Factors associated with good self-management in older adults with a schizophrenic disorder compared with older adults with physical illnesses

The number of older people living with a schizophrenic disorder (SD) is increasing yet little attention paid has been paid to the needs of this population relative to people with other chronic illnesses. In order to achieve optimal functioning people with a SD need to manage their illness and its impact; therefore, this study set out to determine the factors associated with self-management in this population. The illness management of people over 50 years of age and living with schizophrenia (n= 84) was compared with their peers who were diagnosed with a chronic physical illness (n= 216). Participants completed a survey that included an illness management inventory, self-rated health and sense of coherence. The results demonstrated that participants with a SD had lower illness management levels, particularly for understanding their symptoms and taking appropriate actions in relation to health care. Poor self-rated health and the presence of comorbid conditions had a pervasive negative effect on self-management factors in the SD group, whereas being married, having a greater sense of coherence and being voluntary to treatment had a positive effect. Nurses need to develop strategies to address general health and self-management in older adults living with a SD.     

Depressive symptoms moderated the effect of chronic illness self-management training on self-efficacy

BACKGROUND: Identifying moderators of the effects of self-efficacy enhancing interventions could facilitate their refinement and more targeted, cost-effective delivery. Current theories and data concerning the potential moderating effect of depressive symptoms on interventions to enhance patient chronic illness self-management self-efficacy are conflicting. OBJECTIVES: To explore the moderating effect of depressive symptoms on the effect of an intervention to enhance patient self-efficacy for self-managing chronic illness. RESEARCH DESIGN: Regression analyses using baseline and postintervention (6 weeks) data from an ongoing randomized controlled trial. SUBJECTS: Patients (N = 415) aged >or=40 years recruited from a primary care network in Northern California with arthritis, asthma, chronic obstructive pulmonary disease, congestive heart failure, depression, and/or diabetes mellitus, plus impairment in >or=1 basic activity, and/or a score of >or=4 on the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). MEASURES: Stanford self-efficacy scale, self-reported depression, CES-D, and Medical Outcomes Study Short Form health status questionnaire (SF-36) Mental Component Summary score. RESULTS: Regression analyses revealed the intervention was effective primarily in those with self-reported depression (interaction effect F = 8.24, P = 0.0003), highest CES-D score category (F = 5.68, P = 0.0037), and lowest (most depressed) Mental Component Summary-36 tercile (F = 4.36, P = 0.0135). CONCLUSIONS: Individuals with more depressive symptoms seem more likely to experience self-efficacy gains from chronic illness self-management training than individuals with less depressive symptoms. Future self-management training studies should stratify subjects within study groups by depressive symptom level to further explore its potential moderating effect.     

Chronic disease self-management improved with enhanced self-efficacy

This pilot study used a quasi-experimental pretest-posttest design to examine if participation in a chronic disease self-management program (CDSMP) improved self-efficacy, self-efficacy health, and self-management behaviors in an underserved, poor, rural population. The sample, recruited from two clinics in a south central state, consisted of 48 adults (59.70 +/- 11.22 years) and was 79.2% Caucasian (n = 38) and 20.8% (n = 10) African American. Trained lay leaders with chronic illnesses directed the interactive CDSMP based on Bandura's self-efficacy theory that included strategies for personal exercise program development, cognitive symptom management, problem solving, and communication skills. Program-specific paper-and-pencil instruments were completed prior to and immediately after completion of the 6-week program. Significant improvements (p <.10) in self-efficacy, self-efficacy health, and self-management behaviors occurred. Results underscore the need to evaluate intervention programs for specific populations and for a new paradigm that focuses on patient-provider partnerships that can improve health outcomes in underserved, poor, rural populations.     

Promoting self-management improves the health status of patients having peritoneal dialysis

Title.  Promoting self-management improves the health status of patients having peritoneal dialysis.
Aim.  This paper is a report of a study conducted to explore the effects of promoting self-management on the well-being of patients having peritoneal dialysis.
Background.  Peritoneal dialysis is a home-based treatment for end-stage renal disease. Promoting self-management has been shown to improve the health status of people with diabetes mellitus and other chronic diseases. However, little is known about the effects of self-management support for patients having peritoneal dialysis.
Method.  Thirty patients who had received peritoneal dialysis for at least 6 months and were clinically stable were enrolled in the study in 2006. A multidisciplinary team was built to support the patients' self-management. Various forms of education such as group discussion and individual consultation were used to improve patients' self-efficacy and all were followed up for 6 months. We compared the volume status, adequacy of dialysis, nutritional status, quality of life, rehabilitation status, self-management capacity and self-efficacy levels at baseline, 3 and 6 months after enrolment.
Results.  During follow-up, patients' urine volume and residual renal function decreased, while the adequacy of dialysis (Kt/v and Ccr) did not change. Volume status, quality of life and rehabilitation status all improved, whereas nutritional status did not deteriorate. Both self-management capacity and self-efficacy level increased statistically significantly.
Conclusion.  A team approach needs to be taken to achieve successful self-management in patients having peritoneal dialysis, as with other chronic disease treatments. Nurses should use multiple strategies based on self-efficacy theory to improve patients' self-efficacy levels and self-management capacities.     

Effects of treatment on two types of self-efficacy in people with chronic obstructive pulmonary disease

Self-management is crucial in people with chronic diseases, and self-efficacy has been shown to impact patients' self-management. The purposes of this study were to 1) determine the effect of intervention on self-efficacy and 2) determine the relationship between domain-specific self-efficacy, walking performance, and symptom severity in patients with chronic obstructive pulmonary disease (COPD). Subjects (n=102, forced expiratory volume in 1 second % predicted 44.8+/-14) received one of three self-management interventions. Self-efficacy for walking and managing shortness of breath, walking performance, and shortness of breath severity were measured at baseline and after intervention. Self-efficacy increased after intervention (P<0.01). Self-efficacy for walking was positively related to walking performance (P<0.05). Self-efficacy for managing shortness of breath was positively related to symptom severity (P<0.05). This study examined two types of disease-specific self-efficacy in patients with COPD and demonstrated that improving self-efficacy is an important outcome of self-management interventions. Studies in other domains of self-efficacy are needed.     

Strategies to enhance chronic disease self-management: How can we apply this to stroke?

Purpose. Social Cognition Theory and the cognitive construct of self-efficacy often form the theoretical basis for many chronic disease self-management programmes. Self-efficacy can be influenced through these programmes and has been shown to be predictive of greater levels of functioning and psychological well-being. Stroke is regarded as a complex chronic disability, and individuals may share many of the same concerns as those living with other chronic diseases such as arthritis and chronic pulmonary disease. However there has been minimal reported research on the utility of self-management programmes following stroke.

Search strategy. To comprehend the composition of chronic disease self-management programmes which could be applied to stroke, this paper examined the theoretical basis of self-management and particularly the evidence relating to interventions which have utilized self-efficacy enhancing strategies. Selected papers were retrieved from an extensive search of literature using Medline, Cinahl, PsychInfo and Web of Science databases and the Cochrane Collaboration. The search request focused on literature that specifically related to chronic disease, self-management and self-efficacy that had been published since 1995. However, seminal literature on self-efficacy produced prior to this date was also included.

Discussion and conclusions. There is strong evidence to support the use of self-management programmes and their effect on self-efficacy and associated health outcomes. While there are differences in the nature of each chronic condition, there are similarities in the core skills required for self-management. Many effective strategies could be incorporated into current stroke rehabilitation programmes or used to develop targeted self-management interventions. Future research which informs stroke rehabilitation should utilize the evidence relating to other chronic conditions. This could be used to develop the most effective methods of equipping individuals following stroke to cope confidently with the transition from being discharged from therapy towards effective self-management in the longer term.     

Strategies to enhance chronic disease self-management: how can we apply this to stroke?

PURPOSE: Social Cognition Theory and the cognitive construct of self-efficacy often form the theoretical basis for many chronic disease self-management programmes. Self-efficacy can be influenced through these programmes and has been shown to be predictive of greater levels of functioning and psychological well-being. Stroke is regarded as a complex chronic disability, and individuals may share many of the same concerns as those living with other chronic diseases such as arthritis and chronic pulmonary disease. However there has been minimal reported research on the utility of self-management programmes following stroke. SEARCH STRATEGY: To comprehend the composition of chronic disease self-management programmes which could be applied to stroke, this paper examined the theoretical basis of self-management and particularly the evidence relating to interventions which have utilized self-efficacy enhancing strategies. Selected papers were retrieved from an extensive search of literature using Medline, Cinahl, PsychInfo and Web of Science databases and the Cochrane Collaboration. The search request focused on literature that specifically related to chronic disease, self-management and self-efficacy that had been published since 1995. However, seminal literature on self-efficacy produced prior to this date was also included. DISCUSSION AND CONCLUSIONS: There is strong evidence to support the use of self-management programmes and their effect on self-efficacy and associated health outcomes. While there are differences in the nature of each chronic condition, there are similarities in the core skills required for self-management. Many effective strategies could be incorporated into current stroke rehabilitation programmes or used to develop targeted self-management interventions. Future research which informs stroke rehabilitation should utilize the evidence relating to other chronic conditions. This could be used to develop the most effective methods of equipping individuals following stroke to cope confidently with the transition from being discharged from therapy towards effective self-management in the longer term.     

Strategies to enhance chronic disease self-management: How can we apply this to stroke?

Purpose. Social Cognition Theory and the cognitive construct of self-efficacy often form the theoretical basis for many chronic disease self-management programmes. Self-efficacy can be influenced through these programmes and has been shown to be predictive of greater levels of functioning and psychological well-being. Stroke is regarded as a complex chronic disability, and individuals may share many of the same concerns as those living with other chronic diseases such as arthritis and chronic pulmonary disease. However there has been minimal reported research on the utility of self-management programmes following stroke.

Search strategy. To comprehend the composition of chronic disease self-management programmes which could be applied to stroke, this paper examined the theoretical basis of self-management and particularly the evidence relating to interventions which have utilized self-efficacy enhancing strategies. Selected papers were retrieved from an extensive search of literature using Medline, Cinahl, PsychInfo and Web of Science databases and the Cochrane Collaboration. The search request focused on literature that specifically related to chronic disease, self-management and self-efficacy that had been published since 1995. However, seminal literature on self-efficacy produced prior to this date was also included.

Discussion and conclusions. There is strong evidence to support the use of self-management programmes and their effect on self-efficacy and associated health outcomes. While there are differences in the nature of each chronic condition, there are similarities in the core skills required for self-management. Many effective strategies could be incorporated into current stroke rehabilitation programmes or used to develop targeted self-management interventions. Future research which informs stroke rehabilitation should utilize the evidence relating to other chronic conditions. This could be used to develop the most effective methods of equipping individuals following stroke to cope confidently with the transition from being discharged from therapy towards effective self-management in the longer term.     

Vascular risk management through nurse-led self-management programs.

In current clinical practice, adequate cardiovascular risk reduction is difficult to achieve. Treatment is primarily focused on clinical vascular disease and not on long-term risk reduction. Pertinent to success in vascular risk reduction are proper medication use, weight control, healthy food choices, smoking cessation, and physical exercise. Atherosclerotic vascular disease and its risk constitute a chronic condition, which poses specific requirements on affected patients and caregivers who should be aware of the chronicity. In patients with vascular disease, there is lack of awareness of their chronic condition because of the invisibility of most risk factors. In other patient groups with chronic illness, self-management programs were successful in achieving behavioral change. This strategy can also be useful for patients with vascular disease to adapt and adhere to an improved lifestyle. Self-management refers to the individual's ability to manage both physical and psychosocial consequences including lifestyle changes inherent to living with a chronic condition. Interventions that promote self-management are based on enhancing self-efficacy. In self-management, attention can be given to what is important and motivational to the individual patient. In this article the challenge of nursing care promoting self-management for patients with vascular risk and how this care can be applied will be explained. Nurses can play a central role in vascular risk management with a self-management approach for patients with chronic vascular disease. In vascular prevention clinics, nursing care can be delivered that includes medical treatment of vascular risks (hypertension, hypercholesterolemia, hyperglycemia, and hyperhomocystinemia) and counseling on promoting self-management (changes in diet, body weight, smoking habits, and level of exercise). Nursing interventions based on self-management promotion can provide a new and promising approach to actually achieve vascular risk reduction.     

Importance of illness beliefs and self-efficacy for patients with coronary heart disease

AIM: This paper is a report of a study to assess the association between coronary heart disease patients' illness beliefs and their self-efficacy 3 years after hospital discharge. BACKGROUND: Cardiac rehabilitation guidelines recommend that both the illness representation model and the concept of self-efficacy are relevant frameworks for developing effective psychological support, although little is known about what aspects of patients' illness beliefs influence their self-efficacy. METHOD: In a longitudinal prospective survey, consecutive patients with coronary heart disease were asked to complete questionnaires measuring illness perceptions; self-efficacy and demographic, illness characteristics; and attendance at a cardiac rehabilitation programme. The questionnaire was completed three times between 2001 and 2005. The response rates were 84% at time 1, 77% at time 2 and 72% at time 3. Multiple regression analysis was used to assess the association between illness beliefs and self-efficacy. The data were collected between 2001 and 2005. FINDINGS: The average age of the participants was 65 years, 79% were male, 50% had acute myocardial infarction, 50% had angina and 61% had no previous history of cardiac illness; 55% had been admitted as an emergency and 57% subsequently attended cardiac rehabilitation. At baseline 30% of the variance in the exercise self-efficacy at 3 years after index admission was accounted for by patients' view of their illness being long-term. Data collected 9 months after discharge showed similar findings. CONCLUSION: Early interventions designed to address individuals' sense of control, beliefs about the length of illness and the management of perceived symptoms before hospital discharge could increase rehabilitation programmes effectiveness in sustaining patients' long-term lifestyle changes.     

慢性下腰痛患者自我管理行为及影响因素分析

目的 调查慢性下腰痛患者自我管理行为现状,分析其影响因素。方法 应用便利抽样,于2019年1月-12月采用一般资料、慢性病自我管理行为量表、下腰痛疾病知识问卷、慢性病自我效能量表、社会支持评定量表对226例慢性下腰痛患者进行调查,采用多重线性回归分析探讨自我管理行为的影响因素。结果 慢性下腰痛患者自我管理行为总分(21.76±7.82)分；疾病知识、自我效能、社会支持、治疗方式、辅助工具使用史进入回归方程,解释慢性下腰痛患者自我管理行为总变异的51.3%。结论 慢性下腰痛患者自我管理水平较低,社会支持、疾病知识、自我效能、治疗方法、辅助工具应用史是其主要影响因素。建议在进行自我管理健康教育时,应考虑患者个体特点,采用针对性、适合的健康教育方式,提供多渠道健康信息获取方法,鼓励家庭参与,提高患者疾病知识和社会支持水平,增强自我效能,从而改善自我管理行为。     

Sense of coherence as a predictor of quality of life in persons with coronary heart disease surviving cardiac arrest

The unique contribution of sense of coherence to explained variance in quality of life was studied in 149 persons with coronary heart disease who survived cardiac arrest. Using hierarchical multiple regression, 16 predictors, including 5 social status variables related to poor health vulnerability, perceived social support, self-esteem, and 9 variables reflecting instability and work of the chronic illness trajectory, accounted for 50% of variance in quality of life. The addition of sense of coherence resulted in a 15% increment to the explained variance (total R² = .64). As a strong independent predictor of quality of life, sense of coherence has promise as a variable that might be strengthened by nursing interventions and merits continued study. © 1996 John Wiley & Sons, Inc.     

哮喘患者自我效能与自我管理水平的相关性分析

目的：探讨成人支气管哮喘患者自我效能与自我管理水平之间的关系.方法：以方便取样法选择120例门诊成人哮喘患者,采用《慢性病自我管理研究测量表》中的自我效能量表和自我管理行为量表调查哮喘患者的自我效能和自我管理水平,并分析两者之间的相关性.结果：成人支气管哮喘患者自我效能与自我管理水平偏低;哮喘患者的自我效能与自我管理水平呈正相关.结论：科学运用自我效能理论设计和开展哮喘患者自我管理项目,提高患者的自我管理水平,从而提高哮喘患者的生存质量.     

Randomized controlled trial of a self-management intervention in persons with spinal cord injury: design of the HABITS (Healthy Active Behavioural IntervenTion in SCI) study

Purpose: To evaluate the effectiveness of a 16-week self-management intervention on physical activity level and self-management skills (self-efficacy, proactive coping and problem solving skills) in persons with chronic SCI. Method and design: Multicenter randomized controlled trial (RCT). Eighty persons with a SCI for at least 10 years and aged 18 to 65 will randomly be assigned to the intervention (self-management) or the control group (information provision). During the 16-week self-management intervention (one home-visit, five group and five individual sessions) active lifestyle will be stimulated and self-management skills will be taught. Data will be collected at baseline (T0), 16 (T1) and 42 (T2) weeks after baseline. Primary outcome measure is level of daily physical activity (self-report/objectively measured). Secondary outcome measures are self-managements skills, stage of behaviour change and attitude. Conclusion: This is the first RCT on self-management in people with chronic spinal cord injury. This trial will provide knowledge on the effects of a self-management intervention on physical active lifestyle in persons with a long-term SCI.

Implications for Rehabilitation

• Persons with long-term SCI benefit from a higher activity level in terms of health- and psychological benefits.

• Self-management interventions have shown to be effective in modifying behaviours and preventing health problems in different chronic disorders.

• This study aims to enhance a physically active lifestyle in persons with long-term SCI by improving self-management skills (self-efficacy, problem solving & proactive coping) through a self-management intervention.

     

短信平台教育在慢性肾脏病患者自我管理中的应用

目的通过短信平台定期向慢性肾脏病患者发送自我管理及健康教育内容,以增强患者的自我效能、改善其自我管理能力。方法选择2011年11月至2012年4月瑞金医院肾脏内科诊断为慢性肾脏病1～4期且能独立查看手机短信的患者108例,按随机数字表法分为两组:短信对照组患者接受常规健康指导;短信干预组患者出院后,护士通过医院短信平台向患者手机定期发送短信,内容主要为自我管理及健康教育内容;比较两组患者出院后3个月的自我管理行为及自我效能。结果出院前,两组患者的自我管理行为及自我效能水平差异均无统计学意义(P>0.05);出院后3个月,短信干预组在运动锻炼、饮食控制、认知症状管理、与医生沟通等方面的自我管理得分及症状管理、疾病共性管理等方面的自我效能得分均高于对照组,差异有统计学意义(P<0.05)。结论短信平台教育能提高慢性肾脏病患者的自我管理能力,增强其自我效能。     

Effects of self-efficacy, social support and knowledge on adherence to PEFR self-monitoring among adults with asthma: a prospective repeated measures study

BACKGROUND: Long-term adherence to self-monitoring of peak expiratory flow rate (PEFR) is essential for early detection of declining lung function in individuals with asthma. Psychosocial and cognitive factors can influence adherence to PEFR self-monitoring behaviors. OBJECTIVES: The specific aims of this prospective, repeated measures study were to: (1) determine the effects of asthma self-efficacy, perceived satisfaction with social support and asthma knowledge on adherence to PEFR self-monitoring behavior; and (2) examine whether adherence to PEFR self-monitoring mediates the effects of psychosocial/cognitive factors on lung function and asthma symptoms in adults with asthma. DESIGN: Sixty-eight participants completed standardized questionnaires three times at baseline, 1 month, and 3 months and kept the records of PEFR self-monitoring behaviors twice a day. Data were analyzed using multiple linear regressions. Adherence rates to PEFR self-monitoring were 93.5% and 74.9% at 1 and 3 month, representing those who remained in the study (n=39). Other participants withdrew from the study. FINDINGS: Both at 1 and 3 month, psychosocial/cognitive factors as a whole did not account for a significant variance in adherence to PEFR self-monitoring. Univariate analyses, however, indicated that baseline asthma self-efficacy and asthma knowledge at 1 month were significant independent predictors for adherence to PEFR self-monitoring at 3 month. CONCLUSION: Adherence to PEFR self-monitoring did not mediate the effects of asthma self-efficacy, perceived satisfaction with social support, and asthma knowledge on lung function and asthma symptoms. Lung function was low, but participants reported low asthma symptoms, both of which remained stable over time. Because of a small sample size and high attrition, the findings of the study need to be interpreted with caution. Given the importance of long-term adherence to self-management in asthma and other chronic illnesses, factors influencing adherence need to be further investigated to set a basis for future interventions.     

Effects of a self-management arthritis programme with an added exercise component for osteoarthritic knee: randomized controlled trial

AIM: This paper is a report of a study to assess the effect of an adapted arthritis self-management programme with an added focus on exercise practice among osteoarthritic knee sufferers. BACKGROUND: Osteoarthritis of the knee is a major source of loss of function in older people. Previous studies have found self-management programmes to be effective in increasing arthritis self-efficacy and in mastery of self-management practice. METHOD: A randomized control trial was carried out from December 2002 to May 2003 and 120 participants (65.9%, including 67 in intervention group and 53 in control group) completed the 16-week postintervention assessments. Outcome measures included arthritis self-efficacy, use of self-management techniques, pain intensity and daily activity. FINDINGS: At 16 weeks, there was a 'statistically' significant improvement in the arthritis self-efficacy level (P 相似文献   

十二指肠溃疡患者自我管理水平的影响因素

目的了解十二指肠溃疡患者自我管理水平的现状,并探讨其影响因素。方法便利抽样选择2012年1月至2014年3月期间在南方医科大学南方医院消化科就诊的十二指肠溃疡患者200例,采用《慢性病自我管理研究测量表》中的自我管理行为量表及自我效能量表,对其进行自我管理水平的调查,并分析其影响因素。结果十二指肠溃疡患者总体自我管理行为得分为(12.26±1.90)分,自我管理水平中等偏低。主要影响因素为自我效能、文化程度和工作压力,3个因素共同解释自我管理水平变异的20.4%。结论通过对十二指肠溃疡患者自我管理水平及其影响因素分析,进行有针对性的健康教育和护理干预,有助于使患者从被动管理疾病到主动参与疾病管理,提高患者自我管理水平,减少复发率,有效提高治愈率及患者的生活质量。