Psychometric testing of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory version 2.

AIM: To assess the psychometric properties of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory version 2 (CC-SC-CII-v2) among primary caregivers of individuals with any single or multiple chronic illnesses. BACKGROUND: The instrument encompasses three scales that evaluate Caregiver Contribution to Self-Care (CC-SC) Maintenance, Monitoring and Management. METHODS: The English version CC-SC-CII-v2 was translated and adapted for Thai context, and a cross-sectional multicenter study involved 430 caregivers from 16 primary care centres in Thailand. Structural validity, internal consistency reliability and test-retest reliability were examined. RESULTS: The original two-factor CC-SC Maintenance scale required a re-specified model for good fit, while the CC-SC Monitoring and CC-SC Management scales fit well. The simultaneous model of three scales demonstrated satisfactory fit. The CC-SC Maintenance and CC-SC Management scales both had a composite reliability index of 0.85, with omega coefficients of 0.86 and 0.83, respectively. CC-SC Monitoring had an alpha coefficient of 0.89. The intraclass correlation coefficients ranging from 0.84 to 0.91, indicating good test-retest reliability. CONCLUSION: The Thai CC-SC-CII-v2 is a valid and reliable instrument that can provide clinicians and investigators with an evaluation of the contributions of caregivers to the self-care of patients with chronic illnesses.

A psychometrics evaluation of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory Version 2 in stroke caregivers.

Objectives: To evaluate the psychometric characteristics of the Thai version of Caregiver Contribution to Self-Care (CC-SC) of Chronic Illness Inventory version 2 (CC-SC-CII-v2) in stroke caregivers. Methods: We conducted a multicenter, cross-sectional study following the COSMIN guidelines, evaluating validity and reliability of three separate scales, CC-SC Maintenance, CC-SC Monitoring, and CC-SC Management, as well as overall CC-SC-CII-v2. From September to December 2022, we enrolled 422 stroke caregivers from primary care centers in southern Thailand. Structural validity was assessed through confirmatory factor analysis (CFA), while concurrent validity was evaluated using Pearson's correlation r coefficients between CC-SC-CII-v2 and the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC). Internal coherence reliability was assessed using Cronbach's α coefficient, the composite reliability index, and the McDonald's ω coefficient. Additionally, test-retest reliability was assessed with intraclass correlation coefficients (ICCs). Results: The study included mostly middle-aged women who cared for their parent. CFA supported the two-factor structure of the CC-SC Maintenance and Management scales and the one-factor structure of the CC-SC Monitoring scale. A simultaneous CFA on the combined set of items supported the more general model. The concurrent validity of CC-SC-CII-v2 with CSE-CSC was established (r ranging 0.47-0.65, all P < 0.001). Reliability estimates supported adequate Cronbach's α coefficient (ranging 0.83-0.89), composite reliability (ranging 0.84-0.85), McDonald's ω coefficients (ranging 0.83-0.85), and ICCs (ranging 0.86-0.90) across the three scales. Conclusions: The Thai CC-SC-CII-v2 demonstrated strong psychometric properties among stroke caregivers. It can be a valuable instrument to investigate the role of caregivers in contributing to stroke patients' self-care in diverse cultural contexts like Thailand.

Exploring factors associated with hypertension self-care in primary care: The role of nurse education levels and patient-related factors.

AIM: To explore the association between nurse education levels and patient-related factors with hypertension self-care. BACKGROUND: Although self-care development is recognized as a healthcare provider-patient encounter, the attribution of nurse education level to hypertension self-care is not well addressed. DESIGN: A cross-sectional study. METHODS: Hypertensive patients from 15 primary care facilities were sampled, and self-care was assessed using the Self-Care of Hypertension Inventory version 2.0, with standardized scores ≥70 indicating adequate self-care. Data on patient-related factors were obtained from electronic health records, self-reports and laboratory tests, while nurse education levels were categorized as standard (baccalaureate-prepared) or higher (post-baccalaureate specialty). RESULTS: A total of 1493 participants were included in this study, with a median age of 66 years and 77.7% being female. Approximately 10% of participants had adequate self-care, and 66% received care from higher educated nurses. The study showed the relation between nurse education levels and the self-care of the patients. Adequate hypertension self-care was significantly associated with higher educated nurse providers and patient-related factors, including intermediate to higher education, non-overweight/obese and the absence of age-related comorbidities. CONCLUSIONS: Hypertensive patients who had been provided care by higher educated nurses and their favourable sociodemographic, lower cardiometabolic risk and no concomitant disease were more likely to demonstrate adequate self-care.

Cross-cultural adaptation and psychometric evaluation of the Thai version of Self-Care of Chronic Illness Inventory Version 4.c.

Objectives: To translate and validate the Thai Self-Care of Chronic Illness Inventory version 4.c (Thai SC-CII v4.c) in individuals with chronic illnesses. Methods: A scale translation and cross-sectional validation study was conducted. The English version was translated for Thai involved nine steps: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing and finalization, and proofreading. A cross-sectional study was conducted from July to November 2022 at 16 primary care centers in southern Thailand, involving 410 participants with at least one chronic condition. Validity assessments included structural, convergent, and discriminant validity. Concurrent validity examined correlations between SC-CII v4.c with the Self-Care Self-Efficacy Scale (SCSES) and self-perceived health. Internal coherence reliability was calculated using Cronbach's α coefficient, item-total correlation coefficients, and the composite reliability (CR) index. Results: Thai SC-CII v4.c demonstrated excellent translational validity (κ = 0.99). The specified Self-Care Maintenance model fit well, with minor differences in health promoting behavior and illness-related behavior items compared to the original model. The original Self-Care Monitoring, and Self-Care Management models fit well with Thai data. Simultaneous confirmatory factor analysis confirmed a satisfactory fit of the full SC-CII v4.c. Convergent validity had partial support (average variance extracted = 0.23-0.51), and discriminant validity was established (heterotrait-monotrait ratios = 0.37-0.88). Concurrent validity was supported by positive correlations between each scale and overall SC-CII v.4c with SCSES (r = 0.25-0.65) and self-perceived health (r = 0.09-0.35). The Cronbach's α coefficient were adequate for all scales except the Self-Care Maintenance scale (Cronbach's α = 0.68), but the CR estimate improved the reliability of all three scales (ranging 0.80-0.82). All items had satisfactory item-total correlation coefficients (ranging 0.34-0.71), except the one pertaining to sleep. Conclusions: The Thai SC-CII v4.c is valid and reliable for assessing self-care in various chronic illnesses. Further testing is recommended for patients with specific diseases.

Validating the caregiver self-efficacy in contribution to self-care scale Thai version for stroke: A psychometric evaluation.

AIM: To test the validity and reliability of the Caregiver Self-Efficacy in Contribution to Self-Care Scale Thai Version (CC-Self Efficacy Scale (Thai)) for Stroke. DESIGN: A cross-sectional study was undertaken from September to December 2022. METHODS: Four hundred thirty-four caregivers of people with stroke were selected from the registry of stroke patients in primary care units or hospitals following inclusion criteria. The research assistants collected information when the caregiver took a patient for a doctor's appointment or visited the patient's and caregiver's home. RESULTS: The 434 caregivers had a mean age of 48 years, female 77.67%, 51.97% child or grandchild of patients, and 72.85% living with the patient. Ten items of the CC-Self Efficacy Scale (Thai) were normally distributed and appropriate for exploratory factor analysis (EFA). EFA suggested three-factor model. The confirmatory factor analysis (CFA) of the three-factor model was an unfit model, with the root mean square error of approximation (RMSEA) = 0.09. We regrouped items based on content to create six-factor model. CFA supported the six-factor model of CC-Self Efficacy Scale (Thai) questionnaire with the reliability judged by McDonald's omega being 0.87. The 434 sample size was enough for EFA and CFA. The CC-Self Efficacy Scale (Thai) with the six-factor model is appropriate for evaluating the caregiver confidence of people with stroke.

Sex-based differences in risk of cardiovascular disease development and cardiovascular risk factors among individuals with hypertension: A cross-sectional study from primary care facilities.

BACKGROUND: Over the last two decades, the understanding of cardiovascular disease (CVD) has expanded in Asian countries. Despite this progress, there have been limited investigations into sex-based differences in the development of CVD and cardiovascular risk factors (CVRFs). AIM: We investigated whether males and females with hypertension had different risks of developing CVD and CVRFs. METHODS: We used a stratified multi-stage sampling design involving 15 primary care centers in Thailand. We recruited 1,448 individuals aged 35-74 years old. The Framingham cardiovascular risk algorithm was used to determine the risk of CVD development. RESULTS: Female patients were overall more likely to have lower CVD risk scores. However, they demonstrated higher scores in the moderate-risk (p < 0.001) and high-risk (p < 0.001) groups as compared with males. One in four females was at a high risk of developing CVD. Females had higher rates of all CVRFs against males across sub-risk groups, with the highest odds ratio observed in the high-risk group, which persisted after adjusting for covariations. Overall, female patients had higher rates of diabetes, hyperlipidemia, obesity, and abdominal obesity as compared with males. Females in the overall group had a lower prevalence of uncontrolled hypertension than males, in contrast to the high-risk group. Female patients also had a lower prevalence of cigarette smoking and alcohol consumption than males. CONCLUSION: There is evidence of sex-based differences in the risk of CVD development in hypertensive individuals. The interaction of CVRFs with a high risk of developing CVD was noted in females.

Translation and Cross-cultural Adaptation of the Self-care of Hypertension Inventory for Thais With Hypertension.

BACKGROUND: Self-care is essential for treating hypertension by lowering and controlling blood pressure, to ultimately reduce cardiovascular disease. A valid and reliable hypertension self-care measure is needed for the Thai population. OBJECTIVE: The aim of this study was to translate a cross-cultural adaptation of the Self-care of Hypertension Inventory (SC-HI) into Thai and conduct a pretest of the Thai SC-HI (version 2.0). METHODS: We performed a methodological study. The stepped approach included translation of the original version of the SC-HI into Thai (forward), synthesis of translation, translation of the Thai version back to English, expert committee review, and pretesting. Pretest phase for feasibility, interobserver agreement, and temporal stability tests were performed in 140 patients with hypertension. RESULTS: Translation equivalence was obtained between the Thai and the original US versions. The item-level content validity index was rated by 9 experts; the relevance, clarity, simplicity, and ambiguity criteria were all 1.00. Similarly, the scale-level content validity indices were 1.00 for the overall instrument and the self-care maintenance, self-care management, and self-care confidence scales. The item-level intraclass correlation coefficients (ICCs) had a range of 0.97 to 1.00 for interobserver agreement and 0.95 to 1.00 for test-retest, respectively. The interobserver ICCs were 0.99 for the total scale and 3 separate scales. The test-retest ICCs were 0.99 for the total scale, with a range of 0.97 to 0.99 for the three separate scales. CONCLUSION: The process of cross-cultural adaptation warranted validity and reliability testing of the Thai SC-HI. Psychometric testing of this instrument is needed for evaluation in a large sample of individuals with hypertension.

Evaluating the Dimensionality and Reliability of the Thai Self-Care of Hypertension Inventory Version 2.0.

PURPOSE: Self-care is essential for hypertensive individuals to promote optimal health and illness treatment. We developed the Thai Self-Care of Hypertension Inventory (SC-HI) version 2.0 from the original US version using a multi-stage approach for cross-cultural adaptation. Scales previously studied outside a US context had different dimensions and factor solutions. Therefore, we examined the Thai SC-HI's factorial validity, construct validity, and internal reliability within a Thai context. METHODS: We administered a cross-sectional survey with hypertensive patients in 10 primary care settings, and conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on two sets of separate samples from each of five sites to examine the model's factorial validity and construct validity. We estimated scale reliability with Cronbach's alpha and McDonald's omega coefficients. RESULTS: Participants were predominantly female, older adults, with mean age 66 years (SD = 11.94; range 36-97 years). The Self-Care Maintenance scale had three factors and demonstrated good fit when the error covariances were respecified. The two-factor Self-Care Management scale had different factorial solutions compared to previous models. The CFA result showed good fit indices for the Thai, original US, and Brazilian models. The Self-Care Confidence scale was unidimensional, with partially supported fit indices that improved after we respecified the error covariances. Reliability coefficients estimated by difference methods were nearly equal: slightly lower than desired for Self-Care Maintenance (.68-.70) and inadequate for Self-Care Management (.62-.65); Self-Care Confidence reliability was adequate (.89-.90). CONCLUSION: The Thai SC-HI has good psychometric characteristics and reflects the original instrument's theoretical basis.

Maladaptive Fall Risk Appraisal and Falling in Community-Dwelling Adults Aged 60 and Older: Implications for Screening.

OBJECTIVES: We aimed to examine the characteristics of maladaptive fall risk appraisal (FRA), discrepancies between physical and perceived-fall risk, and their associations with falls. METHODS: Fall risk appraisal was determined using the full-tandem stand test as an objective measure and the Fall Efficacy Scale-International as a subjective measure, and 433 adults aged ≥60 years from Thailand were classified into four groups: irrational (low physical/high perceived risk), incongruent (high physical/low perceived risk), congruent (high physical/high perceived risk) and rational (low physical/low perceived risk) FRAs. RESULTS: Only 20.8% of adults aged ≥60 years had rational FRA. The rest of the participants had either irrational (57.3%) or incongruent (2.3%), or congruent (19.6%) FRAs. Approximately 74% of those with congruent FRA reported experiencing a fall last year, followed by incongruent (60%), irrational (41.1%), and rational FRAs (27.8%, p < .001). After covariates adjustment, participants with congruent FRA were 3.06 times more likely of falling than those with rational FRA (p = .011). CONCLUSIONS: Maladaptive FRA is highly prevalent among adults aged ≥60. Identifying maladaptive FRA is essential for ensuring that adults aged ≥60 receiving early treatment associated with falls. CLINICAL IMPLICATIONS: Preventing a transition from rational to irrational, incongruent, and congruent fall risk appraisals is vital to prevent falls and mitigate this problematic health condition.

Comparison of self-care behaviors of heart failure patients in 15 countries worldwide.

OBJECTIVE: Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents. METHODS: Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale. RESULTS: In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries. CONCLUSION: Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide. PRACTICE IMPLICATIONS: Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior.

Development of the Thai healthy aging model: A grounded theory study.

To develop a model of healthy aging from the perspective of Thais, a grounded theory approach, including in-depth interviews and focus groups, was used. A purposive sample of 39 community-dwelling adults aged 40-85 years old was interviewed. The Thai healthy aging model composed of three themes: normality, nature, and dharma. In Thai, they are called tham-ma-da, tham-ma-chat, and tham-ma, or "Thai 3Ts". The theme of normality encompasses subthemes of staying physically active by being involved in plenty of physical activities, and being mentally active with creative and thoughtful hobbies and work. The theme of nature encompasses subthemes of living simply and being careful with money. The theme of dharma encompasses subthemes of enjoyment through helping family and participating in community activities, staying away from stress and worries by talking openly and honestly with someone, making merit, and helping other people without expecting anything in return. A greater understanding of healthy aging is a benefit for older adults and healthcare providers in an intervention-design process. Research can contribute valuable information to shape policy for healthy aging as well.

Heart failure self-care in developed and developing countries.

BACKGROUND: Heart failure (HF) self-care is poor in developed countries like the United States, but little is known about self-care in developing countries. METHODS AND RESULTS: A total of 2082 adults from 2 developed (United States and Australia) and 2 developing countries (Thailand and Mexico) were studied in a descriptive, comparative study. Self-care was measured using the Self-Care of HF Index, which provided scores on self-care maintenance, management, and confidence. Data were analyzed using regression analysis after demographic (age, gender, education), clinical (functional status, experience with the diagnosis, comorbid conditions), and setting of enrollment (hospital or clinic) differences were controlled. When adequate self-care was defined as a standardized score >or=70%, self-care was inadequate in most scales in most groups. Self-care maintenance was highest in the Australian sample and lowest in the Thai sample (P < .001). Self-care management was highest in the US sample and lowest in the Thai sample (P < .001). Self-care confidence was highest in the Mexican sample and lowest in the Thai sample (P < .001). Determinants differed for the three types of self-care (eg, experience with HF was associated only with self-care maintenance). CONCLUSION: Interventions aimed at improving self-care are greatly needed in both the developed and the developing countries studied.

Gender differences in heart failure self-care: a multinational cross-sectional study.

BACKGROUND: Despite a common view that women are better at self-care, there is very little evidence to support or challenge this perspective in the heart failure (HF) population. OBJECTIVE: The purpose of this study was to determine if there are cross-cultural gender differences in self-reported HF self-care and to describe gender differences in the determinants of HF self-care. DESIGN, SETTING, AND PARTICIPANTS: A secondary analysis was completed of cross-sectional study data collected on 2082 adults with chronic HF from the United States, Australia and Thailand. METHODS: Comparisons were made between men and women regarding self-care maintenance, management and confidence as assessed by the Self-Care of Heart Failure Index, as well as the proportion of subjects engaged in adequate self-care. Multivariate comparisons were made to determine if gender explained sufficient variance in HF self-care and the likelihood of reporting adequate self-care, controlling for nine model covariates. RESULTS: The sample was comprised of 1306 men and 776 women. Most (73.5%) had systolic or mixed systolic and diastolic HF and 45% had New York Heart Association class III or IV HF. Although small and clinically insignificant gender differences were found in self-care maintenance, gender was not a determinant of any aspect of HF self-care in multivariate models. Married women were 37% less likely to report adequate self-care maintenance than unmarried women. Comorbidities only influenced the HF self-care of men. Being newly diagnosed with HF also primarily affected men. Patients with diastolic HF (predominantly women) had poorer self-care maintenance and less confidence in self-care. CONCLUSION: Differences in HF self-care are attributable to factors other than gender; however, there are several gender-specific determinants of HF self-care that help identify patients at risk for practicing poor self-care.

The relationship between self-care and health status domains in Thai patients with heart failure.

BACKGROUND: Little is known about the relationship between self-care in heart failure (HF) and outcomes like health status. The purpose of this study was to describe the relationship between HF self-care and Short Form-36 (SF-36) health status domains. METHODS AND RESULTS: A secondary analysis of cross-sectional data collected on 400 HF patients living in southern Thailand was completed using bivariate comparisons and hierarchical multiple regression modeling. Thai population norm-based SF-36 scores and Self-Care of Heart Failure Index (SCHFI) scores were used in the analysis. The sample was in older adulthood (65.7 +/- 13.8 years), a slight majority of subjects were male (52%); the majority of subjects (62%) had class III or IV HF. Each health domain was low in this sample compared to the general population. SCHFI maintenance and confidence scores were correlated significantly with each health status domain. SCHFI scores explained a significant amount of variance all domains, both in bivariate and multivariate models, except social functioning. In multivariate models, higher levels of self-care were associated with better health in certain domains, but only when both SCFHI management and confidence were high. CONCLUSION: Improving HF self-care may be a mechanism through which future interventions can improve health in this population.

A model predicting health status of patients with heart failure.

OBJECTIVE: To test the causal relationships among the components of sociodemographic (age, gender, education, and income), illness characteristics (duration of illness, severity of illness, and comorbid diseases), and self-management ability, and health status in the model of health status of patients with heart failure (HSHF). DESIGN: : Descriptive cross-sectional study. MATERIALS AND METHODS: Participants were 400 heart failure patients hospitalized or attending an out patient clinic at six hospitals in southern Thailand. A survey-interview method was used for data collection. Questionnaires were related to study factors including sociodemographics, duration of illness, the New York Heart Association Functional Classification (NYHA-FC), the Charlson Comorbidity Index, the Self-Care of Heart Failure Index (SCHFI), the Short Form-36 Health Survey (SF-36). The relationship of the study variables was tested and modified under the structural equation modeling (SEM) technique by using LISREL. RESULTS: The initial hypothesized model did not fit the data. The modified model adequately fit the data and accounted for 64% of the variance in health status. Age had a direct negative effect on health status (beta = -0.20, P < 0.01) and had an indirect negative effect on health status through self-management ability, severity of illness and comorbid disease (beta = -0.13, P < 0.01). Education had a direct positive effect on health status (beta = 0.12, P < 0.01). Gender and income had indirect negative effects on health status through severity of illness (beta = -0.05; -0.05, P < 0.05). Duration of illness had an indirect positive effect on health status through self-management ability (beta = 0.09, P < 0.05). Severity of illness and comorbid disease had a direct negative effect on health status (beta = -0.31; -0.16, P < 0.01, respectively) and indirect negative effect on health status through self-management ability (beta = -0.06; -0.05, P < 0.05, respectively). Self-management ability had a direct positive effect on health status (beta = 0.38, P < 0.01). CONCLUSIONS: This model provides a guideline for explaining and predicting health status of patients with heart failure. Continuity care programs promoting self-management ability should be developed and implemented both in hospital-based and home-based settings in order to improve health status.