Gender, minority, and regional-related disparities have been documented in diabetes management. Self-efficacy, the belief in one's ability to carry out the actions mandated by a task, has been identified as a key predictor in glycemic control; however, it has not been investigated in rural, female populations. This cross-sectional, correlation investigation examined the relationships among self-efficacy, depression, and diabetes self-care management in women living in Appalachia with type 2 diabetes. Using Bandura's Social Cognitive Theory, 85 women ages ≥ 21 with type 2 diabetes for a minimum of 6 months who were residents in Appalachia completed the 1) Diabetes Self-Efficacy Scale, 2) Beck Depression Inventory-II, 3)Summary of Diabetes Self-Care Activities, and a 4) Diabetes Health-Related Demographics tool. Descriptive statistics detailed the sample characteristics. ANOVA, chi-square, and independent t-tests were computed for between group differences as they related to depression, various physiologic states, presence of self-efficacy sources, and glycosylated hemoglobin. Pearson correlation coefficients were used to describe the relationships between self-efficacy, depression, and self-care management. Multiple linear regression analyses examined prediction models for glucose control while controlling for potential confounders. Eighty-four Caucasian and one African-American enrolled in the study with a mean age of 61. The mean time since diabetes diagnosis was 7 years with a mean glycosylated hemoglobin value of 6.9% (SD=1.3). Higher self-efficacy scores were associated with a lower glycosylated hemoglobin (r-.30, p=.005) and ability to choose foods best to maintain a healthy eating plan(r-.415, p=.001). The sources of self-efficacy associated with enhanced self-care management were mastery experience and vicarious experience. There were no significant relationships between self-efficacy and depression or depression and glycosylated hemoglobin. The diabetes self-care management regression model resulted in self-efficacy and education accounting for 7.5% of the variance in glycosylated hemoglobin. Study findings support the social cognitive theory and the utility of self-efficacy as a predictor of glycemic control. Depression was not found to be a significant obstacle in this Appalachian population. Comprehending the significant relationship between self-efficacy and diabetes self-care management allows providers to modify their interventions when caring for women type 2 diabetes in the region.

Purpose: We tested relationships between patient-centered communication (PCC), relatedness to health care providers, and autonomy around health care management among youth with and without mobility limitations (MLs) and examined whether the relationship between PCC and autonomy was mediated by how connected youth feel to their health care providers. Methods: Stratified multiple regression models were used to examine predicted associations for youth with and without MLs. Results: PCC was significantly associated with relatedness to health care providers and autonomy for managing health care among youth with and without MLs. After controlling for covariates, evidence of mediation was observed among youth without MLs but not for youth with MLs. Conclusions: For youth without MLs, mediation suggests that youth's connection to their health care provider contributes to higher levels of health-related autonomy. For youth with MLs, independent of feeling connected to health care providers, more frequent PCC resulted in higher levels of health-related autonomy.

PURPOSE: The purpose of this study is to report preliminary evidence to support a new condition-specific measure of transition readiness that is theoretically grounded in the Stages of Changes framework. The Transition Readiness Assessment Questionnaire-Spina Bifida (TRAQ-SB) supplement is a newly developed tool used to measure independence and skill acquisition related to spina bifida. Similar to the Transition Readiness Assessment Questionnaire (TRAQ), the TRAQ-SB uses a 5-point Likert response set. METHODS: Working with a multi-disciplinary team with expertise in the care of children with spina bifida, the authors developed twelve items pertaining to main aspects of SB self-management. The items were reviewed and revised through several iterations by the team and patients. The items were then fielded at a spina bifida Specialty Clinic, where 93 consecutive patients 12–25 years of age were approached to participate and 90 were administered the 20-item TRAQ and a 12-item TRAQ-SB questionnaire. A principal component analysis (PCA) was conducted on the twelve items with oblique rotation (promax). Criterion validity was also assessed by examining the correlation of the TRAQ-SB supplement with the TRAQ and with age. RESULTS: Results of the factor analysis revealed that eleven of the twelve items loaded onto one factor with factor loadings ranging from 0.46 to 0.84. The scale yielded excellent internal reliability with a Cronbach alpha of 0.90. Correlations of the TRAQ-SB supplement scale score with the TRAQ overall scale score demonstrated good criterion validity (r= 0.74, p< 0.01). In addition, it was highly correlated with the TRAQ subscales, varying from 0.68 to 0.74 (all p< 0.01). Lastly, the TRAQ-SB was significantly correlated with age (r= 0.25, p< 0.01). CONCLUSIONS: Results of our analyses indicated that the TRAQ-SB demonstrated good internal reliability and criterion validity as evidenced by strong correlation with age and the validated TRAQ measure. The TRAQ-SB tool can be useful to incorporate transition readiness assessment and self-management training into routine care for adolescents with spina bifida.

PURPOSE: In order to transition to adulthood and independence, youth with spina bifida must assume significant self-management responsibilities including monitoring for shunt malfunction, maintaining intact skin in areas that are insensate, and maintaining proper bowel and bladder function. Validated measures of specific spina bifida self-management skills are lacking and this hampers the ability of clinical personnel to support successful transition for youth with spina bifida. METHODS: We developed a self-report measure specific to SB self-management skills consistent with the framework of the Transition Readiness Assessment Questionnaire (TRAQ). To test the predictive validity of the tool we surveyed 90 youth and young adults ages 12-25 with spina bifida attending a multidisciplinary clinic participating in the National Spina Bifida Patient Registry (NSBPR). RESULTS: Adjusted for age, gender, race, insurance status and lesion level, higher scores on the TRAQ-SB (increased self-management) were negatively associated with urinary incontinence in the past month. Only lesion level, and not TRAQ-SB scores, was a significant predictor of stool incontinence and skin breakdown. CONCLUSIONS: Higher TRAQ-SB scores are negatively associated with bladder incontinence in youth with spina bifida. While stool continence and skin breakdown were not associated with TRAQ-SB scores, this relation is complex and may be obfuscated by either reporting bias or outcome measurement bias. To further refine the questionnaire and understand this relationship we need to field it prospectively in the SB network with larger samples. The TRAQ-SB questionnaire, however, does have value in the clinical setting to help promote the acquisition of specific self-management skills among youth with spina bifida.

Bakgrund: Hjärtsvikt är en folkhälsosjukdom som ökar i världen. Hjärtsvikt innebär att hjärtats pumpförmåga inte kan tillgodose kroppens organ och vävnader med blod. Sjukdomen medför en hög dödlighet som kan minskas med egenvårdsbehandling. Det handlar om åtgärder för att bibehålla livskvalitet trots sjukdomen. Syfte: Att belysa patienters upplevelser av egenvård vid hjärtsvikt. Metod: En litteraturöversikt genomfördes baserad på 13 kvalitativa vetenskapliga artiklar som analyserades enligt Fribergs analysmodell. Resultat: Det identifierades två teman och fem subteman. Temana är livsstilsförändring och symtom. Under temat livsstilsförändring framkom följande tre subteman: Kost och vätskeintag, utmaning med medicinhantering och erfarenhet av fysisk aktivitet och under temat symtom framkom följande två subteman: Att känna igen symtom vid försämring och att förbättra livskvalitet. Konklusion: Litteraturöversikten visar att personer med hjärtsvikt är i behov av kunskap och stöd för att kunna hantera sin egenvård på ett rätt sätt. Upplevelser av oro, ångest, ensamhet, frustration och rädsla nämndes och alla dessa var kopplade till brist på kunskap av sjukdomen och egenvården. / Background: Heart failure is a public health disease that is increasing worldwide. Heart failure means that the pumping ability of the heart cannot supply blood to the body's organs and tissues. The disease carries a high mortality rate that can be reduced by self-care treatment. This involves measures to maintain physical stability despite the disease. Aim: To describe patients’ experiences of self-care in heart failure. Method: A literature review was conducted based on 13 qualitative scientific articles that were analyzed according to Friberg's analysis model. Findings: Two themes and five subthemes were identified. The themes are lifestyle change and symptoms. Under the theme of lifestyle change, the following three subthemes emerged: Diet and fluid intake, challenges with medication management and experience of physical activity, and under the theme of symptoms, the following two subthemes emerged: Recognizing symptoms in case of deterioration and improving quality of life. Conclusion: People with heart failure need information and support to manage their selfcare appropriately. Experiences of worry, anxiety, loneliness frustration and fear were mentioned and all of these were linked to lack of information. The study shows how information, knowledge and support can help people to continue with their self-care.

[pt] Esta dissertação argumenta a elaboração de conceitos de manifestação de práticas autogestionárias, suas limitações quando em uma democracia liberal e suas potencialidades fora dela. Ela o faz por identificar um mal-estar presente na autogestão que é caracterizado pelas limitações que a democracia liberal impõe através de sua dominação de poder político e burocrático, resultando na opressão e no favorecimento de uns em detrimento de outros. Para explicar essa relação anta-gônica entre a democracia liberal e a autogestão, são elaborados três conceitos: Estado Omisso, Estado como Terror e Estado Inexistente. São utilizados estudos de caso para explicar como cada conceito se encaixa em uma manifestação de prática autogestionada e como esses conceitos conflitam, cada um à sua maneira, com a democracia liberal. Assim, compreende que a autogestão gera inclusão de minorias oprimidas, autonomia e aumento geral de participação política ao diluir a concentração do poder político proporcionado pela democracia liberal, promoven-do relações políticas horizontais e estimulando a democracia direta. / [en] This dissertation argues the elaboration of concepts of manifestation of self-management practices, its limitations when in a liberal democracy and its potentials outside of it. It does so by identifying a malaise present in self-management that is characterized by the limitations that liberal democracy imposes through its domination of political and bureaucratic power, resulting in the oppression and favoring of some over others. To explain this antagonistic relationship between liberal democracy and self-management, three concepts are elaborated: the Missing State, State as Terror and Nonexistent State. Case studies are used to explain how each concept fits into a manifestation of self-managed practice and how these concepts conflict, each in its own way, with liberal democracy. Thus, it understands that self-management generates inclusion of oppressed minorities, autonomy and a general increase in political participation by diluting the concentration of political power provided by liberal democracy, promoting horizontal political relations and stimulating direct democracy.

Det metabola syndromet är ett utbrett och omfattande problem. På grund av syndromets komplexa symtombild valdes insulinresistens alternativt diabetes typ 2 att belysas, eftersom detta är WHO:s (World Health Organisation) huvud-kriterium för syndromet. En stor del av sjuksköterskans arbete med dessa patienter är undervisning. Syftet med föreliggande studie var att belysa sjuksköterskans undervisande funktion i arbetet med patienter med insulinresistens alternativt diabetes typ 2. Litteraturstudie utfördes med 8 inkluderade artiklar som analyserades med manifest innehållsanalys. Tre kategorier av denna identi-fierades; förmedling av kunskap, utbildning i grupp samt empowerment med subkategorin individanpassat tillvägagångssätt. Dessa visade sig vara användbara strategier för sjuksköterskan att tillämpa vid patientundervisningen. Autonomi/ self-management identifierades vara målet med undervisningen. Detta uppnådde patienterna med hjälp av sjuksköterskornas förhållningssätt och tillämpning av dessa patientundervisande strategier. Undervisningen bör baseras på ett samarbete mellan sjuksköterskan och patienten, där den senares behov och intresse är centrala. / The Metabolic Syndrome is a widely spread and extensive problem. Due to its complexity, one diagnostic criterion was chosen to be elucidated. WHO (World Health Organisation) has selected insulin resistance or diabetes type 2 as the main criteria for the syndrome, therefore that symptom/disease was chosen. A major part of the nurse’s work with these patients is education. Hence the purpose of this study was to illuminate the educational function of the nurse working with patients having insulin resistance or type 2 diabetes. Manifest content analysis of 8 articles, which illuminated patient education, was done. This resulted in three categories; mediation of knowledge, group education, empowerment with the subcategory individualization. These were revealed to be useful teaching strategies for the nurse. Autonomy/self-management was identified to be the goal of patient education. The patients achieved this with the help from the nurses using these teaching strategies. The education should be based upon cooperation between the nurse and the patient, of which the patient’s needs and interests are central.

Bakgrund: Diabetes typ 2 är en kronisk folksjukdom världen över. Egenvård är en essentiell del av behandlingen vid diabetes typ 2, om den missköts riskerar patienten att drabbas av allvarliga komplikationer. Sjuksköterskan har ett ansvar att säkerställa att patienten har rätt kompetens för att uppnå en god och långsiktig följsamhet vid egenvård. Syfte: Syftet var att belysa patienters upplevelser av hinder och möjligheter till egenvård vid diabetes typ 2. Metod: Studien var en allmän litteraturstudie med induktiv ansats. Resultat: Fyra kategorier identifierades: kunskapens betydelse för egenvård, levnadsvanors påverkan på egenvård, social, kulturell och ekonomisk påverkan på egenvård samt motivationens betydelse för egenvård. Konklusion/implikation: Patienter upplever både hinder och möjligheter till egenvård vid diabetes typ 2. Kunskapsbrist, svårigheter att ändra etablerade levnadsvanor, dyr hälsosam mat, dyra sjukvårdsbesök och dyra diabetesläkemedel är hinder till egenvård. Familjens påverkan på egenvård kan vara både hindrande och främjande. Individuellt anpassad patientutbildning rekommenderas för att rusta patienter med den kunskap som krävs vid egenvård av diabetes typ 2. Utökad forskning gällande vuxna patienters upplevelse av egenvård inom Skandinavien rekommenderas. / Background: Type 2 Diabetes is a chronic public health disease worldwide. Self-management is an essential part of treatment. Patients with poor adherence to self-management are at risk of developing serious complications. Nurses have a responsibility to ensure that patients have proper competence to achieve good and long-term adherence to self-management. Aim: This study aimed to illustrate patients' experiences of barriers and facilitators to self-management in type 2 diabetes. Method: This study was a general literature review with an inductive approach. Results: Four categories were identified: the importance of knowledge for self-management, the influence of lifestyle on self-management, social, cultural and economic influence on self-management as well as the importance of motivation for self-management. Conclusion/Implication: There are both barriers and facilitators for patients with type 2 diabetes to engaging in self-management. Lack of knowledge, difficulties in changing established lifestyles as well as high cost of healthy food, healthcare visits and diabetes medications serve as barriers to self-management. Family influence on self-management can be both inhibiting and facilitating. Individually tailored patient education is recommended to equip patients with the knowledge required for self-management of type 2 diabetes. More research regarding adult patients’ experience of self-management within Scandinavia is recommended.

Metamorphosis is a theory-driven occupational therapy program using telerehabilitation based on the concept of self-management of stroke (Warner et al., 2015), which emphasizes the crucial role of client adherence and engagement between formal therapy sessions to drive neuroplastic change. This program utilizes self-determination theory (Ryan & Deci, 2000) to cultivate the intrinsic motivation of individuals with chronic stroke to participate in evidence-based therapy from the home setting (Chemtob et al., 2019; Moore et al., 2016). Repetitious but interesting and engaging gamified therapy (Cramer et al., 2019; Proffitt & Lange, 2015; Thielbar et al., 2019) can lead to motor changes which are then translated into improvements in UL engagement during ADL guided by the Active Learning Program for Stroke (ALPS) (Fasoli & Adans-Dester, 2019), solidifying the motor changes by reducing learned non-use of the stroke-affected limb. Emotional support is provided through a moderated forum for stroke survivors (Owen et al., 2010) which can aid in continued translation of skills and motivation to participate in the program during a challenging time. / 2022-09-25T00:00:00Z

Background: Women have experienced increased mortality from coronary heart disease over the last two decades, while men‘s rate has declined. This suggests that current treatment and prevention strategies are less effective for women. Furthermore, since most women don‘t participate in cardiac rehabilitation, alternatives to these programs must be explored. Purpose: This study sought to refine an intervention for rural women with coronary heart disease designed to promote self-management and provide pilot data evaluating the efficacy of the intervention. Design and Methods: The study design was mixed methods. Focused qualitative interviews provided data regarding the self-management program. In-depth interviews determined the efficacy of the intervention including adoption of health promoting behaviors, self-awareness, and self-efficacy. The Self-efficacy for Managing Chronic Disease 6-Item Scale provided additional efficacy data and was administered over the course of the study. Ten women from rural New England, diagnosed with coronary heart disease within the last year, comprised the purposeful sample. Findings: The self-learning program met the women‘s needs; however they provided suggestions for improvement. While the women reported varying degrees of self-awareness, many believed the self-learning program influenced their adoption of health-promoting behaviors. In the interviews, the women expressed confidence in their ability to manage their disease; a finding that was congruent with the findings of the self-efficacy scale. Improvement was seen in five of six items on the self-efficacy scale from pre- to post intervention. The women‘s confidence in managing other symptoms or health problems and management of problems related to heart disease saw a statistically (p > .05) significant increase post intervention, and that increase persisted. One item, emotional distress, was flat over the series of administrations. Conclusions: Since women differ from men in the development, expression, and treatment outcomes for coronary heart disease, educational programs that address those differences and meet their needs must be developed. This study demonstrated that a paper-based, holistic, self-management program is a viable alternative or supplement to traditional cardiac rehabilitation programs. Using the self-and family management framework, this intervention enabled women to learn how to care for themselves.