Poor recognition of prompted treatment seeking even with good knowledge of stroke warning signs contribute to delayed arrival of acute ischemic stroke patients in Thailand.

Intravenous recombinant tissue plasminogen activator given within 4.5 hours after the onset of ischemic stroke is the most powerful standard treatment for patients with acute ischemic stroke. However, most of the patients arrive at the hospital later than 4.5-hours time window for intravenous thrombolysis. We study the factors that might contribute to delayed arrival in patients with acute ischemic stroke. One hundred eighty-one acute ischemic stroke patients (or their respondents) who admitted in stroke unit of 3 different hospitals were interviewed with a questionnaire regarding knowledge of stroke warning signs and recognition of prompted treatment seeking (Stroke Act FAST). Eighty-nine patients who arrived during 4.5 hours after onset were categorized as on-time group and the rest fell into delayed group. Initial National Institutes of Health Stroke Scale, nature of onset (sudden or gradual/fluctuation), day interval of the onset (8 am to 4 pm, 4 pm to midnight, or midnight to 8 am), mode of transportation, place of onset, knowledge of stroke warning signs, and prompted treatment seeking (Stroke Act FAST) were compared between 2 groups. Patients in on-time group presented with sudden-onset nature much more than patients in delayed group (P = .006). Association factors including day interval of the onset, mode of transportation, place of onset and knowledge of stroke warning signs are not different between groups (P > .05), whereas recognition of prompted treatment seeking is better in on-time group than in delayed group. In conclusion, good knowledge of stroke warning signs, most severe stroke, onset at workplace, onset during daytime, and ambulance for transportation are not associated with early arrival within 4.5-hours time window. However, sudden-onset nature and prompted treatment seeking may predict early arrival.

Effect of a self-care promoting program on engagement in self-care behaviors and health-related outcomes among persons with type 2 diabetes and diabetic retinopathy: A single-blind randomized controlled trial.

Background: Diabetic retinopathy (DR) is the most common microvascular complication of diabetes, leading to visual impairment and eventual blindness. Promoting self-care behaviors is crucial in controlling DR progression and preventing blindness. Objective: This study aimed to investigate the effects of a Self-Care Promoting Program (SCPP) on engagement in self-care behaviors, HbA1c levels, visual acuity (VA), severity of DR, and vision-related quality of life (VRQoL) among individuals with type 2 diabetes and DR. Methods: This study employed a single-blind randomized controlled trial design to compare SCPP with conventional diabetic care interventions (standard care). The SCPP was based on the Self-Care of Chronic Illness Theory, Self-efficacy theory, and the Association of Diabetic Care and Education Specialist (ADCES) guidelines incorporating health education, self-care maintenance, monitoring, and management skills training over 12 weeks. Ninety-eight participants were randomly allocated to the experimental or control group (n = 49 per group). While the experimental group received SCPP alongside standard care, the control group received standard care alone. Data collection occurred between May 2022 and March 2023 and included demographic information, the Self-Care of Diabetes Index questionnaire (SCODI), the self-care for diabetes eye care questionnaire (SCFDE), the impact of visual impairment questionnaire (IVI-Thai version), and retinal images for DR severity grading. Data analysis utilized descriptive statistics, Chi-Square tests, t-tests, and MANOVA. Results: Following 8 and 16 weeks of SCPP, the experimental group had significantly higher mean scores in engagement with self-care and eye-care behaviors compared to the control group (p <0.001). The highest scores were observed in self-care and eye-care confidence behaviors, followed by maintenance, monitoring, and management. Furthermore, HbA1c levels and VRQoL significantly decreased and were lower than those of the control group at week 16 (p <0.001 and p <0.05, respectively). However, there were no significant differences in VA, and DR severity increased in both groups by week 16. Conclusion: SCPP benefits individuals with DR, enhancing their confidence and ability to perform, monitor, and manage self-care behaviors. These strategies contribute to improved diabetes management, enhanced quality of life, and reduced DR-related blindness. Integrating SCPP into routine DR management is recommended, with nurses playing a pivotal role in overseeing and driving this integration, highlighting the critical role of nurses in managing this widespread global disease. Trial Registry Number: Thai Clinical Trials Registration (TCTR20230302002).

Evaluating functional activity in older Thai adults.

The purpose of this study was to translate the original English version of the Self-Efficacy and Outcome Expectations Scales for Exercise and Functional Activity and to establish their reliability in older Thai adults in geriatric rehabilitation. This study used a correlational design with repeated measures. Reliability of the Self-Efficacy for Exercise Scale (SEES), the Self-Efficacy for Functional Activity Scale (SEFAS), the Outcome Expectations for Exercise Scale (OEES), and the Outcome Expectations for Functional Activity Scale (OEFAS) developed by Resnick was measured in 20 older adults aged 60 years or older after hip or knee replacement or another orthopedic surgery of their lower extremity. All scales were translated into Thai and back translated into English according to the process described by Marin and Marin. The instruments were administered twice--the 1st and 2nd day in the participants' geriatric rehabilitation program (i.e., the 4th and 5th postoperative day). Results indicated that there was sufficient evidence for internal consistency of the SEES, SEFAS, OEES, and OEFAS with alpha coefficients of 0.84, 0.86, 0.70, and 0.86 respectively. Test-retest reliability of the tools was also demonstrated with Spearman correlation coefficients of 0.84 for the SEES, 0.87 for the SEFAS, 0.61 for the OEES, and 0.54 for the OEFAS. The findings from this study provide important information for instrument adaptation and the applicability of these scales for further studies of older Thai adults.

Effectiveness of a behavioral change intervention in Thai elders after knee replacement.

BACKGROUND: After total knee replacement, elders need an effective intervention to change exercise and physical activity behavior. OBJECTIVES: This study examined the effects of a behavioral change intervention (BCI) on self-efficacy and outcome expectations for exercise and functional activity, physical activity participation, and physical performance of older adults. METHODS: The study was based on the social cognitive theory (SCT), with a longitudinal quasi-experimental, pretest-posttest control group design. Sixty-three Thai elders undergoing knee replacement surgery were studied. The experimental group received a BCI based on SCT given by the investigator. Outcome measures were the Self-Efficacy for Exercise Scale (SEES) and Self-Efficacy for Functional Activity Scale (SEFAS), the Outcome Expectations for Exercise Scale (OEES) and Outcome Expectations for Functional Activity Scale (OEFAS), the Physical Performance Test (PPT), and the Physical Activity Diary (PAD). RESULTS: The experimental group had significantly greater improvements in self-efficacy for exercise, outcome expectations for exercise, and functional activity, significantly more participation in exercise and walking, and significantly greater improvement in physical performance than did the control group at postoperative weeks 2 and 6. DISCUSSION: The BCI based on SCT was effective in changing the outcomes in the expected direction. This BCI may be applicable, with modifications, to elders in other situations in which changing behavior is the key to recovery.