Mediation effect of illness acceptance between perceived social support and self-management behaviors in rural elderly with coronary heart disease.

OBJECTIVE: To explore the relationship between perceived social support, acceptance of illness, and self-management behaviors and the mediating role of acceptance of illness in perceived social support and self-management behaviors. METHODS: Between August 2022 and February 2023, 731 rural older adults with coronary heart disease in Feicheng City participated in this study. Correlation analysis was used to analyze the relationship between variables, and mediating effects were analyzed using AMOS 23.0 software. RESULTS: Perceived social support and acceptance of illness were positively correlated with self-management behaviors. Acceptance of illness mediated the relationship between the perceived social support and the three dimensions of self-management behavior. CONCLUSION: These findings contribute to the understanding that increased perceived social support and acceptance of illness are more likely to improve self-management behaviors.

Positive Psychology Interventions for Improving Self-management Behaviors in Patients with Type 1 and Type 2 Diabetes: a Narrative Review of Current Evidence.

PURPOSE OF REVIEW: Interests have been emerging in using positive psychology interventions (PPIs) to improve diabetes self-management (DSM) behaviors (e.g., blood glucose monitoring, physical activity). To explore the impact of those interventions on DSM behaviors, we summarized the evidence of PPIs on self-management behaviors among both type 1 diabetes (T1D) and type 2 diabetes (T2D) patients between 2012 and 2022. RECENT FINDINGS: Among the eight studies identified, different study designs and types of PPIs were apparent. Typical PPIs (e.g., activities enhancing positive affect/gratitude/self-affirmation/optimism) were usually applied to T1D patients (N = 5); PPIs were usually combined with motivational interviewing for T2D patients (N = 3). Contrary to expectations, PPIs did not consistently demonstrate positive effects on self-management behaviors' change regardless of the types of diabetes patients, compared to the control groups. Improvements in diabetes patients' self-management behaviors from PPIs are still unclear. Future studies should more rigorously evaluate and identify the active ingredients of PPIs for behavioral changes among diabetes patients.

Mediating effect of self-efficacy on the relationship between social support and self-management behaviors among patients with knee osteoarthritis: a cross-sectional study.

BACKGROUND: Good self-management behaviors in patients with knee osteoarthritis can improve disease awareness, treatment effectiveness, quality of life, and reduce medical costs. However, there is a paucity of studies focusing on patients with knee osteoarthritis. Therefore, the purpose of this study was to explore the mediating effect of self-efficacy on aspects of social support and self-management behaviors in this population. METHODS: This study employed a cross-sectional design and convenience sampling to survey patients with knee osteoarthritis in an outpatient department of a regional hospital in northern Taiwan from February 22, 2021, to April 15, 2021. The inclusion criteria for patients were (1) those diagnosed by a physician with knee osteoarthritis and (2) who could communicate in Chinese or Taiwanese. Participants were asked to complete a demographic questionnaire, the Arthritis Self-Efficacy Scale (ASE), the Inventory of Socially Supportive Behavior (including enacted support and perceived social support), and the Arthritis Self-Management Assessment Tool (ASMAT). In addition, the Kellgren-Lawrence Grading Scale was obtained from a chart review. Data were analyzed with descriptive statistics, t-test, one-way analysis of variance, Pearson product-moment correlation, and mediation analysis. RESULTS: A total of 140 patients met the inclusion criteria. The mean age of participants was 70.21 ± 10.84years; most (73.6%) were female. The mean total score of the ASMAT was 64.27 ± 14.84. Scores for the ASE, enacted support, and perceived social support were significantly positively correlated with ASMAT (all p < .001). The standardized coefficient for total effect and direct effect of perceived social support on ASMAT was 0.899 (p < .001) and 0.754 (p < .05), respectively. After introducing the ASE into the model, the indirect effect was 0.145 (p < .05), which indicated that ASE had a partial mediating effect on the relationship between perceived social support and ASMAT. CONCLUSION: Our findings might suggest that perceived social support indirectly affected ASMAT through ASE. Therefore, interventions designed to increase self-efficacy and social support could enhance self-management behaviors for patients with knee osteoarthritis.

The Codevelopment of "My Kidneys & Me": A Digital Self-management Program for People With Chronic Kidney Disease.

BACKGROUND: Health care self-management is important for people living with nondialysis chronic kidney disease (CKD). However, the few available resources are of variable quality. OBJECTIVE: This work describes the systematic codevelopment of "My Kidneys & Me" (MK&M), a theory-driven and evidence-based digital self-management resource for people with nondialysis CKD, guided by an established process used for the successful development of the diabetes education program MyDESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed, DESMOND). METHODS: A multidisciplinary steering group comprising kidney health care professionals and researchers and specialists in the development of complex interventions and digital health provided expertise in the clinical and psychosocial aspects of CKD, self-management, digital health, and behavior change. A patient and public involvement group helped identify the needs and priorities of MK&M and co-design the resource. MK&M was developed in 2 sequential phases. Phase 1 involved the codevelopment process of the MK&M resource (content and materials), using Intervention Mapping (IM) as a framework. The first 4 IM steps guided the development process: needs assessment was conducted to describe the context of the intervention; intervention outcomes, performance objectives, and behavioral determinants were identified; theory- and evidence-based change methods and practical strategies to deliver change methods were selected; and program components were developed and refined. Phase 2 involved the adoption and adaptation of the existing MyDESMOND digital platform to suit the MK&M resource. RESULTS: The needs assessment identified that individuals with CKD have multiple differing needs and that delivering a self-management program digitally would enable accessible, tailored, and interactive information and support. The intended outcomes of MK&M were to improve and maintain effective self-management behaviors, including physical activity and lifestyle, improve knowledge, promote self-care skills, increase self-efficacy, and enhance well-being. This was achieved through the provision of content and materials designed to increase CKD knowledge and patient activation, reduce health risks, manage symptoms, and improve physical function. Theories and behavior change techniques selected include Self-Management Framework, Capability, Opportunity, Motivation Behavior model components of Behaviour Change Wheel and taxonomy of behavior change techniques, Health Action Process Approach Model, Common Sense Model, and Social Cognitive Theory. The program components developed comprised educational and behavior change sessions, health trackers (eg, monitoring blood pressure, symptoms, and exercise), goal-setting features, and forums for social support. The MyDESMOND digital platform represented an ideal existing platform to host MK&M; thus, the MyDESMOND interface and features were adopted and adapted for MK&M. CONCLUSIONS: Applying the IM framework enabled the systematic application of theory, empirical evidence, and practical perspectives in the codevelopment of MK&M content and materials. Adopting and adapting a preexisting platform provided a cost- and time-efficient approach for developing our digital intervention. In the next stage of work, the efficacy of MK&M in increasing patient activation will be tested in a randomized controlled trial.

Self-management Behaviors and Anthropometric Indices after Roux-en-Y Gastric Bypass.

BACKGROUND: The aim of this study was to correlate the connection between self-management behaviors and anthropometric indices after Roux-en-Y gastric bypass (RYGB). METHODS: A sample of 180 patients suffering from obesity were treated with RYGB in 2019; 6 and 18 months after surgery, anthropometric indices, including weight, waist circumference, waist- to-height ratio, body mass index (BMI), and waist-to-hip ratio, were gauged, and participants completed the post-bariatric surgery self-management behaviors questionnaire. RESULTS: Correlation matrix results showed that all anthropometric indices had a significant positive relationship with self-management behaviors after RYGB; the results of the 18-month post-surgical follow-up exhibited no significant difference between anthropometric indices and self-management behaviors, 6 and 18 months after surgery. CONCLUSION: Therefore, the more self-management behaviors increase, the greater decrease in anthropometric indices will happen after RYGB.

Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers.

OBJECTIVE: Survivors of multiple primary cancers (MPC) are at increased risk for poor health outcomes compared with survivors of single cancers. Using an adapted psychobehavioral stress-response model, the study purpose was to identify pathways and individual risk factors associated with poor health outcomes in adults with MPC. METHODS: Adult MPC survivors (N = 211) with first cancers (stages I-III) diagnosed within 1 to 10 years were recruited via tumor registry. Employing a cross-sectional design, established questionnaires were used to operationalize patient characteristics and theoretical constructs including perceived stress, psychological and behavioral responses, financial hardship, social role function, and physical health. Disease and treatment data were obtained via registry and medical records. Structural equation modeling (SEM) was performed to fit, test, and modify the hypothesized psychobehavioral model. RESULTS: Following measurement model refinement, an SEM linking self-management behaviors, distress, financial hardship, and functional health demonstrated a good fit: χ2 (200, N = 206) = 332.06, P < .01; Tucker-Lewis index (TLI) = .95, comparative fit index (CFI) = .96, standardized root mean residual (SRMR) = .06, root-mean-square error of approximation (RMSEA) = .06. Less use of self-management behaviors predicted higher distress which, in turn, predicted higher financial hardship; higher distress and financial hardship predicted poorer functional health. Several sociodemographic and personal factors predicted self-management behaviors and distress. CONCLUSIONS: The hypothesized stress-response model was partially supported. Data supported pathways among self-management behaviors, distress, financial hardship, and functional health. Self-management and distress may represent modifiable intervention targets for MPC survivors. High body mass index (BMI), less education, greater neuroticism, and lower social support were associated with less use of self-management behaviors and higher distress and should be further evaluated as potential markers of vulnerability.

Applying the information-motivation-behavioral model to explore the influencing factors of self-management behavior among osteoporosis patients.

BACKGROUND: The prevalence of osteoporosis (OP) is rapidly increasing. Healthy behaviors are crucial for the management of OP. Application of the information-motivation-behavioral skills (IMB) model has been verified in various chronic diseases, but this model has not been investigated for behavioral interventions among people with OP. This study aimed to examine factors influencing OP self-management behavior and their interaction paths based on the IMB model. METHODS: We conducted a cross-sectional study using a convenience sampling method in 20 community health service centers in Shanghai, China. Predictive relationships between IMB model variables and self-management behaviors were evaluated using an anonymous questionnaire. Structural equation modeling was used to test the IMB model. RESULTS: In total, 571 participants completed the questionnaire, of which 461 (80.7%) were female. Participants' mean age was 68.8 ± 10.1 years. Only 101 (17.7%) participants were classified as having better OP self-management behaviors. The model demonstrated the data had an acceptable fit. Paths from information to self-efficacy (ß = 0.156, P < 0.001) and self-management behaviors (ß = 0.236, P < 0.001), from health beliefs to self-efficacy (ß = 0.266, P < 0.001), from medical system support to self-efficacy (ß = 0.326, P < 0.001) and self-management behaviors (ß = 0.230, P < 0.001), and from self-efficacy to self-management behaviors (ß = 0.376, P < 0.001) were all significant and in the predicted direction. CONCLUSION: This study validated the utility of the IMB model for OP self-management behaviors in this population. Middle-aged and older adult patients with OP have poor self-management behaviors. Enhanced knowledge about OP and is important for improving self-management behaviors.

Self-Management Behaviors in Relation to Psychological Factors and Interdialytic Weight Gain Among Patients Undergoing Hemodialysis in Indonesia.

PURPOSE: The purpose of this study was to understand the influence of demographic and psychological factors on self-management behaviors and interdialytic weight gain (IDWG) as a fluid adherence marker among patients undergoing hemodialysis in Indonesia. DESIGN: A quantitative correlational study. METHOD: A convenience sample of 145 patients undergoing hemodialysis was recruited from the dialysis units in two hospitals in Jakarta from September to December 2015. Questionnaires were used to examine self-management behaviors, depression, anxiety, and stress. Data for IDWG were obtained by subtracting the individual's predialysis weight from his or her postdialysis weight from the previous session. Hierarchical multiple linear regression identified the predictors of IDWG. RESULTS: Self-advocacy was ranked the least performed self-management behavior, while medication adherence was ranked the most likely to be performed. Among the subscales of the Self-Management Behavior Indices, positive correlations were found between the communication dimension with all psychological factors (depression, anxiety, and stress), while self-advocacy had positive correlation with anxiety. Subjects gained a mean of 4.5% of their postdialysis weight, with over 50% exceeding the recommended 4% IDWG. Overall, 53.6% of the IDWG was explained by the weekly duration of hemodialysis, level of depression, communication, partnership in care, and self-advocacy. CONCLUSIONS: Self-management behaviors are potential predictors that can be modified by nephrology nurses in order to enhance clinical outcomes, with the specific outcome being IDWG. Self-management behaviors contribute to the promotion of appropriate IDWG. Depressed patients are less likely to adhere to weight gain restrictions. CLINICAL RELEVANCE: Education combined with training in self-management behaviors-particularly communication, becoming a partner in care, and advocating for care-may improve adherence to IDWG guidelines among Indonesian hemodialysis patients. Interventions targeting depressed patients are needed.

The Mediating Role of Self-Efficacy in Shaping Self-Management Behaviors Among Adults With Type 2 Diabetes.

BACKGROUND: Self-efficacy, diabetes distress, knowledge, and education level are likely the important factors affecting diabetes self-management (DSM) behaviors. However, the theoretical mechanisms underlying these variables remain unclear. AIMS: The study aimed to test a model including variables of self-efficacy, diabetes distress, knowledge, and education level and DSM behaviors that were informed by social cognitive theory and the literature review among adults with type 2 diabetes. METHODS: A cross-sectional study design was employed. Among a convenience sample of 320 adults with type 2 diabetes, 265 eligible participants (response rate = 82.81%) were investigated, using the demographic information questionnaire, the Summary of Diabetes Self-Care Activities, the Self-Efficacy for Diabetes Scale, the Diabetes-Related Knowledge Questionnaire, and the Diabetes Distress Scale. Structural equation modeling was performed with 10,000 bootstrap samples using AMOS 23.0. RESULTS: The final model provided a good fit to the data (χ2 [22, N = 265] = 9.192, df = 5, p = .102, NFI = 0.972, RMSEA = 0.056). Self-efficacy had the strongest direct effect on DSM behaviors (ß = 0.550, p = .000). Knowledge (ß = 0.167, p = .004) and employment status (ß = -0.130, p = .009) had a direct effect on DSM behaviors. The association between knowledge and DSM behaviors was partially mediated by self-efficacy (bootstrap mean = 0.160, 95% CI: 0.088, 0.237), explaining 49.08% of the total effect of knowledge on DSM behaviors. The association between diabetes distress and DSM behaviors (bootstrap mean = -0.113, 95% CI: -0.192, -0.043) and education level and DSM behaviors (bootstrap mean = 0.102, 95% CI: 0.047, 0.165) were completely mediated by self-efficacy. CONCLUSIONS: Self-efficacy plays an important role in the mediation of the association between knowledge and DSM behaviors, diabetes distress and DSM behaviors, and education level and DSM behaviors, as well as a direct contributing role in the predication of DSM behaviors. LINKING EVIDENCE TO ACTION: Self-efficacy plays a direct contributing and mediating role in shaping DSM behaviors. The results of the model can help to develop evidence- and theory-based and culturally sensitive interventions. Strategies including goal setting, practicing, recording, peer models, persuasion, positive feedback, and encouragement can be used to address self-efficacy of patients. Interventions led by nurses that increase knowledge, reduce diabetes distress, and emphasize self-efficacy have the potential to promote changes in DSM behaviors.

Exploratory study of impact of cancer-related posttraumatic stress symptoms on diabetes self-management among cancer survivors.

OBJECTIVE: Posttraumatic stress symptoms (PTSS) can be triggered by a diagnosis of a potentially life-threatening illness such as cancer. Little is known about the impact of cancer-related PTSS symptoms on self-management behaviors for comorbid chronic medical conditions such as diabetes mellitus (DM). METHODS: We recruited patients with DM and a recent diagnosis of early-stage cancer from 2 medical centers in New York City. Cancer-related PTSS were assessed using the Impact of Events Scale (score ≥ 26). DM self-management behaviors (medication adherence, exercise, healthy diet, and glucose testing) were measured 3 months later. Logistic regression was used to assess the association between cancer-related PTSS symptoms and DM self-management behaviors, adjusting for gender, marital status, and anxiety symptoms. RESULTS: Of 56 participants recruited, 33% reported cancer-related PTSS symptoms. Elevated cancer-related PTSS symptoms were associated with lack of healthy diet (odds ratio: 0.08, 95% confidence interval: 0.01-0.62). CONCLUSIONS: Early-stage cancer survivors with cancer-related PTSS symptoms were less likely to adhere to some DM self-management behaviors. Providers should recognize the impact of cancer-related PTSS symptoms to better support comorbid disease management in cancer survivors.

Religiosity, Social Support and Care Associated with Health in Older Mexicans with Diabetes.

The main purpose of this study was to examine the relationships between religiosity, social support, diabetes care and control and self-rated health of people living in Mexico who have been diagnosed with diabetes. Structural equation modeling was used to examine these associations using the Mexican Health and Aging Study, a national representative survey of older Mexicans. Findings indicate that emotional support from one's spouse/partner directly affects diabetes care and control and health. Although there is no direct relationship between religiosity and health, religiosity was positively associated with diabetes care and control, but not significantly related to health.

The Impact of Stigma on Self-Management Behavior Among People with HIV in China: The Role of Social Support and Self-Esteem.

Understanding the psychosocial factors influencing self-management behaviors among people with HIV (PWH) is crucial for effective medical interventions and improving their quality of life. However, there has been limited research exploring the psychosocial mechanisms influencing self-management behaviors among PWH in China. Our study examined the relationship between stigma, social support, self-esteem, and self-management behaviors among PWH, as well as whether social support and self-esteem mediate these relationships. Cross-sectional data were collected from 282 PWH in Sichuan Province, China. Data were collected using four validated self-report measures (HIV Stigma Scale, HIV/AIDS Patient Self-Management Scale, Social Support Rating Scale, and Self-Esteem Scale). Structural equation modeling was used to examine the different pathways influencing self-management behaviors. All the impacts on self-management behavior outcomes were found to be significant. The final mediation model indicated that social support and self-esteem significantly mediated the relationship between stigma and self-management behaviors. These findings underscore the importance of addressing stigma and enhancing social support and self-esteem in interventions aimed at promoting self-management behaviors among PWH.

The relationship between hope level and self-management behaviors in Chinese patients with type 2 diabetes mellitus: a chain-mediated role of social support and disease perception.

BACKGROUND: Type 2 diabetes mellitus is a chronic disease and one of the fastest- growing global health emergencies of the 21st century. The relationships between hope level, social support, disease perception, and self-management behaviors are still unclear. Therefore, this study aimed to create a structural equation model to investigate the underlying mechanisms of self-management behaviors in patients with type 2 diabetes mellitus and provide a theoretical basis for future interventions. METHODS: By using cross-sectional studies and convenience sampling methods. A survey was conducted from June 2023 to April 2024 on 404 patients with type 2 diabetes mellitus at the First and Third Hospitals of Jinzhou Medical University. Data were collected using scales, including the General Information Questionnaire, the Herth Hope Scale, the Social Support Rating Scale, the Brief Disease Perception Questionnaire, and the Diabetes Self-Management Behavior Scale. Data were analyzed using descriptive analysis, Harman's one-way analysis of variance, Pearson's correlation test, structural equation modeling, and the bootstrap method to verify mediating effects. RESULTS: Correlation analyses showed that all four variables were significantly correlated with each other (p < 0.01). Social support had the strongest correlation with self-management behavior (ß = 0.554, p < 0.01), followed by hope level (ß = 0.543, p < 0.01), and disease perception (ß = -0.505, p < 0.01). The structural equation model indicated a strong overall fit (χ2/df = 3.378, GFI = 0.926, CFI = 0.924, IFI = 0.925, TLI = 0.903, RMSEA = 0.077). CONCLUSION: Overall, the chain mediation of social support and disease perception was significant. In developing targeted intervention strategies, future research should prioritize enhancing hope, optimizing social support, and reducing negative perceptions of disease by patients as key areas of focus. At the same time, strengthening self-management abilities and health behaviors in patients with type 2 diabetes should not be neglected.

The Role of Self-Efficacy Enhancement in Improving Self-Management Behavior for Type 2 Diabetes Mellitus Patients.

Background: The effectiveness of a self-efficacy-focused structured education program for patients with diabetes mellitus has been verified. However, changes in self-efficacy for the behavior change mechanism in patients who participated in the program require clarification. Aim: To analyze the mechanism of self-management behavioral variations in patients with type 2 diabetes mellitus who underwent a self-efficacy-focused structured education program. Methods: A secondary analysis of patients who received a self-efficacy-focused structured education program was conducted using data from a multicenter randomized controlled trial. The relationships among the 3-, 6-, and 12-month changes in diabetes knowledge, self-efficacy, diabetes distress, and self-management behaviors in patients with type 2 diabetes mellitus were studied using a structural equation model. Results: Enhancement of self-efficacy among patients receiving a self-efficacy-focused structured education program directly influenced improvements in self-management behaviors at 3, 6 and 12 months. The increase in diabetes knowledge directly and indirectly improved self-management behaviors at 3 months, but the direct effect on behavior disappeared at 6 months and the indirect effect on behavior by enhancing self-efficacy only lasted until 6 months. The decrease in diabetes distress directly influenced improvement in self-management behaviors at 3 months. While it did not directly influence self-management behavior improvement at 6 and 12 months, it indirectly affected behavior improvement by enhancing self-efficacy. Conclusion: The enhancement of self-efficacy plays a core role in improving and maintaining self-management behaviors in patients with type 2 diabetes mellitus who receive self-efficacy-focused structured education programs. Patients' behaviors can be improved by gaining more diabetes knowledge and mitigating diabetes distress at the 3- and 6-month follow-up. Improvements in behaviors at the 12-month follow-up could be achieved by mitigating diabetes distress.

Psychological Factors Motivating Male Japanese Workers With Type 2 Diabetes to Engage in Dietary Modifications: A Qualitative Descriptive Study.

Introduction: Japanese men with type 2 diabetes mellitus (T2DM) usually encounter work-related difficulties when engaging in dietary modifications. Hence, healthcare providers must understand the psychological factors, such as the needs and goals, that motivate them to engage in dietary modifications. Objective: We aimed to describe the psychological factors motivating male Japanese workers with T2DM to engage in dietary modifications. Methods: Using a qualitative descriptive design, we conducted semi-structured interviews with 11 male Japanese workers with T2DM and identified categories based on semantic differences using qualitative content analysis. Results: The following eight categories emerged: (I want to) demonstrate my skills at work, be able to engage in dietary modifications on my own, avoid unpleasant symptoms caused by eating, avoid burdensome treatment, maintain my healthy life, get positive results in medical examinations, maintain my relationships with others, and enjoy healthy food. Conclusion: The factors motivating the participants to engage in dietary modifications were realistic and sincere desires rooted in their ideal lives. Their desire to prioritize work emerged as an important factor. Healthcare providers should identify an individual's ideal daily life, including work aspects, and encourage individuals to set realistic and valuable goals.

Effects of message framing on self-management behaviour among patients with type 2 diabetes: a randomised controlled trial protocol.

INTRODUCTION: Accumulating evidence has indicated successful diabetes health education can potentially help to improve blood sugar levels in people with diabetes. However, with a rapid rise in the number of people with diabetes cases and the increasing burden on healthcare, it is often difficult for healthcare providers to find suitable time to provide health education to meet their needs. Thus, more novel and effective ways are needed to conduct education. The message frame provides a new perspective for implementation of a more effective health education in the form of changing information presentation, and the same objective content is described in either positive or negative language or outcomes. Gain framing emphasises the positive consequences of adhering to useful recommendations, while loss framing highlights the negative consequences of the non-adherence. The purpose of our research is to potentially explore the effectiveness of diabetes education based on message framing on the self-management behaviour. METHODS AND ANALYSIS: A single-blind, three-arm randomised controlled trial involving 84 participants will be conducted. The participants will be assigned into three groups randomly in a 1:1:1 ratio and will receive 12-week intervention. Patients in group 1 will be provided gain framing education videos about the self-management skills for type 2 diabetes, patients in group 2 will be given education videos based on loss framing and patients in group 3 will receive education with no specific message framing. The primary outcome is self-management behaviour. The secondary outcomes will be self-efficacy, patient activation, diabetes-related knowledge and attitude, quality of life and blood glucose level. All outcomes will be measured at baseline and 12 weeks. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of School of Nursing, Jilin University (No. 2020101501). The research results will be published in peer-reviewed publications and presented in international conferences. TRIAL REGISTRATION NUMBER: ChiCTR 2100045772; Pre-results.

Factors associated with self-management behaviors of patients with chronic obstructive pulmonary disease.

AIMS: To examine self-management behaviors level and discuss the associated factors among chronic obstructive pulmonary disease (COPD) patients. METHODS: A descriptive study design was used. A convenience sample of 124 COPD patients was recruited from three hospitals in Fuzhou. Self-management Behaviors, Social Support Rating Scale and The Family APGAR Score were used to collect data. Descriptive statistics, one-way analysis of variance (ANOVA), Pearson correlation and multiple linear regression were used for data analysis. RESULTS: The overall score of self-management behaviors ranged 4-41, with a mean score of 21.26 ± 7.72. Pearson correlation analyses and ANOVA revealed that age, course of disease, education, marital status, family function, subjective support, objective support, and availability of support were positively correlated with overall self-management behaviors (p < .05). Multiple linear regression analyses revealed that subjective support and availability of support significantly predicted self-management behaviors. CONCLUSIONS: The level of self-management behaviors of COPD patients was suboptimal. We suggest that people in the patients' social network should provide support for them, and help them use available resources to improve the level of self-management behaviors.

Applying A Biopsychosocial Framework to Achieve Durable Behavior Change in Kidney Disease.

Chronic disease self-management is the establishment and maintenance of behaviors needed to be an active participant in one's health care and experience the best health outcomes. Kidney disease self-management behaviors to slow disease progression include engaging in exercise or physical activity; adhering to a diet low in sodium, potassium, and phosphorus; monitoring laboratory parameters; managing complex medication regimens; coping with disease-related emotional distress; and communicating effectively with providers. Durable behavior change has been difficult to achieve in kidney disease, in part because of an incomplete understanding of the multilevel factors determining chronic disease self-management in this patient group. The biopsychosocial model of chronic illness care posits that an individual's health outcomes result from biological, psychological, social, and environmental factors as part of a multilevel systems hierarchy. Although this theoretical model has been used to comprehensively identify factors driving self-management in other chronic conditions, it has been applied infrequently to behavioral interventions in kidney disease. In this scoping review, we apply the biopsychosocial model of health to identify individual, interpersonal, and systems-level drivers of kidney disease self-management behaviors. We further highlight factors that may serve as novel, impactful targets of theory-based behavioral interventions to understand and sustain behavior change in kidney disease.

The Association of Mobile Health Applications with Self-Management Behaviors among Adults with Chronic Conditions in the United States.

BACKGROUND: Mobile applications related to health and wellness (mHealth apps) are widely used to self-manage chronic conditions. However, research on whether mHealth apps facilitate self-management behaviors of individuals with chronic conditions is sparse. We aimed to evaluate the association of mHealth apps with different types of self-management behaviors among patients with chronic diseases in the United States. METHODS: This is a cross-sectional observational study. We used data from adult participants (unweighted n = 2340) of the Health Information National Trends Survey in 2018 and 2019. We identified three self-management behaviors: (1) resource utilization using electronic personal health records; (2) treatment discussions with healthcare providers; and (3) making healthcare decisions. We analyzed the association of mHealth apps to self-management behaviors with multivariable logistic and ordinal regressions. RESULTS: Overall, 59.8% of adults (unweighted number = 1327) used mHealth apps. Adults using mHealth apps were more likely to use personal health records (AOR = 3.11, 95% CI 2.26-4.28), contact healthcare providers using technology (AOR = 2.70, 95% CI 1.93-3.78), and make decisions on chronic disease management (AOR = 2.59, 95% CI 1.93-3.49). The mHealth apps were associated with higher levels of self-management involvement (AOR = 3.53, 95% CI 2.63-4.72). CONCLUSION: Among individuals with chronic conditions, having mHealth apps was associated with positive self-management behaviors.

Social Engagement and Urban-Rural Disparity in Self-Management Behaviors: Study of Middle-Aged and Older Chinese Hypertension Patients.

BACKGROUND: This study examines the effect of social engagement on urban-rural disparities in self-management behaviors (medication use, self-monitoring, physical activity, and tobacco and alcohol avoidance) among middle-aged and older Chinese patients with hypertension. METHODS: Data from 2011 to 2018 were extracted from the four latest waves of the China Health and Retirement Longitudinal Study. Chi-square tests and t-tests were performed to examine urban-rural gaps in self-management behaviors. Random-effects panel logit regression models were adopted to confirm the effect of social engagement on urban-rural disparity in self-management behaviors and to explore whether this effect has narrowed or widened with "bilateral flow" between urban and rural residents. A Fairlie decomposition technique was also used to calculate the extent to which social engagement reflects urban-rural disparities. RESULTS: There was significant urban-rural disparity in medication use and tobacco avoidance behaviors among the sampled patients. Medication use behavior (p < 0.001) among urban middle-aged and older patients was significantly better, whereas tobacco avoidance behavior (p < 0.05) was significantly lower compared with the rural population. Social engagement significantly enlarged the urban-rural gap in tobacco avoidance behavior (p < 0.01), but significantly narrowed the urban-rural gap in medication use behavior (p < 0.001). The Fairlie decomposition revealed that ~75.000% and 29.412% of the explained urban-rural gap in tobacco avoidance and medication use, respectively, could be attributed to social engagement. The negative effect of social engagement on urban-rural disparity in medication use increased when urban residents moved to rural areas (p < 0.05). CONCLUSIONS: The urban-rural disparities in self-management behaviors of middle-aged and older Chinese hypertensive patients were mainly manifested in medication use and tobacco avoidance behaviors. The gaps in these two behaviors partly changed with social engagement, while the migration of urban population to rural areas weakens the positive role of social engagement in narrowing the urban-rural gap in medication use behavior. The insights of this paper on social engagement and urban-rural disparity in self-management behaviors, and the effect of urban-rural migration thereof, deserve the attention of health policymakers and researchers.