Elizabeth A. Schlenk

Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36.

The purpose of this report is to examine health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form-36, across patient populations with chronic disorders and to compare quality of life (QoL) in these subjects with normative data on healthy persons. Six studies, within the Center for Research in Chronic Disorders at the University of Pittsburgh School of Nursing, in patients with urinary incontinence, prostate cancer, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), fibromyalgia and hyperlipidaemia provided the data for analysis. The results demonstrated that not only did the prostate cancer and hyperlipidaemia patients have the highest QoL across the chronic disorders, but their QoL was comparable to normative data on healthy persons. Homebound, elderly, incontinent patients had the lowest QoL for physical functioning, whereas patients hospitalized with AIDS had the lowest QoL in general health and social functioning. Patients with COPD had the lowest QoL in role-physical, role-emotional and mental health. Patients with fibromyalgia had the lowest QoL in bodily pain and vitality. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia generally had lower QoL. Prostate cancer and hyperlipidaemia patients had QoL comparable to normative data. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia had more variability for role-emotional. AIDS patients had more variability on physical functioning, bodily pain and social functioning compared to the normative data. These data suggest that patients with various chronic disorders may have QoL that is lower in most domains compared to a healthy population. However, there may be differences in the domains affected as well as the extent of variation across specific chronic disorders.

Adherence in chronic disease.

Nonadherence to treatmeot regimen is a prevalent problem of patients with chronic disorders. Approximately half of the patients with a chronic disease have problems following their prescribed regimen to the extent that they are unable to obtain optimum clinical benefit. This chapter reviews the state of knowledge regarding adherence to chronic disease regimens across the life span and demonstrates that the extent and nature of the adherence problems are similar across diseases, across regimens, and across age groups. Adherence to the commonly prescribed regimens is addressed, including pharmacological therapies, therapeutic diets, and therapeutic exercise. Randomized, controlled studies focusing on various educational, behavioral, cognitive, and affective interventions to improve adherence are included. Based on this review, further work is needed to better understand and improve adherence. New strategies for analysis and measurement will support these needed advances in the field of adherence.

Medication Non-Adherence Among Older Adults: A Review of Strategies and Interventions for Improvement

Medication non-adherence among older adults is a prevalent and costly problem; approximately one half have problems following their prescribed medication regimen, and more than 10% of hospital admissions are the result of medication non-adherence. In this literature review, medication non-adherence is defined and described among adults age 50 and older. Factors associated with medication non-adherence are presented, interventions to improve medication non-adherence are discussed, and methods for assessing medication non-adherence are reviewed. In addition, nursing assessment and intervention to improve medication non-adherence are described.

Maintaining reality: Relational agents for antipsychotic medication adherence

We describe an animated, conversational computer agent designed to promote antipsychotic medication adherence among patients with schizophrenia. In addition to medication adherence, the agent also promotes physical activity and system usage, and includes verbal and nonverbal behavior designed to foster a therapeutic alliance with patients. We discuss special considerations in designing interventions for this patient population, and challenges in developing and evaluating conversational agents in the mental health domain. Results from a pilot evaluation study of the agent indicate that it is accepted and effective.

Predictors of adherence to nutrition recommendations in people with non-insulin-dependent diabetes mellitus.

The purpose of this study was to determine how the components of psychosocial adjustment to diabetes predict adherence to nutrition recommendations based on self-reported successful completion of contingency contracts. The relationships between the components of psychosocial adjustment and adherence to nutrition recommendations were examined in a convenience sample of patients with non-insulin- dependent diabetes mellitus participating in a contingency contracting intervention with nurses. Patients completed a standardized instrument, the Diabetes Care Profile, at the time they were enrolled into this randomized clinical trial. High and low levels of adherence to nutrition recommendations were identified by a median split of the number of contingency contracts completed for adherence to nutrition recommendations. Subjects who reported higher regimen adherence and a higher support ratio (received more diabetes-specific social support than desired) were significantly less likely to engage in contingency contracting for adherence to nutrition recommendations .

Improving Physical Activity and Function in Overweight and Obese Older Adults with Osteoarthritis of the Knee: A Feasibility Study

&NA; Osteoarthritis of the knee, a prevalent condition in older adults, can impact physical function and ability to perform physical activity. This randomized controlled trial examined the effects of a 6‐month self‐efficacy‐based, individually delivered, lower‐extremity exercise and fitness walking intervention with 6‐month follow‐up on physical activity and function. The 26 subjects were mostly older (M = 63.2 years, SD = 9.8), White (83%), obese (BMI M = 33.3, SD = 6.0) women (96%). Physical activity was measured by diaries. Physical function was measured by the 6‐minute walk, Short Physical Performance Battery (SPPB), and WOMAC Physical Function subscale. Exercise self‐efficacy was assessed by a questionnaire. Results showed significant increases in self‐reported performance of lower‐extremity exercise and participation in fitness walking, distance in the 6‐minute walk, and SPPB scores from baseline to 6‐month follow‐up with a trend for improvement in self‐efficacy. Results suggest that the intervention was feasible, acceptable, and improved physical activity and function.

An Integrative Review of Comprehensive Sex Education for Adolescent Girls in Kenya

PURPOSE The purposes of this article are to identify and review comprehensive sex education programs (CSEPs) available to adolescent females in Kenya, East Africa, to discuss barriers to implementing CSEPs in Kenya, and to highlight the role of nurses in improving and institutionalizing available CSEPs in Kenya. DESIGN Integrative review. METHODS A systematic search of six databases and other Internet sources was conducted to identify CSEPs currently available to adolescent girls in Kenya. Five CSEPs were identified. The CSEPs were evaluated using established criteria. FINDINGS All of the CSEPs were well designed and almost all were implemented with fidelity. Four of the five CSEPs met all of the criteria for well-designed CSEPs with only one showing lack of sustainability. Tuko Pamoja (We Are One) shows promise for wider implementation. CONCLUSIONS CSEPs are a valid intervention leading to the reduction of teenage pregnancy, HIV/AIDS, and sexually transmitted infections. The reach of the identified CSEPs varies, and sustainability is challenging due to lack of government and community support, lack of funding, and unsustainable teaching modalities. CLINICAL RELEVANCE Nurses can serve as liaisons between adolescents, the community, and the Kenyan government in promoting CSEPs. Nurses should be more readily utilized in educating community members and policy makers about the need for CSEPs in all Kenyan high schools. Nursing students can also be utilized in their community health role to teach curricula of CSEPs. Nurses should advocate for all adolescents to access reproductive health services and for all healthcare providers to provide comprehensive reproductive health care to them.

Behaviors in type II diabetes during contingency contracting

The purpose of this study was to use existing data to describe the behaviors performed by 117 subjects with Type II diabetes who wrote contingency contracts with nurses. Data were analyzed from a larger, randomized clinical trial of contingency contracting to improve clinical outcomes. Subjects had a high rate of completion of behaviors in contingency contracts (M = 90.9%). Subjects performed a median of six behaviors overall and up to a median of three behaviors of each of the diabetic regimen behaviors. The majority performed diet (n = 68, 58.1%) and exercise (n = 69, 58.9%) behaviors, with only one third performing both behaviors (n = 40, 34.2%). The most frequent behavioral strategies used were breaking the behavior into steps and self-monitoring the behavior. The contingency contracting intervention should be modified to be more comprehensive with increased recognition of the time and effort required for concurrently changing diet and exercise.

Implications of Food Insecurity on Global Health Policy and Nursing Practice

Purpose: The purpose is to discuss the concept of food insecurity (FI) and its impact on current global health policy and nursing practice. Organizing Construct: Food insecurity. Methods: Literature review. Findings: FI means a nonsustainable food system that interferes with optimal self-reliance and social justice. Individuals experiencing FI lack nutritionally adequate and safe foods in their diet. Resources play a significant role in FI by affecting whether or not people obtain culturally, socially acceptable food through regular marketplace sources as opposed to severe coping strategies, such as emergency food sources, scavenging, and stealing. Persons who are living in poverty, female heads of household, single parents, people living with many siblings, landless people, migrants, immigrants, and those living in certain geographical regions constitute populations at risk and most vulnerable to FI. Conclusions: FI influences economics through annual losses of gross domestic product due to reduced human productivity. FI affects individuals and households and is largely an unobservable condition, making data collection and analysis challenging. Policy and research have focused on macronutrient sufficiency and deprivation, making it difficult to draw attention and research dollars to FI. Clinical Relevance: Persons experiencing FI exhibit clinical signs such as less healthy diets, poor health status, poor diabetes and chronic disease management, and impaired cognitive function. Nurses can recognize the physical, psychosocial, and personal consequences that those with FI face and manage daily.PURPOSE The purpose is to discuss the concept of food insecurity (FI) and its impact on current global health policy and nursing practice. ORGANIZING CONSTRUCT Food insecurity. METHODS Literature review. FINDINGS FI means a nonsustainable food system that interferes with optimal self-reliance and social justice. Individuals experiencing FI lack nutritionally adequate and safe foods in their diet. Resources play a significant role in FI by affecting whether or not people obtain culturally, socially acceptable food through regular marketplace sources as opposed to severe coping strategies, such as emergency food sources, scavenging, and stealing. Persons who are living in poverty, female heads of household, single parents, people living with many siblings, landless people, migrants, immigrants, and those living in certain geographical regions constitute populations at risk and most vulnerable to FI. CONCLUSIONS FI influences economics through annual losses of gross domestic product due to reduced human productivity. FI affects individuals and households and is largely an unobservable condition, making data collection and analysis challenging. Policy and research have focused on macronutrient sufficiency and deprivation, making it difficult to draw attention and research dollars to FI. CLINICAL RELEVANCE Persons experiencing FI exhibit clinical signs such as less healthy diets, poor health status, poor diabetes and chronic disease management, and impaired cognitive function. Nurses can recognize the physical, psychosocial, and personal consequences that those with FI face and manage daily.

The role of social support on the relationship of depressive symptoms to medication adherence and self‐care activities in adults with type 2 diabetes

AIM To examine the mediating role of social support on the relationship of depressive symptoms to medication adherence and self-care activities in Korean adults. BACKGROUND Recent evidence suggests that higher levels of social support are associated with improved medication adherence and self-care activities; however, the role of social support on the relationship of depressive symptoms to medication adherence and self-care activities is less well understood. DESIGN A cross-sectional survey. METHODS The data were collected from 311 Korean adults with type 2 diabetes who were taking hypoglycaemic agents in the period 2012-2013. Depressive symptoms, social support, medication adherence and self-care activities were assessed using structured questionnaires. Multiple regression analysis with adjustment for covariates and the Sobel test were used to examine the mediating effect of social support on the relationship of depressive symptoms to medication adherence and self-care activities. RESULTS There were statistically significant differences by subgroups with and without depressive symptoms in social support, medication adherence and self-care activities of diet, physical activity and stress management. The Sobel test confirmed that social support mediated the effect of depressive symptoms on medication adherence and self-care activities of diet, physical activity and stress management. CONCLUSION The evidence from this study suggests that social support-enhancing interventions that also manage depressive symptoms may be more timely and effective than interventions that target depressive symptoms alone in promoting adherence to medication adherence and self-care activities in this population.