The effect of a self-learned virtual learning package on knowledge, attitude, and self-care behaviors of COVID-19 in people referred to health and treatment centers.

BACKGROUND: COVID-19 is one of the most common diseases in recent years, the most important way to prevent is through self-care behaviors; therefore, it is important to these behaviors in people. According to the importance of promoting self-care behaviors of this disease, and according to the characteristics and effectiveness of interventions based on behavior change, this study aimed to investigate the effect of educational intervention on self-care behaviors of COVID-19 in a group of patients. METHODS: This quasi-experimental study was conducted on 164 people who referred to health and treatment centers in Dehdasht City, Iran. The cluster sampling method divided the participants into experimental and control groups at random (82 people for each group). Data collection tool was a researcher-made questionnaire completed by the control and experimental groups before and three months after the intervention. The intervention program in this training group is to form a WhatsApp group and send messages in the form of audio files, text messages, text messages with photos, video messages, and PowerPoints. After creating the group and adding the participants, according to the agreement with the group members, every day of the week (8:00 am to 12:00 pm) to send educational files through the WhatsApp application. Also, the group members could ask their questions and problems to the researcher during the designated hours. The control group was also given routine care and follow-up at the centers, and no training was given regarding self-care behaviors. After entering the SPSS 24, data were analyzed by independent t, chi-square, and paired t statistical tests. RESULTS: 164 individuals working in healthcare services from health and treatment centers were included in this study. Before the intervention, demographic characteristics such as marital status, education level, medical history, and smoking history were similar between the two groups (P > 0.05), as indicated by the results of chi-square tests. Furthermore, there were no significant differences in the mean scores of knowledge, attitude, and self-care behaviors between the experimental and control groups prior to the intervention (P > 0.05), according to independent t-tests. Following the intervention, notable changes were observed. The post-intervention analysis revealed statistically significant differences between the experimental and control groups in terms of knowledge, attitude, and self-care behaviors (P = 0.001). Specifically, the experimental group exhibited significant improvements in these variables compared to the control group. CONCLUSION: In this study, education led to the improvement of self-care behaviors in people who referred to health centers. Considering the importance of the role of health education in promoting self-care behaviors as well as preventing infectious diseases such as COVID-19, it is suggested that educational interventions focus on self-care behaviors in other diseases.

The role of emotion dysregulation in self-management behaviors among adults with type 2 diabetes.

Suboptimal disease self-management among adults with type 2 diabetes is associated with greater risk of diabetes related health complications and mortality. Emotional distress has been linked with poor diabetes self-management; however, few studies have examined the role of emotion dysregulation in diabetes management. The purpose of this study was to examine the relations between different facets of emotion dysregulation and diabetes self-management behaviors among a sample of 373 adults with type 2 diabetes. Separate median regression and binary logistic regression models were used to examine the association of emotion dysregulation facets and each diabetes self-care behavior (i.e., medication nonadherence, diet, exercise, self-monitoring of blood glucose (SMBG), foot care, and smoking). Generally, greater difficulties in emotion regulation were associated with poorer self-management behaviors. However, several facets of emotion dysregulation were linked with better self-management behaviors. Addressing emotion dysregulation among adults with type 2 diabetes has the potential to improve diabetes related self-management.

Effect of digital based nursing intervention on knowledge of self-care behaviors and self-efficacy of adult clients with diabetes.

BACKGROUND: In recent years, there has been growing interest in the use of Digital Based Nursing Intervention to support diabetes management. This study aimed to evaluate the effect of digital based nursing intervention on knowledge of self-care behaviors and self-efficacy of clients with diabetes. METHODS: Employing a quasi-experimental design, a sample of 120 adult participants diagnosed with type 2 diabetes, aged more than 18 years with focus on older adults was drawn from outpatient clinics at Cairo University Hospital. The intervention was approved and registered by the ethical committee of the faculty of nursing with IRB number: RHDIRB2019041701. The intervention group (n = 60) received a digital-based nursing intervention, while the control group (n = 60) received standard care. Data were collected using adopted standardized tools including the Diabetes Knowledge Test, the Diabetes Self-Efficacy Scale, and the Summary of Diabetes Self-Care Activities. Demographic characteristics were analyzed, and pre- and post-intervention scores were compared using paired t-tests were statistical methods. RESULTS: The digital-based nursing intervention resulted in significant enhancements in participants with diabetes knowledge and self-efficacy levels. Moreover, the intervention group demonstrated marked improvements in various self-care behaviors encompassing diet, exercise, medication adherence, blood glucose testing, and foot care. While the control group also exhibited some progress, the effects were less pronounced. Regression analyses highlighted age as a consistent factor associated with knowledge, self-efficacy, and specific self-care behaviors. CONCLUSION: This study underscores the potential of tailored digital nursing interventions to complement traditional care approaches, empowering patients with type 2 diabetes to actively engage in self-management. The findings suggest that digital-based nursing interventions hold promise for enhancing patient knowledge, confidence, and proactive health behaviors. Nevertheless, limitations, including the relatively short intervention duration and a sample from a single clinic, warrant consideration. Future research should address these limitations to bolster the validity and applicability of the study's conclusions.

Adverse Childhood Experiences and Their Relationships with Perceived Stress and Self-Care Behaviors in African American Social Work Students: Insights from a Latent Class Analysis.

Based on stress sensitization theory and stress proliferation theory, this study was designed to identify adverse childhood experience (ACE) classes and their relationships with perceived stress and self-care behaviors. Hypotheses were that (a) there would be diverse ACE classes among African American social work students; (b) the identified classes embedded in high/multiple ACEs would have greater levels of perceived stress than those in low ACEs; and (c) the identified classes embedded in high/multiple ACEs would have lower levels of self-care behaviors than those in low ACEs. Recruited from one of the South's historically Black colleges and universities, 186 African American social work students completed an online survey. Latent class analysis found three classes fit the data best: low ACEs, high divorce/abuse/neglect, and high/multiple ACEs. Students in the high divorce/abuse/neglect class had the greatest levels of perceived stress and significantly greater perceived stress levels than the low ACEs class. The low ACEs class had greater self-care behaviors than students in the other two ACEs classes. The study revealed diverse ACE classes and the effect of more ACEs on greater perceived stress and lower self-care behaviors, supporting the importance of using a range of approaches to support African American social work students with different ACEs.

Effectiveness of acceptance and commitment therapy in people with type 2 diabetes mellitus: A systematic review and meta-analysis.

BACKGROUND: Acceptance and commitment therapy (ACT) is a psychotherapy technique, which promotes psychological flexibility and enables patients to change behaviors based on value-directed goals. However, the beneficial effects of ACT on glycemic control, self-care behaviors, acceptance of diabetes, self-efficacy, and psychological burden are still unclear among patients with type 2 diabetes mellitus (T2DM). AIMS: This study aimed to systematically synthesize scientific evidence to determine the effectiveness of ACT among patients with T2DM on glycemic control, self-care behaviors, acceptance of diabetes, self-efficacy, and psychological burden and identify the optimal characteristics of effective interventions. METHODS: Nine electronic databases were searched to identify eligible studies of randomized controlled trials from inception to June 2023. Two reviewers independently assessed the study eligibility, extracted the data, and performed the quality appraisal using the Cochrane Risk of Bias 2 Tool. The meta-analysis was conducted using Review Manager 5.3. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: Ten studies involving 712 participants were included. ACT demonstrated significant improvements on patients' glycemic control (mean difference [MD]: 0.95%; p < .001), self-care behaviors (MD: 1.86; p = .03), diabetes acceptance (MD: 7.80; p < .001), self-efficacy (standardized mean difference [SMD]: 1.04; p < .001), anxiety (SMD: -1.15; p = .006), and depression (SMD: -1.10; p = .04). However, favorable but nonsignificant improvements were found in diabetes distress. Subgroup analyses demonstrated that ACT offered more than five sessions using individualized format, with theoretical underpinnings and professional input from multidisciplinary therapists are recommended to yield better results on glycemic control and self-care behaviors. LINKING EVIDENCE TO ACTION: Acceptance and commitment therapy could generate beneficial effectiveness on glycemic control, self-care behaviors, acceptance of diabetes, self-efficacy, anxiety, and depression among patients with T2DM. Large-scale trials with rigorous design and representative samples are warranted to strengthen the current evidence.

Self-care behaviors and associated factors among individuals with type 2 diabetes in Ghana: a systematic review.

BACKGROUND: Self-care remains an effective model for diabetes management and care in low-and-middle-income countries due to the limited resources available for the clinical management of the disease and its complications This study examined adherence to self-care behaviors and associated factors among people with type 2 diabetes in Ghana. METHODS: PubMed, PsycINFO, Scopus, Web of Science, Embase and Google scholar were used to identify quantitative observational studies published between 1990 and September 30, 2023. Studies exclusive to persons with type 2 diabetes ≥ 18 years of age in a Ghanaian setting were included in this review. Findings of primary studies were analyzed using narrative synthesis. RESULTS: Twelve studies, presenting data on a total of 2,671 persons with type 2 diabetes, were included. All the studies were published in the last decade (2015-2022) and a majority of them were from the Greater Accra Region. The mean number of days (per week) participants adhered to a self-care behavior were in the ranges of 3.9-4.4 for diet, 4.2-4.8 for physical activity, 0.5-2.2 for self-monitoring of blood glucose (SMBG), and 2.9-5.0 for foot care. Adherence rates for medication were in the range of 33.5-84.5%. Patient-related factors, sociodemographic/economic-related factors, condition-related factors, and healthcare system-related factors were associated with various self-care behaviors. CONCLUSION: Adherence to self-care behaviors among persons with type 2 diabetes in Ghana remains an ongoing challenge with significant variations in adherence among patients with different characteristics.

Longitudinal patterns and predictors of self-care behavior trajectories among Korean patients with heart failure: A 6-month prospective study.

PURPOSE: This study aimed to identify distinct trajectories of self-care behaviors over 6 months after hospital discharge in patients with heart failure, including the baseline predictors affecting these trajectories. DESIGN: This was a prospective longitudinal observational cohort study with a 6-month follow-up. METHODS: A total of 158 patients with heart failure (mean age = 66.75 years, 62.7% men) were included in this study. Patients' characteristics, including cognitive function, health literacy, and social support were collected as possible baseline predictors of self-care behavior trajectories using a structured questionnaire and an electronic medical record review. Self-care behaviors were evaluated using the Korean version of the nine-item European Heart Failure Self-care Behavior Scale at baseline, 1, 3, and 6 months after hospital discharge. Latent growth model analysis was conducted to identify the homogeneous subgroups with distinct trajectories of self-care behaviors. Subsequently, multinomial logistic regression was used to assess whether baseline predictors were associated with these trajectories in patients with heart failure. RESULTS: Three distinct self-care behavior trajectory groups were identified: "low-decreased" (n = 33, 20.9%), "middle-increased" (n = 93, 58.9%), and "high-sustained" (n = 32, 20.2%). The multinomial logistic regression analysis showed that baseline adequate health literacy and positive social support significantly predicted patients' belonging to both the middle-increased and high-sustained self-care behavior trajectory groups compared to the low-decreased group. Importantly, better cognitive function at baseline was only significantly associated with the high-sustained self-care behavior trajectory compared to the low-decreased trajectory. CONCLUSION: Our study revealed that only one-fifth of the patients belonged to the high-sustained self-care behavior group 6 months after hospital discharge. Strategies aimed at improving cognitive function, health literacy, and social support should be developed to sustain satisfactory self-care behaviors in patients with heart failure. Further studies with long-term follow-ups are required to identify other possible factors, as well as the baseline predictors of this study affecting longitudinal trajectories of self-care behaviors. CLINICAL RELEVANCE: Healthcare providers should recognize and evaluate the distinct patterns of self-care behaviors over time in patients with heart failure. Importantly, assessing baseline cognitive function, health literacy, and social support before hospital discharge may be necessary to prevent a decline in self-care behaviors over time.

[Effects of a Motivational Interview Intervention on Self-Efficacy, Self-Care Behavior, and Glycemic Control in Type 2 Diabetic Patients].

BACKGROUND: Motivation is an important factor in disease management for diabetic patients. However, motivational strengthening interventions have been inadequately effective in effecting behavior change in this group. PURPOSE: This study was designed to investigate the effect of a motivational interview intervention on self-efficacy, self-care behavior, and blood sugar control in patients with type 2 diabetes. METHODS: The target population comprised patients with type 2 diabetes in two medical wards of a regional hospital in the southern Taiwan. The 112 participants were randomly assigned to the experimental group (n = 56) and control group (n = 56). Over a three month period, the experimental group received 6 motivational interview sessions of 50 minutes each in addition to usual diabetes care, while the control group received usual diabetes care on the ward. Both groups completed the demographic questionnaire, Chinese version of Diabetes Self-Efficacy Scale, Diabetes Self-Care Behavior Scale, glycosylated hemoglobin level pre-test, and 3 months post-test survey. The results were analyzed using SPSS 22.0 for Windows. RESULTS: A total of 55 patients in the experimental group and 52 patients in the control group completed the study. After analysis, significant inter-group differences in self-efficacy and self-care behavior were found between the experimental group and the control group at pre-test and three-month post-test (p < .001). For the experimental group, the three-month post-test score and glycated hemoglobin value were higher than at pre-test. The three-month post-test value was significantly lower (p < .001) than the pre-test value, and the change effect in the experimental group was better than that in the control group. There was a significant difference in the stages of change between pre-test and post-test (χ2 = 43.89, p < .001), and the change effect in the experimental group was better than that in the control group. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The proposed motivational interview intervention can help patients with type 2 diabetes admitted to medical wards improve their self-efficacy, self-care behavior, and glycated hemoglobin values. In the future, nursing education should improve the teaching of motivational interview skills to allow nurses to conduct effective interviews quickly during treatment, increase their patients' motivation to self-control blood sugar, and enable patients to learn blood sugar control skills before discharge to achieve effective blood sugar control.

The role of protective psychological factors, self-care behaviors, and HbA1c in young adults with type 1 diabetes.

OBJECTIVE: To investigate whether protective psychological factors in young adults with type 1 diabetes are associated with more optimal self-care behaviors and HbA1c, and to explore possible mediators between protective psychological factors and HbA1c. RESEARCH DESIGN AND METHODS: This cross-sectional study examined the associations between protective psychological factors (optimism, positive efficacy expectancies, and self-compassion), maladaptive psychological factors (depression, anxiety, and stress), self-care behaviors, and HbA1c in 113 young adults (17-25 years) with type 1 diabetes in Auckland, New Zealand. Pearson's correlations, multiple linear regressions, and multiple mediation analyses were used to examine associations and mediators. RESULTS: Higher positive efficacy expectancies (beliefs about coping with difficulties) were associated with more optimal HbA1c (ß = -0.26, 95% CI: -1.99 to -0.45) and more optimal self-care behaviors (ß = 0.33, 95% CI: 0.28 to 0.92) in the adjusted models. Higher levels of self-compassion were associated with more optimal self-care behaviors (ß = 0.27, 95% CI: 0.09 to 0.43). Depression was associated with less optimal self-care behaviors (ß = -0.35, 95% CI: -1.33 to -0.43) and stress was associated with less optimal HbA1c (ß = 0.26, 95% CI: 0.27 to 1.21). Mediation results suggested that self-care behaviors mediated the relationship between all three of the protective psychological factors and more optimal HbA1c, and that lower stress also mediated the relationship between higher self-compassion and more optimal HbA1c. CONCLUSIONS: This study adds to the emerging literature that protective psychological factors may play an adaptive role in improving health outcomes in young adults with type 1 diabetes. Interventions targeting protective psychological factors present a promising approach to optimizing wellbeing and self-care in youth with type 1 diabetes.

Self-care behaviors mediates the relationship between resilience and quality of life in breast cancer patients.

Previous studies have shown that resilience could play an important role in enhancing the quality of life in women with breast cancer; however, the mediating role of self-care behaviors have not been studied. This study aims to explore the mediating role of self-care behaviors in the relationship between resilience and quality of life in breast cancer patients. A sample of 195 women with breast cancer (aged from 21 to 60 years; M = 45.32 ± 8.2) from three hospitals in Tehran, Iran completed online questionnaires measuring resilience, self-care and quality of life. The results of structural equation modeling showed that resilience (ß = 0.546, p < .01) and self-care behaviors (ß = 0.621, p < .01) positively predicted the quality of life in breast cancer patients. The bootstrapping analysis showed that self-care behaviors acted as a partial mediator between resilience and quality of life. The present study brings to light an underlying mechanism of the relationship between resilience and quality of life via the mediating variable of self-care behaviors for patients with breast cancer.

Relationship between housing insecurity, diabetes processes of care, and self-care behaviors.

BACKGROUND: The aim of this analysis was to examine the influence of housing insecurity on diabetes processes of care and self-care behaviors and determine if that relationship varied by employment status or race/ethnicity. METHODS: Using nationally representative data from the Behavioral Risk Factor Surveillance System (2014-2015), 16,091 individuals were analyzed for the cross-sectional study. Housing insecurity was defined as how often respondents reported being worried or stressed about having enough money to pay rent/mortgage. Following unadjusted logistic models testing interactions between housing insecurity and either employment or race/ethnicity on diabetes processes of care and self-care behaviors, stratified models were adjusted for demographics, socioeconomic status, health insurance status, and comorbidity count. RESULTS: 38.1% of adults with diabetes reported housing insecurity. Those reporting housing insecurity who were employed were less likely to have a physicians visit (0.58, 95%CI 0.37,0.92), A1c check (0.45, 95%CI 0.26,0.78), and eye exam (0.61, 95%CI 0.44,0.83), while unemployed individuals were less likely to have a flu vaccine (0.84, 95%CI 0.70,0.99). Housing insecure White adults were less likely to receive an eye exam (0.67, 95%CI 0.54,0.83), flu vaccine (0.84, 95%CI 0.71,0.99) or engage in physical activity (0.82, 95%CI 0.69,0.96), while housing insecure Non-Hispanic Black adults were less likely to have a physicians visit (0.56, 95%CI 0.32,0.99). CONCLUSIONS: Housing insecurity had an influence on diabetes processes of care and self-care behaviors, and this relationship varied by employment status and race/ethnicity. Diabetes interventions should incorporate discussion surrounding housing insecurity and consider differences in the impact by demographic factors on diabetes care.

Self-compassion moderates the perceived stress and self-care behaviors link in women with breast cancer.

OBJECTIVE: Women with breast cancer are exposed to various stressors, and self-care behaviors play an important role in their recovery. However, very few studies have investigated self-care behaviors specifically for women with breast cancer. The current study examined the relationship between perceived stress and self-care behaviors, and explored whether self-compassion moderated this relationship. METHODS: A sample of 210 women with breast cancer aged 27 to 60 years old from three hospitals in Tehran, Iran completed online self-report questionnaires of self-care behaviors, self-compassion, and perceived stress. RESULTS: Data analyses with structural equation modeling showed that perceived stress (ß = -.37, P < .01) and self-compassion (ß = .38, P < .01) were significant predictors of self-care behaviors. The interaction-moderation analysis showed that self-compassion acted as a moderator between perceived stress and self-care behaviors. CONCLUSIONS: The findings enhance our understanding about the protective role of self-compassion in the relationship between perceived stress and self-care behaviors in women with breast cancer.

The Role of Self-regulation Failures and Self-care in the Link Between Daily Sleep Quality and Blood Glucose Among Adults with Type 1 Diabetes.

BACKGROUND: Sleep, a process that restores the body's ability to self-regulate, may be one important factor affecting self-care behaviors and blood glucose (BG) levels. The link between sleep quality, self-care behaviors, and BG levels may occur by sleep-altering daily self-regulatory failures. PURPOSE: This study examined whether the relation between sleep quality and self-care behaviors occurred through self-regulation failures and whether the relation between sleep quality and BG levels occurred through self-regulation failures and self-care behaviors sequentially. METHODS: One hundred and ninety-nine adults with type 1 diabetes (T1D) completed an online questionnaire for 14 days in which they reported sleep quality, self-regulation failures, and self-care behaviors. BG levels were gathered from glucometers. Analyses involved multilevel mediation models and focused on daily within-person and between-person variability of sleep quality. RESULTS: Better daily sleep quality was associated with higher self-care behaviors at both within-person and between-person levels, and self-regulation failures mediated the association between daily sleep quality and daily self-care behaviors at both within-person and between-person levels. Better daily sleep quality was associated with better BG levels at the within-person level and self-regulation behaviors and self-care behaviors sequentially mediated the association between daily sleep quality and daily BG levels at the within-person level. CONCLUSION: This study provides a process account of the importance of daily sleep quality of adults with T1D, as well as one potential mechanism-self-regulation-that may explain the effect of sleep quality on diabetes outcomes.

Non-health outcomes affecting self-care behaviors and medical decision-making preference in patients with type 2 diabetes: a cross-sectional study.

BACKGROUND: The effects of patient sustained self-care behaviors on glycemic control are even greater than the effects of medical treatment, indicating the value of identifying the factors that influence self-care behaviors. To date, these factors have not been placed in a single model to clarify the critical path affecting self-care behaviors. The aims of this study were to explore the relationships of these factors and the differences in patient preference for medical decision-making. METHODS: A cross-sectional study was conducted among outpatients with type 2 diabetes at a regional teaching hospital. Purposive sampling was adopted to recruit 316 eligible patients via self-administered questionnaires. Partial least squares structural equation modeling was used for analysis. RESULTS: Significant direct pathways were identified from health literacy to self-efficacy, patient empowerment, and self-care behaviors; from self-efficacy to self-care behaviors; and from patient empowerment to self-care behaviors. Indirect pathways were from health literacy to self-care behaviors via self-efficacy or patient empowerment. The pathway from health literacy to self-efficacy was significantly stronger in those preferring shared decision-making than in those who preferred physician decision-making. CONCLUSIONS: Health literacy is a critical factor in improving self-care behaviors in patients with type 2 diabetes, and the effect of health literacy on self-efficacy was more significant in the shared decision-making than in the physician decision-making. Therefore, developing an effective health strategy to strengthen health literacy awareness and designing friendly, diverse health literacy materials, and application tools is the most important factor to facilitate self-care behaviors in this population.

Differential Impact of Food Insecurity, Distress, and Stress on Self-care Behaviors and Glycemic Control Using Path Analysis.

BACKGROUND: The aim of this study was to investigate the direct and indirect pathways through which food insecurity influences glycemic control and self-care behaviors. METHODS: Using data collected from 615 adults with type 2 diabetes, we investigated pathways between food insecurity and diabetes outcomes using path analysis. We included measures of perceived stress, diabetes distress, diabetes fatalism, and depression as psychosocial factors in the pathway. Self-care behaviors included general diet, specific diet, exercise, blood sugar testing, foot care, and medication adherence. Analyses were conducted using Stata v14, to include both direct and indirect effects, with standardized estimates to allow comparison of paths. RESULTS: Food insecurity was directly associated with stress (r = 0.43, p < 0.001), depression (r = 0.34, p < 0.001), fatalism (r = 0.09, p = 0.03), and distress (r = 0.36, p < 0.001). The type of stress, however, was differentially associated with outcomes, with distress associated with HbA1c (r = 0.25, p < 0.001), general and specific diet (r = - 0.28 and - 0.17, respectively, p = 0.001), and medication adherence (r = - 0.26, p < 0.001), while stress was associated with specific diet (r = - 0.14, p = 0.005) and medication adherence (r = - 0.15, p < 0.001) and depression was associated with exercise (r = - 0.06, p = 0.007). Food insecurity was indirectly associated with HbA1c (r = 0.08, p = 0.001), and four self-care behaviors (general diet, specific diet, exercise, and medication adherence). CONCLUSIONS: Food insecurity influences self-care behaviors indirectly via multiple psychosocial factors, and glycemic control indirectly through diabetes distress, supporting the hypothesis that stress is an important mechanism. Programs to improve access to resources and manage psychosocial concerns should be combined with food-based programs for food insecure populations with diabetes.

Determinants for quality of life trajectory patterns in patients with type 2 diabetes.

PURPOSE: The purpose of the study was to identify quality of life (QoL) trajectory patterns and the determinants in patients with Type 2 diabetes (T2DM). METHODS: A longitudinal design was employed. Totally, 466 patients with T2DM recruited from five diabetic clinics in Taiwan were participants of this study. Demographic and disease characteristics, biomedical factors (HbA1c levels and body mass index), psychosocial factors (self-care behaviors, social support, resilience, diabetes distress), and QoL were collected at baseline. QoL was further measured every 6 months for four waves after baseline. Latent class growth analysis was used to identify QoL trajectory patterns. The multinomial logistic regression was further applied to explore the important determinants of different QoL trajectory patterns. RESULTS: The "steadily poor" (n = 27, 5.8%), "consistently moderate" (n = 174, 37.3%), and "consistently good" (n = 265, 56.9%) trajectory patterns were identified. The HbA1c levels (OR 2.16) and diabetes distress (OR 1.18) were important for determining participants in the "steadily poor" QoL trajectory pattern. HbA1c levels (OR 1.25) and diabetes distress (OR 1.14) were important for determining participants in the "consistently moderate" QoL trajectory pattern. CONCLUSIONS: To prevent development of relatively worse QoL trajectory patterns in patients with T2DM in a timelier manner, healthcare providers could regularly assess the QoL and provide intervention, especially for those with high HbA1c levels and high diabetes distress. Meanwhile, early intervention for decreasing HbA1c levels and diabetes distress may improve the trajectory development of QoL in patients with T2DM.

Effects of a Symptom Management Program for Patients With Type 2 Diabetes: Implications for Evidence-Based Practice.

BACKGROUND: Findings from previous studies examining the effectiveness of symptom management on patients with diabetes that were implemented in home settings were inconclusive. Exploring the effects of a diabetes symptom management program on patients with type 2 diabetes mellitus (T2DM) in clinical settings is useful for healthcare providers to improve their diabetes care. AIMS: To examine the effects of a diabetes symptom management program (DSMP) on HbA1c levels, self-care behaviors, quality of life (QoL), and symptom severity in clinics in patients with T2DM. METHODS: This study was a single-blind randomized controlled trial. The control group (n = 30) received usual care. The experimental group (n = 30) received DSMP and usual care. The primary outcome variable was HbA1c levels; the secondary outcome variables were self-care behaviors, QoL, and diabetes symptom severity. Outcome variables were measured at baseline (T0), 3 months (T1) and 6 months after the intervention (T2), and HbA1c levels were further collected at 9 months after the intervention (T3). RESULTS: The decreasing levels of HbA1c from T0 to T2 and from T0 to T3 and for severity of diabetes symptoms from T0 to T2 in the experimental group were significantly better than those in the control group. The increasing levels of self-care behavior and QoL from T0 to T1 and from T0 to T2 in the experimental group were significantly higher than those in the control group. LINKING EVIDENCE TO ACTION: DSMP implemented in the clinic setting has effects on improving HbA1c, self-care behaviors, QoL, and preventing worsening severity of diabetes symptoms for outpatients with T2DM. Healthcare providers could assess diabetes symptoms of patients with high HbA1c levels and provide symptom management care rather than merely providing education on improvement of self-care behaviors.

Relationships of health literacy to self-care behaviors in people with diabetes aged 60 and above: Empowerment as a mediator.

AIM: To examine the relationships of health literacy to diabetes self-care behaviors (diet, physical exercise, foot care and blood glucose monitoring) through empowerment controlling for diabetes education. BACKGROUND: Potential mechanisms of how health literacy links to health outcomes have not clearly elucidated. DESIGN: A cross-sectional study design was used. METHODS: Participants were recruited from three community health centers in South Korea from September 2016 to April 2017 using a convenience sampling method. A total of 136 people with diabetes aged 60 and above were participated in this study. The main study variables of health literacy, empowerment and diabetes self-care activities were assessed using self-reported questionnaires. This study applied a simple mediation analysis with a single covariate using the PROCESS macro, with health literacy entered as an antecedent variable, empowerment as a mediator, diabetes self-care behaviors as outcome variables and diabetes education as a covariate. RESULTS: After controlling for diabetes education, the indirect effects of health literacy to self-care behaviors through empowerment were significant when the self-care behaviors were particularly diet and physical exercise. Whereas, the indirect effects were not significant when the self-care behaviors were foot care and blood glucose monitoring. CONCLUSIONS: This study indicates that the people with higher health literacy were more empowered and those with higher empowerment were more likely to eat healthy foods and exercise. In the light of these findings, a health literacy-tailored empowerment enhancing program may be important targets for interventions promoting diabetes self-care behaviors of diet and physical exercise.

Influencing Pathways to Quality of Life and HbA1c in Patients With Diabetes: A Longitudinal Study That Inform Evidence-Based Practice.

BACKGROUND: Determining possible associated factors and the influencing pathways to hemoglobin A1C (HbA1C) levels and quality of life (QoL) will facilitate the development of effective interventions to improve the physical and psychosocial health of patients with type 2 diabetes mellitus (T2DM). OBJECTIVES: To test a hypothesized model that addressed the pathways among personal characteristics, social support, diabetes distress, and self-care behaviors to HbA1C and QoL. METHODS: A total of 382 adults with T2DM were recruited. Self-reported questionnaires and medical records were used to collect data regarding personal characteristics, diabetes distress, and social support at baseline. The self-care behaviors characters were collected 6 months later, as well as QoL and HbA1C levels 1 year later. RESULTS: The 12-month QoL directly affected 12-month HbA1C levels. The 6-month self-care behaviors directly affected 12-month QoL, and indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline diabetes distress directly affected 12-month QoL. Moreover, baseline diabetes distress indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline social support directly affected baseline diabetes distress and 6-month self-care behaviors. In addition, baseline social support indirectly affected 12-month QoL through baseline diabetes distress. Baseline social support also indirectly affected 12-month QoL through 6-month self-care behaviors. LINKING EVIDENCE TO ACTION: Enhancing QoL is important to improve HbA1C levels. Enhancing self-care behaviors is essential to improve subsequent HbA1C control and QoL. Reducing diabetes distress is crucial to improve subsequent QoL. Improving social support is suggested a favorable strategy to reduce diabetes distress and enhance subsequent self-care behaviors in patients with T2DM.

Effectiveness of a PRECEDE-based education intervention on quality of life in elderly patients with chronic heart failure.

BACKGROUND: One of the most important challenges in public health is to improve the quality of life in patients with chronic heart failure (CHF). Depression, self-care capacity, and quality of life interact each other in these patients. It's difficult to treat with general education programs and conventional therapy. PRECEDE model is a comprehensive and exclusive theory-based education programs. Its effectiveness for reducing depression and increasing quality of life has been demonstrated in patients with coronary artery bypass grafting, type 2 diabetes, and the elderly. It has not been used in elderly patients with CHF. Thus, this study aims to investigate the effects of this model on self-care behaviors, depression, and quality of life in these patients. METHODS: Patients who met the inclusion criteria were randomly assigned to the intervention or control group. All the patients received conventional medical care. The patients in the intervention group also received 9 sessions of education intervention based on the PRECEDE model and then followed up for 3 months after the intervention. Data were collected before and 3 months after the intervention using 4 questionnaires, namely a PRECEDE-based questionnaire to evaluate predisposing, reinforcing, and enabling factors; the 9-item European Heart Failure Self-care Behavior Scale (EHFScBS-9); the 9-item Personal Health Questionnaire (PHQ-9); and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). RESULTS: No significant differences were found in the mean scores for the predisposing, enabling, and reinforcing factors, and the mean total scores in EHFScBS-9, PHQ-9, and MLHFQ before the intervention between the intervention and control groups. After the intervention, the scores for the predisposing, reinforcing, and enabling factors increased significantly, and the mean total scores in EHFScBS-9, PHQ-9, and MLHFQ decreased significantly in the intervention group. In addition, these scores significantly differed from those of the control group. Furthermore, the MLHFQ score significantly correlated with the EHFScBS-9 and PHQ-9 scores. CONCLUSION: This study demonstrates a trend that PRECEDE model of health education promotion is effective in relieving depression symptoms, enhancing self-monitoring, and improving the quality of life of elderly patients with CHF. TRIAL REGISTRATION: Trial registration number: ChiCTR-IOR-17012779 ; Trial registry: Chinese Clinical Trial Registry; Date registered: 22 Sep 2017; Retrospectively registered.