A Systematic Review of the Hill-Bone Compliance to Blood Pressure Therapy Scale.

Background: Poor medication adherence hampers hypertension control and increases the risk of adverse health outcomes. Medication adherence can be measured with direct and indirect methods. The Hill-Bone Compliance to High Blood Pressure Therapy (HBCHBPT) Scale, one of the most popular adherence measures, indirectly assesses adherence to hypertension therapy in three behavioral domains: appointment keeping, diet and medication adherence. Aim: To synthesize evidence on the use of the HBCHBPT Scale, including psychometric properties, utility in diverse patient populations, and directions for future clinical use and research. Methods: We searched electronic databases, specifically CINAHL, PubMed, PsychInfo, Embase, and Web of Science. We included original studies that used the HBCHBPT Scale or its subscales to measure a health outcome, or methodological studies involving translations and validations of the scale. We extracted and synthesized data following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Results: Fifty studies were included in this review, 44 on hypertension, two on diabetes, and others on other chronic conditions. The scale was successfully translated into numerous languages and used in descriptive and intervention studies. The scale demonstrated sound psychometric properties (Cronbach's α coefficient 0.75) and sensitivity to capture intervention effects when used to evaluate the effectiveness of high blood pressure adherence interventions. The medication-taking subscale of HBCHBPT performs best and is widely used in diverse contexts to assess medication adherence for chronic conditions. Conclusion: The HBCHBPT Scale has high versatility globally and has been used in various settings by various healthcare worker cadres and researchers. The scale has several strengths, including high adherence phenotyping capabilities, contributing to the paradigm shift toward personalized health care.

Addressing hypertension among Haitian adults with insufficient access to quality healthcare: A discursive review.

AIM: The purpose of this article is to summarize research targeting hypertension and healthcare access among adults living in rural Haiti. BACKGROUND: Hypertension is a significant public health problem that impacts one in five persons globally. It is the leading cause of cardiovascular-related conditions such as stroke and myocardial infarction and accounts for most global non-communicable disease-related deaths. Limited healthcare access and social determinants of health are known contributors to poor health outcomes among persons with hypertension. Among Haitians, there are stark health disparities between those who live in urban versus rural areas. DESIGN: A discursive review. RESULTS: Several issues are identified as barriers to proper hypertension prevention and management. However, after examining the effective interventions, we found that social determinants of health such as transportation costs, lack of field care facilities close to patients, roadway conditions, political disturbance, and ineffective leadership and policies are major barriers to controlling hypertension in Haiti. Although Haiti has received help from international organizations, strengthening its internal infrastructure is paramount in improving healthcare access. DISCUSSION: The review concludes that Haitians living in rural parts of Haiti are less likely to receive healthcare to manage non-communicable diseases such as hypertension. Similar to other developing countries, a heightened awareness is needed to address the lack of healthcare access for those living in rural communities. IMPACT TO NURSING PRACTICE: Nurses and other healthcare professionals working with populations in Haiti should become aware of the barriers and facilitators that promote sufficient healthcare access. To achieve this goal, nurses must understand the social determinants and other factors that serve as barriers for achieving access to quality care for this vulnerable population. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or drafting of this discursive paper.

Hand hygiene practices in Caribbean and Latin American countries: An integrative review.

AIM AND OBJECTIVE: To explore what is known about knowledge, attitudes and beliefs that influence hand hygiene practices in in low- and middle-income Caribbean and Latin American countries. BACKGROUND: With the emergence of infectious diseases such as the recent COVID-19 pandemic, handwashing is key to preventing communicable diseases as they disproportionately affect populations in low-income countries. While hand hygiene is known to be the single most effective method for avoiding the transmission of infection, little is known about the beliefs and practices of individuals in these regions. METHODS: Following PRISMA 2020 Checklist, an integrative review of studies published from 2008-2020 was conducted (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Whittemore and Knafl's method was used to review the literature. Six databases were searched, and the Johns Hopkins Evidence Based Rating Scale was used for study appraisal. RESULTS: The review yielded 18 studies conducted across Latin America. Poor handwashing practices are influenced by various factors including inadequate education and training, cultural beliefs, lack of resources and substandard government regulations. Communicable diseases and other diarrheal illnesses were highly prevalent, especially after a major disease outbreak. CONCLUSION: Future post-disaster campaigns aimed at improving hand hygiene and handwashing practices should focus on beliefs and attitudes to affect behaviour change since there was a higher disease susceptibility during those times. Barriers to proper hand hygiene include false attitudes such as, washing hands only after touching bodily fluids/patient contact or not washing hands at all after open defecation. RELEVANCE TO CLINICAL PRACTICE: Researchers working with populations in Latin America and the Caribbean should partner with local community health workers to improve compliance to recommended hand hygiene practices.

Efficacy of Mobile Health for Self-management of Cardiometabolic Risk Factors: A Theory-Guided Systematic Review.

BACKGROUND: Although mobile health (mHealth) technologies are burgeoning in the research arena, there is a lack of mHealth interventions focused on improving self-management of individuals with cardiometabolic risk factors (CMRFs). OBJECTIVE: The purpose of this article was to critically and systematically review the efficacy of mHealth interventions for self-management of CMRF while evaluating quality, limitations, and issues with disparities using the technology acceptance model as a guiding framework. METHODS: PubMed, CINAHL, EMBASE, and Lilacs were searched to identify research articles published between January 2008 and November 2018. Articles were included if they were published in English, included adults, were conducted in the United States, and used mHealth to promote self-care or self-management of CMRFs. A total of 28 articles were included in this review. RESULTS: Studies incorporating mHealth have been linked to positive outcomes in self-management of diabetes, physical activity, diet, and weight loss. Most mHealth interventions included modalities such as text messaging, mobile applications, and wearable technologies. There was a lack of studies that are (1) in resource-poor settings, (2) theoretically driven, (3) community-engaged research, (4) measuring digital/health literacy, (5) measuring and evaluating engagement, (6) measuring outcomes related to disease self-management, and (7) focused on vulnerable populations, especially immigrants. CONCLUSION: There is still a lack of mHealth interventions created specifically for immigrant populations, especially within the Latino community-the largest growing minority group in the United States. In an effort to meet this challenge, more culturally tailored mHealth interventions are needed.

Empirically Tested Health Literacy Frameworks.

BACKGROUND: Health literacy is a significant determinant of health behaviors, but the pathways through which health literacy influences health behaviors are not completely clear nor consistent. The purpose of this systematic review is to critically appraise studies that have empirically tested the potential pathways linking health literacy to health behavior. METHODS: We performed searches of the electronic databases PubMed, Embase, and CINAHL to identify studies that proposed a conceptual framework and empirically tested the proposed mechanism through which health literacy influences certain health behaviors. Twenty eligible studies were included for analysis. KEY RESULTS: The 20 studies addressed various health behaviors: chronic disease self-management (n = 8), medication adherence (n = 2), overall health status (n = 4), oral care (n = 1), cancer screening (n = 1), shared decision-making (n = 1), health information sharing (n = 1), physical activity and eating behaviors (n = 1), and emergency department visits (n = 1). Most studies were conducted in the United States (n = 13) and used a cross-sectional design (n = 15). The Short Test of Functional Health Literacy in Adults was commonly used to assess health literacy levels. Selection of variables and their operationalization were informed by a theoretical model in 12 studies. Age, gender, race/ethnicity, and insurance status were reported antecedents to health literacy. The most commonly tested mediators were self-efficacy (n = 8) and disease knowledge (n = 4). Fit indices reported in the studies ranged from acceptable to excellent. DISCUSSION: Current evidence supports self-efficacy as a mediator between health literacy and health behavior. Further research is needed to identify how health literacy interplays with known psychosocial factors to inform people's use of preventive care services. Future studies should include more disadvantaged populations such as immigrants with high disease burden and those with low health literacy. Theory-based, empirically tested health literacy models can serve as the conceptual basis for developing effective health interventions to improve health behaviors and ultimately decrease the burden of disease in such vulnerable populations. [HLRP: Health Literacy Research and Practice. 2020;4(1):e21-e44.] PLAIN LANGUAGE SUMMARY: This review systemically compiles, and critically appraises 20 existing studies that test conceptual frameworks that propose potential pathways through which health literacy affects health behaviors. The findings from this review can help inform the development of health literacy-focused interventions to improve the health behaviors of populations with disease burdens.

Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty.

As the demographics in the United States continue to change, nurses must deliver care to patients from diverse cultural backgrounds. Cultural humility is a lifelong process of self-reflection which is also defined by that individual. It allows an individual to be open to other people's identities, which is core to the nursing standard of providing holistic care. Embracing and incorporating cultural humility is essential for creating a comprehensive and individualized plan of care. One of the ways to achieve cultural humility in nursing is to train future faculty to become agents of cultural humility. This also helps to create a pipeline of nurses who have respect and empathy for the patients they serve. The aims of this paper include: 1) define cultural humility and its importance to healthcare professionals; 2) explore the intrapersonal, interpersonal, and system levels of cultural humility; 3) provide insight on how to promote cultural humility; 4) reflect on best practices across a variety of healthcare disciplines; and 5) provide suggestions for practice.

Views of regulatory authorities on standards to assure quality in online nursing education.

BACKGROUND: With the rapid growth in online education programs in nursing, quality of education through this modality is becoming of greater importance. PURPOSE: This paper aims to explore current recommendations and standards for quality in online nursing education offered by nursing regulatory, accrediting, and licensing organizations. METHOD: Individual interviews were conducted with the leaders from four accrediting, licensing and certifying organizations in nursing about their perspectives on quality standards for online education. FINDINGS: The following themes emerged from the qualitative interviews: Theme 1- Standards are not specific to online education; Theme 2-This is not up to us - Professional organizations can offer recommendations but not responsible for regulations; and Theme 3- Each institution has responsibility to provide support and evaluate the quality of online education. DISCUSSION: Schools of nursing should continue to incorporate current standards for quality in online education as the methods of delivery continue to evolve in this highly technologically-oriented world.

Hypertension among adults living in Haiti: An integrative review.

AIMS AND OBJECTIVES: To determine what is known about hypertension among adults living in Haiti. BACKGROUND: Hypertension is the leading cause of morbidity, the identified cause of heart failure in 45% of patients and is associated with more than 70% of cardiovascular disease-related hospital admissions in Haiti. DESIGN: An integrative review of the literature. METHODS: Searching four databases from 2007 to 2018, Whittemore and Knafl's method was used to review the literature. Three nurse researchers independently reviewed and appraised each publication applying the Johns Hopkins Evidence-based Practice Appraisal tool. RESULTS: Eight publications were identified and appraised for level and quality of evidence. The synthesis of the literature yielded common themes of (i) high prevalence of hypertension among adults living in rural areas, (ii) public health challenges, (iii) lack of knowledge and awareness of hypertension and (iv) barriers to effective treatment. CONCLUSION: Hypertension is a highly prevalent disease in Haiti that is understudied and warrants attention. To better serve this vulnerable population, culturally tailored prevention strategies and disease management programmes are recommended. RELEVANCE TO CLINICAL PRACTICE: There is a lack of quality evidence to guide nurses in the management of hypertension for this vulnerable population. Identification of barriers to effective treatment among this underserved population will assist nurses and other healthcare professionals in identifying best possible practices for patient care in clinical settings across Haiti.

A Health Literacy-Focused Intervention for Latinos with Hypertension.

Latinos in the United States are experiencing increasing incidences of uncontrolled high blood pressure (HBP). Health literacy is an important determinant of adequate HBP self-management, yet no community-based intervention has effectively addressed health literacy in the management of HBP in the target community. The purpose of this study was to test the acceptability and preliminary efficacy of a health literacy-focused HBP intervention in Spanish-speaking Latinos with uncontrolled HBP. Using a one-group pre- and post-test study design, the study intervention was delivered to Spanish-speaking Latinos in Baltimore, MD, who had uncontrolled HBP. The intervention consisted of four weekly group sessions for health literacy training combined with disease knowledge education in HBP management, followed by phone counseling and text messages for 3 months. Seventeen participants received the study intervention. Eleven who completed the follow-up assessment at 16 weeks reported high satisfaction with the intervention. Participation in the intervention resulted in improved blood pressure, numeracy, and psychological outcomes. Our findings support health literacy education as a promising avenue in promoting HBP control among inner-city Spanish-speaking Latinos. [HLRP: Health Literacy Research and Practice. 2018;2(1):e21-e25.].