Levels and predictors of self-care among patients with hypertension in Pakistan

Background: Globally, hypertension is the leading non-communicable disease and strongest predictor of cardiovascular diseases. To mitigate and prevent hypertension-related complications, self-care behavior adaptation has proven to be vital. In this study, we examined the six clinically prescribed levels of self-care as prescribed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and its predictors among a select sample of hypertensive individuals in Karachi, Pakistan.Methods: This study reports the cross-sectional survey of a sequential mixed method study which assessed the levels of self-care of hypertensive individuals residing in an urban cosmopolitan setting within Karachi Pakistan. Four hundred and two patients were screened using the H-SCALE questionnaire, while socio-demographic predictors of self-care and level of knowledge of hypertension were identified using a study-specific checklist. Self-care was assessed against six clinical domains including medication adherence, diet, weight management, physical activity, and abstinence from alcohol.Results: Participants were recruited from the two largest tertiary care hospitals in Karachi. Good knowledge about hypertension, including its causes, management, and complications was reported by 4.47% of the participants. Highest levels of self-care adherence were found for abstinence from alcohol (100%), smoking cessation (83.33%), and medication compliance (71.89%), whereas lowest levels were found for diet (27.11%), and physical activity (24.88%). In terms of predictors for self-care, age, male gender, and self-checking of blood pressure at home, followed by the level of education were the most common predictors for each self-care behavior in the given population.Conclusion: Overall knowledge of self-care for hypertension is sub-optimal among hypertensive patients in Pakistan which is reflected in their behaviors. There is a need to introduce healthcare educational programs in Pakistan which can improve self-care behaviors of hypertensive individuals and potentially reduce the prevalence of associated cardiovascular diseases and its complications

Safety and Efficacy of Drug-Eluting Balloons in the Treatment of Drug-Eluting In-Stent Restenosis: Experience of a Tertiary Care Hospital

Background: The advent of drug-eluting balloons (DEBs) is a promising development for coronary revascularization procedures, especially for in-stent restenosis (ISR). This study aims to highlight our experience with DEBs in the treatment of drug-eluting ISR at a tertiary care hospital in Pakistan. Methods: All Patients presenting to our institution from August 2008 to February 2011 with significant drug-eluting in-stent restenosis (DES-ISR) who were eligible to receive treatment via DEB were included in the analysis. Patient baseline characteristics and angiographic data about the lesion characteristics were obtained. Postprocedural and follow-up endpoints, including cardiac death, myocardial infarction, and repeat revascularization, ie, major adverse cardiovascular events (MACE), were included in the analysis. Results: A total of 26 Patients received treatment with DEB in the study period, with a significant number having major predisposing factors for the development of ischemic heart disease (IHD, 46% diabetics, 92% hypertensives). The culprit lesion was most commonly identified in the left anterior descending (31%), with presence of American College of Cardiology/American Heart Association lesion type C in 68% of Patients. The SeQuent Please paclitaxel-eluting balloon (B. Braun) was used for revascularization. Patients were followed for a median of 16 months. Only 5 Patients (19%) developed MACE during this period. Conclusion: Our experience demonstrates the effectiveness of DEBs in the treatment of drug-eluting ISR, especially in complex lesions with Patients having significant risk factors for development of IHD. However, further studies are needed to define their indications in this role

Facilitators and barriers to NCD prevention in Pakistanis-invincibility or inevitability: a qualitative research study.

Background: Non-communicable diseases (NCD) are the leading causes of death globally. In Pakistan, they are among the top ten causes of mortality, especially in the productive age group (30–69 years). Evidence suggests that health perceptions and beliefs strongly influence the health behavior of an individual. We performed focus group interviews to delineate the same so as to design the user interface of a non-invasive stroke risk monitoring device. Methods: It was a qualitative study, designed to explore how health perceptions and beliefs influence behavior for NCD prevention. Four focus group discussions (FGD) were conducted with 30 stable participants who had diabetes mellitus, ischemic heart disease, blood pressure, and stroke. The data was collected using a semi-structured interview guide designed to explore participants’ perceptions of their illnesses, self-management behaviors and factors affecting them. The interviews were transcribed and content analysis was done using steps of content analysis by Morse and Niehaus [10]. Results: Medication adherence, self-monitoring of blood sugars and blood pressures, and medical help seeking were the commonly performed self-management behaviors by the participants. Personal experience of illness, familial inheritance of disease, education and fear of premature death when life responsibilities were unfulfilled, emerged as strong facilitators of self-management behaviors. A sense of personal invincibility, Fatalism or inevitability, lack of personal threat realization, limited knowledge, inadequate health education, health care and financial constraints appeared as key barriers to the self-management of chronic disease in participants. Conclusions: Behavioural interventional messaging will have to engender a sense of personal vulnerability and yet empower self-efficacy solutions at the individual level to deal with both invincibility and inevitability barriers to adoption of healthy behavior

Translating knowledge for action against stroke – using 5-minute videos for stroke survivors and caregivers to improve post-stroke outcomes: study protocol for a randomized controlled trial (Movies4Stroke)

Participant timeline. (DOCX 48 kb

Self-care behaviors and their determining factors among heart falilure patients in Pakistan

Heart Failure (HF) is a progressively worsening clinical syndrome associated with poor quality of life and higher hospital readmissions. Therefore, self-care behaviors in heart failure are considered equally important to its pharmacological management. Literature indicates that the level of self-care varies among different culture. However, little is known about the self-care behaviors and its predictors among HF patients in the developing countries. Therefore, this study aimed to determine the level of Self care behaviors (SCB) and its associated factors among HF patients in Pakistan. The study was conducted using a sequential mixed method approach. The SCB of 230 heart failure patients were assessed using Euoropean Heart Failure Sel care behavior scale (EHFScBS) via a cross sectional survey. Moreover, six patients were interviewed to explore the factors affecting their SCB. The mean score of the EHFSCB was 29.30. Among the specific SCB, following medication regimen was the highest (89%) whereas, weight monitoring was the lowest (12%) adhered SCB. In multivariate Analysis education, income and chronicity of the HF diagnosis were positively associated with better SCB (P\u3c0.005). Analyses of the qualitative data showed patients\u27 financial status, family support, health education and support of the health care system as important predictors of SCB. The overall level of the self-care was found low. The convergence of the quantitative and qualitative findings reveled that patients \u27financial status, education and experience of the illness are the key determinants of SCB among HF patients in Pakistan. Hence, this study has implications for the health care providers, policy makers and donors to establish HF management programs for the patients in our culture

Introducing a flipped classroom in a pharmacology course

Background: Flipped classroom pedagogy has been shown to improve nursing students\u27 academic performance.Aim: The study aimed to determine the effect of a flipped classroom approach on students\u27 pharmacology assessment scores in a school of nursing in Karachi, Pakistan.Methods: A retrospective chart review was performed. The pharmacology test scores of the BSc nursing cohort of 2020, when flipped classroom pedagogy was used, was compared with those of the BSc nursing cohort of 2019, where traditional pedagogy was employed. Students\u27 summative evaluation for the course and their verbal feedback were analysed.Results: The median continuous assessment test score of the 2019 cohort was 35 (interquartile range (IQR) 32-38), while that of the 2020 cohort was 38 (IQR 35-41). The difference in the score was statistically significant (P\u3c0.001).Conclusion: The study gives an insight into a relatively novel pedagogy that was found to improve pharmacology knowledge test scores among nursing students

Self- care behaviors and its determinents among heart failure patients in Karachi

Objective: To determine the level of self-care behaviors (SCB) and its associated factors among heart failure (HF) patients in Karachi, Pakistan. Background: HF is a progressively worsening clinical syndrome which not only deteriorates the quality of life of the patients but also stretches the utilization of health care resources and increases the cost of the health care. Therefore self-care in HF is now considered equally important to its pharmacological management. The level of self-care among HF patients of developed countries is well documented, however, little is known about the SCB and its predictors among HF patients in the developing countries. Methods: The study was conducted using a sequential mixed method approach. The SCB of 230 heart failure patients (recruited from four tertiary care hospitals of Karachi) were assessed using European Heart Failure Self-care Behavior Scale (EHFScBS) via a cross sectional survey. Moreover, purposively, eight patients from the quantitative survey were also interviewed to explore the factors affecting their SCB. Results: The study sample comprised of two third males and one third females with mean age of 58+/-12 years. The average score of the EHFScBS was (29.30+/-6.81) indicating a moderate level of self-care. Adherence to self-maintenance behaviors was higher (15.4+/-3.9) as compared to the self-management behaviors (13.2+/-3.6). In multivariate analysis, education, high income and chronicity of the HF diagnosis were found significantly positive predictors of the SCB (P\u3c0.005, R2=23.4). Also financial status, family support, health literacy and support of the health care system were found as important factors affecting the SCB of the patients, through analysis of patients’ narratives. Hence, from the convergence of the quantitative and qualitative findings, it can be predicted that patients ‘financial status, education and experience of the illness are the key determinants of SCB among HF patients in Pakistan. Keywords: Heart Failure, self-care behaviors, self-maintenance, self managemen

Developing the reliability and validity of an Urdu version-self-efficacy scale for breast cancer patients in Pakistan

Background and purpose: No suitable scale was identified in literature that comprehensively measure self-efficacy of Pakistani breast cancer patients. The study aimed to develop a self-efficacy scale in Urdu language and determine its dimensions.Methods: The scale was developed with input from experts and literature. It was administered, in crosssectional phase of two pilot studies, on breast cancer patients receiving chemotherapy. Post hoc internal consistency reliability was computed and principal component analysis (PCA) was performed.Results: SES-U comprised 17 questions. PCA revealed a total of five factors explaining cumulative variance of 68.7%. These factors were self-confidence, faith, coping, optimism, and decision making. Post hoc internal consistency (Cronbach\u27s alpha) value was high (∞ = 0.87).Conclusions: The self-efficacy scale has acceptable validity and reliability and has potential to obtain information related to self-efficacy of cancer patients receiving chemotherapy

Spirituality and COVID-19 pandemic: A qualitative inquiry of real time experiences in Pakistan

Many individuals are now reflecting on spirituality and religiosity being essential parts of their life that helped them cope and overcome the fears associated with COVID-19 during the quarantine period. Although medical interventions remained vital in managing the COVID-19 outbreak, little attention was given to the contributions of spirituality as a personal coping mechanism in South Asian culture. Through a qualitative descriptive exploratory approach, we explored the roles which spirituality and faith played in lives of COVID-19 patients and their families during the quarantine period in Karachi, Pakistan. Twenty-two dyads of COVID-19 patients and their family members were purposively selected and interviewed via telephone or Zoom. Quarantine was a reflective opportunity to focus on one’s inner-self and make spiritual connection or re-connection with God. Participants felt the pandemic reminded them that humanity must come closer, act as one household, and extend help to each other. However, there were conflicting views regarding the impacts of spirituality and religiosity during the restrictions and quarantine period