The dyadic self-care experience of stroke survivors and their caregivers: A qualitative descriptive study

background promoting self-care is the core response strategy of the global health system to the burden of stroke. although self-care in stroke represents a dyadic phenomenon, the dyadic self-care experience of stroke survivors and their caregivers is often overlooked in clinical practice. objectives the aim of this study was to explore the dyadic self-care experience of stroke survivors and their caregivers. design a descriptive qualitative design was used to conduct the study. results the consolidated criteria for reporting qualitative research was used for study reporting. a total of 21 stroke survivor-caregiver dyads were recruited for this study between may 2022 and september 2022. data were collected through semistructured interviews and analyzed using thematic analysis. In this study, four themes were identified: (1) poor relationship quality of the dyads, (2) dyadic incongruence in managing stroke, (3) a slow and tiring dyadic self-care process and (4) happy cooperation in coping with dyadic self-care. discussion and conclusion healthcare professionals should give greater consideration to the contradictions and disparities that may arise between stroke survivors and caregivers during the self-care process. It is crucial for them to provide personalized and tailored support and interventions that can assist these individuals in achieving a more optimal balance in their dyadic self-care. patient/public contribution patients were involved in the formulation of interview questions for this study. no members of the public were involved in this study

Recent Advances in Return-to-work Self-efficacy Assessment Tools

Returning to work is an important sign of recovery and returning to normal life for patients. Most patients have a strong desire to return to work, however, their confidence is low. Return-to-work self-efficacy is not only a reflection of patients' confidence in returning to work but also an important predictor of his readiness to get back to work. Based on the concept and meaning of return-to-work self-efficacy, this study introduces its related theoretical models, summarizes the contents, scoring criteria, validity and reliability of related assessment tools, and conducts a comparative analysis of the tools, to provide Chinese rehabilitation care workers with evidence contributing to the selection of an appropriate return-to-work self-efficacy assessment tool

Prevalence and Influencing Factors of Sedentary Behavior in Community Stroke Patients

BackgroundAs a kind of unhealthy lifestyle, sedentary behavior is closely related to poor prognosis of stroke patients. So it is of great significance to understand sedentary behavior prevalence in stroke patients, and to formulate intervention measures based on its influencing factors.ObjectiveTo investigate sedentary behavior prevalence and associated factors in stroke patients in the community, providing a reference for the development of targeted interventions.MethodsFrom August to December 2020, by use of convenience sampling, 230 eligible community stroke patients from Zhengzhou (including individuals who underwent reexaminations in neurology and neurosurgery clinics of three grade A tertiary hospitals and those who were from three communities) were selected to attend a survey using Demographic Questionnaire, Sedentary Behavior Questionnaire, the Chinese version of Fatigue Severity Scale, the Chinese version of Stroke Self-Efficacy Questionnaire, and Social Support Scale. Binary Logistic regression analysis was used to explore associated factors of sedentary behavior.ResultsThe survey achieved a response rate of 97.8%. The average daily sedentary time of the respondents was (7.10±2.75) hours, and 179 cases (79.6%) had daily sedentary time ≥5 hours. The daily sedentary time differed significantly by age, living in rural or urban areas, education level, number of complications, number of chronic diseases and fatigue (P<0.05) . Binary Logistic regression analysis showed that age, number of complications, number of chronic diseases and fatigue had significant impacts on sedentary behavior (P<0.05) .ConclusionThe prevalence of sedentary behavior in community-dwelling patients with stroke was high. It is recommended that health managers develop targeted interventions measures based on the above factors associated with sedentary behavior, thereby reducing sedentary behavior prevalence in this group

Development，Reliability and Validity of the Chinese Version of the Return-to-Work Self-Efficacy Questionnaire among Young and Middle-aged Stroke Patients

BackgroundThe prevalence of varying degrees of post-stroke dysfunctions commonly found in an increasing number of young and middle-aged stroke patients, has hindered them from returning to work quickly, and caused serious socioeconomic burdens. Return-to-work self-efficacy is an important predictor of returning to work, and the assessment of which may provide guidance for promoting patients to return to work. However, there is no scale measuring the return-to-work self-efficacy of Chinese stroke patients.ObjectiveTo develop a Chinese version of the Return-to-work Self-efficacy Questionnaire (RTW-SE) by translating the English version of the RTW-SE, then assess its reliability and validity in young and middle-aged Chinese stroke patients.MethodsBy use of forward and backward translation of the English version of the RTW-SE, the Chinese version of the scale was developed. Then the scale was tested in a sample of 130 cases, and was analyzed for item analysis and exploratory factor analysis. Then, the scale was retested in another sample (n=255) from November 2020 to April 2021 for confirmatory factor analysis. The Pearson correlation and critical ratio were used as parameters for item analysis, and the Cronbach's α and split-half reliability were used as parameters of the reliability of the scale. Content validity and structural validity were adopted as parameters of the scale validity. Content validity was expressed by scale- and item-level content validity indices. Structural validity was evaluated by factor analysis, including exploratory factor analysis and confirmatory factor analysis.ResultsThe response rates of the test, and retest for the scale were 93.1% (121/130) , and 96.1% (245/255) , respectively. The results of item analysis showed that item-total correlation coefficients ranged from 0.636 to 0.897, with critical ratios greater than 3 for all items (P<0.001) . Reliability analysis showed that the Cronbach's α and split-half reliability of the scale were 0.942, and 0.940, respectively. The scale- and item-level content validity indices were 0.95 and 0.80~1.00, respectively. By exploratory factor analysis, one common factor was extracted, and the factor loadings of items ranged from 0.628 to 0.901, with 63.919% as the percentage of explained total variance. The confirmatory factor analysis showed that the model fit was good.ConclusionThe Chinese version of RTW-SE may be a reliable and valid tool for measuring return-to-work self-efficacy in young and middle-aged Chinese patients with stroke

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Association between medication literacy and medication adherence and the mediating effect of self-efficacy in older people with multimorbidity

Abstract Background Multimorbidity has a significant impact on public health and primary care. Medication adherence is recognized as the most effective measure for managing and preventing multimorbidity. Studies have shown that medication literacy has a positive effect on medication adherence in patients with multimorbidity. However, limited knowledge exists regarding the underlying mechanisms of this relationship in older adults with multimorbidity. Therefore, the aim of this study was to investigate the mediating role of self-efficacy in the association between medication literacy and medication adherence in this population. Methods This study employed a cross-sectional design and convenience sampling method to survey older patients with multimorbidity in six communities in Zhengzhou, China, from July 12, 2021, to December 15, 2021. Participants were assessed using a demographic questionnaire, the Chinese Version of the Medication Literacy Scale (C-MLS), the Self-Efficacy for Appropriate Medication Use Scale (SEAMS), and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8). Data were analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson correlation analysis, and mediation analysis. Results A total of 350 elderly patients met the inclusion criteria, and 328 valid questionnaires were collected. The mean age of the participants was 74.90 ± 7.37 years, with a slightly higher proportion of males (55.8%) than females (44.2%). The mean score for medication adherence was 4.85 ± 1.57, indicating poor medication adherence among the participants. Medication adherence scores varied significantly among participants of different ages, education levels, employment statuses and kinds of medication (p < 0.01). Scores for medication literacy and self-efficacy showed a significant positive correlation with medication adherence scores (all p < 0.001). The standardized coefficient for the total effect and direct effect of medication literacy on medication adherence was 0.268 (95% CI: 0.201, 0.335) and 0.187 (95% CI: 0.123, 0.252), respectively. After introducing self-efficacy into the model, the standardized coefficient for the indirect effect was 0.081 (95% CI: 0.049, 0.120), indicating that self-efficacy partially mediated the relationship between medication literacy and medication adherence, accounting for 30.22% of the total effect. Conclusion This study might suggest that medication literacy indirectly affected medication adherence in older people with multimorbidity through self-efficacy. Health care providers should be aware of the importance of improving medication literacy and implement strategies aimed at increasing self-efficacy to achieve the goal of improving medication adherence in older adults with multimorbidity

Nudge Theory in Chronic Disease Self-management: Advances in Application and Recommendations for Promotion

Nudge theory is an emerging behavioral intervention theory based on behavioral economics and positive psychology, which has been widely used and proven effective in chronic disease self-management abroad. Compared with traditional intervention methods for chronic disease self-management, nudge theory-based intervention program possesses stronger generalization owing to lower requirements for patients&apos; knowledge and attitude regarding chronic disease self-management without interfering with their freedom of choice. We introduced the concept, mechanism of action and classification of nudge theory, and reviewed the advances in its application in chronic disease self-management from four aspects: symptom monitoring, diet control, physical exercise, and medication adherence. On this basis, we put forward the following recommendations to ensure the effectiveness of nudge theory-based interventions: developing nudge theory-based intervention programs targeting the barriers to chronic disease self-management, delivering different types of interventions to different patients using digital technology as a method for classifying the intervention program, having close contact with the community during the intervention, and strengthening the supervision of relevant departments

The Urban-Rural Disparity in the Status and Risk Factors of Health Literacy: A Cross-Sectional Survey in Central China

Health literacy is the ability of individuals to access, process, and understand health information to make decisions regarding treatment and their health on the whole; it is critical to maintain and improve public health. However, the health literacy of urban and rural populations in China has been little known. Thus, this study aims to assess the status of health literacy and explore the differences of its possible determinants (e.g., socio-economic factors) among urban and rural populations in Henan, China. A cross-sectional study, 78,646 participants were recruited from a populous province in central China with a multi-stage random sampling design. The Chinese Resident Health Literacy Scale was adopted to measure the health literacy of the respondents. In the participants, the level of health literacy (10.21%) in central China was significantly lower than the national average, and a big gap was identified between urban and rural populations (16.92% vs. 8.09%). A noticeable difference was reported in different aspects and health issues of health literacy between urban and rural populations. The health literacy level was lower in those with lower levels of education, and a significant difference was identified in the level of health literacy among people of different ages and occupations in both urban and rural areas. Note that in rural areas, as long as residents educated, they all had higher odds to exhibit basic health literacy than those uneducated; in rural areas, compared with those aged 15 to 24 years, residents aged 45 to 54 years (OR = 0.846,95% CI (0.730, 0.981)), 55 to 64 years (OR = 0.716,95% CI (0.614, 0.836)) and above 65 years (OR = 0.679, 95% CI (0.567, 0.812)) were 84.6%, 71.6%, and 67.9%, respectively, less likely to exhibit basic health literacy. Considering the lower health literacy among rural residents compared with their urban counterparts, a reorientation of the health policy-making for Chinese rural areas is recommended. This study suggests that urban&ndash;rural disparity about health literacy risk factors should be considered when implementing health literacy promotion intervention