Assessing the relationship between health literacy intervention and hypertension self-management:A 7-year systematic review from January 2016 to December 2022

Hypertension(HTN)is one of the most common chronic diseases affecting over 30%of the adult population globally,with a growing incidence rate.This review assesses the relationship between health literacy(HL)intervention and hypertension(HTN)self-management among people with HTN.The study design was a systematic review of empirical research articles using a well-defined strategy.Online journals were accessed through databases such as PubMed,CINAHL,Google Scholar,ProQuest,Global Health,WHOLIS,Embase,and EbscoHost,spanning from January 2016 to December 2022 as the scope of the study.Articles selected for inclusion were those published in English during the specified time frame and adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Sample,Phenomenon of Interest,Design,Evaluation,Research Type framework for systematic review,focusing on criteria related to the sample,the phenomenon of interest,study design,evaluation,and research type.Out of 180 studies initially identified in the database search,20 studies were ultimately included in the review.The findings were reported based on these five emerging themes:Relationship between HL and HTN self-management;Effect of HL intervention on HTN self-management;Factors predicting self-care behaviors among HTN patients with low HL;Effect of HL and self-management efficacy on health-related quality of life(HRQoL);and level of self-care practices.This review highlights a relationship between HL,self-efficacy,self-care,and HRQoL,underscoring the necessity for further well-designed intervention studies focused on enhancing HL in individuals with HTN in Nigeria to enhance their quality of life.

Sexual and Reproductive Health Knowledge and Behaviour among Adolescents in Rural Burkina Faso

Background: Adolescents in developing countries have limited knowledge about the prevention of STIs and unwanted pregnancies. In several African countries, risky sexual behaviour persists, including early sexual debut, multiple sexual partners, economic and sexual exchange, and low condom and contraceptive use. The purpose of this study is to assess the sexual and reproductive health knowledge and behaviour of adolescents in rural Burkina Faso in order to improve their sexual and reproductive health. Method: This was a descriptive cross-sectional study with prospective data collection conducted from 07 March to 04 April 2022 in the area of the Demographic and Health Surveillance System of the Nouna Research Centre. A questionnaire was administered to a randomly selected sample of 1202 adolescents. Results: The mean age of the adolescents was 14.1 years and 56.6% were male. Only 58.2% of the adolescents had ever heard of HIV/AIDS. Of these, 95.7% did not know their HIV status. In addition, 15.8% had ever had sexual intercourse and 2.4% had been sexually active at an early age. Almost 45% had not used any contraceptive method the last time they had sex. Condoms were the most frequently used contraceptive method (47.4%). Among teenagers, 27.6% had been pregnant at least once, 7.3% were married and the average age at marriage was 18.45 years. Almost 7% (6.9%) of teenagers had more than one sexual partner. Conclusion: Adolescents have limited knowledge about reproductive health. Risky sexual behaviour persists. Awareness campaigns need to be intensified to improve their sexual and reproductive health.

The Impact of Behavioural Insights on Effective Prescription of Antibiotics by Doctors: A Case Study from Latifa Hospital for Women and Children, Dubai Health Authority

Introduction: Wise prescription of antibiotics is an ethical duty of physicians in view of rising antimicrobial resistance in the community, it should be balanced between the health requirements of the patients and resulting long-term antibiotics resistance. Overuse of antimicrobials is a major cause of emerging resistance to antimicrobials. There are multiple factors in the community that influence the physician’s antibiotic prescriptions. Methods: This is a systematic case-control study on antibiotics prescription for paediatric patients attending Latifa Hospital for Women and Children (LWCH), Dubai Health Authority, to know the effects of behavioral interventions on rates of inappropriate antimicrobials prescription by doctors in the Paediatric Emergency Department. Results: The results of our study showed the effectiveness of behavioral insights by peer comparison in antibiotic use among paediatricians in Latifa Hospital had a statistical significance (P = 0.0038). The rate of the prescription decreased from 41% to 21%, a difference of 20%. Conclusion: The study concluded behavioural intervention is an effective measure in reducing the improper prescription of antibiotics in the hospital setting.

Multiple mediation effects of health locusof control and hope on the relationshipbetween stroke patients’ social supportand self-management

Objective:This study aimed to identify the mediation effects of health locus of control(HLC)and hope between stroke patients’social support and self-management.Methods:A cross-sectional study was conducted.A total of 300 Chinese stroke patients were recruited by convenient sampling from the acupuncture department of two Chinese Traditional Medical Hospitals in Tianjin Province from June to September 2018.The self-report questionnaires include Social Support Assessment Scale,Herth Hope Index,Mental Health Locus of Control Scale,Stroke Self-management Behavior Scale,and personal information questionnaires.All the survey data were entered in Excel and analyzed using the SPSS 24.0 program.Mediation was tested with Bootstrapping in AMOS 23.0 program.Results:The result showed that internal health locus of control(IHLC),chance health locus of control(CHLC)and hope were the mediators between social support and self-management.The direct,indirect,and total effects of social support on self-management behavior were 0.306 (P<0.01),0.109(P<0.01),and 0.415(P<0.01),respectively.Conclusions:Social support can directly influence self-management,and it can also indirectly influence self-management through IHLC,CHLC,and hope.

Effect of self-management program on health status of elderly patients with heart failure: a single-blind, randomized clinical trial

Objective:To determine the effect of self-management program on the health status of elderly patients with heart failure.Methods:The present study was a single-blind,randomized clinical trial,and conducted on 90 patients with heart failure of stages Ⅱ-Ⅲ at one teaching hospital in eastern Iran in 2017.The participants were randomly assigned into two groups:the intervention group and the control groups,with 45 patients in each group.Self-management programs including awareness and recognition,problem-solving process,diet,exercise,and stress management were carried out.The participants were trained for six weeks and were followed for two months.Data of the health status were collected before,after and eight weeks after intervention by Kansas City Cardiomyopathy Questionnaire.Data analysis by chi-square,independent t-test,Fisher,ANOVA with repeated measures was conducted.Results:Patients in both groups were matched in terms of demographic characteristics before the intervention.There was no significant difference in the mean scores of health status between the two groups (P=0.1) before the intervention.However,the second measurement after intervention showed a significant difference in the mean scores between the two groups (P=0.001).Conclusions:Self-management program can improve the different dimensions of health (except in the subscale of sign and symptoms).Therefore,this supportive method can be used to improve the health of patients and manage problems caused by heart failure.

Awareness, self-management behaviors, health literacy and kidney function relationships in specialty practice

AIM To determine the relationship between chronic kidney disease(CKD) awareness(CKD-A), self-management behaviors(CKD-SMB) knowledge, performance of CKDSMBs, health literacy(HL) and kidney function. METHODS Participants were eligible patients attending an outpatient nephrology clinic. Participants were administered: Newest Vital Sign to measure HL, CKD self-managementknowledge tool(CKD-SMKT) to assess knowledge, past performance of CKD-SMB, CKD-A. Estimated GFR(e GFR) was determined using the MDRD-4 equation. Duration of clinic participation and CKD cause were extracted from medical charts. RESULTS One-hundred-fifty patients participated in the study. e GFRs ranged from 17-152 m L/min per 1.73 m2. Majority(83%) of respondents had stage 3 or 4 CKD, low HL(63%), and were CKD aware(88%). Approximately 40%(10/25) of patients in stages 1 and 2 and 6.4%(8/125) in stages 3 and 4 were unaware of their CKD. CKD-A differed with stage(P < 0.001) but not by HL level, duration of clinic participation, or CKD cause. Majority of respondents(≥ 90%) correctly answered one or more CKD-SMKT items. Knowledge of one behavior, "controlling blood pressure" differed significantly by CKD-A. CKD-A was associated with past performance of two CKD-SMBs, "controlling blood pressure"(P = 0.02), and "keeping healthy body weight"(P = 0.01). Adjusted multivariate analyses between CKD-A and:(1) HL; and(2) CKD-SMB knowledge were nonsignificant. However, there was a significant relationship between CKD-A and kidney function after controlling for demographics, HL, and CKD-SMB(P < 0.05). CONCLUSION CKD-A is not associated with HL, or better CKD-SMBs. CKD-A is significantly associated with kidney function and substantially lower e GFR, suggesting the need for focused patient education in CKD stages 1.

Use of Mobile Health Applications and the Self-Management of Cancer: A Gendered Approach

The growing use of mobile health applications for health purposes increased the expectations about their effectiveness. The study examines the effectiveness of mobile health applications on the self-management behaviors of 168 individuals diagnosed with cancer. The results of a secondary analysis indicate that using extensively mobile health applications significantly increases women’s health empowerment attitudes—reaching health decisions, changing their approach to health concerns, seeking additional health consultation. However, the use of mobile health applications does not increase the likelihood of adopting self-management behaviors. The study indicates that the effectiveness of mobile health applications in self-management practices is contingent upon a set of personal characteristics and the level of technology skills.

Positive correlations between the health locus of control and self-management behaviors in hemodialysis patients in Xiamen

Objective:To investigate the association between the health locus of control and selfmanagement behaviors in patients receiving hemodialysis.Methods:Patients receiving hemodialysis in Xiamen,Fujian province,from December 2014 to March 2015 answered the Chinese version of the Multidimensional Health Locus of Control scale and the self-management behavior questionnaire.Results:The participants in this study indicated that they believed others exerted more control over their health than themselves or chance.In addition,the majority of participants had a medium to low level of self-management behaviors.Positive correlations were also observed between a participant's health locus of control and their level of selfmanagement behaviors.Internal health locus of control and external(others)health locus of control were significant predictors of self-management behaviors controlling for the effect of payment method.Conclusion:The results of this study provided evidence that there is a strong relationship between the health locus of control and self-management behaviors in hemodialysis patients.This study provides important information for medical professionals as they design strategies to educate hemodialysis patients on their health locus of control and selfmanagement behaviors.

Prediabetes and cardiovascular complications study:Highlights on gestational diabetes, self-management and primary health care

International collaboration on the prediabetes and cardiovascular complications study started in 2013.In 2017,a reflection was reported.Incompleteness of documentation and screening of antenatal cases for gestational diabetes mellitus(GDM)was concerning.Hence,further observations have been made that warrant an update.The objective of this review is to highlight gaps between clinical knowledge and practice in GDM,diabetes self-management and primary health care(PHC)for rural dwellers.We followed a descriptive field notes method.Antenatal records of patients screened for GDM with incomplete documentation were examined to determine incompleteness of data in those that also met the criteria for GDM risk assessment.Experiences on development of a diabetes register and education and notes on behavioural change wheel were also reviewed.Other data included cross-sectional evaluation of activities of daily living at two private hospitals.Up to 29%had high GDM risk factors,which fulfilled selection criteria for laboratory screening.Demographic data was complete in all women;however,incomplete documentation was observed with as much as 98%of basic data.High levels of physical activity were found in the population,and health lectures proved effective in food choices.The workforce need for diabetes care seems underestimated,but this may be better understood with reactivation of PHC services.The observations highlight behavioural change wheel issues on GDM and PHC services that need concerted focus.Two proposals are to advance the use of a‘risk assessment and screening sheet’for GDM screening and enlightenment of stakeholders on the central hub role of PHC in diabetes management.

The correlation between socioeconomic status and health self-management in the elderly

Purpose:To determine the correlation between socioeconomic status and health selfmanagement in the elderly and to provide a scientific basis for the promotion of healthy ageing.Methods:We recruited 6173 people aged
60 years from three regions in Hebei Province using the multi-stage stratified cluster sampling method.The participants were surveyed using questionnaires.Results:The health self-management behaviours of elderly people differed with the area of residence,education level,and personal monthly income.An ordered probit model showed that behaviours were better in elderly people who lived in urban areas,who were educated to college level or higher,and with higher monthly incomes(p<0.05).Conclusion:Socioeconomic status plays a decisive role in health self-management in the elderly.We suggest appropriate measures for promoting health self-management among the elderly.

“I Am Getting Healthier”. Perceptions of Urban Aboriginal and Torres Strait Islander People in a Chronic Disease Self-Management and Rehabilitation Program

Chronic disease is a main contributor to the disproportionately high burden of illness experienced by Aboriginal and Torres Strait Islander Australians. However, there are very few programs addressing chronic disease self-management and rehabilitation which are designed specifically for urban Aboriginal and Torres Strait Islander people. This paper aims to explore client and staff perceptions of the Work It out Program, a chronic disease rehabilitation and self-management program designed for urban Aboriginal and Torres Strait Islander people. The study used a mixed methods approach to explore the success, barriers and self-reported outcomes of the program. Quantitative data were collected through a structured survey, comprising social and demographic data. Qualitative data were collected through interviews using Most Significant Change theory. Twenty-eight participants were recruited, 6 staff and 22 clients (M = 7, F = 21) with an age range between 21 and 79 years of age (Mean = 59.00, SD = 17.63). Interviews were completed in 2013 across four Work It out locations in Southeast Queensland. Semi-structured interviews were conducted either individually or in groups of two or three, depending on the participants’ preference. Thematic analysis of the data revealed six main themes;physical changes, lifestyle improvements, social and emotional well-being, perceptions about the successful features of the program, perceived barriers to the program and changes for the future. This exploratory study found that clients and staff involved in the Work It out Program perceived it as an effective self-management and rehabilitation program for urban Aboriginal and Torres Strait Islander Australians. Further evaluation with a larger sample size is warranted in order to establish further outcomes of the program.

Primary Healthcare System of Pakistan: Challenges to Self-Management of Type 2 Diabetes

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.

Exploring the Influences of Continuous Self-Management Education on the Self-Care Skills and Health Behavior of Patients with PICC Intubation

Objective:To analyze the effects of continuous self-management education on the selfcare ability and health behavior of patients with tumor through peripherally inserted central venous catheters(PICC).Methods:The period from August 2018 to August 2020 was used as the research time range,and the random number table method was used as the basis for grouping.80 patients with malignant tumors who regularly performed fixed catheter maintenance care in the PICC clinic of our hospital were admitted in the experimental group(given PICC specialist nursing,and implemented continuous self-management education),and 80 patients with PICC tube malignant tumors discharged from the superior hospital during this time range served as the control group(return to the original catheterization hospital from time to time or perform catheter maintenance care in the nursing clinic of our hospital).The self-care ability scores,health behavior scores,and complications during intubation between both groups were analyzed.Results:(1)There was no significant difference in self-care ability score and healthy behavior score between groups before the intervention,P>0.05;the self-care ability score and health behavior score of the research group were better than the control group after intervention,P<0.05;(2)After investigation,the incidence of complications in the research group(2.50%)was lower than that of the control group(10.00%),but there was no difference between the groups,P>0.05.Conclusion:Continuous self-management education has good effects on improving the self-care ability of tumor patients with PICC intubation.It can urge patients to maintain good health behaviors and reduce complications.It is worthy of promotion.

Predictors of health-promoting behaviour among older adults with hypertension in Indonesia

Objectives:This study aimed to determine the predictors of health-promoting behaviour among older adults with hypertension in Bengkulu City,Bengkulu,Indonesia.Methods:A cross-sectional study was conducted in 333 older adults with hypertension,who were selected using multistage sampling method.Data were obtained by face-to-face interview with structured questionnaires.The questionnaires used in this study included the Health-Promoting Lifestyle Profile II(HPLP II),Hypertension Knowledge-Level Scale(HK-LS),Self-Rated Abilities for Health Practices Scale(SRAHP),Barriers to Health-promoting Behaviour Scales(BAS),Benefits to Health-Promoting Behaviour Scales(BES),Multidimensional Scale of Perceived Social Support(MSPSS)and Situational Influences Questionnaire(SIQ).Data were analysed by using multiple linear regressions.Results:The mean and standard deviation(Mean±SD)of each questionnaire were as follows:HPLP II,2.55±0.19;HK-LS,11.83±3.00;SRAHP,2.00±5.87;BAS,27.89±2.70;BES,34.29±2.29;MSPSS,60.35±8.12;and SIQ,47.71±6.66.According to the multiple linear regression model,36.9% of the variation in health-promoting behaviour among older adults with hypertension can be explained by six variables,namely,education,knowledge,self-efficacy,perceived barriers,social support and situational influences(adjusted R^(2)=0.369).Conclusions:High and good-quality education will increase the level of health-promoting behaviour,whereas barriers,such as expense and time requirement,can decrease it.Situational influences and support from family and friends can also influence the older adult's attempts to change their health behaviour.Increased self-efficacy will clearly result in improved health-promoting behaviour of older adults with hypertension.

Illness perception and cardiovascular health behaviour among persons with ischemic heart disease in Indonesia

Objective:A study was conducted to explore the level of illness perception,the level of cardiovascular health behaviour and the relationship between illness perception and cardiovascular health behaviour among persons with ischemic heart disease(IHD)in a community setting.Method:The participants comprised 235 persons with IHD.The instruments used were as follows:1)Demographic Data and Health Information,2)The Brief Illness Perception Questionnaire(Brief IPQ),3)The Open-ended Questionnaire(OEQ),and 4)The Modified Cardiac Health Behaviour Scale(MCHBS).Findings from the OEQ are used to assess in-depth illness perception and to extend the information obtained from the Brief IPQ.The design of the study was descriptive correlational.The data were analysed using descriptive statistics to present the demographic data and health information.Inferential statistics was used to resolve the relationship between illness perception and cardiovascular health behaviour by using Pearson's Product Moment Correlation.Result:The mean score of illness perception was at a moderate level(M=43.65,SD=3.93),whereas the mean score of cardiovascular health behaviour was at a high level(M=80.29,SD=5.42).A significant positive relationship existed between illness perception and cardiovascular health behaviour among persons with IHD(r=0.38,P<0.01).Conclusion:Persons with higher illness perception showed a positive correlation with higher cardiovascular health behaviour at a significant level of 0.01.Results provided important information for nurses to develop an intervention program to promoting appropriate illness perception and cardiovascular health behaviour among persons with IHD.

Health-seeking behaviour and student perception of health care services in a university community in Nigeria

Objectives: Examining consumers’ healthcare behavior can help in the design of ways to ensure better access to health and the quality of care. Health-seeking behavior is viewed as the varied response of individuals to states of ill-health, depending on their knowledge and perceptions of health, socioeconomic constraints, adequacy of available health services and attitude of healthcare providers. This study examines health-seeking behavior of university students, their use of healthcare services in the community and barriers to seeking help at the university health centre. Method: Structured questionnaires were validated and administered on a random sample of university students spread over different academic disciplines in a large institution. The sample consisted of 1608 undergraduate students attending the public university in southwesternNigeria. The demographic profile reflects the national university student population. Relevant information was collected on preferred health services consulted by the undergraduates such as barriers to seeking adequate medical attention and their experiences with salient aspects of service delivery. Responses were weighted and the average was taken to be representative. Results: Students consulted their peers (37.5%) in health related academic disciplines rather than seek treatment at the university health centre. Some students (24.7%) preferred community pharmacies while others took personal responsibilities for their health or abstained from medical care for religious reasons (16.8%). Significant barriers to seeking medical attention at the health centre were cost of care, protracted waiting time, inadequate health information, unfriendly attitude of healthcare workers and drug shortage. Conclusions: Students sought help from community pharmacies (ease of access) and from peers in health related academic programmes rather than from physicians at the health centre. Health-seeking behavior of the students was influenced, essentially, by the nature of ailment, waiting time in the health facility and attitude of healthcare professionals. Implications for policy, practice or delivery: The findings of this research identified the relative use of available health services within the university. Initiatives to improve student access to the university health centre should address significant barriers of patient delays, the need for attitudinal change and continuing professional development of relevant workers in the health facility. Promotional activities may be necessary to inform and educate students on rational use of medicines and access to treatment at the health centre.

Development and validation of a self-management ability questionnaire for patients with chronic periodontitis

Objective: This study aimed to develop and validate a self-management ability questionnaire for patients with chronic periodontitis.Methods: A questionnaire was developed through theoretical research,literature review,semistructured interview,and expert consultation.A total of 231 patients with chronic periodontitis from the Department of Periodontics in the Stomatological Hospital of Tianjin Medical University were recruited by convenient sampling.Validity and reliability were analyzed.Results: The questionnaire consisted of 24 items.Exploratory factor analysis identified three principal factors,which explained 66.949% of the total variance.The item-level content validity was between 0.800 and 1.000,and the scale-level content validity was 0.969.The coefficient of correlation between the gold standard and the whole questionnaire was 0.869.Cronbach's α of the whole questionnaire was 0.931,and the test-retest reliability coefficient was 0.825.Conclusion: The questionnaire developed in this study satisfies the measurement standard and has good reliability and validity.It is useful for clinical work to measure self-management among patients with chronic periodontitis.

Visualization analysis of research“hot spots”:self-management in breast cancer patients

Objective:To identify the research on“hot spots”and frontiers of self-management in patients with breast cancer.Methods:We searched the Web of Science database for articles associated with keywords,and used CiteSpaceIII to analyze the data.Results:A total of 958 documents were included.High-frequency keywords covered“quality of life(QOL),”“randomized controlled trial,”“depression,”“fatigue,”and“meta-analysis.”Research on self-management by patients with breast cancer has mainly been conducted in the United States of American(USA)and other western countries,whereas the Asian country,China ranked eighth among the top 10 countries.Conclusions:The analysis revealed research on“hot spots”particularly research on psychological health and QOL.Promoting clinical research,encouraging evidence-based practice,and developing nursing specialization may improve research on self-management interventions for patients with breast cancer.

Health-Promoting Behaviours of University Nursing Students in Jordan

The purpose of this study was to determine health-promoting behaviours of university nursing students in Jordan. This descriptive cross-sectional study used convenient sampling technique to recruit 167 undergraduate nursing students in Jordan. Data were collected by using an Arabic version of Health-Promoting Lifestyle Profile II. The study results revealed that the mean item score for total Health-Promoting Lifestyle Profile II was (127.24 ± 21.03). The students obtained highest scores in spiritual growth (25.04 ± 4.70) and lowest in physical activity subscales (16.27 ± 5.21). Significant difference was found between Health-Promoting Lifestyle Profile II subscales (stress management, health responsibility, and interpersonal relations) and students’ age and gender.

Health Care Seeking Behaviour and Predictors of Combined Orthodox and Traditional Health Care Utilization among Households in Communities in Owerri, Imo State, Nigeria

Background: Health care seeking behaviour is a complex, dynamic and multidimensional process that involves a sequence of remedial actions that are influenced by the interaction between the individual, household and community with the intention of addressing perceived ill health. Objective: To determine health care seeking attitude and behaviour and the predictors of combined orthodox and traditional health care use among households in communities in Owerri, Imo State. Nigeria. Methods: A cross sectional design that used a multistage random sampling technique to select 500 participants from households in two communities in Owerri, Imo State. Data was collected using a pretested, semi structured questionnaire. Descriptive analyses were done with frequencies and summary statistics. Chi square statistics were computed to determine significant relationships and binary logistic regression was used to determine predictors of combined use. P was set at 0.05 significance level. Results: The results revealed that, while just more than half of the respondents (56.4%) had a moderate to good level of overall knowledge of health care, almost all of the respondents (96.2%) also had a moderate to good level of overall positive attitude towards seeking health care;with less than one third (29.4%) using combined orthodox and traditional health care treatments. It further revealed that, respondents who were female, traders and from households of polygamous families were significantly more likely to use combined orthodox and traditional health care treatments (p < 0.05) while those with a tertiary level of education, from households with a professional as head, having private water closet toilets and earning a monthly income of more than 50,000 Naira ($140) were significantly less likely to use combined orthodox and traditional health care treatments (p < 0.05). Conclusion: There is a need to be more sensitive to the realities of the combined use of orthodox and traditional treatments, as its use will be difficult to prevent because this behaviour is rooted in the traditional and cultural belief system of our societies.