Predictors of self-care behaviour trajectories in patients with chronic obstructive pulmonary disease: A latent class growth analysis.

AIMS AND OBJECTIVES: To explore the trajectories of self-care behaviours in patients with chronic obstructive pulmonary disease based on the latent class growth model and investigate the predictors of each trajectory based on the capability opportunity motivation and behaviour model. BACKGROUND: Studies on self-care behaviours of patients with chronic obstructive pulmonary disease are mainly cross-sectional surveys. However, little is known about longitudinal trends of self-care behaviours changes among those population. DESIGN: This was a prospective observational research performed according to STROBE Checklist. METHODS: One hundred and nineteen patients with chronic obstructive pulmonary disease were followed up at baseline, 3 and 6 months. Data collection included the scores of self-care behaviours, specific demographic and clinical characteristics, and scores for the predictors. A latent class growth model was used to explore the self-care behaviours trajectories. Multiple logistic regression analysis was conducted to identify predictors of self-care behaviours trajectories. RESULTS: Three trajectories in the self-care behaviours of patients with chronic obstructive pulmonary disease were found: a persistently negative trajectory, a maintenance trajectory after a slight increase and an active trajectory with a slow upward improvement in self-care behaviours. Medical insurance and access to medical resources were the predictors of self-care behaviours. CONCLUSION: The patients with poor medical resources and medical insurance are at high risk for the poor self-care behaviours and the negative trajectory. Thus, dynamic and individualised intervention should be continuously provided to ensure patients acquire adequate medical resources to comprehensively improve self-care behaviours. RELEVANCE TO CLINICAL PRACTICE: People with better self-care trajectory may be patients who receive more medical resources or have less financial burden, which will help with the early identification of high-risk patients with a negative self-care trajectory. Intervention guided by Behaviour Change Wheel Theory should be conducted dynamically for patients for patients with different trajectories. PATIENT OR PUBLIC CONTRIBUTION: Thank the patients and their families for their cooperation in data collecting in this study.

Acceptance of clinical decision support system to prevent venous thromboembolism among nurses: an extension of the UTAUT model.

BACKGROUND: Venous thromboembolism has been a major public health problem and caused a heavy disease burden. Venous thromboembolism clinical decision support system was proved to have a positive influence on the prevention and management of venous thromboembolism. As the direct users, nurses' acceptance of this system is of great importance to support the successful implementation of it. However, there are few relevant studies to investigate nurses' acceptance and the associated factors are still unclear. OBJECTIVE: To investigate the determinant factors of nurses' acceptance of venous thromboembolism clinical decision support system with the modified Unified Theory of Acceptance and Use of Technology. METHODS: We designed a questionnaire based on the modified Unified Theory of Acceptance and Use of Technology and then a cross-sectional survey was conducted among nurses in a tertiary hospital in Nanjing, China. Statistically, a Structural Equation Modeling -Partial Least Squares path modeling approach was applied to examine the research model. RESULTS: A total of 1100 valid questionnaires were recycled. The modified model explained 74.7%, 83.0% and 86% of the variance in user satisfaction, behavioral intention and user behavior, respectively. The results showed that performance expectancy (ß = 0.254, p = 0.000), social influence (ß = 0.136, p = 0.047), facilitating conditions (ß = 0.245, p = 0.000), self-efficacy (ß = 0.121, p = 0.048) and user satisfaction (ß = 0.193, p = 0.001) all had significant effects on nurses' intention. Although effort expectancy (ß = 0.010, p = 0.785) did not have a direct effect on nurses' intention, it could indirectly influence nurses' intention with user satisfaction as the mediator (ß = 0.296, p = 0.000). User behavior was significantly predicted by facilitating conditions (ß = 0.298, p = 0.000) and user intention (ß = 0.654, p = 0.001). CONCLUSION: The research enhances our understanding of the determinants of nurses' acceptance of venous thromboembolism clinical decision support system. Among these factors, performance expectancy was considered as the top priority. It highlights the importance of optimizing system performance to fit the users' needs. Generally, the findings in our research provide clinical technology designers and administrators with valuable information to better meet users' requirements and promote the implementation of venous thromboembolism clinical decision support system.

Factors Related to Activation in Chinese Patients With Chronic Obstructive Pulmonary Disease: A Cross-Sectional Survey Study.

BACKGROUND: Improving patient activation can lead to better health outcomes among patients with chronic obstructive pulmonary disease (COPD). However, no studies have focused on the issue of activation in patients with COPD in China. PURPOSE: This study was designed to explore the status of activation in patients with COPD in China and explicate the significant influencing factors. METHODS: One hundred seventy patients with COPD were recruited using a convenience sampling method from eight tertiary and secondary hospitals in Nanjing, China. Sociodemographic, clinical, and patient-reported factor data were collected. Univariate analysis and multivariate linear regression were performed. RESULTS: Only 10.6% of the patients were identified as activated for self-management. Multivariate linear regression analysis revealed four explanatory elements as significantly associated with patient activation, including social support (ß = .463, p < .001), free medical insurance (ß = .173, p = .007), smoking status (ß = -.195, p = .002), and health status (ß = -.139, p = .04). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study indicate that a minority of patients with COPD are activated for self-management in China. Having a higher level of patient activation was associated with having better social support, having free medical insurance, being a nonsmoker, and having a better health status. Creating a supportive environment, promoting smoking cessation, and improving medical security and health status may be considered as potential strategies to activate patients into better self-management.