Factors Associated with Telehealth Initiation Among Heart Failure Patients at Home

This dissertation aims to examine factors associated with telehealth initiation among heart failure patients in home care settings using a mixed methods study design. Chapter One identifies the current gap in the literature on telehealth adoption and the significance of this study in filling this gap. Chapter Two provides an integrative review of the literature on factors affecting heart failure patients’ decision making to accept telehealth services in a home setting. Chapter Three presents a quantitative analysis of data from the Outcome and Assessment Information Set (OASIS) on 2,832 heart failure patients referred to telehealth services using a modified Unified Theory of Acceptance Use of Technology (UTAUT) framework, to identify patient-related factors or characteristics associated with telehealth initiation. Chapter Four describes the findings of a qualitative study using individual telephone interviews with heart failure patients at home to explore reasons for telehealth initiation. Finally, in Chapter Five, the findings of all three studies are summarized and overarching conclusions are reported with a discussion of their relationship to previous research. This chapter concludes with a consideration of the strengths and limitations of the study, and implications for practice, policy, and research

Gender differences in the relationship between informal caregiving and subjective health: the mediating role of health promoting behaviors

Abstract Background In most of developed societies, the prevalence of informal care is on the rise due to rapid population ageing. This study investigates longitudinal associations between informal caregiving and health among caregivers and potential gender differences in this relationship. Moreover, drawing on the Health Promotion Model, this study examines the mediating role of health promoting behaviors in the link between informal caregiving and caregivers health. Methods Seven waves of a large-scale (N = 9,608), a nationally representative longitudinal study of middle- and old-aged adults in Korea between 2006 and 2018, were used. To address the possibility of omitted variable bias, this study employed ordinary least squares models with lagged dependent variables (OLS-LDV) as well as fixed effects (FE) models. Univariate Sobel-Goodman mediation tests were used. Results Findings from OLS-LDV models showed that transition into informal caregiving is negatively associated with health satisfaction and self-rated health. FE results also suggest that our results are robust to controlling for unobserved heterogeneity. In the model where informal caregiving is interacted with gender, we found that these associations were largely driven by women caregivers. Results from Sobel-Goodman tests revealed that a decrease in regular exercise partially explains the observed association between informal caregiving and subjective health outcomes (11% for health satisfaction and 8% for self-rated health). Conclusions Although informal caregiving can be a rewarding role, it poses a threat to caregivers subjective health. Findings of this hold important implications and provide evidence in support of a gender-conscious approach to improve the health and well-being of informal caregivers

Informal caregiver decision-making factors associated with technology adoption and use in home health care: A systematic scoping review

Technology systems to alleviate the burden of managing patient’s health at home are increasing. The home is a unique place where chronic disease self-management is often performed by informal caregivers. Informal caregivers provide up to 80% of in‐home care to dementia patients. Yet, how caregivers make decisions about adopting a specific technology has not been thoroughly explored. This review mapped evidence on decision-making factors associated with technology adoption and use by caregivers for patients at home. This study followed the recommendations for performing systematic scoping reviews that were developed by members of the Joanna Briggs Institute. Four electronic databases (PubMed, Medline, CINAHL, and Embase) were searched using both medical subject headings (MeSH terms) and key words. A total of 6 papers were included for data synthesis. The scope of the technology types and patient diagnoses explored in the included studies has been mapped. Factors such as information, comprehension, motivation, time, perceived burden, and perceived caregiving competency were found to affect whether to adopt caregiver decision-making regarding on the use of technology when caring for patients at home. There are other factors uniquely springing from the patient and technology as well as shared issues between caregivers and patient or caregivers and technology. Informal caregiver decision-making on technology adoption can have a considerable impact on patient care at home. This systematic scoping review found that although some factors depend on technology type and patient diagnosis, there were some common factors across the research. Those factors can be carefully considered in referring technology use for caregivers. Further, more focused study in this under-investigated area is much needed

Do caregivers’ involvement in Type 2 diabetes education affect patients’ health outcomes?: A systematic review and meta-analysis

Introduction: The prevalence of Type 2 diabetes mellitus (T2DM) is rising worldwide. Patients frequently struggle with controlling their diabetes and need the assistance of caregivers for effective self-management because managing diabetes requires a variety of strategies, including diet, glucose monitoring, and exercise. This study aimed to examine the effect of caregiver involvement in T2DM education within a community on patients’ diabetes care outcomes. Methods: Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of all published studies from the earliest record to May 2022 that reported adult caregivers of T2DM patients who participated in educational interventions concerning diabetes management and that reported one or more outcomes of the interventions were conducted. Four databases were used, including PubMed, Cochrane Library, EMBASE, and CINAHL. The meta-analysis focused on glycated hemoglobin (HbA1c) levels among randomized controlled trials (RCTs), with additional attention to lipid levels. Review Manager 5.4 was used to perform this meta-analysis. Results: A total of 17 out of 683 studies were synthesized. Involvement of caregivers in T2DM education is shown to reduce body mass index and HbA1c. This involvement also improves patients’ knowledge, physical activity, and self-efficacy, but the effect on medication adherence varies. A meta-analysis of six RCT studies shows that caregiver involvement in T2DM education reduced pooled HbA1c levels by 0.83 (95% Confidence interval: −1.27–−0.38) compared to involvement (p = 0.0003). Meta-analysis of three types of lipids (low-density lipoprotein, total cholesterol, and high-density lipoprotein) showed no strong evidence that caregiver participation in diabetes education improved lipid levels. Conclusions: Caregivers play key roles in diabetes management and can contribute to improving patient HbA1c levels. Future research should focus on enhancing caregiver participation in T2DM education

The associations between bone mineral density and cerebral white matter hyperintensity in elderly stroke patients

Purpose Osteoporosis is an important senile disease and has significant relationship with ischemic stroke and cerebral small vessel disease (SVD). Correlation between bone mineral density (BMD) and cerebral white matter hyperintensity on magnetic resonance imaging were analyzed to investigate the relationship between osteoporosis and cerebral SVD. Methods Medical records of acute stroke patients with age ≥ 65 years were retrospectively collected from single center. Cerebral white matter hyperintensity was classified into two categories, periventricular white matter hyperintensity (PWMH) and deep white matter hyperintensity (DWMH), and the severity was graded according to maximal lesion size. Association between the clinical factors including BMD and the severity of cerebral white matter hyperintensity was analyzed. Results Four hundred eight patients were included in the study. High severity grade of both MWMH and DWMH was independently correlated with low BMD. Additionally, high PWMH grade was correlated with old age and high serum homocysteine. High DWMH grade was correlated with old age, atrial fibrillation history and high serum total calcium. Conclusion Low BMD was associated with a high severity of cerebral white matter hyperintensity in elderly Asian stroke patients, independent of other clinical factors

An integrative review on mothers' experiences of online breastfeeding peer support: Motivations, attributes and effects

Abstract Information on the experiences surrounding online breastfeeding peer support among breastfeeding mothers and its effects on breastfeeding outcomes is growing yet to be synthesized. The aim of this review was to synthesize the evidence of mothers' experiences of online breastfeeding peer support. An integrative review was conducted. Five electronic databases were searched. Two reviewers independently screened the articles for inclusion. The inclusion criteria were (1) involved original data focusing on mothers' experiences of online breastfeeding peer support, (2) participants who were mothers who were breastfeeding or had experiences of breastfeeding and (3) studies focusing on interaction and communication among mothers through online communities. In total, 14 publications met the inclusion criteria. Breastfeeding mothers turned to online groups when they felt isolated, lacked professional support or preferred online support over face‐to‐face support. Online breastfeeding peer support was characterized as a virtual community, with easy access, availability and a wealth of resources from actual experiences of mothers. It empowered breastfeeding mothers and resulted in changes in breastfeeding outcomes and perceptions. The positive aspects of online breastfeeding peer support have recently garnered more attention. This review provided baseline data and evidence to supplement and improve the current breastfeeding support system for breastfeeding mothers. The evidence on the effectiveness of online breastfeeding peer support for influencing breastfeeding outcomes remains inconclusive. Further empirical studies with rigorous study designs are warranted

A cross-sectional study on public health nurses' disaster competencies and influencing factors during the COVID-19 pandemic in Korea

Public health nurses are performing various roles during the COVID-19 pandemic: counseling, surveillance, specimen collection, epidemiological investigation, education, and vaccination. This study investigated their disaster competencies in the context of emerging infectious diseases, and identified their influencing factors based on Deci and Ryan's self-determination theory. A convenience sample of 242 was selected from public health nurses working in a metropolitan city of South Korea. Data were collected using a structured questionnaire and analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation, and multiple regression analysis using the SPSS Statistics ver. 23.0. Results showed that the significant factors influencing disaster competencies included "willingness to respond to a disaster," "preventive behavior," "experience of receiving education on emerging infectious diseases response," "public health center experience," "job satisfaction," and "education." This regression model explained 33.2% of the variance in disaster competencies. "Willingness to respond to a disaster" was the strongest factor affecting disaster competencies. Based on these results, it is concluded that interventions to improve disaster competencies and psychological well-being of public health nurses are needed. Additionally, strategies such as creating a supportive work environment, deploying experienced nurses primarily on the front line, and reducing the tasks of permanent public health nurses should be implemented.N