Trajectories of self-efficacy in persons with chronic illness: An explorative longitudinal study

Background: Self-efficacy is important for changing health behavior in persons with chronic illness. Longer-term trajectories have not been previously explored. Objective: This study’s objective was to explore the trajectories of self-efficacy in two different groups with chronic illnesses attending a patient education course. Design: The study design was a longitudinal, comparative cohort study with five time points during a one year follow-up, using repeated measures analysis of variance. Setting and participants: Persons with morbid obesity (n = 55) and persons with chronic obstructive pulmonary disease (COPD; n = 56) were recruited at the start of patient education courses in Norway and followed-up four times the following year. Main outcome measure: The General Self-Efficacy Scale (GSE) was the main outcome. Results: Obese persons showed a linear pattern of increasing self-efficacy during the follow-up period, whereas persons with COPD had an initial increase followed by a decrease in self-efficacy. Having paid work was associated with a more positive self-efficacy trajectory. Conclusion: The results provide support for the currently employed patient education course for morbidly obese persons. In contrast, persons with COPD may need more extensive and/or more frequent support in order to increase and maintain self-efficacy across tim

Trajectories of illness perceptions in persons with chronic Illness: An explorative longitudinal study

Accurate illness perceptions are essential to the self-management of chronic illness. This study explored trajectories of illness perceptions in persons with morbid obesity (n = 53) and persons with chronic obstructive pulmonary disease (n = 52) following a patient education course. Participants completed the Brief Illness Perception Questionnaire five times over a 1-year period. Repeated measures analysis of variance was employed. Over time, obese participants perceived shorter illness duration, fewer consequences, less emotional stress, and more personal control. Chronic obstructive pulmonary disease participants had initial increases in personal control and understanding, but these changes were not maintained throughout the follow-up period

A 1-year follow-up study exploring the associations between perception of Illness and health-related quality of life in persons with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease with an increasing prevalence worldwide. Its potential consequences, including reduced function and reduced social participation, are likely to be associated with decreased health-related quality of life (HRQoL). However, illness perceptions and self-efficacy beliefs may also play a part in determining HRQoL in persons with COPD. The aim of this study was to explore the relationships between illness perceptions, self-efficacy, and HRQoL in a sample of persons with COPD in a longitudinal perspective. The context of the study was a patient education course from which the participants were recruited. Data concerning sociodemographic variables, social support, physical activity, illness perceptions, general self-efficacy, and HRQoL were collected before the course started and 1 year after completion. Linear regression was used in the analyses. The results showed that less consequences and less symptoms (identity) were associated with higher physical HRQoL (PCS) at baseline and at 1-year follow-up. Less emotional response was similarly associated with higher mental HRQoL (MCS) at both time points. Lower self-efficacy showed a borderline significant association with higher PCS at baseline, but was unrelated to MCS at both time points. Self-efficacy showed no influence on the associations between illness perceptions and HRQoL. In conclusion, the study showed that specific illness perceptions had a stable ability to predict HRQoL in persons with COPD, whereas self-efficacy did not. The associations between illness perceptions and HRQoL were not mediated by self-efficac

Rasch analysis of the Sense of Coherence scale in a sample of people with morbid obesity - A cross-sectional study

Background: The prevalence of morbid obesity is an increasing health problem in most parts of the world and is related to lower quality of life. Sense of coherence, or the perception that the world is meaningful and predictable, is considered a promising health resource for changing behaviour and adopting a healthier lifestyle. Thus, a valid and reliable instrument for measuring sense of coherence is needed to further research and clinical efforts in this area. The purpose of the study was to examine the psychometric properties of the 13-item Sense of Coherence scale and its sub-dimensions (Comprehensibility, Manageability, and Meaningfulness) in a sample of people with morbid obesity using a Rasch analysis approach. Methods: Data were collected cross-sectionally in Norway in 2009 from 142 patients attending a mandatory patient education course for patients with morbid obesity on a waiting list for treatment. Participants completed a socio-demographic questionnaire and the 13-item Sense of Coherence scale at the beginning of the course. Evidence of rating scale functioning, internal scale validity, person-response validity, person-separation reliability and differential item functioning of the 13-item version were explored. The scale’s three sub-dimensions were also evaluated. Results: A 12-item version of the scale demonstrated the best fit to the Rasch model and increased the variance explained without reducing the separation index. The three sub-dimensions demonstrated good fit but lacked unidimensionality and person-separation reliability. The Meaningfulness sub-dimension showed better psychometric properties than the Comprehensibility and Manageability sub-dimensions. Conclusion: A 12-item version of the Sense of Coherence scale has better psychometric properties than the original 13-item version among persons with morbid obesity. Further studies should explore whether these questionable validity findings for the 13-item scale generalize to other populations and examine whether including other items from the longer 29-item version may improve the psychometric properties of an abbreviated Sense of Coherence measure

Sleep-Wake Patterns during the Acute Phase after First-Ever Stroke

This study describes the pattern of day and night sleep and explores relationships between these patterns and sociodemographic and clinical factors as well as sleep environmental context and the patient's subjective sleep quality. Data from 110 patients with first-ever stroke was collected by structured interview surveys, medical record, and objective estimated sleep data from wrist actigraphy. The variability in estimated sleep is large. Half the patients slept either <6 hours or >8 hours per night, and 78% had more than nine awakenings per night. Men slept less than women, and patients sleeping at home had fewer awakenings than those who slept in hospital. It was estimated sleep during daytime in all, except 4, patients. Longer stay in hospital was related to more daytime sleep, and the subjective sleep quality correlated with estimated sleep time, wake time, and wake percentage

The Course of Fatigue during the First 18 Months after First-Ever Stroke: A Longitudinal Study

Background. Little is known about the course of poststroke fatigue. Objectives. To describe the course of poststroke fatigue in relation to the patient's level of physical functioning, depressive symptoms, and self-reported history of prestroke fatigue. Methods. A longitudinal study using structured face-to-face interviews, questionnaires, and patients' medical records. Data were collected from 95 patients in Norway with first-ever stroke. Fatigue was measured with the Fatigue Severity Scale 7 item version and assessed for change between the acute phase, six, 12, and 18 months after stroke using 2-way ANOVA repeated-measures analyses. Results. The patients' level of fatigue did not change over time. However, those who reported prestroke fatigue showed a relatively high level of fatigue over time in the poststroke period, while patients with no history of pre-stroke fatigue showed a stable course of relatively low fatigue over time. Conclusion. Studies on poststroke fatigue should control for the patient's pre-stroke fatigue level

Rasch analysis of the General Self-Efficacy Scale in a sample of persons with morbid obesity

Background: Self-efficacy is needed for effectuating lifestyle changes, and it is therefore an important target related to health. The purpose of this study was to evaluate the psychometric properties of the General Self-Efficacy Scale (GSE) using Rasch analysis in a sample of adults with morbid obesity. Methods: A convenience sample of adults with morbid obesity was recruited from patient education courses. A total of 141 participants completed the GSE and a demographic questionnaire at the beginning of the course. The statistical approach included analysis of rating scale function, item fit to the Rasch partial credit model, unidimensionality, aspects of person-response validity, person-separation reliability, and differential item function. A version omitting items with poor fit to the Rasch model was also evaluated. Results: The rating scale did not advance monotonically for item #2 in the original 10-item version, and the first three GSE items did not demonstrate acceptable goodness-of-fit to the Rasch model. In a 7-item version omitting these three items, the rating scale functioned well for all items, and all items demonstrated good fit to the Rasch model. Both the 10-item and 7-item versions of the GSE partially met the criteria for unidimensionality. Neither version met the criterion for person response validity, although the results were slightly better for the 7-item than for the 10-item version. Both versions of the GSE demonstrated the ability to separate the respondents into three distinct levels of general self-efficacy. Several items had differential item function in relation to age, education or work status, but there were fewer in the 7-item version. Conclusions: For adults with morbid obesity, a 7-item version of the GSE seems to have better psychometric properties than the original 10-item version

A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

Rates of revision surgery due to deep infection following total hip arthroplasty (THA) increased at a Norwegian hospital following implementation of fast-track procedures. The purpose of this study was to determine whether selected demographic (age and sex) and clinical (body mass index, American Society of Anesthesiologists (ASA) classification, surgery duration, length of hospital stay, cemented versus uncemented prosthesis, and fast-track procedures) factors were associated with higher risk of revision surgery due to deep infection following THA. In a prospective designed study 4,406 patients undergoing primary THA between January 2001 and January 2013 where included. Rates of infection-related revision surgery within 3 months of THA were higher among males and among patients who received fast-track THA. Adjusting for sex and age, the implemented fast-track elements were significantly associated with increased risk of revision surgery. Risk of infection-related revision surgery was unrelated to body mass index, physical status, surgery duration, length of hospital stay, and prosthesis type. Because local infiltration analgesia, drain cessation, and early mobilization were introduced in combination, it could not be determined which component or combination of components imposed the increased risk. The findings in this small sample raise concern about fast-track THA but require replication in other samples

Serious life events and post-traumatic stress disorder in the Norwegian population

Background: It has been suggested that countries with more resources and better healthcare have populations with a higher risk of posttraumatic stress disorder (PTSD). Norway is a high-income country with good public healthcare. Aims: To examine lifetime trauma exposure and the point prevalence of PTSD in the general Norwegian population. Method: A survey was administered to a national probability sample of 5500 adults (aged ≥18 years). Of 4961 eligible individuals, 1792 responded (36%). Responders and non-responders did not differ significantly in age, gender or urban versus rural residence. Trauma exposure was measured using the Life Events Checklist for the DSM-5. PTSD was measured with the PTSD Checklist for the DSM-5. We used the DSM-5 diagnostic guidelines to categorise participants as fulfilling the PTSD symptom criteria or not. Results: At least one serious lifetime event was reported by 85% of men and 86% of women. The most common event categories were transportation accident and life-threatening illness or injury. The point prevalence of PTSD was 3.8% for men and 8.5% for women. The most common events causing PTSD were sexual and physical assaults, life-threatening illness or injury, and sudden violent deaths. Risk of PTSD increased proportionally with the number of event categories experienced. Conclusions: High estimates of serious life events and correspondingly high rates of PTSD in the Norwegian population support the paradox that countries with more resources and better healthcare have higher risk of PTSD. Possible explanations are high expectations for a risk-free life and high attention to potential harmful mental health effects of serious life events.publishedVersio