Effectiveness of nurse-led interventions on medication adherence in adults taking medication for metabolic syndrome: A systematic review and meta-analysis.

AIMS AND OBJECTIVES: To determine the effectiveness of nurse-led interventions on medication adherence, medication knowledge and clinical outcomes in adults taking medication for metabolic syndrome. BACKGROUND: Despite the significance of interventions designed to improve medication adherence, a systematic review of nurse-led intervention studies for metabolic syndrome is lacking. DESIGN: A systematic review and meta-analysis of randomised controlled trials. METHODS: The study was conducted following the PRISMA guidelines checklist. PubMed, EMBASE, PsychINFO, CINAHL, Cochrane CENTRAL and other manual sources were searched in May 2021.The quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Comprehensive Meta-Analysis 3.0 was used to calculate the pooled effect sizes with 95% confidence intervals. RESULTS: This review included 20 studies of nurse-led medication adherence interventions in 6017 adults at risk for metabolic syndrome. The pooled effect size using the random effects model indicated that nurse-led interventions had a significantly moderate impact on enhancing medication adherence and medication knowledge and improving selected clinical outcomes of available studies in nurse-led intervention groups compared with control groups. Duration of intervention (median 12 weeks), mode of delivery (group vs. individual) and using multiple strategies influenced outcomes of nurse-led medication adherence interventions. The results revealed that interventions of moderate- to high-quality studies were more likely to show significant improvements in medication adherence than those of low-quality studies. CONCLUSION: The meta-analyses showed that nurse-led interventions may enhance medication adherence and knowledge and improve clinical outcomes of this population. RELEVANCE TO CLINICAL PRACTICE: The findings may contribute to evidence-based information about nurse-led intervention and its selection of appropriate interventions for improving medication adherence in this population. PATIENT OR PUBLIC CONTRIBUTION: Patients or the public were not directly involved in this review.

Effects of a self-determination theory-based physical activity programme for postmenopausal women with rheumatoid arthritis: A randomized controlled trial.

AIMS: The study aimed to develop and evaluate the effects of a self-determination theory-based, nurse-led, physical activity programme for postmenopausal women with rheumatoid arthritis. METHODS: Between December 2019 and April 2020, this randomized controlled trial recruited 62 postmenopausal women with rheumatoid arthritis from a university-affiliated hospital in South Korea. The intervention group participated in a self-determination theory-based, nurse-led, physical activity programme that consisted of Tai Chi-based physical activity, a supportive psychosocial strategy, and interactive counselling for 16 weeks, and the control group continued to undergo their usual care. RESULTS: There were statistically significant group-by-time interactions in physical activity and perceived sarcopenia, which favoured the intervention group. Additionally, the intervention group showed significant improvements in the perceived therapeutic efficacy of physical activity, grip strength, walking speed, disease activity score, and health-related quality of life. CONCLUSIONS: The programme developed in this study can be an effective and feasible approach for postmenopausal women with rheumatoid arthritis in improving physical activity, selected osteosarcopenic outcomes, and health-related quality of life. Further research is required to investigate the long-term effects of this theory-based programme for postmenopausal women in diverse settings.

Psychometric properties of the Barriers Self-Efficacy Scale for Physical Activity-Korean.

This study examined the psychometric properties of the Barriers Self-Efficacy Scale-Physical Activity for Korean-speaking adults with osteoarthritis at risk for metabolic syndrome (N = 150). Factor analysis identified three dimensions of the Korean Barriers scale, explaining 65.9 % of the total variance. Confirmatory factor analysis indicated that the structural validity adequately fits the data. Construct validity confirmed significant associations between the amount of physical activity and psychological variables. The test-retest reliability was 0.87; the alpha was 0.90. The standardized response mean (0.497) indicated responsiveness to medium-magnitude change. The Korean Barriers scale can assess self-efficacy to engage in regular physical activity in clinical settings.

Predictive Model for Quality of Life in Patients With Heart Failure.

BACKGROUND: Although many studies have been conducted to examine predictors of quality of life (QoL), little information exists on the real-world application of Rector's conceptual model for QoL related to heart failure (HF). OBJECTIVES: In this study, we aimed to examine a hypothetical model of QoL based on Rector's conceptual model for QoL in relation to HF and the existing literature on patients with HF. METHODS: Using a cross-sectional survey, 165 patients with HF were recruited from an outpatient clinic in Korea. Data were collected based on Rector's model constructs, such as cardiac function, symptoms, functional limitation, depression, distress, and QoL. Left ventricular ejection fraction for cardiac function was measured using echocardiography. RESULTS: Functional limitation, depression, and distress, but not symptoms, had a direct effect on QoL (all Ps < .001). Cardiac function and symptoms directly affected functional limitation (ß = 0.186, P = .004, and ß = -0.488, P = < .001, respectively), whereas cardiac function, symptoms, and depression affected QoL through functional limitation and distress. CONCLUSIONS: These results confirm that the Rector's model is suitable for predicting QoL in patients with HF. These findings have potential to guide and inform intervention programs designed to alleviate symptoms in patients with HF, enhance their physical functioning, and moderate their psychological distress with the ultimate goal of improving their QoL.

Prevalence and correlates of depression among South Korean older adults living in relative poverty.

This secondary analysis of the Tailored Health Visiting Service Program examined depression prevalence and associated factors among 1181 community-dwelling, South Korean older adults (range: 65 to 99 years) who live in relative poverty. Depression was assessed using the Geriatric Depression Scale short form. Generalized linear models with Poisson family and log link functions were employed to identify factors associated with depression. The overall depression prevalence was 46.3%, with most subjects mildly depressed. Better self-rated health and healthy activities were associated with lower depression prevalence, while having a disability was associated with higher prevalence. The factors identified in this study should be considered in community mental health interventions for older adults, especially those who experience economic disadvantage.

The moderating role of acculturation mode on the relationship between depressive symptoms and health-related quality of life among international students in Korea.

We examined the moderating role of acculturation mode on the relationship between depressive symptoms and health-related quality of life (HRQoL) in international students. This cross-sectional study enrolled a convenience sample of 147 international students at a university in Korea. Participants' overall HRQoL was moderate (mean = 57.2 of 80). The main and interaction effects of depressive symptoms and selected acculturation modes explained 39.9% of the variance in HRQoL. For all acculturation modes except the integration mode, as depressive symptom scores increased, HRQoL decreased. Specifically, at high depressive symptoms levels, participants with the marginalization, separation, and assimilation modes had worse HRQoL than did the integration mode, while HRQoL was similar for all acculturation modes at low depressive symptom levels. These findings suggest that future prospective intervention strategies should be considered for not only depressive symptoms levels, but also for different acculturation modes to enhance HRQoL in this population.

Effects of an individualised nutritional education and support programme on dietary habits, nutritional knowledge and nutritional status of older adults living alone.

AIMS AND OBJECTIVES: The effects of an individualised nutritional education and support programme on dietary habits, nutritional knowledge and nutritional status of 71 older adults living alone were examined. BACKGROUND: Although a regular dietary meal plan is recommended for improving nutritional status of older adults living alone, little research is done in this field in Korea. DESIGN: A pre- and post-test controlled quasi-experimental design was used at public health centres. METHODS: The intervention group participated in an intensive nutritional education and support programme once a week for 8 weeks with dietary menus provided by home visiting nurses/dieticians; control group received usual care. Dietary habits and nutritional knowledge were assessed using structured questionnaires; nutritional intake status was analysed using Computer Aided Nutritional Analysis Program 5.0. RESULTS: The mean age of participants was 77.6 years, and 81.7% of the participants were women. At 8 weeks, there were significant interactions of group by time for dietary habits, nutritional knowledge and selected nutritional status of protein, iron and vitamins of B2 and C. Changes over time in the mean score of dietary habits and nutritional knowledge were significantly improved in the intervention group compared to the control group. The percentages of normal nutrition intake of protein, iron and vitamins A and C in the intervention group were significantly higher than the control group at 8 weeks. CONCLUSIONS: Nutritional education and support programme positively impacted dietary habits, nutritional knowledge and selected nutritional status in older adults living alone, and we highlight the need for community-based nutritional education and counselling programmes. RELEVANCE TO CLINICAL PRACTICE: Older adults living alone in a community have relatively poor nutritional status and thus require tailored nutritional intervention according to objective nutritional analysis. It is necessary to link visiting nurses with dieticians in the community to manage effective nutritional programme continuously.

Self-administered health literacy instruments for people with diabetes: systematic review of measurement properties.

AIMS: The aims of this study were to identify all available self-administered instruments measuring health literacy in people with diabetes and to determine the current instrument that is the most appropriate for applying to this population in both practice and research. DESIGN: A systematic review of measurement properties. DATA SOURCES: MEDLINE, EMBASE and CINAHL electronic databases from their inception up to 28 March 2016. REVIEW METHOD: The methodological quality of each included study was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The reported results for measurement properties in the studies were assessed according to Terwee's quality criteria. RESULTS: Thirteen self-administered instruments measuring health literacy in people with diabetes were identified, of which six (44%) were diabetes-specific instruments. The instruments that covered the broadest contents of health literacy were the Health Literacy Scale and Health Literacy Questionnaire. The (test-retest) reliability, measurement error and responsiveness were not evaluated for any instrument, while internal consistency and hypothesis testing validity were the most frequently assessed measurement properties. CONCLUSIONS: With the current evidence, the Health Literacy Scale may be the most appropriate instrument for patients with diabetes in practice and research. However, the structural validity of this scale needs to be further established, particularly in other language versions. It is also recommended to use the Diabetes Numeracy Test-15 along with the Health Literacy Scale to complement the lack of numeracy measures in the Health Literacy Scale.

Factors affecting aging cognitive function among community-dwelling older adults.

AIM: The study purpose was to determine factors affecting aging cognitive function of 3,645 community-dwelling older adults in Korea. METHODS: The Hasegawa Dementia Scale assessed aging cognitive function, blood analyses and anthropometrics assessed cardio-metabolic risk factors, and the Geriatric Depression Scale Short Form Korean Version assessed depressive symptoms. RESULTS: Participants with poor aging cognitive function were more likely to be in the late age group (≥75 y) and currently smoking and have a medical history of stroke, high body mass index, and high level of depressive symptoms; they were also less likely to engage in regular meals and physical activities. CONCLUSION: Regular meals and physical activities may be primary factors for clinical assessment to identify older adults at risk for aging cognitive function. With aging, depressive symptoms and other unhealthy lifestyle behaviours should be managed to prevent cognitive function disorders.

Effects of an empowerment program for self-management among rural older adults with hypertension in South Korea.

OBJECTIVE: This study aimed to examine the effects of an empowerment program for hypertension self-management among rural older adults in South Korea. DESIGN: A pretest-posttest controlled design for a 12-month hypertension self-management program with assessments at commencement, 6 months and 12 months. SETTING: Two subsistence farming areas. PARTICIPANTS: Subsistence farmers aged 65 and over: intervention group (n = 41) and control group (n = 36). INTERVENTION: Twelve-month empowerment program for hypertension self-management. MAIN OUTCOME MEASURES: Self-efficacy, social support, self-care behaviours, blood pressure control and renal function. RESULTS: There were significant interactions of group by time for self-efficacy (P < 0.001) and self-care behaviour (P = 0.019). Blood pressure control at 12 months also showed a significant improvement in the empowered group compared with the control group (82.8% versus 56.8%, P < 0.014). Other clinical outcomes, including systolic blood pressure (P = 0.006) and renal function (P < 0.001), showed significant interactions of group by time. CONCLUSIONS: The empowerment program was effective for rural older adults with hypertension in South Korea. Further investigation of the relationships among core components of empowerment would be beneficial.

The role of social support on the relationship of depressive symptoms to medication adherence and self-care activities in adults with type 2 diabetes.

AIM: To examine the mediating role of social support on the relationship of depressive symptoms to medication adherence and self-care activities in Korean adults. BACKGROUND: Recent evidence suggests that higher levels of social support are associated with improved medication adherence and self-care activities; however, the role of social support on the relationship of depressive symptoms to medication adherence and self-care activities is less well understood. DESIGN: A cross-sectional survey. METHODS: The data were collected from 311 Korean adults with type 2 diabetes who were taking hypoglycaemic agents in the period 2012-2013. Depressive symptoms, social support, medication adherence and self-care activities were assessed using structured questionnaires. Multiple regression analysis with adjustment for covariates and the Sobel test were used to examine the mediating effect of social support on the relationship of depressive symptoms to medication adherence and self-care activities. RESULTS: There were statistically significant differences by subgroups with and without depressive symptoms in social support, medication adherence and self-care activities of diet, physical activity and stress management. The Sobel test confirmed that social support mediated the effect of depressive symptoms on medication adherence and self-care activities of diet, physical activity and stress management. CONCLUSION: The evidence from this study suggests that social support-enhancing interventions that also manage depressive symptoms may be more timely and effective than interventions that target depressive symptoms alone in promoting adherence to medication adherence and self-care activities in this population.

Prevalence of metabolic syndrome and cardiovascular risk level in a vulnerable population.

This study examined the prevalence of metabolic syndrome and the risk level of cardiovascular disease (CVD) in a vulnerable population of 407 subjects in Korea. This descriptive study was a part of the Tailed Health Visiting Service Program, using baseline data from public health centres in Suwon, Korea. The definition of metabolic syndrome was based on the National Cholesterol Education Program criteria, and risk of CVD was estimated according to the Framingham study equation. This study demonstrated that the prevalence of metabolic syndrome was 40.8% higher and the risk of CVD was significantly 3.1 times higher among those with metabolic syndrome than among those without it. Of those with metabolic syndrome, 50.6% overall and 81.1% of men had a high risk for CVD. These findings suggest a need to screen and prevent the risk of CVD in vulnerable populations with metabolic syndrome.

Health-promoting lifestyles and cardio-metabolic risk factors among international students in South Korea.

This study examined the health-promoting lifestyles and cardio-metabolic risks among international students in Korea. This descriptive, cross-sectional study design enrolled a convenience sample of 118 international students at a university in Korea. Collected data included items from the Health-promoting Lifestyle Profile (II) scale and cardiovascular risk factors. The participants had a moderately health-promoting lifestyle (2.5 of 4). Men engaged in more physical activity than did women (p = .002). The most prevalent risk factor was elevated blood lipid profiles (26.3%), followed by overweight/obesity (25.4%), elevated blood pressure (17.8%), and elevated fasting glucose levels (5.1%). More than half of the participants (54.2%) had one or more cardiac risk factors, and these participants also scored lower in health-promoting lifestyle factors than other students (p = .034). Regular health check-ups are needed to identify the cardio-metabolic risks of international students. A university-based programme aimed at promoting healthy lifestyles could help prevent cardio-metabolic risks among international students.

Effects of team-based learning on perceived teamwork and academic performance in a health assessment subject.

The purpose of this study was to examine the effectiveness of team-based learning (a well-recognized learning and teaching strategy), applied in a health assessment subject, on nursing students' perceived teamwork (team-efficacy and team skills) and academic performance (individual and team readiness assurance tests, and examination scores). A prospective, one-group, pre- and post-test design enrolled a convenience sample of 74 second-year nursing students at a university in Suwon, Korea. Team-based learning was applied in a 2-credit health assessment subject over a 16-week semester. All students received written material one week before each class for readiness preparation. After administering individual- and team-readiness assurance tests consecutively, the subject instructor gave immediate feedback and delivered a mini-lecture to the students. Finally, students carried out skill based application exercises. The findings showed significant improvements in the mean scores of students' perceived teamwork after the introduction of team-based learning. In addition, team-efficacy was associated with team-adaptability skills and team-interpersonal skills. Regarding academic performance, team readiness assurance tests were significantly higher than individual readiness assurance tests over time. Individual readiness assurance tests were significantly related with examination scores, while team readiness assurance tests were correlated with team-efficacy and team-interpersonal skills. The application of team-based learning in a health assessment subject can enhance students' perceived teamwork and academic performance. This finding suggests that team-based learning may be an effective learning and teaching strategy for improving team-work of nursing students, who need to collaborate and effectively communicate with health care providers to improve patients' health.

Effects of a community-based intervention on cardio-metabolic risk and self-care behaviour in older adults with metabolic syndrome.

This pilot study was performed to investigate the effects of a community-based intervention (CBI) on cardio-metabolic risk and self-care behaviour in 92 older adults with metabolic syndrome at public health centres in Suwon, Korea. A prospective, pretest and posttest, controlled, quasi-experimental design was used. The older adults in the intervention group participated in an 8-week intensive lifestyle counselling, whereas those in the control group received usual care. The mean (standard deviation) age of the participants was 71.4 (4.43) years ranging from 60 to 84, and 75.0% of the participants were female. The intervention group at 8 weeks showed significant reduction in waist circumference by -1.35 cm (P<0.001) and improved self-care behaviour (+5.17 score, P<0.05) and self-efficacy (+4.84 score, P<0.001) when compared with the control group. The percentages of those who successfully completed the targeted behavioural modification were 71.7% for exercise and 52.2% for dietary control in the intervention group at 8 weeks. This pilot study provided evidence of the beneficial impact of the CBI for Korean older adults with metabolic syndrome.

A predictive model for medication adherence in older adults with heart failure.

AIMS: Although many studies have examined the predictors of medication adherence (MA), further empirical research is required to clarify the best model for predicting MA for older adults with heart failure (HF). Thus, we hypothesized a model in which information (knowledge), motivation (social support and depressive symptoms), and behavioural skills (barriers to self-efficacy) would be associated with MA in patients with HF. METHODS AND RESULTS: Using a cross-sectional survey, 153 adults aged ≥ 65 years taking medication for HF were recruited from a university hospital in Korea. Data were collected based on the information-motivation-behavioural skills (IMB) model constructs and MA. In the hypothesized path model, self-efficacy was directly related to MA (ß = -0.335, P = 0.006), whereas social support was indirectly related to MA through self-efficacy (ß = -0.078, P = 0.027). Depressive symptoms were directly related to MA (ß = 0.359, P = 0.004) and indirectly related to MA through self-efficacy (ß = 0.141, P = 0.004). The hypothesized MA model showed a good fit for the data. Knowledge, social support, and depressive symptoms accounted for 44.3% of the variance in self-efficacy (P = 0.004). Left ventricular ejection fraction, knowledge, social support, depressive symptoms, and self-efficacy explained 64.4% of the variance in MA (P = 0.004). CONCLUSION: These results confirmed the IMB model's suitability for predicting MA in older adults with HF. These findings may guide and inform intervention programmes designed to alleviate depressive symptoms in older adults with HF and enhance their HF knowledge, social support, and self-efficacy, with the ultimate goal of improving their MA.

Development and a pilot test of an internet-based cardiovascular risk reduction program for Korean male workers with metabolic syndrome.

An Internet-based, Best Exerciser Super Trainer program for risk reduction among Korean male workers with metabolic syndrome was developed, and a pilot test was conducted. The Best Exerciser Super Trainer program was designed to be delivered via the Internet to promote the initiation and maintenance of behavioral lifestyle modification using a transtheoretical model. Stage-matched psychobehavioral strategies were derived from the main constructs of a transtheoretical model and matched to each individual's stage of readiness for physical activity/weight control using the cardiovascular risk assessment. A simulated version of Best Exerciser Super Trainer was evaluated by an expert group (n=8). Eighteen male workers participated in an 8-week pilot test of the program. The Best Exerciser Super Trainer Web site consisted of an introduction, main, and administrator components. A majority of the expert group (87.5%) either strongly agreed or agreed with the contents on the Web site. Significant changes in cardiovascular disease risk reduction over the study period among the participants included decreased cardiovascular risk (-2.4%), waist circumference (-2.9 cm), diastolic blood pressure (-9.9 mm Hg), and fasting plasma glucose (-16.7 mg/dL). The findings of this pilot study provide evidence that the Best Exerciser Super Trainer program may be useful for conducting Web surveys and delivering an intervention.

Psychometric evaluation of a Korean version of the 8-item Medication Adherence Scale in rural older adults with hypertension.

OBJECTIVE: To examine the psychometric properties of a structured self-reported 8-item Korean-version Morisky Medication Adherence Scale (MMAS-K) among rural older adults with hypertension. DESIGN: Cross-sectional descriptive survey. SETTING: A rural community comprising three primary health care posts in Gangwon Province, South Korea. PARTICIPANTS: Ninety-two older adults with hypertension who received treatment at primary health care posts. MAIN OUTCOME MEASURES: Participants completed an 8-item MMAS-K questionnaire, and the community health practitioners manually measured blood pressure. Factor analysis and correlation coefficient for validity and the Kuder-Richardson alpha coefficient for reliability of the MMAS-K were used, while the association between medication adherence and blood pressure control was determined using Fisher's exact test. RESULTS: Internal consistency reliability was acceptable with a coefficient alpha of 0.71. The factor analysis of construct validity identified two dimensions of the 8-item MMAS-K, explaining 52.22% of the total variance. There was a high correlation between the 8-item MMAS-K and the original 4-item MMAS (r = 0.874), indicating that these scales measure theoretically related constructs for convergent validity. There was a significant association between the 8-item MMAS-K score and blood pressure control (P < 0.05), indicating that, for the known-groups validity, the controlled blood pressure group was more likely to have higher rate of medication adherence than the poor-control group. CONCLUSIONS: The findings indicate a positive association between medication adherence and blood pressure control. The 8-item MMAS-K possesses adequate validity and reliability among rural older adults with hypertension.

Predicting physical activity and sarcopenia-related health outcomes in women with rheumatoid arthritis: A test of the self-determination theory.

AIM: This study aimed to examine a hypothetical model of physical activity (PA) and health outcomes related to sarcopenia in women with rheumatoid arthritis (RA) based on self-determination theory. DESIGN: Cross-sectional study. METHODS: This study included 214 women diagnosed with RA from the outpatient rheumatology department of a university-affiliated hospital in South Korea. Data were collected from September 2019 to August 2020 through structured questionnaires and anthropometric measurements and analysed using path analysis to test the hypothesized model. The primary health outcomes were perceived health status and sarcopenia-related health (thigh circumference, handgrip strength and sarcopenia risk). RESULTS: The final model's fit indices were adequate. Physical activity was directly affected by motivation for PA, while depression, self-efficacy for PA, health care provider's autonomy support and basic psychological needs satisfaction indirectly affected PA. Physical activity directly affected perceived health status and thigh circumference, while perceived sarcopenia risk and handgrip strength were directly affected by disease activity and age. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in a questionnaire-based survey.

Psychometric Properties of the Korean Version of the Patient Knowledge Questionnaire-Osteoarthritis.

This study examined the psychometric properties of the Korean version of the Patient Knowledge Questionnaire-Osteoarthritis (PKQ-OA-K). A cross-sectional survey was conducted with 157 adults with osteoarthritis from the outpatient clinic at a university hospital in Korea. The overall correct answer rate for the PKQ-OA-K was 60.4%; notably, the drug therapy subscale had the lowest median score percentage (42.9%). For structural validity, exploratory factor analysis identified the PKQ-OA-K as two-dimensional, explaining 52.4% of the total variance. Confirmatory factor analysis showed that the two-factor model adequately fit the data. The PKQ-OA-K was positively correlated with education level (r = 0.24) and osteoarthritis outcomes (r = 0.17), thus verifying the hypotheses of construct validity. The intraclass correlation coefficient for test-retest reliability was 0.52; alpha was 0.44. The PKQ-OA-K has excellent validity but imperfect reliability for adults with osteoarthritis. This study recommends cautious use of the PKQ-OA-K to assess Korean patients' knowledge of osteoarthritis.