Psychometric Properties of the Patient Activation Measure in Family Caregivers of Patients With Chronic Illnesses.

BACKGROUND: The Patient Activation Measure (PAM) is used clinically and in research to measure an individual's knowledge, skills, and confidence related to their health management engagement. Despite the use of "patient" in the title, the instrument can be used in nonpatient populations. A group at high risk for low activation concerning their own health is family caregivers of patients with chronic illnesses. The psychometric properties of the PAM have not been established in family caregivers. OBJECTIVES: This study aimed to examine the psychometric properties of the PAM 10-item version (PAM-10) in a sample of family caregivers of patients with chronic illnesses. Our focus was on family caregivers' health activation of their own healthcare needs. METHODS: We evaluated the internal consistency reliability of the PAM-10 in a sample of 277 family caregivers. Item-total correlations and interitem correlations were used to assess item homogeneity. Construct validity of the PAM-10 was examined using exploratory factor analysis and testing hypotheses on known relationships. RESULTS: The PAM-10 demonstrated adequate internal consistency. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Construct validity of the instrument was supported. Factor analysis yielded two factors that explained 62.3% of the variance in the model. Lower levels of depressive symptoms were significantly associated with better activation, providing evidence of construct validity. Caregivers with high activation levels were significantly more likely to engage in and adhere to self-care behaviors such as regular exercise, eating a healthy diet, and engaging in stress reduction strategies. DISCUSSION: This study demonstrated that the PAM-10 is a reliable and valid measure for family caregivers of patients with chronic illnesses to measure caregivers' health activation of their own healthcare needs.

Effect of a Remotely Delivered Self-directed Behavioral Intervention on Body Weight and Physical Health Status Among Adults With Obesity: The D-ELITE Randomized Clinical Trial.

Importance: The effectiveness of remotely delivered, self-directed, weight loss programs in routine clinical practice is largely unknown. Objective: To test whether a self-directed, remotely administered behavioral lifestyle intervention improves weight and self-reported general health status compared with usual care. Design, Setting, and Participants: In this randomized clinical trial, 511 adults with a body mass index (BMI) of 30 or more and less than 45 (based on electronic health record [EHR] weight and height), were enrolled from 30 Veterans Health Administration (VHA) sites between February 15, 2018, and December 18, 2018 (final follow-up February 18, 2021). Interventions: Participants were randomly assigned to the intervention group (n = 254) or the control group (n = 257). Both received usual care. Participants randomized to the intervention received Diabetes Prevention Program-based self-directed videos, handouts, and coaching messages via an online platform or US mail for 12 months. Main Outcomes and Measures: Coprimary outcomes were weight measured in primary care and recorded in the EHR and self-reported general health status using the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) physical component score (PCS; higher scores are better [range, 0-100]) at the 12-month follow-up. The between-group minimal clinically important differences are 3 kg for weight and 5 points for the SF-12 PCS. Linear mixed models used weights and SF-12 PCS measured at either time point, with participants analyzed according to randomization assignment. Statistical significance for each coprimary outcome was based on a 2-sided α level of .025. Results: Among 511 participants randomized (mean age, 57.4 [SD, 13.9] years; 231 female [45%]), 429 (84.0%) had EHR-based weights and 410 (80.2%) had SF-12 PCS data at 12 months. The unadjusted mean weight at 12 months declined from 102.7 kg to 99.8 kg in the intervention group compared with 101.9 kg to 101.0 kg in the control group (adjusted between-group mean difference, -1.93 [97.5% CI, -3.24 to -0.61]; P = .001). At 12 months, the unadjusted mean SF-12 PCS scores declined from 44.8 to 44.3 among intervention participants compared with 44.5 to 43.2 among control participants (adjusted between-group mean difference, intervention minus control, 0.69 [97.5% CI, -1.11 to 2.49]; P = .39). Cardiovascular events represented the highest percentage of serious adverse events, accounting for 25% of events in the intervention group and 35% in the control group. Conclusions and Relevance: Among adults with obesity, a remotely delivered self-directed, behavioral lifestyle intervention, compared with usual care, resulted in statistically significantly greater weight loss at 12 months, although the difference was not clinically important. There was no significant difference in self-reported general physical health status at 12 months. Trial Registration: ClinicalTrials.gov Identifier: NCT03260140.

Testing a self-directed lifestyle intervention among veterans: The D-ELITE pragmatic clinical trial.

Nearly half of Veterans have obesity, fueling chronic diseases. The Department of Veterans Affairs (VA) offers an evidence-based behavioral weight management intervention called MOVE!, mostly delivered through in-person group sessions. Few eligible Veterans participate due to factors like distance and preferences, mirroring barriers in the general population. Practical alternatives to standard in-person programs are needed to improve access and engagement. A self-directed lifestyle intervention called D-ELITE-delivered through pre-recorded videos by DVD or online streaming-previously efficacious in a general primary care population, may provide such an alternative. This pragmatic clinical trial will evaluate whether D-ELITE improves weight and general health status among Veterans with obesity, relative to VA usual care. The yearlong intervention includes one orientation by phone, supplemental lifestyle coaching primarily via technology-based messages, 12 DVD or online streaming sessions over 3 months, and continued self-directed weight management for months 4-12. Participants use MyFitnessPal.com or paper booklets for self-monitoring weight, diet, and physical activity. Follow-up assessments at 12 and 24 months are administered by mail or phone. The study hypothesis is that compared with usual care, D-ELITE will lead to greater improvements in 12-month weight loss, per VA electronic health records, and general physical health status, assessed using the self-reported SF-12 physical composite score. We will also explore D-ELITE's effects on secondary biometric (e.g., HbA1c) and intermediate (e.g., diet) outcomes, reach, and budget impact. If effective, D-ELITE will offer a potentially scalable, low-cost alternative to VA's existing weight loss interventions by mitigating barriers presented by distance and technology.

Effectiveness of mHealth Interventions in Improving Medication Adherence Among People with Hypertension: a Systematic Review.

PURPOSE OF REVIEW: This study aims to systematically review existing evidence on the effectiveness of mobile health technology (mHealth) interventions in addressing medication adherence among people with hypertension. RECENT FINDINGS: Twenty-one studies of mHealth interventions were included in the final review after systematic searching and screening of publications from 2000 to 2017 in PubMed, Web of Science, and Embase. Key features of the mHealth interventions include high intervention intensity, multifactorial components, and patient-centered approaches with tailored content and interaction. All studies found tendencies to improvement in medication adherence, but only 12 studies reported that the improvements were statistically significant in the intervention groups compared with the control groups. Twelve studies also found that mHealth interventions were beneficial for blood pressure control. None of the studies was conducted in a low-income country. Our systematic review found evidence that mHealth interventions improved medication adherence and blood pressure control among people with hypertension. However, most studies were small in sample size and short in study duration, and not all results were statistically significant. Future research should focus on investigating the sustainability and generalizability of mHealth interventions.

A comprehensive needs assessment to identify priority program targets for mosquito vector control and related diseases in Belmopan, Belize

This was a mixed-methods study aimed to comprehensively assess factors associated with mosquito control in Belmopan, Belize, in order to better inform stakeholders on the effectiveness of their efforts. A knowledge, attitudes, and perceptions (KAP) survey was employed within the four target communities of San Martin, Salvapan, Maya Mopan, and Las Flores. Additional epidemiological and entomological data was provided by relevant stakeholders. A total of 228 households were surveyed among the four target communities. Only 1/3 of respondents were able to demonstrate proficient knowledge. Knowledge was attained mostly through TV, Ministry of Health, hospital, and radio sources. Over 90% of respondents believed that mosquitos and the diseases they carry were a real issue for the community. Respondents living in Salvapan and Las Flores were more likely to have contracted Dengue Fever, Malaria, Chikungunya, or Zika than in other areas. Fan usage and regularly cleaning the yard were the two most employed practices for preventing mosquito bites and breeding. Approximately 85% of those surveyed viewed insecticide spraying to be effective. This assessment provides valuable insight into the needs of at- risk communities in regards to vector control. An increased focus on community outreach, education, and behavioral change can greatly impact the effectiveness of current vector control efforts. Stakeholders must work together and pool resources in order to effectively employ control interventions. Continued evaluation and community involvement is necessary to control mosquitos and prevent disease outbreaks...(AU)

Living with depressive symptoms: patients with heart failure.

BACKGROUND: Patients with heart failure often experience depressive symptoms that affect health-related quality of life, morbidity, and mortality. Researchers have not described the experience of patients with heart failure living with depressive symptoms. Understanding this experience will help in developing interventions to decrease depressive symptoms. OBJECTIVE: To describe the experience of patients with heart failure living with depressive symptoms. METHODS: This study was conducted by using a qualitative descriptive design. The sample consisted of 10 outpatients (50% female, mean age 63 [SD, 13] years, 70% New York Heart Association class III or IV) with heart failure who were able to describe depressive symptoms. Data were collected via taped, individual, 30- to 60-minute interviews. ATLAS ti (version 5) was used for content analysis. RESULTS: Participants described emotional and somatic symptoms of depression. Negative thinking was present in all participants and reinforced their depressed mood. The participants experienced multiple stressors that worsened depressive symptoms. The overarching strategy for managing depressive symptoms was "taking my mind off of it." Patients managed depressive symptoms by engaging in activities such as exercise and reading, and by using positive thinking, spirituality, and social support. CONCLUSIONS: Patients with heart failure experience symptoms of depression that are similar to those experienced by the general population. Clinicians should assess patients with heart failure for stressors that worsen depressive symptoms. Strategies that researchers and clinicians can use to reduce depressive symptoms in patients with heart failure include engaging patients in activities, positive thinking, and spirituality. Helping patients find enhanced social support may also be important.

Sponsored professional seminars: enhancing professionalism among baccalaureate nursing students.

If we are to emphasize professionalism within nursing, students need to understand the opportunities, responsibilities, and concerns that are integral to the nursing profession. Sharing ideas related to nursing practice in a specified area with practicing nurses, expert faculty, and a speaker provide students with a sense of excitement about their chosen career. The sponsored seminar series permits undergraduate nursing students to converse with their future colleagues over dinner, develop lasting relationships, and advance their learning in an area of interest.

Characteristics and treatment of patients with heart failure in the emergency department.

INTRODUCTION: This study was conducted to develop a detailed profile of patients who come to the emergency department for heart failure treatment. METHODS: Patient interviews were supplemented by medical record reviews in a convenience sample of 57 participants. A structured interview guide included data concerning patient characteristics and ED treatment. RESULTS: Participants used a variety of self-care strategies before coming to the emergency department. Many of the patients studied (25%) reported barriers to medication adherence, such as memory problems and lack of knowledge regarding self-administration. The most frequently reported symptoms were breathing difficulties (88%), chest discomfort (35%), and fatigue (16%). Seventy-four percent of the participants were classified as specific activity scale class III or IV, indicating moderate to severe functional limitation. Mean quality of life at the time of interview was 5.1 (on a 1 to 10 scale). Length of stay was < or = 2 days for 33%. DISCUSSION: A number of the findings of this study have implications for ED nurses. For example, almost one third of the patients studied had not received directions for a low-sodium diet during hospitalization, when fluid volume overload with sodium retention was the most common cause of hospitalization in a study of patients with decompensated heart failure. Hospital lengths of stay of no more than 2 days suggest that early detection and treatment of acute heart failure may reduce the need for ED visits for some patients. Patients need education and support with self-help strategies and need to better understand the administration of their medication.