQ in the present study.

Assessment of urine colour using a wallet card: a randomised study of a novel patient self-care tool during chemoradiation for oesophageal cancer.

BACKGROUND: Patients undergoing neoadjuvant chemoradiation for oesophageal cancer often experience dehydration from decreased fluid intake and increased losses. Despite frequent clinical visits during treatment, patients can still present with dehydration, suggesting the need for increased patient awareness and engagement around adverse event management at home. Evidence for benefits of self-monitoring may help motivate patients to engage proactively in their own care to improve their treatment experience. METHODS: We performed a randomised single-centre study of a urine colour self-monitoring card (UCC) during chemoradiation therapy for oesophageal cancer, compared with standard dietitian counselling. Primary outcome was self-efficacy as determined by the Self-Management Resource Centre Self-Efficacy for Managing Chronic Disease Scale (SMCD). Secondary outcomes included Burge thirst scores, Edmonton Symptom Assessment System scores (ESAS), patient-initiated hydrations, creatinine rise and satisfaction with the UCC. RESULTS: Thirty-five patients were randomised. UCC use was not associated with improved SMCD or ESAS scores compared with standard counselling. The card was highly rated by patients as a welcome tool for self-monitoring. CONCLUSIONS: No beneficial effect on self-efficacy or dehydration markers with UCC use was demonstrated. The study nonetheless drew attention to several factors potentially hindering its use for effective self-care: the unexpected severity of other symptoms consuming patients' attention, reduced sensitivity of urine colour due to chemotherapy, absence of active inquiry by the healthcare team and the inconvenient location of the UCC in wallet/purse. Urine colour monitoring in patients with oesophageal cancer to improve the patient experience during treatment warrants further study but supported by active healthcare provider inquiry, more accessible format of the card, and possibly home vital checks to increase its sensitivity in the clinical context.

Healing Baltimore: Creating Support for VALUE (Vaccine Access & Acceptance, Lives in Unity, Education & Engagement) Baltimore Ambassadors as They Serve During the COVID-19 Pandemic.

VALUE (Vaccine Acceptance & Access Lives in Unity, Engagement & Education) Baltimore began in February 2021 with the vision of helping underserved communities in Baltimore City value COVID-19 vaccination and have access to the vaccine. VALUE dispatched ambassadors to provide COVID-19 education and risk-mitigation strategies in their communities. Once the project was implemented, we noticed that our ambassadors were often overwhelmed by misinformation in the community and our priority populations faced deeper issues relating to the social determinants of health (SDOH) and social needs such as food, transportation, job loss, and housing.To help our ambassadors cope with and address these issues, we created Healing Baltimore in April 2021. Healing Baltimore aims to support our VALUE ambassadors as they contribute toward improving the wellbeing of Baltimore now and after COVID. Healing Baltimore has four elements: (1) Weekly Self-Care Tips, (2) Weekly Positive Facts about Baltimore, (3) SDOH Referral to Baltimore City Health Department Services, and (4) Webinars to teach us about the VALUE communities while offering the opportunity to discuss historical trauma. We share our lessons learned from Healing Baltimore, which include (1) increasing ambassador input, (2) engagement, (3) co-creation, (4) collaboration, and (5) community appreciation.

Associations between social determinants of health and diabetes self-care behaviors among insured adult patients.

AIMS: This study explored the association between social determinants of health (SDOH) and diabetes care behaviors among individuals with health insurance. METHODS: Data from 57,206 US residents, representing a population of over 25.58 million adults with health insurance and diagnosed diabetes, were included in this cross-sectional analysis of data from the 2017 Behavioral Risk Factor Surveillance System. Logistic regression models were constructed to evaluate the likelihood of various diabetes care behaviors given the presence of several SDOH (e.g., food insecurity, poverty, housing insecurity, rurality). RESULTS: Most respondents exercised, ate vegetables, saw a provider for diabetes-related care in the last year, and reported checking their feet and testing their blood sugar daily. Not feeling safe (odds ratio (OR) 1.77, 95 % confidence interval (CI) 1.04, 3.01) was related to never checking blood sugar. Experiencing frequent stress was associated with a lower likelihood of exercise (OR .77, 95% CI 0.60, 0.999) and lower likelihood of checking blood sugar at least once a day (OR 0.73, 95% CI 0.54, 0.99). Food insecurity was associated with lower likelihood of vegetable consumption (OR 0.63, 95 % CI 0.47, 0.85) but a higher likelihood of checking blood sugar (OR 1.80, 95 % CI 1.26, 2.57). Low-income respondents were less likely to exercise (OR 0.72, 95 % CI 0.64, 0.80) or eat vegetables (OR 0.83, 95 % CI 0.75, 0.93) but more likely to check their feet (OR 1.19, 95 % CI 1.04, 1.35) and blood sugar at least once per day (OR 1.15, 95% CI 1.01, 1.31). Those who rent their home were also more likely to check their blood sugar (OR 1.22, 95% CI 1.07, 1.37) but less likely to have eaten vegetables in the last week (OR 0.87, 95% CI 0.78, 0.97). Respondents living in rural areas were more likely to have visited a provider in the last year (OR 1.21 95% CI 1.00, 1.47). CONCLUSIONS: SDOH can adversely affect diabetes self-care behaviors, providers should assist vulnerable patients by connecting them with community resources and providing individualized care.

Assessment of diabetes self-care behaviors and knowledge among Marshallese adults with type 2 diabetes in the Republic of the Marshall Islands.

AIMS: The aim of this study is to assess and document engagement in type 2 diabetes mellitus (T2DM) self-care behaviors and self-reported diabetes knowledge among Marshallese adults living in the Republic of the Marshall Islands (RMI). METHODS: The study uses data from a T2DM health screening study completed in the RMI; survey and biometric data were captured as part of the health screenings. Study objectives were examined using descriptive statistics to describe the characteristics of the participants, their diabetes self-care behaviors, and their levels of self-reported diabetes knowledge. RESULTS: Results indicate many Marshallese diagnosed with T2DM did not engage in adequate self-care behaviors, including blood sugar checks and foot examinations. Participants reported having forgone needed medical care and medication due to issues with cost and/or access, and participants reported low levels of diabetes knowledge. CONCLUSIONS: The results demonstrate the need for further work in improving engagement in diabetes self-care by Marshallese living in the RMI. Increased engagement in self-care and diabetes education programs may help Marshallese with T2DM to improve control of their glucose and avoid long-term health complications, as well as reduce costs to the healthcare system.

Determinants of diabetes self-care activities in patients with type 2 diabetes based on self-determination theory.

AIMS: In type 2 diabetes control, self-management is an effective way to minimize the risk of developing complications and improve the quality of life. Self-determination theory (SDT) proposed a promising explanatory framework to predict self-regulated behavior which was particularly relevant for self-management. This study aimed to investigate whether SDT constructs can affect the self-management and controlling glycated hemoglobin A1c (HbA1c) levels in type 2 diabetic patients or not. METHODS: This cross-sectional study was conducted from August to December 2022 at two diabetes clinics in Zahedan. The study included 300 patients with type 2 diabetes. Data collection was done using a researcher-administrated questionnaire that included demographic data, diabetes self-care activities, and self-determination constructs including autonomous support, autonomous motivation, and perceived competence. RESULTS: The mean of the overall score of self-care activities was 34.62 ± 11.86 out of a maximum of 70. Patients in the fourth quarter (wealthiest) of the socioeconomic status had the highest mean self-care score (P = 0.003). There was a significant relationship between diet score with perceived competence (P = 0.009). Perceived competence (P<0.001) and controlled self-regulation (P<0.001) were the predictors of exercise score in diabetes patients. Independent self-regulation (P<0.001, r = 0.21) and overall self-regulation (P = 0.001, r = 0.19) were significantly related to blood-glucose testing score. There was a significant relationship between foot care score with perceived competence (P = 0.048, r = 0.11) and autonomous support (P = 0.013, r = 0.14). Multiple regression showed that exercise was the predictor of HbA1c (P = 0.014). CONCLUSION: Exercise is crucial for achieving good individualized glycemic control and reducing the risk of diabetes complications. The findings provided valuable insights into the determinants of self-care activities in patients with type 2 diabetes and underscore the need for interventions that address socioeconomic disparities, enhance perceived competence, and provide autonomy support to improve diabetes self-care.

Urban-rural differences in associations among perceived stress, resilience and self-care in Chinese older adults with multiple chronic conditions.

BACKGROUND: Social determinants of health (SDH) are mainly comprised of structural and intermediary domains. Emerging evidence suggests that the burden of multiple chronic conditions (MCCs) in older adults is exacerbated by structural determinants (e.g. low income and low education). However, less attention was paid to the intermediary determinants (i.e. material circumstances, psychosocial factors and behavioural factors) of MCCs. OBJECTIVES: To investigate the associations among perceived stress, resilience and self-care in Chinese older adults with MCCs by comparing urban and rural groups. METHODS: A convenience sample (125 and 115 participants from urban and rural settings, respectively) of Chinese older adults with MCCs was enrolled between January and April 2022. Hierarchical multiple regression analyses and propensity score weights were used to determine the associations among perceived stress, resilience and self-care. RESULTS: Hypothesis 1 regarding the negative associations between perceived stress and self-care was fully supported in the rural group. However, for the urban group, the negative association was only supported for the relationship between MCCs-related perceived stress and self-care maintenance. Hypothesis 2 was fully supported regarding the positive associations between resilience and the three components of self-care in both groups, although the relationship between resilience and self-care monitoring was marginally significant in the urban group. Hypothesis 3 regarding the moderating effect of resilience was only supported in the relationship between general perceived stress and self-care monitoring in the rural group. After adding the propensity score weights, the moderating effect was no longer statistically significant in the rural group. CONCLUSIONS: The urban-rural disparities in the Chinese context might largely be attributed to the complex interactions of the structural determinants and intermediary determinants. Findings can inform the development of culturally tailored interventions to promote self-care and reduce urban-rural disparities for Chinese older adults with MCCs. IMPLICATIONS FOR PRACTICE: With the increasing number of older adults in China who are living with multiple chronic conditions and the call for effective interventions to improve their health outcomes, current findings can inform the development and implementation of nurse-led culturally tailored interventions to promote self-care and reduce urban-rural disparities for Chinese older adults with MCCs.