Effects of risk factor targeted lifestyle counselling intervention on quality of lifestyle counselling and on adherence to lifestyle change in stroke patients

Abstract The purpose of the study was to explain the effects of risk factor targeted lifestyle counselling intervention on quality of lifestyle counselling and on adherence to lifestyle change in stroke patients. Content and characteristics of stroke patient counselling was described (I) with narrative literature review (n=33). Lifestyle habits of hospital-admitted stroke patients were described and explained (II) with cross-sectional design (n=150). Quasi-experimental, nonequivalent control group pretest-posttest design explained (III) the effects of lifestyle counselling intervention on working-age stroke patients’ adherence to lifestyle change (n=75/group). Cross-sectional, explorative between-groups prospective design explained (IV) associations between the quality of counselling and adherence to lifestyle change during the 12-month follow-up (n=98). The literature data was gathered from the databases and analysed with content analysis (I). The empirical data was collected with Lifestyle (II), Adherence to Lifestyle Change (III, IV) and Counselling Quality (IV) instruments. Descriptive statistics, factor analysis, cross-tabulation of variables, logistic regression, and ANCOVA were used for data analysis. Counselling was described with seven themes: information about the disease and concerns regarding stroke, aims of counselling, counselling methods, interaction as a method for counselling, stroke nurse as a counsellor, emotional support and decision making in patient care (I). Patients were overweight or obese (75%) and 86.7% had high waist circumference levels. They generally had rather unhealthy eating habits, were physically inactive and quite highly stressed, and 33.5% drank to excess every month or every week, and 32.9% were current smokers (II). After intervention the experimental group lost their weight at 3 and 6 months, reduced cigarette consumption at 3 months, and increased smoking cessation at 6 months. The experimental group received more support from nurses, family and friends (III). Lifestyle counselling quality was estimated rather good, with the exception of patient-centred counselling, and significantly better by the experimental group. Interactiveness, resources, and advantages of counselling were related to adherence variables (IV). Intervention had effects on lifestyle counselling quality and on adherence to lifestyle change in the short term.Tiivistelmä Tutkimuksen tarkoituksena oli selittää aivoverenkiertohäiriöpotilaiden (AVH) riskitekijöihin kohdistuvan elintapaohjausintervention vaikutuksia elintapaohjauksen laatuun ja elintapamuutokseen sitoutumiseen. Ohjauksen sisältöä ja ominaispiirteitä kuvattiin (I) narratiivisen kirjallisuuskatsauksen avulla (n=33). AVH-potilaiden elintapoja (n=150) sairaalaan tulovaiheessa kuvattiin ja selitettiin (II) poikkileikkaustutkimuksella. Kvasikokeellinen tutkimus selitti (III) elintapaintervention vaikutuksia työikäisten AVH-potilaiden elintapamuutokseen sitoutumiseen (n=75/ryhmä). Ohjauksen laadun ja elintapamuutokseen sitoutumisen välistä yhteyttä 12 kuukauden seurannan aikana selitettiin (IV) poikkileikkaus- ja pitkittäistutkimuksen avulla (n=98). Kirjallisuuskatsauksen aineisto kerättiin tietokannoista ja analysoitiin sisällön analyysillä (I). Empiirinen data kerättiin elintapamittarilla (II), elintapamuutokseen sitoutumismittarilla (III, IV) ja ohjauksen laatu mittarilla (IV). Aineisto analysoitiin kuvailevin tilastollisin menetelmin, faktorianalyysillä, ristiintaulukoinnilla, logistisella regressiolla sekä varianssianalyysillä. Seitsemän teemaa kuvasi ohjausta: tieto sairaudesta ja siihen liittyvistä tekijöistä, ohjauksen tavoitteellisuus, ohjausmenetelmät, vuorovaikutus ohjausmenetelmänä, sairaanhoitaja ohjaajana, emotionaalinen tuki, sekä potilaan hoitoon liittyvä päätöksenteko (I). Potilaista 75% oli ylipainoisia tai lihavia ja suurella osalla vyötärönympärys oli liian suuri (86.7%). He söivät jokseenkin epäterveellisesti, liikkuivat liian vähän ja olivat stressaantuneita. Potilaista 33.5% joi humalahakuisesti kuukausittain tai joka viikko ja 32.9% tupakoi (II). Koeryhmän potilaiden paino laski kolmen ja kuuden kuukauden kuluttua kotiutumisesta. Savukkeiden määrä väheni kolmen kuukauden kuluttua kotiutumisesta ja tupakoinnin lopettaminen lisääntyi kuuden kuukauden kuluttua. Koeryhmän potilaat saivat enemmän tukea hoitajilta, perheeltä ja ystäviltä (III). Ohjauksen laatu arvioitiin hyväksi, poikkeuksena oli ohjauksen potilaskeskeisyys. Kokonaisuutena ohjauksen laatu arvioitiin paremmaksi koeryhmässä. Vuorovaikutus, resurssit ja ohjauksen vaikutukset olivat selkeimmin yhteydessä elintapamuutokseen sitoutumiseen (IV). Elintapainterventiolla oli vaikutusta elintapaohjauksen laatuun sekä elintapamuutokseen sitoutumiseen lyhyellä aikavälillä

Endometriosis patients’ experiences of the counseling they need from the nurses through the digital care pathway:a qualitative descriptive study

Abstract Endometriosis is a chronic disease associated with severe, life-impacting pain symptoms and impaired fertility that can affect relationships, sexuality, family life, social relationships, and working life. The aim of the present study was to describe endometriosis patients’ experiences of the counseling they need from the nurses through the digital care pathway. A qualitative descriptive study was conducted; 14 Finnish women with endometriosis were interviewed. Content analysis revealed four main categories related to counseling provided through the digital care pathway: counseling on endometriosis and its role in life; counseling on how to live with endometriosis; comprehensive support for self-care; and patient-oriented counseling. Nurses should provide counseling at different stages of the disease, because the symptoms of endometriosis can change rapidly in a short period of time, and these are the moments when the patient needs support and advice from the nurses. The digital care pathway can provide reliable information to patients at the right time of disease progression. The study was planned and reported using the Consolidated Criteria for Reporting Qualitative Research Checklist

Patient activation for self-management among adult patients with multimorbidity in primary healthcare settings

Abstract Background and Aims: Multimorbidity is a major public health and healthcare challenge around the world, including in Finland. As multimorbidity necessitates self-management in everyday life, the effects of patient activation — a patient’s knowledge, skills, and confidence in managing own health — on the capacity for self-management warrant study, especially in primary healthcare settings. This study aimed to assess patient activation among multimorbid primary healthcare patients, identify factors associated with patient activation, and determine whether patients with low and high activation differ in terms of health and self-management behavior, related perceptions, and health-related quality of life (HRQoL). Methods: A cross-sectional survey was conducted among multimorbid patients who attended Finnish primary healthcare consultations (November 2019 to May 2020). The main outcome, patient activation, was assessed using the patient activation measure, PAM-13®. Responses from 122 patients were analyzed using descriptive statistics, t-tests, analysis of variance, linear modeling, the χ2 test, and binary regression analysis. Results: The mean score of patient activation was 56.12 (SD 12.82) on a scale 0–100 where ≤55.1 indicate low activation. The lower activation scores were significantly associated with old age, obesity, loneliness, and lower perceived health, functional ability, and vitality. Patients with low activation (47%) had significantly poorer physical activity, diets, adherence to care, and HRQoL, and significantly worse perceptions related to self-management including motivation and energy, sense of normality, and support from physicians, nurses, and close people. Conclusion: Patient activation among multimorbid outpatients was rather low. Findings indicate that patients’ perceptions of their health and psychosocial factors may be important for activation and that patients with low and high activation differ with respect to several health variables. Determining patient activation in multimorbid patients may facilitate adaptation of care to better meet patient capabilities and needs in clinical settings. Knowledge of a patient’s activation level may also be useful when developing interventions and care strategies for this patient group

The effects of risk factor-targeted lifestyle counselling intervention on working-age stroke patients’ adherence to lifestyle change

Abstract Introduction: Since a history of stroke or transient ischaemic attack is a major risk factor for a recurrent event, lifestyle counselling during the hospital phase is an essential component of treatment and may increase the probability of lifestyle change. Aims and objectives: To study the effect of risk factor‐targeted lifestyle counselling intervention on working‐age stroke patients’ adherence to lifestyle changes. Design: A quasi‐experimental, nonequivalent control group pretest–post‐test design. Methods: Stroke patients in an acute neurological unit were divided into a control group (n = 75) receiving standard counselling and an experimental group (n = 75) receiving risk factor‐targeted counselling. Lifestyle data and clinical outcomes were collected at hospital between January 2010 and October 2011, while data on adherence to lifestyle changes 3, 6, and 12 months after discharge. Results: The baseline lifestyle habits did not differ significantly other than in alcohol behaviour. Both groups increased their intake, but the intervention group to a lesser degree. However, the experimental group significantly lost their weight for the first 3 and 6 months; at 3 months reduction in cigarette consumption and at 6 months significant increases in smoking cessation were also achieved. All improved some of their lifestyle habits. Intervention was associated with support from nurses as well as from family and friends. Adherence scores were higher in the experimental group. Conclusion: Some short‐term advantages in lifestyle habits due to the intervention were noted. Participants in both groups improved some of their lifestyle habits

Patient participation during primary health-care encounters among adult patients with multimorbidity:a cross-sectional study

Abstract Background: Patient participation is essential for achieving high-quality care and positive outcomes, especially among patients with multimorbidity, which is a major challenge for health care due to high prevalence, care complexity and impact on patients‘ lives. Objective: To explore the patient participation related to their own care among patients with multimorbidity in primary health-care settings. Methods: A cross-sectional survey was conducted among adult multimorbid patients who visited primary health-care facilities. The key instrument used was the Participation in Rehabilitation Questionnaire. Data representing 125 patients were analysed using various statistical methods. Results: The respondents generally felt patient participation to be important, yet provided highly varying accounts regarding the extent to which it was realized by professionals. Information and knowledge and Respect and encouragement were considered the most important and best implemented subcategories of participation. Several patient-related factors had a statistically significant effect on patient perceptions of participation for all subcategories and as explanatory factors for perceptions of total participation in univariate models. Most patients reported active participation in health-care communication, positively associated with patient activation and adherence. Gender, perceived health, patient activation and active participation were explanatory factors for total importance of participation in multivariate models, while patient activation was retained for realization of participation. Conclusions: Multimorbid patients require individualized care that promotes participation and active communication; this approach may further improve patient activation and adherence. Poor perceived health and functional ability seemed to be related to worse perceptions of participation. Patient and public involvement: The study topic importance was based on the patients‘ experiences in author‘s previous research and the need to develop patient-centred care

Adherence to self-management in patients with multimorbidity and associated factors:a cross-sectional study in primary health care

Abstract Aim: The aim of the study was to explore the adherence to self-management of patients with multimorbidity, identify associated factors, and determine explanatory factors of their adherence to self-management in terms of the Theory of Adherence of People with Chronic Disease. Background: Adherence to self-management is essential for successful care of multimorbid patients, but multimorbidity poses challenges for both patients and practitioners due to its care complexity and broad impact on patients’ lives. Design: A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. Methods: Adult multimorbid patients who attended primary healthcare consultations in Finland were surveyed using self-administered questionnaires with several instruments including the Adherence of People with Chronic Disease Instrument, Kasari’s FIT Index, and Alcohol Use Disorders Identification test. Responses of 124 patients were analysed using descriptive statistics, Spearman correlations, binary logistic regression analysis, and Chi-squared, or corresponding, tests. Results: Most patients’ responses indicated good or adequate adherence to care regimens and medications. However, adherence to self-management for a healthy lifestyle was more frequently inadequate. Adherence was significantly associated with several patient-related factors, including demographic and health-related factors, perceived adequacy of loved ones, and patient activation. Significant explanatory factors for adherence included energy and willpower, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, from physicians, and from family and friends. Various factors were relevant for specific aspects of self-management. Conclusions: Multimorbid patients’ adherence to self-management is not an ‘all or none phenomenon, but a multifaceted process with numerous associated and explanatory factors. Relevance to clinical practice: The findings highlight needs for an individualised whole-person approach in multimorbid patients’ care to provide the required support for good adherence to self-management. Healthcare professionals, especially nurses working in primary health care, are well-positioned to meet this need

Quality of working life of employees in public healthcare organization in Finland:a cross-sectional study

Abstract Aim: Work dissatisfaction, burnout and workforce shortage are major problems in healthcare globally, all of which are associated with QWL. Previous studies have found that the QWL of healthcare professionals is moderate or low. The aim was to describe the quality of working life (QWL) of employees working in public healthcare and describe the association between QWL and background variables. Design: This study had a quantitative cross-sectional survey design. Methods: Data was collected from the employees of a Finnish healthcare organization in autumn 2021 using an online questionnaire (n = 837). Convenience sampling was used in the selection of the healthcare organization. The study was reported according to STROBE guidelines. Results: The QWL was moderate, and the mean QWL index calculated from the questionnaire responses was 0.524. The QWL index was lowest in healthcare professionals and highest in upper management, with some dissatisfaction towards leadership noted

Lifestyle counseling intervention effects on counseling quality in patients with stroke and transient ischemic attack

Abstract Background: Studies have shown that counseling about risk factor-related lifestyle habits can produce significantly beneficial changes in stroke patients’ lifestyle habits. However, it is not sufficient nearly to provide a patient with appropriate information, but the quality of lifestyle counseling is also essential. The aim of the study was to investigate the effects of lifestyle counseling intervention on lifestyle counseling quality in stroke and TIA patients. Methods: Post-test control group design was used. Stroke and TIA patients (n=98), divided into intervention and control group, completed Counseling Quality Questionnaire after receiving lifestyle counseling at the hospital (January 2010–October 2011). Data were analyzed with analysis of variance. Results: The patients rated lifestyle counseling quality quite high in terms of all sum variables except patient centeredness. Counseling quality except for counseling resources was estimated to be significantly better by the intervention group. Conclusion: Lifestyle counseling quality at hospital can be enhanced by counseling intervention. More attention to factors that promote patient centeredness of counseling is required since patient centeredness has repeatedly been recognized as the weakest aspect of counseling by both stroke patients and other patient groups

The quality of long-term counselling for percutaneous coronary intervention patients:a cross-sectional study

Abstract Aim: To compare the long-term counselling quality among the patients visited and not visited at cardiac nurse after percutaneous coronary intervention (PCI) and related factors one to two years after PCI. Design: An explorative, register-based cross-sectional study. Methodology methods: A sample was drawn from the one university hospital’s procedure register consisted of the patients undergone a PCI (n = 977). The data was collected by Counselling Quality Instrument (CQI) questionnaire by mail, and analysed by basic and multivariate methods. Findings results: Of the respondents (n = 459), less than half the patients (48.4%) visited at cardiac nurse one to two years after PCI as instructed in the national current care guidelines. Patients, who visited the nurse (n = 194) had higher satisfaction for counselling than the ones not visited (n = 70). Nevertheless, patients, especially those who had no dyslipidemia, had Unstable Angina Pectoris or Non-ST-elevated myocardial infarction or were out of the workforce, were unsatisfied with counselling, and needed more social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. A half of the PCI patients (51.6%) did not visit the cardiac nurse at the primary health care. Patient or public contribution: Cardiac nurses assisted the members of research group by assessing the questionnaire prior sending it to the patients and patients contributed by completing the questionnaires. We thank both parties for their contribution. Implication for profession and patient care: This study demonstrated, that patients out of the workforce and having emergency PCI are in need for better quality counselling, concentrating on social support, patient-centred counselling and goal orientating implementation from the cardiac nurse. Those patients, who did not visit the cardiac nurse, should be offered easier access to cardiac nurse for example, by novel digital solutions