With ageing population in Hong Kong, the prevalence of osteoarthritis is expected to be increasing. The most common type of osteoarthritis is osteoarthritis of knee. Osteoarthritis adversely affects physical activities, social activities and quality of life. It causes socioeconomic burdens and has become a more prominent public health issue in Hong Kong. Self-management of this irreversible health problem in the daily living is crucial to those elders suffering from osteoarthritis. However, no evidence-based guidelines on self-management education for elders with knee osteoarthritis have been formed. The objectives of this paper are to review literatures on the effectiveness of self-management program and to formulate evidence-based guidelines on self-management education for Chinese older adults with knee osteoarthritis. The literature review showed that self-management program was an effective measure to improve self-efficacy for self-management and to reduce pain among the elders with knee osteoarthritis. The assessment on the implementation potential of the self-management program showed that self-management program could be transferred to the community-dwelling Chinese elders with knee osteoarthritis and was found to be feasible for implementation in Elderly Health Centers in Hong Kong. The benefits of self-management program outweigh the costs for the implementation of such a program. The proposed self-management program would mainly provide the elders with the self-management skills, osteoarthritis related information and exercise practice in group sessions. There would also be follow-up telephone coaching. Guidelines for implementing the proposed self-management program are shown in this thesis. Implementation plan was formulated to propose communication strategies to initiate and sustain the implementation of the proposed self-management program. Pilot test was designed to test the feasibility of the program. Evaluation plan was developed to evaluate the effectiveness of the program in improving self-efficacy for self-management and reducing osteoarthritis pain for Chinese older adults with knee osteoarthritis. In sum, self-management program was found to be effective in improving self-efficacy for self-management and reducing pain among the elders with knee osteoarthritis. The guidelines on the proposed self-management program could support the evidence-based self-management education for Chinese older adults with knee osteoarthritis in Hong Kong. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Physical inactivity has been widely regarded as a leading cause of non-communicable chronic diseases such as type 2 diabetes mellitus (T2DM) and hypertension. Physical activity (PA) has been shown to be the most effective self-care behaviour in alleviating T2DM, an incurable chronic disease. Previous behavioural modification programs intended to encourage and maintain PA behaviour among middle-aged and older patients with T2DM have had inconsistent results. PA has remained as a recommended diabetes self-care behaviour with the lowest compliance rate in many regions of the world. This thesis proposes a program focusing on health literacy (HL) as a means to nurture T2DM patients’ ability to navigate, read, understand, process, comprehend and act on health information, and thereby modify PA behaviour. This approach is proposed for three reasons: (1) the flood of available health information of varying quality affects patients’ decision making with regard to self-care behaviour; (2) the high prevalence of low HL in the US, Europe, and Asia affects the comprehension of self-care behaviour programs; (3) because 50% of older T2DM patients are impaired cognitively due to the impact of aging and hence have difficulty in carrying out suitable self-care behaviour without proper guidance. All of these factors can influence the effectiveness of PA behavioural modification programs designed to help middle-aged and older T2DM patients make self-care decisions based on sound health information according to their level of HL. This thesis reviews existing HL-oriented programs and models and validates the instrument used to examine the effects of a culture-, language-, disease- and age-specific, theory-based, HL-oriented program on PA behaviour among middle-aged and older patients with T2DM. In the study, 324 middle-aged and older Chinese T2DM patients recruited from two hospital diabetes centres in Hong Kong were divided randomly into intervention and control groups. The intervention group participated in an HL-oriented program on PA behaviour. The program significantly improved the mean of PA behaviour of patients in the intervention group from a sedentary level (under 1,000 average Metabolic Equivalents/minutes/week; 4463 mean number of steps per week) to an internationally acceptable standard (over 2,000 average METs-minutes/week; 7459 mean number of steps per week), and this improvement was maintained at three- and six-month follow-ups. The PA behaviour of the control group actually subsided. This study showed that a program addressing and nurturing patients’ ability to explore, understand and manage health information on T2DM and PA was effective in improving the PA behaviour of middle-aged and older adults with T2DM. This thesis is the first study to use objective measurements to evaluate the effect of a culture-, language-, disease- and age-specific, theory-based, HL-oriented program on PA behaviour. It extends the generalizability of culture and language-sensitive HL oriented programming from the United States (where previous HL studies were conducted) to China. The study can serve as a model for future investigations of self-care behaviour among patients with different chronic illnesses in various regions of China. / published_or_final_version / Nursing Studies / Doctoral / Doctor of Philosophy

Background: Intestinal diseases that can cause a person to receive a stoma may include colorectal cancer, Crohn's disease and Ulcerative colitis. Aim: The aim of the study was to describe experiences of living with intestinal stoma. Method: A qualitative literature study in which eleven scientific articles have been analyzed according to Fribergs (2006a) analysis model. Result: The result was based on two categories which are experiences of altered body image, and experienced changes in social life. The result showed that patients with stoma felt that their body image changed and it was hard to accept the altered body image and thereby self image. Difficulties in controlling emissions, odor and leakage contributed to the experience of loss of control with limited social life as a result. The stoma also resulted in a change in everyday life which required careful planning. The sexual activity was affected due to altered body image. Despite the constraints of everyday life support, a functioning self care and acceptance contributed to a better quality of life. Conclusion: It can be concluded it's clear from the result that it is important for the patient to receive accurate information both before and after ostomy to get an adequate picture of what it means to live with a stoma. By supporting the patient and customizing information and creating a patient-centered care quality of life can significantly improve.

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Aims: Elders with type 2 diabetes represent the faster growing demographic segment today, yet there is little known about the factors that influence their diabetes self care management. The factors (age related developmental deficits, health literacy, knowledge of diabetes as a disease, and prior attendance within a structured diabetes educational program) that most impact diabetes self care among this age group was determined from the literature. Seven research questions and three model hypothesis questions were posed to examine the relationships between these identified factors. Method: The study was composed of 75 elders with type 2 diabetes who resided within two metropolitan regions in the Southwest. The elders were asked to perform manual dexterity tests, visual acuity examination, and tests of cognition along with answering questions in regard to their health literacy and knowledge of diabetes. Results: Of all the factors examined only health literacy and cognitive reasoning ability were statistically significant to the measure of diabetes self care.

Shorter hospital stays increases the need for well functioning post hospital aftercare. Persons close to the patient are often involved in the aftercare and need information about self-care. This need is frequently not satisfied. The aim of this study was to investigate if the next-of-kin of patients cared for at the thoracic clinic at Uppsala University hospital, have received information about self-care and how they perceive the information they have been given. METHOD: To investigate this, questionnaires were sent out by mail. MAIN RESULT: Most of the respondent’s states that they have not received enough information but that they consider it important to get information. Those who state that they have been given information say that they are pleased with the information received.  CONCLUSION: A tendency in the results shows that the information that is given at the clinic is satisfying, but that not everybody receive it. There is also shown that the next-of-kin’s thinks that it is important to be given information about the patients self-care. / Kortare vårdtider ökar behovet av en välfungerande posthospital eftervård. Närstående är ofta inblandade i patientens egenvård i hemmet och har stort behov av information inför utskrivning. Detta behov är ofta inte tillfredställt. Syftet med denna studie var att undersöka om närstående till patienter på thoraxkliniken vid Akademiska sjukhuset i Uppsala, anser sig ha fått information inför utskrivning och hur de uppfattar den. METOD: För att undersöka detta skickades studiespecifika enkäter ut per post. HUVUDRESULTAT: De flesta svarar att de inte fått tillräckligt med information men att de tycker det är viktigt med information. De som anger att de fått information är generellt nöjda med den information de fått. SLUTSATS: Resultaten tyder på att den information som ges på kliniken är bra men att inte alla får ta del av den samt att de närstående anser att det är viktigt att få information om patientens egenvård.

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Traumatic brain injury is one of the leading causes of death and disability in the North America, and can result in long-term physical and psychological consequences, which over time change brain injury from a medical problem to an issue of quality of life. Various self-care activities can significantly improve the quality of life in people living with a chronic health condition. However, research on self-care in these populations has focused on the physical aspect of self-care, often excluding other domains of functioning. There is minimal self-care research involving people who had a traumatic brain injury; however, it is important to understand how they experience and make sense of their injury and its consequences in order to develop more effective approaches to their rehabilitation and support systems. In this study, I interviewed adults with traumatic brain injury who had their injury at least two years prior to the study. Narrative analysis of their stories revealed that the participants faced the following difficulties: constructing an explanation for the injury, dealing with losses and limitations, feeling misunderstood and insignificant, and dealing with memory deficits and physical problems. The ways in which participants tried to overcome these difficulties was understood as self-care. It manifested in a variety of ways, including deliberate health-related behaviours, changes in one’s way of thinking, emotional regulation strategies, and linguistic and paralinguistic means used in the narratives. I discuss ways to understand the findings using different theoretical models, such as illness narratives, social disenfranchisement, and social disability models. The results of the study strongly suggest that our understanding of self-care should encompass both physical and psychological health.

Traumatic brain injury is one of the leading causes of death and disability in the North America, and can result in long-term physical and psychological consequences, which over time change brain injury from a medical problem to an issue of quality of life. Various self-care activities can significantly improve the quality of life in people living with a chronic health condition. However, research on self-care in these populations has focused on the physical aspect of self-care, often excluding other domains of functioning. There is minimal self-care research involving people who had a traumatic brain injury; however, it is important to understand how they experience and make sense of their injury and its consequences in order to develop more effective approaches to their rehabilitation and support systems. In this study, I interviewed adults with traumatic brain injury who had their injury at least two years prior to the study. Narrative analysis of their stories revealed that the participants faced the following difficulties: constructing an explanation for the injury, dealing with losses and limitations, feeling misunderstood and insignificant, and dealing with memory deficits and physical problems. The ways in which participants tried to overcome these difficulties was understood as self-care. It manifested in a variety of ways, including deliberate health-related behaviours, changes in one’s way of thinking, emotional regulation strategies, and linguistic and paralinguistic means used in the narratives. I discuss ways to understand the findings using different theoretical models, such as illness narratives, social disenfranchisement, and social disability models. The results of the study strongly suggest that our understanding of self-care should encompass both physical and psychological health.