Application value of DSMB-O scale in self-management of elderly patients with type 2 diabetes mellitus.

BACKGROUND: To enhance the self-management ability of elderly diabetes mellitus (DM) patients, priority should be given to the accurate evaluation of their current self-management ability, and then provide corresponding guidance. OBJECTIVE: To explore the application value of Diabetes Self-Management Behaviors among Older Koreans (DSMB-O) in self-management of elderly patients with type 2 diabetes mellitus (T2DM). METHODS: Using convenient sampling, this study retrospectively collected the clinical data of 215 elderly patients with T2DM who were admitted to our hospital from June 2020 to June 2022. Enrolled patients were divided into an effective-control group (n= 80) and an ineffective-control group (n= 135) based on whether the glycated hemoglobin (HbA1C) was < 7.5% for further comparison of the collected data. RESULTS: There were statistically significant differences in the comparison of the proportion of diabetes mellitus (DM) course (χ2= 26.000, P< 0.001), DSMB-O score (17.67 ± 4.07 VS 14.67 ± 4.70 points, t= 4.582, P< 0.001), and Summary Diabetes Self Care Activity (SDSCA) score (43.16 ± 11.17 VS 37.58 ± 12.47 points, t= 5.492, P< 0.001) between the two groups. The total score of DSMB-O was negatively correlated with both HbA1c (r=-0.281, P< 0.001) and complications (r=-0.193, P= 0.004); moreover, the total score of SDSCA was also negatively correlated with both HbA1c (r=-0.234, P< 0.001) and complications (r=-0.153, P= 0.025). Among various dimensions of DSMB-O, active exercise (OR= 0.699, 95%CI: 0.541 ∼ 0.902) and blood glucose monitoring (OR= 0.603, 95%CI: 0.431 ∼ 0.817) were protective factors for T2DM patients with HbA1c levels < 7.5%. The area under the curve (AUC) of SDSCA score and DSMB-O score predicting self-management level in elderly T2DM patients was 0.643 (95%CI: 0.611 ∼ 0.756) and 0.716 (95%CI: 0.689∼ 0.774), respectively. CONCLUSION: DSMB-O exhibits a higher accuracy in predicting the self-management level of elderly patients with T2DM than that of SDSCA. Regular exercise, medication, blood glucose monitoring, and reducing the risk of complications are all intimately associated with the control of blood glucose.

Does integrated health management within a county medical consortium improve rural type 2 diabetic patients' self-management behavior and quality of life? An empirical analysis from Eastern China.

BACKGROUND: Levels of self-management behaviors (SMB) and quality of life (QoL) are suboptimal in Chinese adults with type 2 diabetes (T2D), especially in rural China. Integrated health management within a county medical consortium, featuring multi-level teams of doctors, nurses, and other professionals offering follow-up services such as check-ups, assessments, treatment, and health education, is promising in improving this. This study aimed to assess the effect of integrated health management within a county medical consortium on the SMB and QoL of rural T2D patients in China. METHODS: Based on a survey conducted on the county medical consortium in Eastern China, this study initially employed propensity score matching (PSM), a nonparametric technique, to precisely estimate the average treatment effect on the treated (ATT) of integrated health management on SMB and QoL in rural T2D patients. Subsequently, quantile regression was also performed to estimate the relationship between the implementation of integrated health management, sociodemographic factors, follow-up services (offered during integrated health management) and both SMB and QoL. RESULTS: The ATT values for SMB and QoL, representing the net effect of integrated health management within a county medical consortium on SMB and QoL, were significantly positive. They ranged from 4.34 to 4.67 for SMB and from 0.89 to 1.06 for QoL, respectively, based on the four different PSM modalities. The results of quantile regression also revealed a statistically significant positive association between the implementation of integrated health management and both SMB (coef. = 4.15) and QoL (coef. = 1.54). These findings suggest that integrated health management within a county medical consortium can effectively improve SMB and QoL in rural T2D patients. Furthermore, frequency of follow-up service and health behavior guidance were positively associated with SMB and QoL. Conversely, on-call follow-up services, medication guidance and follow-up services at medical institutions were negatively correlated with SMB or QoL. CONCLUSIONS: The study highlights the effectiveness of integrated health management within a county medical consortium in improving SMB and QoL among individuals with T2D in rural China. The findings offer invaluable insights for the advancement of chronic disease management in rural areas of developing countries.

A qualitative study on inner experience of self-management behavior among elderly patients with type 2 diabetes in rural areas.

BACKGROUND: As a chronic metabolic disease, diabetes poses a serious threat to human health and has become a major public health problem in China and worldwide. In 2020, 30% of Chinese people (aged ≥ 60 years) reported having diabetes mellitus. Moreover, individuals with diabetes living in rural areas face a significantly higher mortality risk compared to those in urban areas. In this study, we explored the inner experience of self-management behaviors in elderly patients with type 2 diabetes in rural areas to inform targeted interventions. METHODS: A phenomenological research design was used to explore the inner experience of self-management in rural elderly diabetes. Ten elderly diabetic patients were sampled from December 2022 to March 2023 in rural areas of Yangcheng County, Jincheng City, ShanXi Province, China. The seven-step Colaizzi phenomenological was used to analyze the interview data and generate themes. RESULTS: Four themes emerged: "Insufficient self-management cognition", "Negative self-management attitude", "Slack self-management behavior", and "No time for self-management". CONCLUSION: The level of self-management among elderly patients with type 2 diabetes in rural areas is low. Healthcare professionals should develop targeted interventions aimed at enhancing their cognitive levels, modifying their coping styles, and improving their self-management abilities to improve their quality of life.

The mediating role of hope in the relation between uncertainty and social support with self-management among patients with ESKD undergoing hemodialysis.

BACKGROUND: Self-management behaviours are critical for patients requiring regular hemodialysis (HD) therapy. This study aimed to test the relationship between social support, uncertainty and self-management among HD patients and to explore whether hope plays a mediating role. METHODS: In a cross-sectional study, a convenience sample of 212 HD patients from two hospitals completed the Perceived Social Support Scale (PSSS), Herth Hope Index (HHI), Short form Mishel Uncertainty in Illness Scale (SF-MUIS), and hemodialysis Self-Management Instrument (HD-SMI). Data were analysed using structural equation modelling. RESULTS: The main finding indicated that social support positively affected self-management (ß = 0.50, t = 4.97, p < 0.001), and uncertainty negatively affected self-management (ß =-0.37, t=-4.12, p = < 0.001). In mediational model analysis, the effect of social support on self-management was fully mediated [(ß = 0.12; 95% BC CI (0.047, 0.228)] by hope. Also, the effect of uncertainty on self-management was fully mediated [(ß=- 0.014; 95% BC CI (-0.114, -0.003)] by hope. CONCLUSIONS: "Considering factors influencing self-management in HD patients is crucial for improving quality of life. Receiving support and informational resources can not only foster hope but also reduce their uncertainty, thus aiding in enhancing clinical outcomes, quality of life, and reducing complications. "Health care providers, especially nurses were advised to accept the existence of uncertainty, help patients make optimal use of support resources, and give more importance to disambiguation to reassure them. Therefore, well-designed interventions that enhance social support and hope and reduce uncertainty may help improve self-management behaviour in HD patients.

FREE: A randomized controlled feasibility trial of a cognitive behavioral therapy and technology-assisted intervention to reduce fear of hypoglycemia in young adults with type 1 diabetes.

OBJECTIVE: The purpose of this study was to test the preliminary effectiveness of a cognitive behavioral therapy intervention (Fear Reduction Efficacy Evaluation [FREE]) designed to reduce fear of hypoglycemia in young adults with type 1 diabetes. The primary outcome was fear of hypoglycemia, secondary outcomes were A1C, and glycemic variability. METHODS: A randomized clinical trial was used to test an 8-week intervention (FREE) compared to an attention control (diabetes education) in 50 young adults with type 1 diabetes who experienced fear of hypoglycemia at baseline. All participants wore a continuous glucose monitor for the 8-week study period. Self-reported fear of hypoglycemia point-of-care A1C testing, continuous glucose monitor-derived glucose variability were measured at baseline, Week 8, and Week 12 (post-program). RESULTS: Compared to controls, those participating in the FREE intervention experienced a reduction in fear of hypoglycemia (SMD B = -8.52, p = 0.021), change in A1C (SMD B = 0.04, p = 0.841) and glycemic variability (glucose standard deviation SMD B = -2.5, p = 0.545) by the end of the intervention. This represented an 8.52% greater reduction in fear of hypoglycemia. CONCLUSION: A cognitive behavioral therapy intervention (FREE) resulted in improvements in fear of hypoglycemia. CLINICALTRIALS: govNCT03549104.

Daily Functioning of Veterans With Type 2 Diabetes: Protocol for an Ambulatory Assessment Study.

BACKGROUND: Diabetes impacts nearly 25% of veterans. Many veterans do not engage in recommended physical activity and other diabetes self-management behaviors. Type 2 diabetes is generally asymptomatic; as such, the long-term consequences of inadequate self-management and benefits of consistent self-management are not salient in the short term. Furthermore, self-management behaviors typically take place outside of medical visits; however, self-management-related factors are only assessed during medical visits, likely missing large amounts of variability. Thus, ambulatory assessment methods such as ecological momentary assessment (EMA), accelerometry, and continuous glucose monitoring are needed to understand the dynamics of daily self-management and identify potential intervention targets. OBJECTIVE: The overarching goal of this study is to understand daily, time-varying factors (comorbid affective symptoms and social context) that influence physical activity, diabetes self-management, glycemic management, daily functioning, and quality of life in participants' natural environments. METHODS: We are recruiting veterans with type 2 diabetes (target N=100). Participants are required to complete a battery of baseline assessments related to mental health, psychosocial factors, and self-management behaviors. Participants then receive 5 momentary EMA surveys and 1 daily EMA survey per day, in which veterans report comorbid affective symptoms (mood, stress, and pain), social support, social interactions, physical activity, and other self-management behaviors. Momentary surveys are delivered randomly during daily preprogrammed intervals over a 14-day sampling period. Accelerometry and continuous glucose monitoring are also used to assess physical activity and blood glucose, respectively. The first 6 participants also completed interviews assessing their experience in the study and barriers to participation. These test participants informed modifications to the protocol for the remaining participants. RESULTS: The project received funding in April of 2023. Enrollment began in March of 2023 and is planned to be completed in April 2025. Among the 6 test participants, the overall EMA response rate was 87% (range 74%-95%). The response rate for the EMA survey including daily items (67%, range 21%-93%) was lower than the earlier shorter EMA surveys (89%, range 81%-96%). The mean rate of valid accelerometer wear of at least 20 hours per day was 93% (SD 11%), and continuous glucose monitoring data were available for 91% (SD 17%) of days on average. Participants reported few barriers to completing EMA surveys but noted the random timing of questions made it difficult to plan around, and the end-of-day survey was long. Two participants reported survey items reminded or motivated them to engage in diabetes self-management behaviors. CONCLUSIONS: Assessment tools developed from this study can inform clinical decision-making by considering barriers to self-management that occur in daily life. Clinical applications include tailored, adaptive technology-supported interventions to improve self-management that provide the right type and amount of support at the right time by adapting to an individual's changing internal and contextual state. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53874.

Application of protection motivation theory in epidemic prevention in patients with respiratory diseases under the COVID-19 pandemic: A cross-sectional study.

OBJECTIVE: This study aimed to investigate the effects of nursing intervention based on protection motivation theory (PMT) on patients with respiratory diseases in the context of the Coronavirus Disease 2019 (COVID-19) pandemic. METHODS: A total of 74 patients with respiratory diseases who were hospitalized from June 2020 to February 2021 were enrolled and stratified into a control group (n = 37) and an experimental group (n = 37) according to a stratified random sampling method. The control group adopted a routine nursing intervention program of the respiratory department, whereas the experimental group received a PMT-based nursing intervention program on the basis of the control group. Chronic Disease Self-Management Study Measures (CDSMS) and Self-Efficacy for Managing Chronic Diseases 6-item Scale (SECD6) were used to evaluate the effect of PMT intervention before intervention, after 1 week, and after 4 weeks of intervention. The levels of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC and peak expiratory flow (PEF) were measured to evaluate pulmonary function. RESULTS: Before the intervention, there were no significant differences in the scores of CDSMS and SECD6 scales and liver function indexes between the two groups (p > 0.05). After 1 and 4 weeks of intervention, the scores of CDSMS and SECD6 scales of the experimental group were significantly higher than those of the control group (p < 0.0001). The indexes of pulmonary function of the experimental group were improved, but there was no significant difference compared with the control group (p > 0.05). CONCLUSION: Nursing intervention based on PMT contributes to the improvement of self-management behaviors and self-efficacy, which is conducive to the prognoses of patients.

[Mediating effect of self-efficacy on self-management ability and self-management behavior in patients with type 2 diabetes mellitus].

OBJECTIVE: To investigate the mechanism of self-efficacy between self-management ability and self-management behavior and its differences among patients with different disease courses through mediation tests. METHODS: In the study, 489 patients with type 2 diabetes who attended the endocrinology departments of four hospitals in Shanxi Province and Inner Mongolia Autonomous Region from July to September 2022 were enrolled as the study population. They were investigated by General Information Questionnaire, Diabetes Self-Management Scale, Chinese version of Diabetes Empowerment Simplified Scale, and Diabetes Self-Efficacy Scale. Mediation analyses were performed using the linear regression model, Sobel test, and Bootstrap test in the software Stata version 15.0 and divided the patients into different disease course groups for subgroup analysis according to whether the disease course was > 5 years. RESULTS: In this study, the score of self-management behavior in the patients with type 2 diabetes was 6.16±1.41, the score of self-management ability was 3.99±0.74, and the score of self-efficacy was 7.05±1.90. The results of the study showed that self-efficacy was positively correlated with self-management ability (r=0.33) as well as self-management behavior (r=0.47) in the patients with type 2 diabetes (P < 0.01). The mediating effect of self-efficacy accounted for 38.28% of the total effect of self-management ability on self-management behaviors and was higher in the behaviors of blood glucose monitoring (43.45%) and diet control (52.63%). The mediating effect of self-efficacy accounted for approximately 40.99% of the total effect for the patients with disease course ≤ 5 years, while for the patients with disease course > 5 years, the mediating effect accounted for 39.20% of the total effect. CONCLUSION: Self-efficacy enhanced the effect of self-management ability on the behavior of the patients with type 2 diabetes, and this positive effect was more significant for the patients with shorter disease course. Targeted health education should be carried out to enhance patients' self-efficacy and self-management ability according to their disease characteristics, to stimulate their inner action, to promote the development of their self-management behaviors, and to form a more stable and long-term mechanism for disease management.

Associations Between Self-Management Behaviors and Psychological Resilience in Patients With COPD.

BACKGROUND: COPD is a common but irreversible disease. Nevertheless, patients with COPD can maintain good quality of life through psychological resilience and effective self-management. However, limited studies have investigated the relationship between self-management behaviors and resilience in patients with COPD. Thus, the present study aimed to determine the factors associated with self-management behaviors and resilience among patients with COPD. METHODS: A total of 100 subjects with COPD were recruited from a medical center in northern Taiwan from February 2020 to January 2021. Each subject completed a questionnaire based on the 20-item COPD Self-Management Scale and 25-item Resilience Scale through a face-to-face interview. A multiple linear regression model that controlled for sociodemographic and clinical factors was used to examine the relationship between self-management behaviors and resilience. RESULTS: Analysis of our data indicated that differences in educational level, smoking status, religion, modified Medical Research Council dyspnea scale score, degree of COPD impacting wellbeing, number of COPD-related hospitalizations within 1 year, and self-reported comorbidities were associated with differences in self-management and resilience scores. The GOLD (Global Initiative for Chronic Obstructive Lung Disease) D group had the lowest scores for self-management and resilience among GOLD groups A, B, C, and D. Self-management and resilience were positively correlated (r = 0.703, P < .001). In the linear regression model, a better self-management value was associated with a higher resilience score (ß = 0.749, P < .001), whereas an increasing resilience score was also associated with a better self-management score (ß = 0.461, P < .001). CONCLUSIONS: This study revealed that self-management and psychological resilience were positively correlated and associated in our linear regression model. Future work may focus on finding the causative relationship between self-management and resilience among patients with COPD.

Metabolic Syndrome-Related Knowledge, Attitudes, and Behavior among Indigenous Communities in Taiwan: A Cross-Sectional Study.

BACKGROUND: Metabolic syndrome is characterized by cardiovascular and chronic disease risk factors that cause health problems. Inequalities in medical resources and information present a challenge in this context. Indigenous communities may be unaware of their risk for metabolic syndrome. AIMS: This study explored factors associated with metabolic syndrome-related knowledge, attitudes, and behaviors among Taiwanese indigenous communities. METHODS: For this descriptive cross-sectional survey, we collected anthropometric data and used a self-administered questionnaire between 1 July 2016, to 31 July 2017, from a convenience sample of an indigenous tribe in eastern Taiwan. The response rate was 92%. RESULTS: The prevalence of metabolic syndrome was as high as 71%, and the average correct knowledge rate was 39.1%. The participants' self-management attitudes were mainly negative, and the self-management behaviors were low in this population. Stepwise regression analysis showed that knowledge, attitude, age, perception of physical condition, and body mass index, which accounted for 65% of the total variance, were the most predictive variables for self-management behaviors. CONCLUSIONS: This is the first study to report the relationship between metabolic syndrome knowledge, attitudes, and behaviors in an indigenous population. There is an urgent need to develop safety-based MetS health education programs that can provide access to the right information and enhance self-management approaches to lessen the growing burden of MetS in indigenous communities.

Determinants associated with self-management behavior among type 2 diabetes patients in China: A structural equation model based on the theory of planned behavior

Background: Diabetes self-management (DSM) is essential for patients to achieve better health outcomes. However, previous studies have demonstrated that the performance of DSM is not optimal. This study was designed to identify the significant determinants of self-management behavior in type 2 diabetes(T2DM) patients to improve DSM. Method: A convenient sampling method was employed in this study. Data were collected from a community health center from January to February 2021 in Nanjing city, China. A total of 431 patients completed the self-administered questionnaires. A structural equation model based on the theory of planned behavior(TPB) was adopted for analysis. Results: TPB model presents excellent goodness of fit of data. Attitude (β=0.161, P < 0.01), subjective norms (SN) (β=0.239, P < 0.001), and perceived behavior control (PBC) (β=0.197, P < 0.001) were strong predictors of intention. Intention (β=0.230, P < 0.001) and PBC (β=0.259, P < 0.001) had a direct effect on self-management behavior. The impact of attitude and SN on behavior was significantly mediated via behavioral intention. Conclusion: The application of TPB to self-management behavior in T2DM patients can significantly enhance our understanding of theory-based self-management behavior. This predictive model could potentially be a valuable tool and provide a feasible approach for formulating more targeted and population-specific DSM interventions in future research. (AU)

Factors influencing self-management behavior during the "Blanking Period" in patients with atrial fibrillation: A cross-sectional study based on the information-motivation-behavioral skills model.

BACKGROUND: Atrial fibrillation (AF) is becoming increasingly common. Effective self-management during the "Blanking Period" is critical. The Information-Motivation-Behavioral skills (IMB) model can be used to study health behaviors in chronic disease patients, but it has not been studied in AF patients. OBJECTIVE: The goal of this study was to explore the influencing factors and interaction pathways of self-management behavior in AF patients during the "Blanking Period" using the IMB model. METHODS: From June to December 2021, a cross-sectional design was conducted. Patients with AF during the "Blanking Period" (N=220) were recruited. They filled out several quantitative questionnaires, including the Jessa Atrial Fibrillation Knowledge Questionnaire, the Confidence in Atrial Fibrillation Management Scale, the Perceived Social Support Scale, the All Aspects of Health Literacy Scale, and the Self-care Scale for Chronic Atrial Fibrillation Patients. Data were analyzed using correlation analysis, multiple regression analysis, and path analysis. RESULTS: Total score of self-management behavior was (33.83 ± 10.66). AF knowledge (ß = 0.252, P < 0.001), self-management confidence (ß = 0.219, P < 0.001), social support (ß = 0.291, P < 0.001), and health literacy (ß = 0.262, P < 0.001) were all positively correlated with patients' self-management behavior, accounting for 66.50 percent of the total variance. CONCLUSIONS: During the "Blanking Period", the IMB model can be used to predict the factors that influence self-management behavior in AF patients. By using IMB model, interventions targeting patient-specific influencing factors could improve self-management behavior and quality of life in AF patients.

Determinants associated with self-management behavior among type 2 diabetes patients in China: A structural equation model based on the theory of planned behavior.

Background: Diabetes self-management (DSM) is essential for patients to achieve better health outcomes. However, previous studies have demonstrated that the performance of DSM is not optimal. This study was designed to identify the significant determinants of self-management behavior in type 2 diabetes(T2DM) patients to improve DSM. Method: A convenient sampling method was employed in this study. Data were collected from a community health center from January to February 2021 in Nanjing city, China. A total of 431 patients completed the self-administered questionnaires. A structural equation model based on the theory of planned behavior(TPB) was adopted for analysis. Results: TPB model presents excellent goodness of fit of data. Attitude (ß=0.161, P < 0.01), subjective norms (SN) (ß=0.239, P < 0.001), and perceived behavior control (PBC) (ß=0.197, P < 0.001) were strong predictors of intention. Intention (ß=0.230, P < 0.001) and PBC (ß=0.259, P < 0.001) had a direct effect on self-management behavior. The impact of attitude and SN on behavior was significantly mediated via behavioral intention. Conclusion: The application of TPB to self-management behavior in T2DM patients can significantly enhance our understanding of theory-based self-management behavior. This predictive model could potentially be a valuable tool and provide a feasible approach for formulating more targeted and population-specific DSM interventions in future research.

Effect of Triangle hierarchical management among community patients with hypertension / 预防医学

Objective@#To evaluate the effect of Triangle hierarchical management among community patients with hypertension, so as to provide insights into the improvements of standardized hypertension management.@*Methods@#Patients with newly diagnosed hypertension from 2 community health service centers in Qiantang District of Hangzhou City by the end of 2020 were randomly assigned to the conventional group and the Triangle group. Patients in the conventional group were given health management services according to the requirements of basic public health service standard for one year, while patients in the Triangle group were given Triangle hierarchical management. The blood pressure, self-management behaviors, treatment compliance, smoking, alcohol consumption and exercise were collected using the self-management behavior scale, treatment compliance scale and self-designed questionnaires, and were compared before and after intervention with analysis of covariance and generalized estimation equations.@*Results@#Totally 200 patients with hypertension were recruited, including 100 patients in the conventional group and 100 patients in the Triangle group. There were no significant differences between the two groups before implementation of interventions in terms of gender, age, educational level or occupation (P>0.05). The reduction in blood pressure, increase in the score of treatment, diet, exercise and living habitat management and the total score of self-management behaviors, increase in the score of adherence to medication regimens, daily living management behaviors, smoking and alcohol consumption preference and the total score of treatment compliance, and increase in the number of patients with normal standard of quitting smoking, quitting alcohol consumption, exercise and blood pressure were significantly higher in the Triangle group than in the conventional group after intervention (P<0.05). @*Conclusions @#Triangle hierarchical management may increase the treatment compliance, improve the self-management behavior and facilitate hypertension control among hypertensive patients, which may be popularized for health management among community patients with hypertension.

Mediating effect of self-efficacy on self-management ability and self-management behavior in patients with type 2 diabetes mellitus / 北京大学学报(医学版)

OBJECTIVE@#To investigate the mechanism of self-efficacy between self-management ability and self-management behavior and its differences among patients with different disease courses through mediation tests.@*METHODS@#In the study, 489 patients with type 2 diabetes who attended the endocrinology departments of four hospitals in Shanxi Province and Inner Mongolia Autonomous Region from July to September 2022 were enrolled as the study population. They were investigated by General Information Questionnaire, Diabetes Self-Management Scale, Chinese version of Diabetes Empowerment Simplified Scale, and Diabetes Self-Efficacy Scale. Mediation analyses were performed using the linear regression model, Sobel test, and Bootstrap test in the software Stata version 15.0 and divided the patients into different disease course groups for subgroup analysis according to whether the disease course was > 5 years.@*RESULTS@#In this study, the score of self-management behavior in the patients with type 2 diabetes was 6.16±1.41, the score of self-management ability was 3.99±0.74, and the score of self-efficacy was 7.05±1.90. The results of the study showed that self-efficacy was positively correlated with self-management ability (r=0.33) as well as self-management behavior (r=0.47) in the patients with type 2 diabetes (P < 0.01). The mediating effect of self-efficacy accounted for 38.28% of the total effect of self-management ability on self-management behaviors and was higher in the behaviors of blood glucose monitoring (43.45%) and diet control (52.63%). The mediating effect of self-efficacy accounted for approximately 40.99% of the total effect for the patients with disease course ≤ 5 years, while for the patients with disease course > 5 years, the mediating effect accounted for 39.20% of the total effect.@*CONCLUSION@#Self-efficacy enhanced the effect of self-management ability on the behavior of the patients with type 2 diabetes, and this positive effect was more significant for the patients with shorter disease course. Targeted health education should be carried out to enhance patients' self-efficacy and self-management ability according to their disease characteristics, to stimulate their inner action, to promote the development of their self-management behaviors, and to form a more stable and long-term mechanism for disease management.

Preferring self-management behavior of patients with chronic kidney disease.

This study explores the preferred behavior of self-management among chronic kidney disease (CKD) patients and offers suggestions for different patients from personalized medicine. According to some related references, a questionnaire was designed in 2020 to collect data from 131 patients with CKD in a general hospital. The Sampling patients showed no difference in their disease progress. The questionnaire covered two aspects of demographic and behavior with 29 items on six dimensions. Statistical methods such as a descriptive analysis of the F test in behavior dimensions on demographic characteristics and Principal component analysis from items have been applied to classify some kinds of self-management behavior into different groups. In the demographic insight, employment status closely relates to self-management behavior, and income is insignificant. In the behavior aspects, according to some key items, we found four types of self-management behavior preferred in the sorting: cognitive-knowledge, Diet-exercise-medical, emotion management, and exercise-medical, which were defined by behavior dimensions. Although patients had the same disease progress, their self-management behavior mainly existed in four types based on critical factors. According to their favorite behavior and personality group, healthcare stakeholders can offer lean support for improving patients' self-management of CKD in China.

Factors Influencing Self-Management Behaviors among Hemodialysis Patients.

AIM: To investigate the factors affecting hemodialysis patients' self-management ability at a dialysis center in Taiwan. BACKGROUND: Taiwan has the highest incidence and prevalence of end-stage kidney disease (ESKD) in the world. Over 90% of patients with ESKD receiving hemodialysis (HD) and self-management behaviors are critical among these patients. Failure to adhere to self-managed care increases the cost of medical care and the risk of morbidity and mortality. METHODS: In this cross-sectional study, a total of 150 HD patients were observed for their self-management behaviors and the factors influencing these behaviors including education level, comorbid conditions, biochemical analysis, depression, and social support, etc., were analyzed. RESULTS: Self-management behaviors in HD patients were significantly impaired in the presence of diabetes mellitus, hypertension, anemia, hypoalbuminemia, and depression. The major predictor of patients' self-management was depression, explaining 14.8% of the total variance. Further addition of social support, hypertension, and diabetes mellitus into the regression model increased the total explained variance to 28.6%. Of the various domains of self-management, the partnership domain received the highest score, whereas emotional processing received the lowest score. CONCLUSIONS: This study found the important factors influencing self-management behaviors; through this acknowledgement and early correction of these factors, we hope to improve HD patients' individual life quality and further decrease their morbidity and mortality.

Transitions of self-management behaviors and frailty status among community-dwelling older adults: a national longitudinal population-based cohort study.

BACKGROUND: Frailty in older adults is a common geriatric syndrome that could be prevented; thus, coping strategies for the aging population are essential. Self-management behaviors may represent cost-effective strategies to prevent physical frailty in community-dwelling older adults. This study aimed to describe the changes in frailty status among community-dwelling older adults in Taiwan and investigate the association between transitions of self-management behaviors and frailty status over 4 years of follow-up (2007 to 2011). METHODS: Data were retrieved from the Taiwan Longitudinal Study of Aging (TLSA), years 2007 and 2011. In this prospective cohort study, 1283 community-dwelling older adults aged 65 years and older without cognitive impairment were recruited. Frailty was defined based on Fried's frailty phenotype. Self-management behaviors (maintaining body weight, quitting smoking or no smoking, drinking less or no drinking, exercising, keeping diet control, and maintaining a regular lifestyle) were assessed using a questionnaire. Multinomial logistic regression analyses were used to investigate the associations between changes in self-management behaviors and in frailty status. The age group was further stratified to examine the moderation effect in the relationship between changes in self-management behaviors and in frailty status among older adults. RESULTS: The prevalence of frailty was 8.7% at baseline and 14.9% after 4 years of follow-up, with 196 (15.3%) deaths. Overall, 514 (40.1%) participants maintained their frailty status, 424 (33.0%) worsened, and only 149 (11.6%) improved. Being aged ≥75 years old, having chronic diseases, and an absence of self-management behaviors were associated with frailty at baseline and after follow-up. Among individuals aged 65-74, compared to those who maintained no self-management behaviors, those who decreased the exercise behaviors (yes-to-no) had a higher risk of worsening (RRR = 2.518), while increasing (no-to-yes) and maintaining (yes-to-yes) frequent physical exercise were associated with a lower risk of worsening (RRR = 0.466 and 0.572, respectively) than stable frailty; those who maintained body weight (yes-to-yes) were associated with a lower risk of worsening (RRR = 0.327) than stable frailty after controlling for individual covariates and chronic diseases. Among individuals over 75 years old, compared to no exerciser, older old who decreased their physical exercise had a higher risk of frailty worsening (RRR = 3.255), and increasing frequent physical exercise (no-to-yes) was associated with an improvement in frailty status (RRR = 3.684). Age was a moderator between the effects of maintaining body weight on frailty worsening. There were no associations between the behavioral transitions of smoking, drinking, diet control, or regular lifestyle on the frailty status changes. CONCLUSIONS: Maintaining body weight and frequent physical exercise increased the ratio of frailty stability among individuals 65-74 years old. Increasing exercise behavior is the only factor to improve their frailty status among older adults aged 75 years and over. Older adults should be encouraged to perform adequate physical exercise and maintain a healthy body weight to maintain the frailty status in younger old aged 65-74 years, and especially perform more frequent exercise to improve frailty status in older old over 75 years.

Self-management behavior, associated factors and its relationship with social support and health literacy in patients with obstructive sleep apnea-hypopnea syndrome.

BACKGROUND: The proportion of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) is increasing year by year in China, which has become a major public health problem. Self-management of OSAHS and multiple support from caregivers are key to low hospital admissions and high quality of life for patients with OSAHS. Social support and health literacy are the main promoters of self-management behavior. However, their contributions have not been adequately studied. The purpose of this study is to investigate the level of self-management among patients with OSAHS and its relationship with general demographics, social support, and health literacy. METHODS: A total of 280 patients with OSAHS treated in two Classiii Grade A hospitals in Jinzhou City, Liaoning Province from October 2020 to July 2021 were selected as the study subjects. Patients were investigated by General Characteristics Questionnaire, Social Support Rating Scale (SSRS), Health Literacy Scale for Chronic Patients (HLSCP), and OSAHS Self-management Behavior Questionnaire, and the influencing factors of self-management of patients with OSAHS were analyzed. RESULTS: The average score of OSAHS self-management was 74.49(SD = 8.06), SSRS and HLSCP scores were positively correlated with total scores of self-management behavior. Furthermore, we found that disease duration, SSRS, and HLSCP scores were the main predictors of self-management behavior (R2 = 0.390, P < 0.001). CONCLUSION: This study found that OSAHS patients with a longer duration of disease and higher SSRS or HLSCP scores also had higher levels of self-management. The factors discussed in this study may be helpful in developing individualized interventions in self-management for patients with OSAHS.

The Impact of Triangle Hierarchical Management on Self-Management Behavior and Quality of Survival in Parkinson's Patients.

Objective: To investigate the effect of Triangle tiered and graded management on the self-management behavior and quality of survival of Parkinson's Disease (PD) patients. Methods: Eighty ambulatory PD patients admitted to the neurology outpatient clinic of our hospital from June 2020 to January 2021 were selected for the study. Eighty patients were divided into 40 cases each in the test group and the control group using the random number table method. Patients in the control group were given conventional treatment and care, while in the test group, Triangle hierarchical management was applied on the basis of the control group. Non-motor symptoms [assessed by the Montreal Cognitive Inventory (MoCA), the Scale for Outcomes in PD for Autonomic Symptoms disability Scale (SCOPA-DS) and the Nocturnal Scale (SCOPA-NS)], motor symptoms [assessed by the Functional Gait Assessment (FGA), the Modified Ashworth Scale, and the Unified Parkinson's Disease Rating Scale (UPDRS-III)], quality of life (assessed by Barthel Index), medication adherence (self-administered medication adherence questionnaire), quality of survival (assessed by the 39-item Parkinson's Disease Quality of Survival Questionnaire, PDQ-39), and self-management effectiveness (assessed by the Chronic Disease Self-Efficacy Scale, symptom management and disease co-management) were compared between the two groups before and after the intervention. The two groups were also observed for satisfaction with care. Results: After the intervention, the MoCA score, FGA score, Barthel Index, Medication adherence and all scores of self-management effectiveness were significantly higher in the test group than in the control group (P < 0.05); the SCOPA-DS score, SCOPA-NS score, Ashworth score, UPDRS-III score and PDQ-39 score were significantly lower than in the control group (P < 0.05). Satisfaction with nursing care was significantly higher in the test group than in the control group (P < 0.05). Conclusion: The application of Triangle's tiered and graded management to the home care of ambulatory PD patients was effective in improving their non-motor and motor symptoms, their ability to perform daily activities, medication adherence and self-management effectiveness, and their overall survival outcome.