Psychometric testing of the cross-culturally adapted Thai version of the Self-Care Self-Efficacy Scale version 3.0 in individuals with chronic illnesses

Objective:To assess the psychometric properties of the Thai version of the Self-Care Self-Efficacy Scale version 3.0(SCSES-v3.0)in individuals with chronic illnesses.Although originally developed and tested in a Western context,its applicability in Asian populations,including Thailand,remains inadequately explored.Methods:Psychometric tests were guided by COSMIN principles.This included the translation of the English version into Thai based on the ISPOR framework.Nine nursing experts evaluated the content validity.Data were obtained from a multicenter cross-sectional study conducted between July and November 2022.This study included individuals with chronic conditions from 16 primary care centers in Thailand.We tested the structural validity using exploratory factor analysis(EFA)and confirmatory factor analysis(CFA),and concurrent validity in relation to the Self-Care of Chronic Illness Inventory version 4.c(SC-CII-v4.c).We tested the scale’s reliability with McDonald’s u,Cronbach’s a,and the intraclass correlation coefficient(ICC).Results:The Thai SCSES-v3.0 demonstrated excellent content validity(k¼1.00).Thefinal analysis included a total of 385 participants.The EFA with thefirst split-half subsample(n¼193)extracted a twofactor structure.One reflected SCSES for maintenance and monitoring behaviors and another captured SCSES for management behaviors(item 6e10).CFA with the second split-half subsample(n¼192)and the overall sample(n¼385)supported the scale’s two-factor model with high factor loadings.Each dimension and the overall SCSES-v3.0 positively correlated with each scale and the overall SC-CII-v4.c.McDonald’s u and Cronbach’s a(both ranged 0.91e0.94)and ICC(ranged 0.95e0.96),indicated excellent internal reliability and test-retest reliability,respectively.Conclusions:The identification of a valid and reliable two-factor model for the Thai SCSES-v3.0 renders it a valuable tool for clinicians and investigators,facilitating the assessment of self-efficacy in self-care across diverse contexts.

Decision-Making and Management of Self-Care in Persons with Traumatic Spinal Cord Injuries: A Preliminary Study

Patients and physicians understand the importance of self-care following spinal cord injury (SCI), yet many individuals with SCI do not adhere to recommended self-care activities despite logistical supports. Neurobehavioral determinants of SCI self-care behavior, such as impulsivity, are not widely studied, yet understanding them could inform efforts to improve SCI self-care. We explored associations between impulsivity and self-care in an observational study of 35 US adults age 18 - 50 who had traumatic SCI with paraplegia at least six months before assessment. The primary outcome measure was self-reported self-care. In LASSO regression models that included all neurobehavioral measures and demographics as predictors of self-care, dispositional measures of greater impulsivity (negative urgency, lack of premeditation, lack of perseverance), and reduced mindfulness were associated with reduced self-care. Outcome (magnitude) sensitivity, a latent decision-making parameter derived from computationally modeling successive choices in a gambling task, was also associated with self-care behavior. These results are preliminary;more research is needed to demonstrate the utility of these findings in clinical settings. Information about associations between impulsivity and poor self-care in people with SCI could guide the development of interventions to improve SCI self-care and help patients with elevated risks related to self-care and secondary health conditions.

Impact of applying the theory of human becoming and self-care deficit theory of nursing on insomnia in after stroke urinary incontinence patients

Objective:To determine the impact of applying the theory of human becoming and self-care deficit theory of nursing in overcoming insomnia in patients of urinary incontinence(UI)after stroke.Insomnia is a sleep disorder experienced by UI patients after stroke which can exacerbate problems related to brain damage and can complicate the recovery process.Methods:This study was a quasi-experimental conducted in 4 hospitals.Fifty-six patients were selected by convenience sampling and divided into 2 groups(the intervention and control group).Participants in the intervention group received“applying the theory of Human becoming and self-care deficit theory of nursing,”starting when the patient is about to go home from the hospital and continuing at the house.Measurement of insomnia is done using the Pittsburgh Sleep Quality Index(PSQI).Results:The mean insomnia scores of participants from both groups increased in the first and third measurements.The second and third insomnia measurements found a significant difference(P<0.001).This intervention decreased the average score of insomnia by 4.11 times in the second measurement and 5.82 times in the third measurement.The most important item that decreased in the third measurement of insomnia was sleep efficiency.Conclusions:Applying the theory of human becoming and self-care deficit theory of nursing in this study significantly decreased the insomnia score of post-stroke UI patients.It can be used as a guide for nurses,patients,and families in managing insomnia.In addition,the application of nursing theory in nursing practice can systematize nursing care plans and organize the knowledge of professionals into a conceptual framework,as well as provide effective guidance for nurses on what to do.

Effect of Brisk Walking on Self-Care Agency or Care Dependency among Colorectal Cancer Patients with Permanent Stoma

Objective:The purpose of this study was to determine the effectiveness of brisk walking as an intervention for self-care agency and care dependency in patients with permanent colorectal cancer stoma.Method:This study adopted a quasi-experimental research design,specifically a non-equivalent control group pre-test and post-test design.Utilizing the Exercise of Self-Care Agency Scale(ESCA)and Care Dependency Scale(CDS),a survey was administered to 64 patients from a hospital in Shandong Province.The statistical methods used for analyzing data included frequency,mean,standard deviation(SD),independent t-test,P-value calculation,and dependent t-test.Result:After two months of a brisk walking exercise program,participants in the experimental group had a higher level of self-care agency than before the experiment(P<0.05),and their level of care dependency was significantly reduced(P<0.05).Participants in the control group also showed higher levels of self-care agency(P<0.05)and lower levels of care dependency(P<0.05)after two months compared to their levels before the two months.Conclusion:The brisk walking program had a positive impact on patients’self-care agency and reduced their care dependency.

Analysis of the Application Effect of Family Collaborative Care Model on Elderly Patients with Type 2 Diabetes Mellitus and the Situation of Self-Care Ability

Objective: To study the application effect of the family collaborative care model on elderly patients with type 2 diabetes mellitus and its influence on self-care ability. Methods: The elderly type 2 diabetes mellitus patients (400 cases) treated in our hospital between March 2020 and July 2023 were divided into two groups by randomized grouping method;the control group received the conventional nursing program, while the observation group received the family collaborative nursing model. Blood glucose level, self-care ability, and quality of life were compared between the groups. Results: The blood glucose level of the observation group was lower than that of the control group (P < 0.05). The self- care ability and quality of life scores of the observation group were higher than those of the control group (P < 0.05). Conclusion: The family collaborative care model for elderly patients with type 2 diabetes mellitus can promote their self- care ability, improve the effect of glycemic control, and improve their quality of life, and is suitable for further promotion and application.

Analysis of the Role of Cognitive Behavioral Therapy on Self-Care in Thyroid Cancer Patients

Objective:To explore the effect of cognitive behavioral therapy on self-care in thyroid cancer patients.Methods:A total of 144 thyroid cancer patients treated at the Affiliated Hospital of Hebei University from January 2022 to August 2023 were selected as research subjects.Using the random number table method,they were divided into a control group and an experimental group,each consisting of 72 cases.The control group received routine nursing intervention,while the experimental group received cognitive behavioral therapy based on standard nursing practices.The self-care ability(self-concept,self-efficacy,self-care skills,health knowledge level),coping style(confrontation,avoidance,and surrender),and quality of life(psychological function,social function,material life,physical function)of both groups before and after the intervention were compared.Results:In comparison to the pre-intervention period,the experimental group exhibited significantly higher self-care ability,quality of life,and confrontation scores after the intervention,as opposed to the control group.Additionally,the avoidance and surrender scores were lower in the experimental group than in the control group,with these differences proving to be statistically significant(P<0.01).Conclusion:The application of cognitive behavioral therapy can enhance the self-care ability of thyroid cancer patients,aid in better disease coping,and improve their overall quality of life.This approach is deserving of further promotion.

Analysis of the Effect of Comfort Care in The Perioperative Care of Patients with Hysteromyomectomy and its Influence on Self-Care Ability

Objective:To analyze the effect of perioperative comfort care for patients with hysteromyomectomy(HYS).Methods:Seventy cases of HYS patients admitted to our hospital from October 2022 to October 2023 were randomly selected and divided into Group A(control group,35 cases,conventional care)and Group B(observation group 35 cases,comfort care).The effects of the two groups before and after nursing care were compared.Results:The self-rating anxiety(SAS)scores,exercise of self-care agency(ESCA)scores,and nursing satisfaction scores at the time of discharge of Group B were better than in Group A after nursing care(P<0.05).Conclusion:Perioperative comfort care for HYS patients improved the patient’s adverse emotions,self-care ability,and nursing satisfaction.

Information Needs and Self-Care Practices of Diabetic Patients in Mbala, Northern Province, Zambia

Introduction: Diabetes mellitus (DM) is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. It is “a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both” manifested by carbohydrates, fat and protein metabolism abnormality. If untreated high blood sugar can damage the nerves, eyes, kidneys, and other organs. The purpose of this study was to assess the information needs and self-care practice of Diabetic Patients in Mbala, Northern Province Zambia. Methods: This was an analytical cross-sectional study where 105 respondents aged 18 years and above participated in the study. Participants were randomly selected. A structured interview schedule and a check list were used to collect data. Statistics Package for Social Sciences computer software package version 23.0 was used to analyze data. Chi square and fisher’s exact tests were used to test the significance of the association between Knowledge of Diabetes Mellitus, attitude towards self-care practices, self-care practices among Diabetic patients and the need for information among Diabetic patients. A 95% confidence interval and P value of 0.05 were used to ascertain the degree of significance. Multi-variate binary logistic regression model to determine predictors of self-care practices and need for information was also used. Result: On analyzing the dependent variables, more than half (61.9%), had high need for information and three quarters (85.7%) of respondents had poor self-care practices. Slightly more than half (58.1%) had high knowledge levels majority (78.1%), had a negative attitude. Significant associations were found P Conclusion: Negative attitudes and lack of information among Diabetic patients were the main reasons associated with poor self-care practices. Particular attention should therefore be given to ensuring that Diabetic patients are given adequate information on Diabetes self-care in order to improve the quality of life.

Impact of an emergency department nursing intervention on continuity of care, self-care, and psychological symptoms

BACKGROUND The emergency department plays a crucial role in providing acute care to patients.Nursing interventions in this setting are essential for improving the continuity of care,enhancing patients’self-care abilities,and reducing psychological symp-toms.AIM To evaluate the effect of nursing interventions in the emergency department on these indicators in an emergency department.METHODS A retrospective analysis was conducted on 120 patients admitted to the emergency department between January 2022 and May 2023.The patients were divided into two groups:The control group(conventional nursing intervention)and the observation group(conventional nursing intervention+emergency department nursing intervention).The two groups were compared regarding continuity of care,self-care ability,psychological symptoms,and satisfaction with care.RESULTS The emergency department nursing interventions significantly improved the continuity of care,enhanced patients’self-care abilities,and reduced psycho-logical symptoms such as anxiety and depression.CONCLUSION Nursing interventions in the emergency department positively impact continuity of care,self-care,and psychological symptoms.However,it is important to acknowledge the limitations of this study,including the small number of studies,variable methodological quality,and the heterogeneity of the study population.Future research should address these limitations and further explore the effects of different types of nursing interventions in the emergency department.Additionally,efforts should be made to enhance the application and evaluation of these interventions in clinical practice.

Research on the Intervention of Visual Cue Strategy on Self-Care Ability of Children with Autism

The formation of self-care ability is the first step for children with autism to enter the society,and it is also a prerequisite and guarantee for their independent survival.This study aimed to explore the impact of visual cue strategies on the self-care ability of children with autism.Based on the ABA design of a single case study,this research conducted a four-month intervention on a seven-year-old child with autism via visual cue strategy as independent variables and sock-wearing skills as dependent variables,in order to explore the effect of visual cue strategy on self-care ability of children with autism.It turned out that visual cue strategy exerts a positive immediate sustained effect and social validity on the self-care ability of children with autism.Lastly,suggestions were provided for future related research based on the research process,results,and limitations.

Application of self-care based on full-course individualized health education in patients with chronic heart failure and its influencing factors

BACKGROUND The treatment of heart failure not only needs to relieve the clinical symptoms and improve the quality of life for patients but also needs to select scientific and reasonable ways to prevent or delay the progression of the disease,thus reducing the mortality and hospitalization rate.Although the previous regimen can effectively relieve symptoms in the early stage of treatment,long-term use may cause adverse events,such as arrhythmia,and even increase mortality.Therefore,conventional treatment cannot meet the actual health needs of patients,and scientific nursing intervention is very necessary.AIM To investigate the application of self-care based on full-course individualized health education (FCIHE) and its influencing factors in patients with chronic heart failure (CHF).METHODS We enrolled CHF patients who were admitted to our center between September 2015 and June 2016 and divided them into an intervention group (n = 50) and control group (n = 50) using a random number table.Routine nursing care was applied to the control group,and FCIHE was offered to the intervention group.The self-care behavior,6-min walking distance (6MWD),and 36-item short form health survey (SF-36) scores were compared between the two groups.The influencing factors of the self-care were also analyzed.RESULTS The 6MWD was not significantly different between the two groups at admission (P > 0.05);however,at 3 and 6 mo after discharge,6MWD was significantly increased,and it was significantly longer in the intervention group (P < 0.05).The scores for self-care behavior showed no significant difference at admission between the two groups (P > 0.05);however,at 3 and 6 mo after discharge,the total scores for self-care maintenance,management,confidence,and behavior of the intervention group were significantly higher than those of the control group (P < 0.05).There were no significant differences in the SF-36 scores at admission (P > 0.05);however,at 3 mo and 6 mo after discharge,the scores for all eight subscales,including physical functioning,role limitations due to physical problems,bodily pain,general health perceptions,vitality,social functioning,role-limitations due to emotional problems,and mental health,were significantly higher in the intervention group (P < 0.05).As shown by logistic regression analysis,the influencing factors of self-care mainly included age,cardiac function class,and education background (odds ratio > 1;all P < 0.05).CONCLUSION FCIHE improved self-care behavior and cardiac function in CHF patients.Age,cardiac function,and education level affected the implementation of self-care among CHF patients.

Dynamic interaction nursing intervention on functional rehabilitation and self-care ability of patients after aneurysm surgery

BACKGROUND Nursing practices based on the dynamic interaction model have been shown to be superior to generic nursing practices.However,whether this model is effective in patients recovering from intracranial aneurysm surgery is not well studied.AIM To investigate the effect of nursing based on a dynamic interaction model on functional rehabilitation of patients after aneurysm surgery.METHODS A total of 86 cases in our hospital with intracranial aneurysm from April 2019 to April 2021,were selected and divided into the study group and the control group,with 43 patients in each group.The control group received routine nursing,and the research group received nursing intervention based on a dynamic interaction model.The daily living ability(activities of daily living,ADL),cognitive function(Simple Intelligent Mental State Scale,MMSE),quality of life(Generic Quality of Life Inventory-74,GQOL-74),self-care ability(Exercise of Self-Care Agency scale),incidence of complications,and nursing satisfaction were recorded before and after intervention.RESULTS Before intervention,ADL(52.09±6.44),MMSE(18.03±4.11),and GQOL-74(53.68±4.34)scores in the study group were not significantly different from those in the control group(ADL:50.97±7.32,MMSE:17.59±3.82,GQOL-74:55.06±3.98)(P>0.05).After intervention,ADL(86.12±5.07),MMSE(26.64±2.66),and GQOL-74(83.13±5.67)scores in the study group were higher than those in the control group(ADL:79.81±6.35,MMSE:24.51±3.00,and GQOL-74:77.96±6.27)(P<0.05).Before intervention,self-concept(17.46±4.44),self-care skills(25.22±4.20),self-care knowledge(22.35±4.74),and self-care responsibility(15.06±3.29)scores in the study group was similar to those in the control group(self-concept:16.89±5.53,self-care skills:24.59±4.46,self-care knowledge:21.80±3.61,and self-care responsibility:14.83±3.11)(P>0.05).After the intervention,self-concept(26.01±3.18),self-care skills(37.68±6.05),self-care knowledge(45.56±5.83),and self-care responsibility(22.01±3.77)scores in the study group were higher than those in the control group(self-concept:22.97±3.46,self-care skills:33.02±5.65,selfcare skills knowledge:36.81±5.54,and self-care responsibility:17.97±3.56 points)(P<0.05).The incidence of complications in the study group(4.65%)was lower than that in the control group(18.60%)(P<0.05).Nursing satisfaction in the study group(95.35%)was higher than that in the control group(81.40%)(P<0.05).CONCLUSION Nursing intervention based on a dynamic interaction model can improve postoperative cognitive function,daily living ability,self-care ability,quality of life,and patient satisfaction,while reducing the risk of complications.

Diabetes self-care in primary health facilities in India-challenges and the way forward

India has approximately 73 million people living with diabetes and another 37 million with prediabetes while nearly 47% of the diabetes cases are undiagnosed. The high burden of poor glycemic control and early onset of complications with associated economic costs indicates a high prevalence of poor self-management practices. It is well-established that achieving patient-centered primary care consistent with a chronic care model ensures optimum diabetes self-management support and improves long-term clinical and health outcomes in diabetes patients. The public sector primary care system in India provides services free of cost to beneficiaries but lacks patient-centered care that undermines diabetes selfmanagement education and support. Furthermore, factors like poor patient knowledge of diabetes, suboptimal medication adherence, persistent clinical inertia, lack of data for monitoring and evaluation through clinical audit worsens the standards of diabetes care in primary care settings of India. There is a need for government initiatives to be directed towards the provision of comprehensive outpatient care that is inclusive of uninterrupted supply of drugs, provision of essential laboratory investigators, training and availability of qualified diabetes educators and availability of specialist support when required. Furthermore, the integration of depression screening and smoking cessation services at the primary care level is warranted.

Factors affecting anxiety, depression, and self-care ability in patients who have undergone liver transplantation

BACKGROUND Depression,anxiety,and altered self-care ability are among the most important factors affecting the quality of life of liver transplant recipients.Depending on the severity of the underlying liver disease,signs and symptoms of anxiety and depression may become more pronounced.AIM To evaluate the factors affecting depression,anxiety and self-care abilities of liver transplant recipients.METHODS Recipients who are≥18 years and who underwent liver transplantation at Inonu University Liver Transplantation Institute were included in this descriptive and cross-sectional study.Sample size analysis showed that the minimum number of recipients should be 301(confidence level=95%,confidence interval=2.5,population=1382).Three hundred and twenty recipients were interviewed and 316 recipients that have answered the questionnaires accurately were analyzed.The dependent variables were the Beck Depression Scale,State-Trait Anxiety Scale(Form I and II),and Self-Care Agency Scale.The independent variables of the study were sociodemographic characteristics,biliary complications,hepatocellular carcinoma,recommending liver transplantation to other patients,and the interval of out-patient clinic visits.RESULTS Self-care ability scores were lower(P=0.002)and anxiety scores were higher(P=0.004)in recipients with biliary complications.On the other hand,in recipients with hepatocellular carcinoma,self-care scores were lower(P=0.006)while depression(P=0.003)and anxiety scores(P=0.009)were higher.Liver transplantation recipients with a monthly income<3000 Turkish liras had higher depression(P<0.001)and anxiety(P=0.003)scores.The recipients who stated that they would not recommend liver transplantation to others had lower self-care scores(P=0.002),higher depression(P<0.001),higher state anxiety(P=0.02),and trait anxiety(P<0.001)scores.CONCLUSION Presence of biliary complications and hepatocellular carcinoma,low income level,and an obligation for monthly visits to the outpatient clinic are factors that are found to affect self-care capability,depression,and anxiety.

Motivational interviewing to improve the self-care behaviors for patients with chronic heart failure: A randomized controlled trial

Objectives:This study aimed to investigate the effect of motivational interviewing on the self-care behaviours in patients with chronic heart failure.Methods:Sixty-two hospitalized patients with chronic heart failure were recruited in this study from April 2014 to April 2015 from a hospital.Twenty-nine patients were in the intervention group,and 33 patients were in the control group.Patients in the intervention group received four sessions of motivational interviewing,whereas those in the control group received traditional health education.At 2,4,and 8 weeks post-discharge,the intervention group underwent telephone follow-up based on motivational interviewing,whereas the control group underwent routine telephone follow-up.Primary outcome was measured using the Self-care of Heart Failure Index at baseline and at 2 months postdischarge.Results:Before intervention,the self-care behaviours scores were 79.00±48.80 in the intervention group and 88.68±29.26in the control group.No statistically significant differences were found between two groups in scores for each subscale and total scale(P>0.05).After intervention,the scores of self-care behaviours in the two groups were both improved at 155.13±35.65 for the intervention group and 115.44±22.82 for the control group with statistically significance(P<0.01).The score of self-care behaviours increased by 76.13 point in the intervention group on average,whereas 26.76 point in the control group.There was significant difference between increases in scores of self-care behaviours in two groups(P<0.01).Conclusions:The self-care behaviours of patients with chronic heart failure could be improved effectively through motivational interviewing.

Self-care practices and health-seeking behavior among older persons in a developing country:Theories-based research

Purpose:The aim of this study was to examine the self-care practices and health-seeking behaviours of older adults in urban Indonesia.Methods:The cross-sectional study was performed from January to March 2014 in the Tammua sub-district of Indonesia.At the time of the study,273 older adults resided in Tammua,and half of them(51.2%)participated in this study.Data collection was carried out including self-care practices,health literacy,self-efficacy and basic conditioning factors.Results:It was found that most respondents(124;88.6%)always ate various protein sources daily.However,many participants never limited consumption of sugar(55;39.3%)or salt(40;28.6%),and more than half of respondents(96;68.6%)did not regularly visit MHCs.Health status(p<0.05),health maintenance(p<0.01)and salt limitation(p<0.05)were all significantly associated with salt limitation.It was found that respondents with higher selfefficacy,those who did not want to get information,and those of younger ages are less likely to visit MHCs regularly.Conclusion:An understanding of self-care practices and self-efficacy is needed to improve health care in developing countries.High self-efficacy should be promoted along with adequate health literacy.Older persons should learn the importance of regular health examinations to promote health,prevent diseases,and slow the progress of chronic diseases.The number of respondents who never limit their sugar and salt intake was especially surprising.An intervention program should be developed to limit salt and sugar intake of Indonesian elderly and to motivate older persons to use primary health services.

The Process of Compliance with Self-Care among Patients with Hypertension: A Grounded Theory Study

Introduction: Controlling hypertension across world continues to be challenging. Managing hypertension is not only concerned with lowering blood pressure by using antihypertensive medications;it also aims to minimize its consequences through adopting self-care practices. Compliance with self-care practices among patients with hypertension is considered a multidimensional phenomenon. The phenomenon of hypertension has been studied quantitatively, however;little qualitative studies were conducted to understand the compliance with self-care among patients with hypertension. Aim: To understand the process that patients with hypertension go through to comply with self-care practices. Methods: This study used a qualitative design that followed constructivist grounded theory approach;purposive sampling was used to recruit participants from cardiac clinics;semi structured, in-depth and face-to-face interview was used as a major method for data collection. Findings: Four participants with hypertension participated in this study;the phenomena of self-care was identified as the central phenomena;the start of the disease was identified as a casual condition;beliefs toward hypertension disease, beliefs toward self-care practices, knowledge and awareness regarding hypertension disease and self-care practices were identified as strategies;experiencing self-care practices was identified as consequence and being patients with hypertension in a social context. Conclusions: The process of compliance with self-care has a path of actions and interactions. The process started from the moment of diagnosis where the patients start to think about self-care. The absence of health care context leads to varying level of compliance with self-care among patients with hypertension. This indicated the need for more effective patient and health care provider relationship, education and awareness campaign.

Interaction between Locomotion and Self-Care for Patients with Stroke in Severity Classification Based on the Motor Functional Independence Measure upon Admission to the Recovery Ward

Background: A correlation between self-care and gait in stroke patients has been shown. However, there are few reports suggesting an interaction between self-care and gait. Purpose: To investigate the interaction between locomotion and improvements in self-care. Participants and Methods: We retrospectively analyzed 3034 stroke patients who were registered in the Japanese Rehabilitation Database. Using their data, patients were classified into three groups (severe, moderate, slight) based on the motor functional independence measure upon admission, and data were modified as mean-centered values. We performed a correlation analysis to evaluate the relationship among all the collected data. Subsequently, a hierarchical multiple regression analysis was performed to evaluate interaction using the self-care motor score from the Functional Independent Measure (FIM) as the dependent variable. Model 1 used two independent variables (National Institutes of Health Stroke Scale and cognitive FIM score), model 2 used two independent variables (locomotion gain and gain of an item with the strongest correlation coefficient to the de-pendent variable), and model 3 used a mean-centering value, which was added to model 2. The simple slope was used for further analysis. Results: Locomotion showed an interaction with self-care, except in the slight group. The R2 changes in models 1 and 2 were significant in the following: grooming, dressing lower body, and bladder management in the severe group (p < 0.01), and only dressing upper body in the moderate group (p < 0.01). Results of the simple slope analysis were significant for grooming, bowel management, and dressing lower body in the severe group and for dressing upper body in the moderate group. Conclusion: Locomotion demonstrated interaction with improving self-care, mainly in the severe group. Therefore, for moderate and slight cases, an intervention that not only involves locomotion training but also focuses on improving activities of daily living should be considered.

Gender differences in self-care maintenance and its associations among patients with chronic heart failure

Objectives:To identify the gender differences in self-care maintenance and its associations among chronic heart failure patients using the Information-Motivation-Behavioral Skills model.Methods:Two hundred and ten patients(54.0%female)with chronic heart failure participated in this cross-sectional study.Self-care,knowledge of heart failure,social support and illness perception were measured using the Self-Care of Heart Failure Index,the questionnaire of heart failure knowledge,the Perceived Social Support Scale,and the Revised Illness Perception Questionnaire,respectively.Results:Mean scores for self-care maintenance were 51.4±14.8 in men and 55.6±14.1 in women(t=-2.066,P<0.05).Associated factors of self-care maintenance were social support and self-care confidence in men and the knowledge of heart failure,self-care management and self-care confidence in women.The relationship between social support and self-care maintenance was meditated by selfcare confidence in men,whereas the relationship between knowledge of heart failure and self-care maintenance was meditated by self-care management and self-care confidence in women.Conclusions:Self-care maintenance were inadequate in both genders with chronic heart failure.Interventions for enhancing social support and self-care confidence in men patients,and strengthening knowledge of heart failure,self-care management and self-care confidence in women patients,may facilitate self-care maintenance.

Self-care among older Chinese people with chronic heart failure： the roles of cognitive and psychosocial characteristics

Chronic heart failure （CHF） is a complex clinical syndrome resulting from inefficient myocardial pumping, and is characterised by a typical progressively deteriorating trajectory punctuated by serious episodes of acute disease decompensation.High prevalence of hospital admission has been reported.[2] However, around 40% of hospital admissions was avoidable if patients demonstrate consistent self-care.