Latent transition analysis of instrumental activities of daily living in Chinese elderly: based on the 2014-2018 wave of the Chinese Longitudinal Healthy Longevity Survey.

BACKGROUND: The instrumental activities of daily living (IADL) among the elderly have been found to be heterogeneous, with different trajectories. However, the transition of the IADL over time remains unclear. We aimed to explore the transition probabilities and the predictors of IADL among the elderly. METHODS: Longitudinal data from the 2014 (T1) and 2018 (T2) waves of the Chinese Longitudinal Healthy Longevity Survey were extracted. A sample of 2,944 participants aged 65 years or older, with complete responses to the IADL scale, was included. Latent profile analysis (LPA) and latent transition analysis (LTA) were employed to identify latent profiles of IADL and investigate the transition probabilities between profiles from T1 to T2. The predictors of latent profiles and transition probabilities were examined using multinomial regression analysis. RESULTS: The results of LPA at both T1 and T2 supported a 4-profile model solution. They were labeled as the "Normal function profile," "Mildly impaired profile," "Moderately impaired profile," and "Highly impaired profile". The Normal function profile and Highly impaired profile were characterized by maintaining stability rather than transitioning over time, with transition probabilities of 0.71 and 0.68, respectively, for maintaining stability. The Mildly impaired profile and Moderately impaired profile were characterized by a stronger tendency towards transition rather than stability, with transition probabilities of 0.29 and 0.45, respectively, of transitioning to the Highly impaired profile. The transition probabilities from the three impaired function profiles to the Normal function profile ranged from 0.05 to 0.19. Age, gender, place of residence, and social participation were significant predictors of profile attribution at T1 and transition probabilities over time. CONCLUSIONS: This study employed the LTA to examine the transition probability of IADL among the Chinese elderly. By recognizing the different profiles of IADL and understanding the factors associated with transitions among the elderly, interventions can be tailored to improve their functional independence and successful reintegration into families and society.

Cross-cultural adaptation and validation of the caregiver self-efficacy in contributing to patient self-care scale in China.

BACKGROUND: Caregiver self-efficacy is crucial in improving patient outcomes and caregiver well-being, but there is a lack of suitable scales to assess this concept within the context of Chinese culture. This study aimed to cross-culturally translate the Caregiver Self-Efficacy in Contributing to Patient Self-Care (CSE-CSC) Scale and evaluate its psychometric properties using classical test theory and item response theory. METHODS: The CSE-CSC scale was adapted using Brislin's translation model after obtaining authorization from the original author. A multicenter, cross-sectional study was conducted to assess the psychometric properties of this scale. Classical test theory was used to evaluate reliability (internal consistency, test-retest reliability), validity (content validity, structural validity, convergent validity), and floor and ceiling effects. Item response theory was employed to assess the fit of the rating scale model, reliability, item difficulties, and measurement invariance. RESULTS: The translation and cultural adaptation process was completed. Classical test theory demonstrated good internal consistency (Cronbach's α = 0.935) and test-retest reliability (ICC from 0.784 to 0.829, p<0.001). The I-CVI and K* of each item ranged from 0.875 to 1.00 and 0.871 to 1.00. The first-order 2-factor model fit well (χ2/df = 3.71, RMSEA = 0.082, SRMR = 0.032, CFI = 0.973, TLI = 0.60). Convergent validity showed that the CSE-CSC scores had a strong positive correlation with three separate scales of the CC-SC-CII. There was no floor and ceiling effect in this scale. Rasch analysis showed that the CSE-CSC scale demonstrated a good fit to the rating scale model and exhibited excellent reliability (person/item separation index>2, person/item reliability coefficients>0.8). The Wright map showed that item difficulty matched the respondents' measured abilities. The analysis of differential item functioning (DIF) showed that all items were comparable in gender. CONCLUSIONS: This study indicated that the CSE-CSC scale had good reliability, validity, difficulty degree, and measurement invariance. The CSE-CSC scale can be used to measure caregiver self-efficacy of Chinese patients with multiple chronic conditions.

Dose-Response Relationship Between Perceived Control and Depression in Patients With Chronic Heart Failure: A Multicenter and Cross-sectional Study.

BACKGROUND: Little is known regarding the relationship between perceived control and depression in patients with chronic heart failure (CHF), particularly in terms of their dose-response relationship. OBJECTIVE: The aim of this study was to explore this relationship based on linear and nonlinear hypotheses and potential subgroup differences in patients with CHF. METHODS: A total of 308 patients with CHF were included in the study. Data on perceived control, depression, and relevant covariates, such as gender, age, New York Heart Association classification, and comorbidity burden, were collected. Logistic regression, Spearman correlation, and restricted cubic spline analysis were used for data analysis. RESULTS: Compared with the patients in the first quartiles of perceived control scores (0-16), those in the other 3 quartiles had a lower risk of depression (odds ratios of 0.29, 0.21, and 0.20, respectively; P < .05). Furthermore, a negative correlation between perceived control and depression (r = -0.317, P < .01) was observed. The restricted cubic spline analysis revealed an "L-shaped" curve relationship between perceived control and the presence of depression (P for nonlinear < .01). Compared with patients with a perceived control within the 5th percentile (10 scores), as the perceived control increased, the risk of depression rapidly decreased from "1" until it reached a threshold (20 scores) and stabilized. This trend remained consistent across the subgroups grouped by gender, age, New York Heart Association classification, and comorbidity burden. CONCLUSIONS: Interventions targeting perceived control may hold valuable implications for reducing the risk of depression in patients with CHF, particularly those who have not yet reached the threshold.

Network Analysis of Dyadic Burdens, Psychological Disorders, Psychological Resilience, and Illness- or Caregiving-Related Beliefs in Patients With Chronic Heart Failure and Their Caregivers.

BACKGROUND: Previous research has examined the dyadic health components consisting of dyadic burdens, psychological disorders, psychological resilience, and illness- or caregiving-related beliefs independently from each other in patients with chronic heart failure (CHF) and their caregivers, but there is a need for further insights into their interconnections. OBJECTIVE: We aimed to explore the interconnections among dyadic health components in patients with CHF and their caregivers. METHODS: We conducted a cross-sectional study, recruiting in a total of 355 patients with CHF and their 355 respective caregivers, totaling 710 individuals across the dyads. Assessments were conducted on symptom burden, caregiver burden, anxiety, depression, psychological resilience, perceived control, and caregiver self-efficacy. Network analysis was used regarding these constructs as nodes and their associations as edges. RESULTS: The strongest edge weight was observed between patients' anxiety and depression, followed by caregivers' anxiety and depression. Patients' depression exhibited the strongest edge weight with dyadic burdens. Caregiver burden was independently correlated with all nodes. Patients' symptom burden had fewer associations with the nodes within the caregiver community. Patients' anxiety, depression, and psychological resilience demonstrated the strongest and most influential correlations with other nodes. CONCLUSIONS: The findings illustrated extensive interconnections among dyadic health components in CHF dyads. These findings underscored the significance of managing and intervening with patients and caregivers as a dyadic whole. Given the strong and frequent associations of patients' anxiety, depression, and psychological resilience with other nodes in the network, interventions targeting these nodes may enhance the overall network health of CHF dyads.

The Association Between Impaired Dyadic Coping and Frailty in Elderly Patients With Hypertension: A Latent Profile Analysis.

BACKGROUND: Lifelong hypertension highlights the importance of dyadic engagement in coping with the disease. Although dyadic coping is heterogeneous in patients with other diseases, little is known about it in elderly patients with hypertension. In addition, whether impaired dyadic coping is associated with frailty has yet to be elucidated. OBJECTIVES: The aim of this study was to investigate the latent profiles and characteristics of dyadic coping and the potential association between impaired dyadic coping and frailty in elderly patients with hypertension. METHODS: We recruited a total of 741 elderly patients with hypertension. Latent profile analysis was then used to identify the best-fitting model. Then, we used regression analysis to determine profile predictors and identify the association between impaired dyadic coping and frailty. RESULTS: The 5-profile model was considered to be the best-fitting model, as follows: profile 1, severely impaired dyadic coping; profile 2, mildly impaired dyadic coping; profile 3, normal dyadic coping; profile 4, better dyadic coping; and profile 5, the highest dyadic coping. In the fully adjusted model, the probability of frailty was 1.94-fold higher in the mildly impaired dyadic coping group (odds ratio, 1.94; 95% confidence interval, 1.09-3.47) and 2.66-fold higher in the severely impaired dyadic coping group (odds ratio, 2.66; 95% confidence interval, 1.11-6.39). CONCLUSIONS: We identified heterogeneity in dyadic coping and demonstrated that impaired dyadic coping was associated with frailty. Those at risk of dyadic coping impairment need to be identified early, followed by dyadic coping-based interventions to prevent or delay frailty.

Network analysis of symptoms, physiological, psychological and environmental risk factors based on unpleasant symptom theory in patients with chronic heart failure.

BACKGROUND: Somatic symptoms and related factors in patients with chronic heart failure have been extensively researched. However, more insight into the complex interconnections among these constructs is needed, as most studies focus on them independently from each other. AIMS: The aim of this study is to gain a comprehensive understanding of how somatic symptoms and related factors are interconnected among patients with chronic heart failure. METHODS: A total of 379 patients were enrolled. Network analysis was used to explore the interconnections among the somatic symptoms and related risk factors. RESULTS: The four core symptoms of chronic heart failure were daytime dyspnea, dyspnea when lying down, fatigue and difficulty sleeping. Within the network, the edge weights of depression-anxiety, subjective social support-objective social support, and subjective social support-social support availability were more significant than others. Among physiological, psychological and environmental factors, the edge weights of NYHA-dyspnea, depression-difficulty sleeping, and social support availability-dyspnea when lying down were more significant than others. Depression and anxiety had the highest centrality, indicating stronger and closer connections with other nodes. CONCLUSIONS: Psychological and environmental factors stood out in the network, suggesting the potential value of interventions targeting these factors to improve overall health.

Effects of an autonomy-supportive intervention programme (ASIP) on self-care, quality of life, and mental health in heart failure patients: a randomized controlled trial.

PURPOSE: Patients with heart failure (HF) possess low self-care activation and motivation, leading to a deprived quality of life and adverse mental health conditions. To this end, self-determination theory emphasizes that autonomy-supportive interventions (ASI) can stimulate intrinsic motivation and improve behaviors and quality of life. Nevertheless, studies that focused on ASI for HF are inadequate. This study aims to evaluate the effects of an HF-ASIP on self-care, quality of life and mental health in HF patients. METHODS: In a two-arm randomized controlled trial, the participants are randomly allocated to the intervention (n = 41) or control (n = 41) groups. The intervention group received routine care and participated in an 8-week HF-ASIP, including individual education and consultation sessions. In contrast, the control group received only routine care. The primary outcome includes self-care management, while the secondary outcomes include self-care maintenance, quality of life, mental health, and motivation. After measuring the outcomes at baseline (T0), 4-week (T1), 8-week (T2), and 12-week (T3) follow-up, the intervention effects are assessed using the generalized equation models. RESULTS: The outcomes indicated that self-care management (T2: P = 0.001; T3: P = 0.016), self-care maintenance (T2: P = 0.003; T3: P = 0.001), depression (T2: P = 0.007; T3: P = 0.012), anxiety (T2: P = 0.001; T3: P = 0.012), MLHFQ total score (T1: P = 0.004; T2: P < 0.001; T3: P = 0.001), autonomous motivation (T2: P = .0.006; T3: P = 0.002) showed statistically difference between the groups. CONCLUSION: In summary, the 8-week HF-ASIP significantly improved the attributes of self-care, quality of life, mental health, and motivation in HF patients, suggesting the potential for practical intervention effect. TRIAL REGISTRATION: ChiCTR2100053970.

Exploring Health Literacy Categories in Patients With Heart Failure: A Latent Class Analysis.

BACKGROUND: Although a growing number of studies have demonstrated that patients' health literacy is associated with health outcomes, the exact relationship between them is not clear. AIMS AND OBJECTIVES: The aim of this study was to explore latent classes of health literacy in patients with heart failure and analyze the differences among different groups. DESIGN AND METHODS: This is a cross-sectional survey. Patients diagnosed with heart failure were selected from 3 tertiary hospitals in Tianjin, China, from March 2019 to November 2019. We measured patients' health literacy using the Health Literacy Scale for Chronic Patients. Latent class analysis was carried out based on the patients' Health Literacy Scale for Chronic Patients scores. Multinomial logistic regression was used to identify the predictive indicators of the latent classes. RESULTS: The health literacy of patients with heart failure was divided into 3 different latent classes, named "high health literacy group," "low literacy high dependence group," and "moderate literacy high willingness group." There were statistically significant differences in gender, age, smoking history, marital status, education level, household income level, and quality of life among different health literacy classes. Low education level and household income level predicted poor health literacy. CONCLUSION: There were 3 latent classes for the health literacy of patients with heart failure. Different health literacy classes exhibited their own distinctive characteristics. Patients in the "moderate literacy high willingness group" had the worst quality of life. Understanding the specific types of health literacy in patients with heart failure facilitates targeted nursing interventions to improve their quality of life.

Linguistic and Psychometric Validation of the Chinese Version of the Control Attitudes Scale-Revised in Patients With Chronic Heart Failure.

BACKGROUND: The concept of perceived control reflects the belief that one has resources needed to cope with negative events and the ability to positively influence consequences of those negative events. In patients with heart failure, perceived control is associated with a variety of health outcomes. Perceived control is commonly measured using the Control Attitudes Scale-Revised (CASR). There is no Chinese version of the CAS-R (CCAS-R). OBJECTIVE: The purpose of this article was to perform linguistic validation and psychometric evaluation of the CCAS-R. METHODS: The CAS-R was translated into Chinese according to Brislin's model. Then, a multicenter observational study was performed. Floor and ceiling effects, internal consistency, structural validity, and hypothesis testing were all assessed for psychometric validation of the CCAS-R. RESULTS: A total of 227 patients with chronic heart failure were included. There were no ceiling or floor effects detected. Cronbach α was 0.94, indicating a high reliability. The results of the confirmatory factor analysis showed that the 1-factor structure as proposed by the original CAS-R fits the data well. The results of the principal component analysis suggested that the 1-factor structure was optimal as well, accounting for 71.6% of the total variance. The a priori hypothesis was supported by a statistically significant correlation between the CCAS-R and 3 theoretically related variables. CONCLUSION: We developed a semantically equivalent version of the CAS-R in Chinese. The evaluation of the instruments' psychometric properties demonstrated that the CCAS-R has good reliability and validity for use in Chinese patients with chronic heart failure.

Self-management Among Elderly Patients With Hypertension and Its Association With Individual and Social Environmental Factors in China.

BACKGROUND: The hypertension control rate in China is much lower than that in developed countries. Self-management among elderly patients with hypertension can improve blood pressure control; thus, it is necessary to explore its association with individual and social environmental factors. OBJECTIVE: Our objective was to investigate self-management among elderly patients with hypertension in China and its association with individual and social environmental factors based on the social ecological model. METHODS: A total of 301 elderly patients with hypertension were recruited to do a questionnaire survey based on the social ecological model, which included the General Demographic Information Questionnaire, Hypertension Patients Self-Management Behavior Rating Scale, World Health Organization Well-Being Index, Family APGAR Index, and Social Support Rating Scale. RESULTS: The lowest level of self-management behaviors was in exercise management, and the highest was in medication management. The results of multiple linear regression analysis showed that well-being, family function, sex, education level, and age were pivotal individual and social environmental factors influencing self-management behaviors among elderly patients with hypertension. CONCLUSIONS: There is a need to develop and test interventions that improve self-management in elderly patients with hypertension. Specifically, individualized interventions to promote exercise among elderly persons with hypertension who are single and living alone are needed. Male patients with a lower education level, poor well-being, poor family function, and the lowest self-management levels are a key population to target.

Well-being mediates the effects of social support and family function on self-management in elderly patients with hypertension.

Previous studies have linked self-management with social support and family function. However, little is known about the mechanisms underlying these relationships. This study aimed to explore the underlying relationships between social support (family function) and self-management and to examine whether well-being mediated these relationships in elderly patients with hypertension. A cross-sectional design was used to study 517 elderly patients with hypertension. Demographics, self-management behaviors, social support, family function and well-being were collected by questionnaires. Results showed that social support, family function and well-being were separately associated with self-management behaviors. When social support, family function and well-being were included in the regression model simultaneously, social support and family function were no longer the significant predictors of self-management, demonstrating mediation. Using bootstrapping approach, 89.9% of the relationship between social support and self-management was explained by well-being, and 66.3% of the relationship between family function and self-management was explained by well-being. Improving self-management in patients with hypertension should be a comprehensive approach which should take social support, family function and well-being into account. Health providers should realize the importance of focusing on the promotion of well-being, especially among elderly hypertensive patients with low social support and low family function.

Self-management and psychological resilience moderate the relationships between symptoms and health-related quality of life among patients with hypertension in China.

PURPOSE: To examine whether and how self-management and psychological resilience could moderate the relationships between symptoms and health-related quality of life (HRQoL) among hypertensive patients in China. METHODS: This was a cross-sectional study of 220 participants recruited from January to May, 2018. Demographic and clinical information were obtained from medical records and by patient interview. The Chinese version of 17-item Hypertension-specific Symptom Scale, 21-item Self-Management Scale, and 10-item Connor-Davidson Resilience Scale (CD-RISC-10) as well as Short Form 12 Health Survey (SF-12) were used to collect information in this research. The moderation effects of self-management and psychological resilience were explored using the PROCESS macro for SPSS. RESULTS: Among all patients, 128 (58.2%) were female, 106 (48.2%) had a bachelor degree or higher, and 133 (60.5%) had moderate to severe Charlson Comorbidity Index. Both self-management and psychological resilience were negatively correlated to symptoms (r = - 0.259, p < 0.001; r = - 0.282, p < 0.001) but positively correlated to physical (r = 0.316, p < 0.001; r = 0.344, p < 0.001) and mental (r = 0.273, p < 0.001; r = 0.309, p < 0.001) HRQoL. After controlling for potential covariates, self-management could moderate the associations between symptoms and physical HRQoL (p = 0.041, ΔR2 = 0.010), while psychological resilience could moderate the relationships between symptoms and mental HRQoL (p = 0.02, ΔR2 = 0.010). CONCLUSIONS: For hypertension patients, HRQoL is dependent on the severity of symptoms, engagement of self-management behaviors, and psychological resilience, which should be carefully considered when to improve patients' HRQoL by health care providers.

Adaption and validation of Nijmegen continuity questionnaire to recognize the influencing factors of continuity of care for hypertensive patients in China.

BACKGROUND: Continuity of care (COC) has become a primary point of concern for care providers in both developed and developing countries, which is regarded as the "cornerstone of care" and an "essential element" of good health care. A robust and proper instrument is of necessity to identify problems and evaluate intervention aimed at improving continuity of care. This study aimed to adapt Nijmegen continuity questionnaire (NCQ) into a Chinese version (NCQ-C) and to delineate the status of COC as well as explore its influencing factors for hypertensive patients in China. METHODS: A forward-back-translation procedure was adopted for the determination of the adaption of NCQ. Then a total of 448 patients completed questionnaires and 24-h ambulatory blood pressure monitoring (ABPM). Proper indexes were calculated to test the reliability and validity of NCQ-C. Logistic analysis were used to detect the influencing factors of COC. RESULTS: The NCQ-C had excellent intraclass correlation coefficient of 0.855 and internal consistency of seven dimensions varied from 0.907 to 0.944. The item-content validity index ranged from 0.71 to 1.00. For construct validity, seven-factor structure was confirmed as original questionnaire and all the fit indices indicated acceptable levels. Gender, education level, medical insurance and frequency of family visits, blood pressure level, depression status as well as general health perception were demonstrated to be statistically related to COC. CONCLUSIONS: In addition, all the parameters of ABPM were negatively significant with COC. The NCQ-C has shown acceptable level of reliability and validity. The related factors of COC should arouse care providers' attention.

Chronic Swimming Exercise Ameliorates Low-Soybean-Oil Diet-Induced Spatial Memory Impairment by Enhancing BDNF-Mediated Synaptic Potentiation in Developing Spontaneously Hypertensive Rats.

Exercise and low-fat diets are common lifestyle modifications used for the treatment of hypertension besides drug therapy. However, unrestrained low-fat diets may result in deficiencies of low-unsaturated fatty acids and carry contingent risks of delaying neurodevelopment. While aerobic exercise shows positive neuroprotective effects, it is still unclear whether exercise could alleviate the impairment of neurodevelopment that may be induced by certain low-fat diets. In this research, developing spontaneously hypertensive rats (SHR) were treated with chronic swimming exercise and/or a low-soybean-oil diet for 6 weeks. We found that performance in the Morris water maze was reduced and long-term potentiation in the hippocampus was suppressed by the diet, while a combination treatment of exercise and diet alleviated the impairment induced by the specific low-fat diet. Moreover, the combination treatment effectively increased the expression of brain-derived neurotrophic factor (BDNF) and N-methyl-D-aspartic acid receptor (NMDAR), which were both down-regulated by the low-soybean-oil diet in the hippocampus of developing SHR. These findings suggest that chronic swimming exercise can ameliorate the low-soybean-oil diet-induced learning and memory impairment in developing SHR through the up-regulation of BDNF and NMDAR expression.

Nurses' satisfaction with use of a personal digital assistants with a mobile nursing information system in China.

BACKGROUND: Personal digital assistants, technology with various functions, have been applied in international clinical practice. Great benefits in reducing medical errors and enhancing the efficiency of clinical work have been achieved, but little research has investigated nurses' satisfaction with the use of personal digital assistants. AIM: To investigate nurses' satisfaction with use of personal digital assistants, and to explore the predictors of this. DESIGN: This is a cross-sectional descriptive study. METHODS: We conducted a cross-sectional survey targeting nurses who used personal digital assistants in a comprehensive tertiary hospital in Beijing. RESULTS: A total of 383 nurses were recruited in this survey in 2015. The total score of nurses' satisfaction with use of personal digital assistants was 238.91 (SD 39.25). Nurses were less satisfied with the function of documentation, compared with the function of administering medical orders. The time length of using personal digital assistants, academic degree, and different departments predicted nurses' satisfaction towards personal digital assistant use (all P < 0.05). CONCLUSION: Nurses were satisfied with the accuracy of administering medical orders and the safety of recording data. The stability of the wireless network and efficiency related to nursing work were less promising. To some extent, nurses with higher education and longer working time with personal digital assistants were more satisfied with them.

Factors related to fatigue in Chinese patients with end-stage renal disease receiving maintenance hemodialysis: a multi-center cross-sectional study.

BACKGROUD: Fatigue is considered as a common symptom in patients with end-stage renal disease (ESRD) and can significantly decrease patients' quality of life. This study aimed to assess fatigue in hemodialysis patients and to investigate risk factors of fatigue in Chinese patients receiving maintenance hemodialysis (MHD) in China. METHODS: Eligible patients completed questionnaires including demographic information, a Chinese version of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), the Family APGAR Index (APGAR), the medical outcomes study health status-Social Functioning subscale (SF-36,SocF), and the Pittsburgh sleep quality index (PSQI). Laboratory parameters were abstracted by medical records review. The multiple linear regression model was used to relate parameters with the FACIT-Fatigue score. RESULTS: A total of 345 MHD patients (216 men and 129 women, age 55.6 ± 12.8) were recruited in this study. The score of FACIT-Fatigue was 39 (Interquartile Range, 31-44). Fatigue was correlated with PSQI scores (p < 0.001), SocF scores (p < 0.001), comorbidity (p = 0.006), exercise time <1 hour per day (p = 0.003), adequacy of dialysis (Kt/V) < 1.2 (p = 0.016), APGAR scores (p = 0.014), and high Scr (p = 0.043). CONCLUSIONS: Fatigue is related to sleep disturbance, social and family functioning, taking physical exercise time, comorbidity condition, Kt/V and serum creatinine level in Chinese MHD patients. Future studies and interventions should focus on developing strategies and improving the quality of life in patients by addressing these significant contributing factors.

Continuity of Care for Older Adults with Chronic Illness in China: An Exploratory Study.

OBJECTIVE: To explore nurses' understanding of continuity of care and existing problems in implementation of continuity of care for Chinese elders with chronic illnesses. DESIGN AND SAMPLE: Cross-sectional survey and semi-structured interview were performed on 15 nurses and older patients and 1,902 older patients between July 2010 and February 2011. MEASURES: Semi-structured interview guideline and four-section scale were used. RESULTS: The interviews showed nurses lacked knowledge of continuity of care, and nurses from small towns or rural areas had less understanding of continuity of care and discharge planning than nurses from central cities. Significant differences were found among patients located in referred areas in selection of medical institutions for treatment, suggesting older adults were more likely to choose general hospitals for treatment. Self-reported surveys demonstrated more than 70% of hospitalized elders chose community hospitals for further recovery after discharge from general hospitals. CONCLUSIONS: Chinese nurses lack knowledge of continuity of care, and significant discontinuity exists between health care provided by general hospitals, community hospitals and other institutions for elders. A further model for the development of continuity of care should be established that addresses older patients' demands and current barriers in China.

The effect of continuous nursing intervention guided by chronotherapeutics on ambulatory blood pressure of older hypertensive patients in the community.

AIMS AND OBJECTIVES: To explore the effect of continuous nursing intervention guided by chronotherapeutics so as to provide the easy, noninvasive, effective and acceptable intervention for older hypertensive patients in the community. BACKGROUND: Many researchers studied the effect of administration at different times on blood pressure control and circadian rhythm. However, the individual administrative time was set ambiguously in previous studies. DESIGN: A semi-experimental study. METHODS: In the study, 90 eligible patients were recruited and separated into three groups randomly, which were the control group, intervention group A (behaviour and chronotherapy intervention) and intervention group B (behaviour intervention). At 6 and 12 months after the study, the intervention groups were measured 24-hour ambulatory blood pressure monitoring. RESULTS: There were significant differences in ambulatory blood pressure monitoring parameters of the two intervention groups at different measurement times, and there were interaction between measurement time and different groups. The number of patients with dipper increased and reverse dipper decreased in group A as the intervention applied. There were statistical differences between two groups. The number of patients with morning surge in group A decreased more, and there were statistical differences between two groups at six months after the intervention. CONCLUSIONS: The behaviour and chronotherapy intervention based on the patients' ambulatory blood pressure monitoring can control casual blood pressure much better and last longer, which can also improve patients' indexes of ambulatory blood pressure monitoring better than behaviour intervention only. The behaviour and chronotherapy intervention can increase patients' nocturnal blood pressure drop, increase the number of patients with dipper and decrease reverse dipper, and improve blood pressure surge in the morning. RELEVANCE TO CLINICAL PRACTICE: Nurses can use continuous nursing intervention guided by chronotherapeutics to help improve hypertension of older patients better in the community.

Effect of a Health Belief Model-based nursing intervention on Chinese patients with moderate to severe chronic obstructive pulmonary disease: a randomised controlled trial.

AIMS AND OBJECTIVES: To test the effect of a Health Belief Model-based nursing intervention on healthcare outcomes in Chinese patients with moderate to severe COPD. BACKGROUND: The Health Belief Model (HBM) has been internationally validated in a variety of chronic conditions. However, nursing intervention based on the HBM is less explored in Chinese patients with COPD. DESIGN: A randomised controlled trial. METHODS: Enrolled patients were randomly assigned to the intervention and control groups. Patients in the intervention group received a 20- to 30-minute HBM-based nursing intervention every 2 days during the hospitalisation period after disease conditions were stable, with additional follow-ups after discharge. Patients in the control group received routine nursing care. RESULTS: Patients had significantly increased scores of health belief and self-efficacy after receiving the HBM-based nursing intervention. After receiving the 3-month follow-up, patients in the intervention group had significantly higher mean total scores in the Health Belief Scale and the COPD Self-Efficacy Scale, as well as in all the subscales, than those in the control group except the perceived disease seriousness. Results showed that the value of FEV1 /FVC ratio had a significant difference between study groups before and after the intervention. Results also indicated that mean scores of the Dyspnea Scale, 6-minute walking distance and ADL were significantly different between the groups and between the study time-points. CONCLUSIONS: Among patients with moderate to severe COPD, nursing intervention based on the HBM can enhance their health belief and self-efficacy towards the disease management, decrease dyspnoea and improve exercise tolerance and ADL. RELEVANCE TO CLINICAL PRACTICE: Nurses can use the HBM-based intervention to enhance patients' health belief and self-efficacy towards the management of COPD, and subsequently benefit healthcare outcomes.

Effects of the family customised online FOCUS programme on patients with heart failure and their informal caregivers: a multicentre, single-blind, randomised clinical trial.

Background: Living with heart failure can severely affect the physical and mental health of patients with heart failure and their caregivers. Available dyadic self-care interventions for heart failure are scarce, especially in China. We aimed to develop and test the family FOCUS programme. Methods: This single-blind, randomised, controlled study was conducted at four hospitals in Tianjin, China. Patients with heart failure (aged at least 18 years) and their caregiver (dyads) were randomly assigned to either the intervention (n = 71) or control (n = 71) group in a 1:1 ratio. The primary outcomes of this study were patient self-care, with three specific dimensions (self-care maintenance, symptom perception, and self-care management), and caregiver contribution to self-care, mirroring these three dimensions. The outcomes were assessed at baseline (T0) and 4 (T1), 12 (T2), and 24 (T3) weeks post-discharge, respectively. This work is registered on ChiCTR, ChiCTR2100053168. Findings: Between May 20, 2022, and September 30, 2022, 142 dyads with heart failure were enrolled. The intervention group exhibited dropout rates of 6%, 8.5%, and 18.3% at 4, 12, and 24 weeks after discharge, while the control group showed 9.9%, 12.3%, and 25.4%. Compared with the control group, patients in the intervention group reported improved self-care maintenance (ß: 8.5, 95% CI: 0.7, 16.4) and management (ß: 7.2, 95% CI: 0.1, 14.3) at T1, as well as improved symptom perception at both T1 (ß: 9.7, 95% CI: 1.5, 17.9) and T2 (ß: 9.6, 95% CI: 0.6, 18.6). Furthermore, caregiver contributions to self-care maintenance, self-care management, and symptom perception (excluding T3) exhibited significant improvements at all timepoints. Interpretation: Although the significant improvements in patients' self-care were not long-lasting, this study suggested that the family FOCUS programme consistently enhanced caregivers' contributions to self-care. Future work could explore the effect of the family FOCUS programme on families with multiple chronic conditions. Funding: The National Natural Science Foundation of China.