BACKGROUND Despite societal guidelines recommending targeted screening for Barrett’s esophagus(BE)and esophageal adenocarcinoma(EAC)in individuals with gastroesophageal reflux symptoms(GERS),screening adherence is su...BACKGROUND Despite societal guidelines recommending targeted screening for Barrett’s esophagus(BE)and esophageal adenocarcinoma(EAC)in individuals with gastroesophageal reflux symptoms(GERS),screening adherence is suboptimal.Current screening approaches fail to identify individuals not seeking medical consultation for GERS or whose GERS are managed with‘over-the-counter’(OTC)acid suppressant therapies.AIM To assess patients’self-management and help-seeking behavior for GERS.METHODS This cross-sectional study collected data from the Dutch general population aged 18-75 years between January and April 2023 using a web-based survey.The survey included questions regarding self-management(e.g.,use of acid suppressant therapy with or without prescription)and help-seeking behavior(e.g.,consulting a primary care provider)for GERS.Simple random sampling was performed to select individuals within the target age group.In total,18156 randomly selected individuals were invited to participate.The study protocol was registered in ClinicalTrials.gov(identifier:NCT05689918).RESULTS Of the 18156 invited individuals,3214 participants(17.7%)completed the survey,of which 1572 participants(48.9%)reported GERS.Of these,904 participants(57.5%)had never consulted a primary care provider for these symptoms,of which 331 participants(36.6%)reported taking OTC acid suppressant therapy in the past six months and 100 participants(11.1%)fulfilled the screening criteria for BE and EAC according to the European Society of Gastrointestinal Endoscopy Guideline.CONCLUSION The population fulfilling the screening criteria for BE and EAC is incompletely identified,suggesting potential underutilization of medical consultation.Raising public awareness of GERS as a risk factor for EAC is needed.展开更多
BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T...BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T2DM).Based on conven-tional nursing methods,community home care has important clinical significance in controlling blood sugar and disease progression.AIM To explore the impact of community public health nursing on treatment effect,health cognition,and self-management in patients with T2DM.METHODS One hundred patients with T2DM were selected as the research subjects.The patients were divided into either a conventional nursing group or community nursing(CN)group using the random number table method.The conventional nursing group(50 cases)received routine care,while the CN group(50 cases)received community public health care in addition to routine care as that for the conventional nursing group.The rate of excellent and good blood glucose control,fasting blood glucose before and after care,2-h postprandial blood glucose,health cognition,and self-management ability,and patient satisfaction were compared between the two groups.RESULTS The CN group had a higher rate of excellent blood sugar control than the conventional nursing group(88%vs 70%,P<0.05).Before care,there was no significant difference in fasting blood glucose or 2-h postprandial blood glucose between the two groups of patients(P>0.05).After nursing,fasting blood glucose and 2-h postprandial blood glucose were reduced to varying degrees in both groups,and both blood glucose levels in the CN group were lower than those of the conventional nursing group(P<0.05).Compared with the scores before care,the cognitive level score for diabetes and self-management ability score improved after care in both groups.The cognitive level and self-management ability of patients in the CN group were higher than those of the conventional nursing group(P<0.05).The overall satisfaction of the CN group was better than that of the conventional nursing group(98%vs 86%,P<0.05).CONCLUSION Community public health care based on conventional care of T2DM can achieve better blood sugar control,and improve patients’health cognitive level and self-management ability.展开更多
Background: Hip osteoarthritis (HOA) causes joint destruction, resulting in hip pain, limited range-of-motion, claudication, and joint deformity. In the conservative treatment of HOA, self-management is important to m...Background: Hip osteoarthritis (HOA) causes joint destruction, resulting in hip pain, limited range-of-motion, claudication, and joint deformity. In the conservative treatment of HOA, self-management is important to manage symptoms and control disease progression. In a previous study, the researchers conducted a conceptual analysis of 43 foreign studies on self-management during conservative therapy for patients with HOA. The results revealed a definition of self-management during conservative therapy for patients with HOA. However, because that study analyzed only the foreign literature, it remains unclear whether the findings reflect the characteristics of the Japanese health-care delivery system, health-care insurance system, or the lifestyles and cultural characteristics of Japanese patients with HOA. Objective: We aimed to clarify the self-management behaviors of patients with HOA. Methods: Semi-structured interviews were conducted with five patients diagnosed with HOA, and the results were subjected to inductive qualitative analysis. Results: Six categories of self-management behaviors were extracted for patients with HOA: [active information gathering about HOA], [personalized pain and weight management, and strategies for reducing hip joint load], [reflection on living conditions with individuals and professionals, and determination for future efforts], [continuation of exercise and weight management based on personal strengths and achievements, and mutual support with others], [coexistence with HOA while managing negative feelings], and [choosing treatment methods by trusting doctors while struggling with personal needs]. Conclusion: These findings suggest the need to develop health guidance and educational programs for patients with HOA that focus on how to prevent disease progression and cope with symptoms.展开更多
BACKGROUND Esophageal cancer(EC)is an aggressive malignancy with low survival(10%-30%).Nutritional problems are present throughout the perioperative period and are key to prognosis.Home enteral nutrition appears to im...BACKGROUND Esophageal cancer(EC)is an aggressive malignancy with low survival(10%-30%).Nutritional problems are present throughout the perioperative period and are key to prognosis.Home enteral nutrition appears to improve the nutritional status of patients with EC.Few studies have addressed the experience of patients administering their own nutritional fluids and managing their own feeding tubes at home.The aim of this study was to explore the real-life experience of self-management of feeding tubes in patients at home after EC surgery in the first 3 months after discharge following surgery.AIM To explore feeding tube self-management experience of patients at home 3 months after discharge following EC surgery.METHODS Face-to-face semi-structured interviews were conducted with 18 patients using a feeding tube at home after EC surgery.Thematic analysis of the recordings identified themes related to feeding tube self-management.RESULTS Patients expressed similar feelings about their tube management experiences concerning three contextualized themes:Self-management dilemmas,distressing experiences,and self-management facilitators.CONCLUSION There are many dilemmas and problems in self-managing feeding tubes in postoperative homebound patients with EC.Clinical staff should provide guidance to promote a positive change in self-management behavior.展开更多
BACKGROUND The correlation conclusions between self-management,frailty,and quality of life(QoL)of chronic obstructive pulmonary disease(COPD)patients are inconsistent.AIM To comprehensively assess the current status o...BACKGROUND The correlation conclusions between self-management,frailty,and quality of life(QoL)of chronic obstructive pulmonary disease(COPD)patients are inconsistent.AIM To comprehensively assess the current status of self-management,psychological cognitive impairment,and QoL in elderly patients with COPD.METHODS Convenient sampling was employed to select 312 elderly patients with COPD who were receiving treatment in the respiratory and critical care medicine department of a tertiary grade A hospital from November 2023 to February 2024.The study utilized demographic information and clinical characteristics,selfmanagement behavior,occurrence of psychological cognitive impairment,and QoL as evaluated through general information questionnaires,the COPD patient self-management scale,simple frailty scale,simple mental status scale,clinical dementia assessment scale,and the clinical COPD assessment test questionnaire.This research aims to describe the current status and correlations among selfmanagement behavior,cognitive impairment occurrence,and QoL.RESULTS The average score for self-management behavior in elderly COPD patients was 136.00(119.00,164.50),indicating a moderate level overall.There were 98 cases of cognitive impairment,accounting for 31.4%,with a mental status score of 3(2,3.75).The average QoL score was 24(19,28),indicating a low level.Additionally,there was a negative correlation between total self-management behavior score and cognitive impairment occurrence(r=-0.589,P<0.001),and QoL total score(r=-0.409,P<0.001).Cognitive impairment occurrence was positively correlated with QoL total score(r=0.345,P<0.001).Disease course and self-management behavior score were independent factors affecting the total QoL score in elderly COPD patients(P<0.05).CONCLUSION The self-management behavior of elderly patients with COPD is at a moderate level.However,the occurrence of cognitive impairment is high and significantly influenced by disease course,level of self-management,and mental status.The QoL is low,emphasizing the urgent need to intervene in the self-management behaviors of elderly COPD patients,actively reduce the occurrence of cognitive impairment,and mitigate the impact of the disease on QoL.展开更多
Objective:To explore the self-management experiences and outpatient nursing needs of intestinal stoma patients during the post-discharge transition period,in order to provide a basis for scientific decision-making in ...Objective:To explore the self-management experiences and outpatient nursing needs of intestinal stoma patients during the post-discharge transition period,in order to provide a basis for scientific decision-making in patient self-care and improvements in specialized stoma outpatient services.Methods:Using purposive sampling,13 colorectal cancer patients in the post-discharge transition period who had undergone intestinal stoma surgery were selected from a tertiary hospital in Shandong Province between November 2024 and March 2025.Semi-structured interviews were conducted,and data were analyzed using Colaizzi’s seven-step method to extract themes.Results:Three core themes were identified:challenges in self-management during the transition period,outpatient nursing needs during the transition period,and gaps in doctor-patient information continuity.Conclusion:Future efforts should focus on high-risk groups of stoma patients during the transition period by building intelligent and systematic outpatient guidance and support systems to improve their quality of life.展开更多
Under the background of exam-oriented education in China,art education has been marginalized,and the career success of junior middle school art teachers is being challenged.The influencing factors have become a topic ...Under the background of exam-oriented education in China,art education has been marginalized,and the career success of junior middle school art teachers is being challenged.The influencing factors have become a topic worthy of exploration.Therefore,this study aims to investigate the influence on career success and career self-development among junior middle school art teachers in Shenzhen,China.This study conducted a questionnaire survey among junior middle school art teachers in Shenzhen,China.The results show that career self-management affects the career success of art teachers.On this basis,this study proposes some strategies to help the group of art teachers achieve higher career success by improving their career self-management levels.展开更多
Self-management interventions for chronic obstructive pulmonary disease(COPD)patients using mobile health technology are beneficial for relieving disease symptoms,improving patients’adherence to rehabilitation self-m...Self-management interventions for chronic obstructive pulmonary disease(COPD)patients using mobile health technology are beneficial for relieving disease symptoms,improving patients’adherence to rehabilitation self-management,and improving quality of life.This paper reviews the application of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,introduces the application form of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,summarizes its application effect in self-management of patients with chronic obstructive pulmonary disease,analyzes the problems and proposes solutions in the process of research and implementation at this stage,with a view to providing a theory for the application of mobile health technology in pulmonary rehabilitation and management of patients with chronic obstructive pulmonary disease This study summarize the effect of its application in the self-management of patients with chronic obstructive pulmonary disease.展开更多
[Objectives]To explore the effects of motivational interviewing intervention based on the transtheoretical model(TTM)on psychological resilience and self-management in patients undergoing finger reimplantation after a...[Objectives]To explore the effects of motivational interviewing intervention based on the transtheoretical model(TTM)on psychological resilience and self-management in patients undergoing finger reimplantation after amputation.[Methods]The patients with finger replantation due to fractures admitted from October 2024 to June 2025 were divided into either the control group or the observation group according to the random number table method,with 40 cases in each group.The control group received conventional perioperative care,while the observation group underwent motivational interviewing based on TTM framework on the basis of the control group.The psychological resilience and self-management levels of the two patient groups were then compared following their respective care interventions.[Results]The psychological resilience and self-management scores of the patients were significantly higher than those of the control group after the intervention,with the difference being statistically significant(P<0.05).[Conclusions]Motivational interviewing based on the TTM can effectively improve the psychological resilience and self-management in patients undergoing severed finger reimplantation,while effectively reducing the occurrence of vascular crisis.展开更多
Diabetes is a major public health concern worldwide. Low and middle-income countries are the most affected. Diabetes self-management can significantly reduce the burden of diabetes complications and mortality. This cr...Diabetes is a major public health concern worldwide. Low and middle-income countries are the most affected. Diabetes self-management can significantly reduce the burden of diabetes complications and mortality. This cross-sectional study was conducted at the outpatient department of a county referral hospital in Kenya, from 1st August 2022 to 30th October 2022. Patients with known type II diabetes of age ≥ 20 years visiting the hospital for routine follow-up visits were included. A 7-tem Summary of Diabetes Self-care Activities (SDSAC) Questionnaire was used to assess Diabetes self-care activities. For data entry and statistical analysis, SPSS for Windows version 27.0 was used. There were 96 (39.2%) males and 149 (60.8%) females. Most of the participants were more than 61 years, 148 (60.4%). Significant association was found between the sum scale scores of dietary activities, blood glucose testing, physical activity, foot care, and neuropathy at 95% CI and (p Conclusions: Diabetes self-management activities have an impact on microvascular complications in patients with diabetes.展开更多
Background:Falls are a significant public health concern among older adults,often leading to severe injuries and decreased quality of life.Fall prevention self-management behaviors are critical in reducing fall risk.H...Background:Falls are a significant public health concern among older adults,often leading to severe injuries and decreased quality of life.Fall prevention self-management behaviors are critical in reducing fall risk.However,the status and influencing factors of these behaviors among community-dwelling older adults in China remain poorly understood.This study aimed to investigate fall prevention self-management behaviors and their influencing factors among community-dwelling older adults in Fuzhou,China.Methods:From June to December 2022,we used multi-stage cluster random sampling and invited 675 community-dwelling older adults from Fujian as participants.We conducted a questionnaire survey using the general information questionnaire,Fall Prevention Self-management Behavior among Older Adults Questionnaire,Questionnaire on Knowledge,Belief,and Practice of Falls Prevention among Older Adults in Community,Modified Falls Efficacy Scale,Social Support Rating Scale,and Chinese Version of the Self-Assessment Fall Risk Scale for Older Adults.Multivariate linear regression was used to identify the factors influencing fall prevention self-management behavior among older adults.Results:The overall score of fall prevention self-management behaviors was 146.81±34.22,indicating a moderate level.Key influencing factors included education level,pre-retirement occupation,income,medication type,self-assessed physical condition,fear of falling,knowledge and practices in fall prevention,social support,and fall risk.These factors collectively explained 34.3%of the variance in self-management behaviors.Conclusion:The findings highlight the need for targeted interventions to enhance fall prevention self-management among community-dwelling older adults.Interventions should focus on improving knowledge,strengthening social support,and addressing psychological barriers such as fear of falling.This study provides valuable insights for developing community-based strategies to reduce fall risks and promote healthy aging.展开更多
Objective:The objective of this study is to explore the current situation of nurses’participant activation for self-management of low back pain,analyze its influencing factors,and provide a reference for improving th...Objective:The objective of this study is to explore the current situation of nurses’participant activation for self-management of low back pain,analyze its influencing factors,and provide a reference for improving the participant activation for self-management of low back pain.Materials and Methods:A cross-sectional study was conducted with 5,120 nurses recruited through convenience sampling from hospitals across 25 provinces and municipalities in China.Participants completed two standardized instruments:General Information Questionnaire which collected demographic characteristics and work-related factors,and the Participant Activation for Self-Management of Back Pain Questionnaire which measured activation levels across three dimensions(including self-management beliefs,self-management awareness,and knowledge related to low back pain).Results:The score of nurses’participant activation for low back pain self-management was 38.00(33.00,44.00).The results of multiple linear regression showed that nurses of different gender,age,and professional titles,whether they had administrative positions,and whether they had back pain in the past year were influencing factors of nurses’participant activation for low back pain management.Conclusion:The overall participant activation for self-management of low back pain is at a medium level.Their self-management awareness is strong,but their beliefs about management of low back pain are insufficient.Targeted intervention measures can be taken to improve their activation for management of back pain and reduce the incidence of occupational low back pain.展开更多
This longitudinal study investigated how self-management and learning burnout influences the relationship between habitual mobile phone use and subjective well-being amongfirst-year university students.A sample of 1172 ...This longitudinal study investigated how self-management and learning burnout influences the relationship between habitual mobile phone use and subjective well-being amongfirst-year university students.A sample of 1172 Chinese university students participated in a two-wave survey,with data collected six months apart at two time points(T1,T2).The results of Pearson correlation revealed that higher habitual mobile phone use at T1 was associated with lower subjective well-being at T2.Self-management was associated with healthy phone use habits and higher subjective wellbeing.Learning burnout risk was higher with habitual phone usage.Lower self-management and learning burnout at T2 played a chain mediating role between habitual mobile phone use at T1 and subjective well-being at T2 so that subjective well-being was much lower that with either of the variables alone.Overall,thesefindings suggest that habitual mobile phone use is a reliable predictor of college student’s subjective well-being,by their self-management and level of learning burnout over time.This research highlights the long-term impact of habitual mobile phone use on students’subjective well-being and provides valuable insights for developing effective interventions to support students well-being.展开更多
Objective:Effective Chronic Kidney Disease(CKD)management is particularly important in cold regions of China,where climate and lifestyle factors play significant roles.However,there is a lack of relevant studies in th...Objective:Effective Chronic Kidney Disease(CKD)management is particularly important in cold regions of China,where climate and lifestyle factors play significant roles.However,there is a lack of relevant studies in this area.Therefore,the purpose of this study was:(1)to assess the status of self-management capacity in individuals with CKD in cold regions of China and analyze the factors influencing it;(2)to identify strategies to improve CKD management in primary care settings in these regions;and(3)to understand patients'attitudes toward eHealth services.Methods:This was a regional,cross-sectional observational study.A questionnaire measuring CKD patients'self-management abilities was derived from the Perceived Kidney Disease Self-Management Scale,the Kidney Disease Behavioral Inventory(KDBI),and the Health Literacy Questionnaire.Data were collected from hospitalized CKD patients in Heilongjiang Province and analyzed using One-Way Analysis of Variance(ANOVA),Hierarchical Regression Analysis,and K-prototype cluster analysis.Results:A total of 957 participants were tested.Of these,70.64%had less than a bachelor's degree,and 56.27%had been diagnosed with hypertensive or diabetic nephropathy.The KDBI scale showed a lower overall score compared to the PKDSMS.Factors such as CKD stage 4(F=2.367,P=0.042),last year's medical expenses(F=3.974,P=0.004),and poor self-rated health(F=33.352,P<0.01)were found to influence scores on both scales.The health literacy questionnaire revealed significant differences(P<0.01)in health knowledge,except by sex.Additionally,healthcare expenditures and poor self-rated health were negatively associated with self-management capacity.Conclusion:This study provides valuable insights into the self-management challenges faced by CKD patients in cold regions of China.Despite some difficulties in improving self-management,patients showed positive attitudes toward enhancing CKD management services in primary care and developing digital management tools.These findings offer useful references and recommendations for future clinical practice and research in this field.展开更多
Objective: To explore the application effect of self-management based on Snyder’s hope theory in diabetic patients. Methods: A total of 260 patients with diabetes from a community were selected through convenient sam...Objective: To explore the application effect of self-management based on Snyder’s hope theory in diabetic patients. Methods: A total of 260 patients with diabetes from a community were selected through convenient sampling and randomly divided into an experimental group and a control group using the random number table method, with 130 cases in each group. Five cases were lost in the experimental group, resulting in 125 effective cases, while all 130 cases in the control group were effective. The control group received standard lectures on diabetes self-management behavior and traditional approaches, such as the distribution of educational manuals. The experimental group underwent a self-management behavior intervention program for diabetic patients based on Snyder’s hope theory model, encompassing three components: goals, pathways, and motivational thinking. The levels of hope and self-management behavior were compared between the two groups. Results: After the intervention, the scores for hope levels and self-management behaviors in both groups were significantly higher than those recorded before the intervention (P < 0.05). Furthermore, the hope level and self-management behavior scores of the experimental group were significantly higher than those of the control group (P < 0.05). Conclusion: The application of Snyder’s hope theory model in diabetic patients demonstrates significant benefits, improving patients’ hope levels and, consequently, enhancing their self-management behaviors.展开更多
In this editorial we comment on the article titled“Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease”by Zeng et al published in a recent ...In this editorial we comment on the article titled“Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease”by Zeng et al published in a recent issue of the World Journal of Gastroenterology.Non-alcoholic fatty liver disease(NAFLD)represents one of the current challenges in hepatology and public health,due to its continuous growing prevalence and the rising incidence of NAFLD-related fibrosis,non-alcoholic steatohepatitis and cirrhosis.The only effective therapeutic strategy for this dis-ease is represented by encouraging patients to improve their lifestyle through the modification of dietary intake and increased physical exercise,but the effective application of such modifications is often limited by various factors such as lack of information,psychological barriers or poor social support.While poor adherence to a healthy lifestyle can be decisive in determining the clinical outcome,in daily practice there is a lack of quantitative instruments aimed at identifying patients with the lowest adherence to lifestyle changes and higher risk of disease progre-ssion in the course of follow-up.In this article,Zeng et al propose a quantitative scale to assess the grade of adherence of patients with NAFLD to hea-lthy lifestyle intervention,called the Exercise and Diet Adherence Scale(EDAS).This scale,consisting of 33 items divided into 6 dimensions which relates to six subjective aspects in the self-management of NAFLD,has shown a good correlation with the identification of the sub-cohort of patients with the highest reduction in caloric intake,increase in physical exercise,probability of a reduction in liver stiffness measurement and alanine aminotransferase levels.The cor-relation among clinical outcomes and specific dimensions of this scale also highlights the pivotal role of a good and confidential doctor-patient relationship and of an effective communication.There is an urgent need for practical and effective instruments to assess the grade of self-management of NAFLD patients,together with the development of multidisciplinary teams with the aim of applying structured behavioral interventions.展开更多
This review article is aimed at describing the primary healthcare system of Pakistan and its challenges in the face of epidemic of type 2 diabetes, focusing particularly on the middle-aged population of rural area of ...This review article is aimed at describing the primary healthcare system of Pakistan and its challenges in the face of epidemic of type 2 diabetes, focusing particularly on the middle-aged population of rural area of Pakistan. The main concern in Pakistan is that its middle-aged population is facing the onslaught of obesity and overweight due to lack of physical activity. In addition unhealthy eating habits making it more difficult for this population to control their weight. All these factors are contributing to a high risk of type 2 diabetes for the population of Pakistan. This article provides insight into the primary health care system of Pakistan and highlights its deficiencies by identifying that its primary healthcare system has a poor utilization of health care services, the poor accessibility to health system and poor management of diabetes by the healthcare system, gender disparity and inequity in the health care system. The primary objective of this study is to provide an overview of self-management of diabetes among the middle-aged population of Pakistan and to identify the overall deficiencies in the primary healthcare system, its delivery and access to the system, barriers to self-management of diabetes and quality of life in that region.展开更多
Objective To explore how older patients self-manage their coronary heart disease （CHD） aider undergoing elective percutaneous transluminal coronary angioplasty （PTCA）. Methods This mixed methods study used a seque...Objective To explore how older patients self-manage their coronary heart disease （CHD） aider undergoing elective percutaneous transluminal coronary angioplasty （PTCA）. Methods This mixed methods study used a sequential, explanatory design and recruited a convenience sample of patients （n = 93） approximately three months after elective PTCA. The study was conducted in two phases. Quantitative data collected in Phase 1 by means of a self-administered survey were subject to univariate and bivariate analysis. Phase 1 findings in- formed the purposive samplhag for Phase 2 where ten participants were selected from the original sample for an in-depth interview. Qualita- tive data were analysed using thematic analysis. This paper will primarily report the findings from a sub-group of older participants （n = 47） classified as 65 years of age or older. Results 78.7% （n = 37） of participants indicated that they would manage recurring angina symptoms by taking glyceryl trinitrate and 34% （n = 16） thought that resting would help. Regardless of the duration or severity of the symptoms 40.5% （n = 19） would call their general practitioner or an emergency ambulance for assistance during any recurrence of angina symptoms. Older participants weighed less （P = 0.02） and smoked less （P = 0.01） than their younger counterparts in the study. Age did not seem to affect PTCA patients＇ likelihood of altering dietary factors such as fruit, vegetable and saturated fat consumption （P = 0.237）. Conclusions The findings suggest that older people in the study were less likely to know how to correctly manage any recurring angina symptoms than their younger counterparts but they had fewer risk factors for CHD. Age was not a factor that influenced participants＇ likelihood to alter lifestyle factors.展开更多
AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-c...AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls whoreceived usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life(HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6%(P < 0.0001), but the reductions did not differ significantly between the two groups(P = 0.885). Few significant differences were observed in participants' diabetes self-care activities. No significant differences were observed in the participants' HRQOL, pain, or fatigue measures.CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.展开更多
Objectives:This study aimed to develop a self-management behavior questionnaire for Chinese enter-ostomy patients and examine its reliability and validity.Methods:Guided by the theory of self-management,an initial que...Objectives:This study aimed to develop a self-management behavior questionnaire for Chinese enter-ostomy patients and examine its reliability and validity.Methods:Guided by the theory of self-management,an initial questionnaire was generated through literature review,group meetings,and two rounds of an expert consultation.Finally,the reliability and validity of the questionnaire were validated through a questionnaire survey of 200 enterostomy patients were selected from the Affiliated Hospital of Medical University from June 2016 to March 2017.Results:The content validity index was 0.80e1.00.The exploratory factor analysis yielded a five-factor(dietary behavior,psychosocial behavior,symptom management behavior,medical compliance behavior,information management behavior),consisting of 40 items.The cumulative variance contri-bution rate was 65.42%.The Cronbach’s a coefficient for the total questionnaire was 0.972,and for the five factors ranged from 0.797 to 0.939,indicating a good internal consistency.The test-retest reliability was 0.867(P<0.01).The self-management behavior questionnaire score was negatively related to the Ostomy Skin Tool score(r=-0.800,P<0.01).Conclusions:The self-management behavior questionnaire developed in this study showed good reli-ability and validity and can be used to assess the self-management behavior of Chinese enterostomy patients.展开更多
文摘BACKGROUND Despite societal guidelines recommending targeted screening for Barrett’s esophagus(BE)and esophageal adenocarcinoma(EAC)in individuals with gastroesophageal reflux symptoms(GERS),screening adherence is suboptimal.Current screening approaches fail to identify individuals not seeking medical consultation for GERS or whose GERS are managed with‘over-the-counter’(OTC)acid suppressant therapies.AIM To assess patients’self-management and help-seeking behavior for GERS.METHODS This cross-sectional study collected data from the Dutch general population aged 18-75 years between January and April 2023 using a web-based survey.The survey included questions regarding self-management(e.g.,use of acid suppressant therapy with or without prescription)and help-seeking behavior(e.g.,consulting a primary care provider)for GERS.Simple random sampling was performed to select individuals within the target age group.In total,18156 randomly selected individuals were invited to participate.The study protocol was registered in ClinicalTrials.gov(identifier:NCT05689918).RESULTS Of the 18156 invited individuals,3214 participants(17.7%)completed the survey,of which 1572 participants(48.9%)reported GERS.Of these,904 participants(57.5%)had never consulted a primary care provider for these symptoms,of which 331 participants(36.6%)reported taking OTC acid suppressant therapy in the past six months and 100 participants(11.1%)fulfilled the screening criteria for BE and EAC according to the European Society of Gastrointestinal Endoscopy Guideline.CONCLUSION The population fulfilling the screening criteria for BE and EAC is incompletely identified,suggesting potential underutilization of medical consultation.Raising public awareness of GERS as a risk factor for EAC is needed.
文摘BACKGROUND At present,China has become the country with the largest number of individuals with diabetes mellitus(DM)in the world,with a total of approximately 140 million patients,the majority of whom have type 2 DM(T2DM).Based on conven-tional nursing methods,community home care has important clinical significance in controlling blood sugar and disease progression.AIM To explore the impact of community public health nursing on treatment effect,health cognition,and self-management in patients with T2DM.METHODS One hundred patients with T2DM were selected as the research subjects.The patients were divided into either a conventional nursing group or community nursing(CN)group using the random number table method.The conventional nursing group(50 cases)received routine care,while the CN group(50 cases)received community public health care in addition to routine care as that for the conventional nursing group.The rate of excellent and good blood glucose control,fasting blood glucose before and after care,2-h postprandial blood glucose,health cognition,and self-management ability,and patient satisfaction were compared between the two groups.RESULTS The CN group had a higher rate of excellent blood sugar control than the conventional nursing group(88%vs 70%,P<0.05).Before care,there was no significant difference in fasting blood glucose or 2-h postprandial blood glucose between the two groups of patients(P>0.05).After nursing,fasting blood glucose and 2-h postprandial blood glucose were reduced to varying degrees in both groups,and both blood glucose levels in the CN group were lower than those of the conventional nursing group(P<0.05).Compared with the scores before care,the cognitive level score for diabetes and self-management ability score improved after care in both groups.The cognitive level and self-management ability of patients in the CN group were higher than those of the conventional nursing group(P<0.05).The overall satisfaction of the CN group was better than that of the conventional nursing group(98%vs 86%,P<0.05).CONCLUSION Community public health care based on conventional care of T2DM can achieve better blood sugar control,and improve patients’health cognitive level and self-management ability.
文摘Background: Hip osteoarthritis (HOA) causes joint destruction, resulting in hip pain, limited range-of-motion, claudication, and joint deformity. In the conservative treatment of HOA, self-management is important to manage symptoms and control disease progression. In a previous study, the researchers conducted a conceptual analysis of 43 foreign studies on self-management during conservative therapy for patients with HOA. The results revealed a definition of self-management during conservative therapy for patients with HOA. However, because that study analyzed only the foreign literature, it remains unclear whether the findings reflect the characteristics of the Japanese health-care delivery system, health-care insurance system, or the lifestyles and cultural characteristics of Japanese patients with HOA. Objective: We aimed to clarify the self-management behaviors of patients with HOA. Methods: Semi-structured interviews were conducted with five patients diagnosed with HOA, and the results were subjected to inductive qualitative analysis. Results: Six categories of self-management behaviors were extracted for patients with HOA: [active information gathering about HOA], [personalized pain and weight management, and strategies for reducing hip joint load], [reflection on living conditions with individuals and professionals, and determination for future efforts], [continuation of exercise and weight management based on personal strengths and achievements, and mutual support with others], [coexistence with HOA while managing negative feelings], and [choosing treatment methods by trusting doctors while struggling with personal needs]. Conclusion: These findings suggest the need to develop health guidance and educational programs for patients with HOA that focus on how to prevent disease progression and cope with symptoms.
文摘BACKGROUND Esophageal cancer(EC)is an aggressive malignancy with low survival(10%-30%).Nutritional problems are present throughout the perioperative period and are key to prognosis.Home enteral nutrition appears to improve the nutritional status of patients with EC.Few studies have addressed the experience of patients administering their own nutritional fluids and managing their own feeding tubes at home.The aim of this study was to explore the real-life experience of self-management of feeding tubes in patients at home after EC surgery in the first 3 months after discharge following surgery.AIM To explore feeding tube self-management experience of patients at home 3 months after discharge following EC surgery.METHODS Face-to-face semi-structured interviews were conducted with 18 patients using a feeding tube at home after EC surgery.Thematic analysis of the recordings identified themes related to feeding tube self-management.RESULTS Patients expressed similar feelings about their tube management experiences concerning three contextualized themes:Self-management dilemmas,distressing experiences,and self-management facilitators.CONCLUSION There are many dilemmas and problems in self-managing feeding tubes in postoperative homebound patients with EC.Clinical staff should provide guidance to promote a positive change in self-management behavior.
文摘BACKGROUND The correlation conclusions between self-management,frailty,and quality of life(QoL)of chronic obstructive pulmonary disease(COPD)patients are inconsistent.AIM To comprehensively assess the current status of self-management,psychological cognitive impairment,and QoL in elderly patients with COPD.METHODS Convenient sampling was employed to select 312 elderly patients with COPD who were receiving treatment in the respiratory and critical care medicine department of a tertiary grade A hospital from November 2023 to February 2024.The study utilized demographic information and clinical characteristics,selfmanagement behavior,occurrence of psychological cognitive impairment,and QoL as evaluated through general information questionnaires,the COPD patient self-management scale,simple frailty scale,simple mental status scale,clinical dementia assessment scale,and the clinical COPD assessment test questionnaire.This research aims to describe the current status and correlations among selfmanagement behavior,cognitive impairment occurrence,and QoL.RESULTS The average score for self-management behavior in elderly COPD patients was 136.00(119.00,164.50),indicating a moderate level overall.There were 98 cases of cognitive impairment,accounting for 31.4%,with a mental status score of 3(2,3.75).The average QoL score was 24(19,28),indicating a low level.Additionally,there was a negative correlation between total self-management behavior score and cognitive impairment occurrence(r=-0.589,P<0.001),and QoL total score(r=-0.409,P<0.001).Cognitive impairment occurrence was positively correlated with QoL total score(r=0.345,P<0.001).Disease course and self-management behavior score were independent factors affecting the total QoL score in elderly COPD patients(P<0.05).CONCLUSION The self-management behavior of elderly patients with COPD is at a moderate level.However,the occurrence of cognitive impairment is high and significantly influenced by disease course,level of self-management,and mental status.The QoL is low,emphasizing the urgent need to intervene in the self-management behaviors of elderly COPD patients,actively reduce the occurrence of cognitive impairment,and mitigate the impact of the disease on QoL.
文摘Objective:To explore the self-management experiences and outpatient nursing needs of intestinal stoma patients during the post-discharge transition period,in order to provide a basis for scientific decision-making in patient self-care and improvements in specialized stoma outpatient services.Methods:Using purposive sampling,13 colorectal cancer patients in the post-discharge transition period who had undergone intestinal stoma surgery were selected from a tertiary hospital in Shandong Province between November 2024 and March 2025.Semi-structured interviews were conducted,and data were analyzed using Colaizzi’s seven-step method to extract themes.Results:Three core themes were identified:challenges in self-management during the transition period,outpatient nursing needs during the transition period,and gaps in doctor-patient information continuity.Conclusion:Future efforts should focus on high-risk groups of stoma patients during the transition period by building intelligent and systematic outpatient guidance and support systems to improve their quality of life.
文摘Under the background of exam-oriented education in China,art education has been marginalized,and the career success of junior middle school art teachers is being challenged.The influencing factors have become a topic worthy of exploration.Therefore,this study aims to investigate the influence on career success and career self-development among junior middle school art teachers in Shenzhen,China.This study conducted a questionnaire survey among junior middle school art teachers in Shenzhen,China.The results show that career self-management affects the career success of art teachers.On this basis,this study proposes some strategies to help the group of art teachers achieve higher career success by improving their career self-management levels.
基金supported by the 2025 Hangzhou Normal University Teaching Development and Reform Project(Project No.JG2025320)。
文摘Self-management interventions for chronic obstructive pulmonary disease(COPD)patients using mobile health technology are beneficial for relieving disease symptoms,improving patients’adherence to rehabilitation self-management,and improving quality of life.This paper reviews the application of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,introduces the application form of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,summarizes its application effect in self-management of patients with chronic obstructive pulmonary disease,analyzes the problems and proposes solutions in the process of research and implementation at this stage,with a view to providing a theory for the application of mobile health technology in pulmonary rehabilitation and management of patients with chronic obstructive pulmonary disease This study summarize the effect of its application in the self-management of patients with chronic obstructive pulmonary disease.
基金Supported by 2023 Shiyan Taihe Hospital Fund Project(2023JJXM024).
文摘[Objectives]To explore the effects of motivational interviewing intervention based on the transtheoretical model(TTM)on psychological resilience and self-management in patients undergoing finger reimplantation after amputation.[Methods]The patients with finger replantation due to fractures admitted from October 2024 to June 2025 were divided into either the control group or the observation group according to the random number table method,with 40 cases in each group.The control group received conventional perioperative care,while the observation group underwent motivational interviewing based on TTM framework on the basis of the control group.The psychological resilience and self-management levels of the two patient groups were then compared following their respective care interventions.[Results]The psychological resilience and self-management scores of the patients were significantly higher than those of the control group after the intervention,with the difference being statistically significant(P<0.05).[Conclusions]Motivational interviewing based on the TTM can effectively improve the psychological resilience and self-management in patients undergoing severed finger reimplantation,while effectively reducing the occurrence of vascular crisis.
文摘Diabetes is a major public health concern worldwide. Low and middle-income countries are the most affected. Diabetes self-management can significantly reduce the burden of diabetes complications and mortality. This cross-sectional study was conducted at the outpatient department of a county referral hospital in Kenya, from 1st August 2022 to 30th October 2022. Patients with known type II diabetes of age ≥ 20 years visiting the hospital for routine follow-up visits were included. A 7-tem Summary of Diabetes Self-care Activities (SDSAC) Questionnaire was used to assess Diabetes self-care activities. For data entry and statistical analysis, SPSS for Windows version 27.0 was used. There were 96 (39.2%) males and 149 (60.8%) females. Most of the participants were more than 61 years, 148 (60.4%). Significant association was found between the sum scale scores of dietary activities, blood glucose testing, physical activity, foot care, and neuropathy at 95% CI and (p Conclusions: Diabetes self-management activities have an impact on microvascular complications in patients with diabetes.
基金the community of older adults who participated in this study.Ministry of Education Science and Technology Industry-University Co-operation Collaborative Education Project(230806630292310).
文摘Background:Falls are a significant public health concern among older adults,often leading to severe injuries and decreased quality of life.Fall prevention self-management behaviors are critical in reducing fall risk.However,the status and influencing factors of these behaviors among community-dwelling older adults in China remain poorly understood.This study aimed to investigate fall prevention self-management behaviors and their influencing factors among community-dwelling older adults in Fuzhou,China.Methods:From June to December 2022,we used multi-stage cluster random sampling and invited 675 community-dwelling older adults from Fujian as participants.We conducted a questionnaire survey using the general information questionnaire,Fall Prevention Self-management Behavior among Older Adults Questionnaire,Questionnaire on Knowledge,Belief,and Practice of Falls Prevention among Older Adults in Community,Modified Falls Efficacy Scale,Social Support Rating Scale,and Chinese Version of the Self-Assessment Fall Risk Scale for Older Adults.Multivariate linear regression was used to identify the factors influencing fall prevention self-management behavior among older adults.Results:The overall score of fall prevention self-management behaviors was 146.81±34.22,indicating a moderate level.Key influencing factors included education level,pre-retirement occupation,income,medication type,self-assessed physical condition,fear of falling,knowledge and practices in fall prevention,social support,and fall risk.These factors collectively explained 34.3%of the variance in self-management behaviors.Conclusion:The findings highlight the need for targeted interventions to enhance fall prevention self-management among community-dwelling older adults.Interventions should focus on improving knowledge,strengthening social support,and addressing psychological barriers such as fear of falling.This study provides valuable insights for developing community-based strategies to reduce fall risks and promote healthy aging.
文摘Objective:The objective of this study is to explore the current situation of nurses’participant activation for self-management of low back pain,analyze its influencing factors,and provide a reference for improving the participant activation for self-management of low back pain.Materials and Methods:A cross-sectional study was conducted with 5,120 nurses recruited through convenience sampling from hospitals across 25 provinces and municipalities in China.Participants completed two standardized instruments:General Information Questionnaire which collected demographic characteristics and work-related factors,and the Participant Activation for Self-Management of Back Pain Questionnaire which measured activation levels across three dimensions(including self-management beliefs,self-management awareness,and knowledge related to low back pain).Results:The score of nurses’participant activation for low back pain self-management was 38.00(33.00,44.00).The results of multiple linear regression showed that nurses of different gender,age,and professional titles,whether they had administrative positions,and whether they had back pain in the past year were influencing factors of nurses’participant activation for low back pain management.Conclusion:The overall participant activation for self-management of low back pain is at a medium level.Their self-management awareness is strong,but their beliefs about management of low back pain are insufficient.Targeted intervention measures can be taken to improve their activation for management of back pain and reduce the incidence of occupational low back pain.
文摘This longitudinal study investigated how self-management and learning burnout influences the relationship between habitual mobile phone use and subjective well-being amongfirst-year university students.A sample of 1172 Chinese university students participated in a two-wave survey,with data collected six months apart at two time points(T1,T2).The results of Pearson correlation revealed that higher habitual mobile phone use at T1 was associated with lower subjective well-being at T2.Self-management was associated with healthy phone use habits and higher subjective wellbeing.Learning burnout risk was higher with habitual phone usage.Lower self-management and learning burnout at T2 played a chain mediating role between habitual mobile phone use at T1 and subjective well-being at T2 so that subjective well-being was much lower that with either of the variables alone.Overall,thesefindings suggest that habitual mobile phone use is a reliable predictor of college student’s subjective well-being,by their self-management and level of learning burnout over time.This research highlights the long-term impact of habitual mobile phone use on students’subjective well-being and provides valuable insights for developing effective interventions to support students well-being.
基金supported by the Natural Science Foundation of China(7247042122)the Key Research and Development Project of Heilongjiang Province,China(2024ZX12C06).
文摘Objective:Effective Chronic Kidney Disease(CKD)management is particularly important in cold regions of China,where climate and lifestyle factors play significant roles.However,there is a lack of relevant studies in this area.Therefore,the purpose of this study was:(1)to assess the status of self-management capacity in individuals with CKD in cold regions of China and analyze the factors influencing it;(2)to identify strategies to improve CKD management in primary care settings in these regions;and(3)to understand patients'attitudes toward eHealth services.Methods:This was a regional,cross-sectional observational study.A questionnaire measuring CKD patients'self-management abilities was derived from the Perceived Kidney Disease Self-Management Scale,the Kidney Disease Behavioral Inventory(KDBI),and the Health Literacy Questionnaire.Data were collected from hospitalized CKD patients in Heilongjiang Province and analyzed using One-Way Analysis of Variance(ANOVA),Hierarchical Regression Analysis,and K-prototype cluster analysis.Results:A total of 957 participants were tested.Of these,70.64%had less than a bachelor's degree,and 56.27%had been diagnosed with hypertensive or diabetic nephropathy.The KDBI scale showed a lower overall score compared to the PKDSMS.Factors such as CKD stage 4(F=2.367,P=0.042),last year's medical expenses(F=3.974,P=0.004),and poor self-rated health(F=33.352,P<0.01)were found to influence scores on both scales.The health literacy questionnaire revealed significant differences(P<0.01)in health knowledge,except by sex.Additionally,healthcare expenditures and poor self-rated health were negatively associated with self-management capacity.Conclusion:This study provides valuable insights into the self-management challenges faced by CKD patients in cold regions of China.Despite some difficulties in improving self-management,patients showed positive attitudes toward enhancing CKD management services in primary care and developing digital management tools.These findings offer useful references and recommendations for future clinical practice and research in this field.
文摘Objective: To explore the application effect of self-management based on Snyder’s hope theory in diabetic patients. Methods: A total of 260 patients with diabetes from a community were selected through convenient sampling and randomly divided into an experimental group and a control group using the random number table method, with 130 cases in each group. Five cases were lost in the experimental group, resulting in 125 effective cases, while all 130 cases in the control group were effective. The control group received standard lectures on diabetes self-management behavior and traditional approaches, such as the distribution of educational manuals. The experimental group underwent a self-management behavior intervention program for diabetic patients based on Snyder’s hope theory model, encompassing three components: goals, pathways, and motivational thinking. The levels of hope and self-management behavior were compared between the two groups. Results: After the intervention, the scores for hope levels and self-management behaviors in both groups were significantly higher than those recorded before the intervention (P < 0.05). Furthermore, the hope level and self-management behavior scores of the experimental group were significantly higher than those of the control group (P < 0.05). Conclusion: The application of Snyder’s hope theory model in diabetic patients demonstrates significant benefits, improving patients’ hope levels and, consequently, enhancing their self-management behaviors.
文摘In this editorial we comment on the article titled“Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease”by Zeng et al published in a recent issue of the World Journal of Gastroenterology.Non-alcoholic fatty liver disease(NAFLD)represents one of the current challenges in hepatology and public health,due to its continuous growing prevalence and the rising incidence of NAFLD-related fibrosis,non-alcoholic steatohepatitis and cirrhosis.The only effective therapeutic strategy for this dis-ease is represented by encouraging patients to improve their lifestyle through the modification of dietary intake and increased physical exercise,but the effective application of such modifications is often limited by various factors such as lack of information,psychological barriers or poor social support.While poor adherence to a healthy lifestyle can be decisive in determining the clinical outcome,in daily practice there is a lack of quantitative instruments aimed at identifying patients with the lowest adherence to lifestyle changes and higher risk of disease progre-ssion in the course of follow-up.In this article,Zeng et al propose a quantitative scale to assess the grade of adherence of patients with NAFLD to hea-lthy lifestyle intervention,called the Exercise and Diet Adherence Scale(EDAS).This scale,consisting of 33 items divided into 6 dimensions which relates to six subjective aspects in the self-management of NAFLD,has shown a good correlation with the identification of the sub-cohort of patients with the highest reduction in caloric intake,increase in physical exercise,probability of a reduction in liver stiffness measurement and alanine aminotransferase levels.The cor-relation among clinical outcomes and specific dimensions of this scale also highlights the pivotal role of a good and confidential doctor-patient relationship and of an effective communication.There is an urgent need for practical and effective instruments to assess the grade of self-management of NAFLD patients,together with the development of multidisciplinary teams with the aim of applying structured behavioral interventions.
文摘This review article is aimed at describing the primary healthcare system of Pakistan and its challenges in the face of epidemic of type 2 diabetes, focusing particularly on the middle-aged population of rural area of Pakistan. The main concern in Pakistan is that its middle-aged population is facing the onslaught of obesity and overweight due to lack of physical activity. In addition unhealthy eating habits making it more difficult for this population to control their weight. All these factors are contributing to a high risk of type 2 diabetes for the population of Pakistan. This article provides insight into the primary health care system of Pakistan and highlights its deficiencies by identifying that its primary healthcare system has a poor utilization of health care services, the poor accessibility to health system and poor management of diabetes by the healthcare system, gender disparity and inequity in the health care system. The primary objective of this study is to provide an overview of self-management of diabetes among the middle-aged population of Pakistan and to identify the overall deficiencies in the primary healthcare system, its delivery and access to the system, barriers to self-management of diabetes and quality of life in that region.
文摘Objective To explore how older patients self-manage their coronary heart disease （CHD） aider undergoing elective percutaneous transluminal coronary angioplasty （PTCA）. Methods This mixed methods study used a sequential, explanatory design and recruited a convenience sample of patients （n = 93） approximately three months after elective PTCA. The study was conducted in two phases. Quantitative data collected in Phase 1 by means of a self-administered survey were subject to univariate and bivariate analysis. Phase 1 findings in- formed the purposive samplhag for Phase 2 where ten participants were selected from the original sample for an in-depth interview. Qualita- tive data were analysed using thematic analysis. This paper will primarily report the findings from a sub-group of older participants （n = 47） classified as 65 years of age or older. Results 78.7% （n = 37） of participants indicated that they would manage recurring angina symptoms by taking glyceryl trinitrate and 34% （n = 16） thought that resting would help. Regardless of the duration or severity of the symptoms 40.5% （n = 19） would call their general practitioner or an emergency ambulance for assistance during any recurrence of angina symptoms. Older participants weighed less （P = 0.02） and smoked less （P = 0.01） than their younger counterparts in the study. Age did not seem to affect PTCA patients＇ likelihood of altering dietary factors such as fruit, vegetable and saturated fat consumption （P = 0.237）. Conclusions The findings suggest that older people in the study were less likely to know how to correctly manage any recurring angina symptoms than their younger counterparts but they had fewer risk factors for CHD. Age was not a factor that influenced participants＇ likelihood to alter lifestyle factors.
基金Supported by The National Institutes of Health’s National Institute on Minority Health and Health Disparities,No.#1P20MD002295
文摘AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls whoreceived usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life(HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6%(P < 0.0001), but the reductions did not differ significantly between the two groups(P = 0.885). Few significant differences were observed in participants' diabetes self-care activities. No significant differences were observed in the participants' HRQOL, pain, or fatigue measures.CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.
文摘Objectives:This study aimed to develop a self-management behavior questionnaire for Chinese enter-ostomy patients and examine its reliability and validity.Methods:Guided by the theory of self-management,an initial questionnaire was generated through literature review,group meetings,and two rounds of an expert consultation.Finally,the reliability and validity of the questionnaire were validated through a questionnaire survey of 200 enterostomy patients were selected from the Affiliated Hospital of Medical University from June 2016 to March 2017.Results:The content validity index was 0.80e1.00.The exploratory factor analysis yielded a five-factor(dietary behavior,psychosocial behavior,symptom management behavior,medical compliance behavior,information management behavior),consisting of 40 items.The cumulative variance contri-bution rate was 65.42%.The Cronbach’s a coefficient for the total questionnaire was 0.972,and for the five factors ranged from 0.797 to 0.939,indicating a good internal consistency.The test-retest reliability was 0.867(P<0.01).The self-management behavior questionnaire score was negatively related to the Ostomy Skin Tool score(r=-0.800,P<0.01).Conclusions:The self-management behavior questionnaire developed in this study showed good reli-ability and validity and can be used to assess the self-management behavior of Chinese enterostomy patients.
