Self-management in Heart Failure: The Importance of Self-regulation but not Complexity of Condition

Heart failure (HF) is a growing public health problem. Self-management (SM) of HF is an important component of chronic disease management. Guided by the Individual and Family Self-Management Theory (IFSMT), we examined the associations among complexity of condition, self-regulation, and self-efficacy mediation of SM behaviors in a population of HF outpatients. A cross-sectional design was used. Seventy-three outpatients with HF were enrolled. Simple and multiple linear regressions were run for each outcome variable. Only self-regulation was significantly associated with SM behavior. Complexity of condition was not significantly associated with SM behavior. There was no mediation by self-efficacy. Future nursing interventions should explore self-regulation in HF to provide a clearer understanding of the processes used to change health behavior. SM may be particularly useful in HF with preserved ejection fraction (EF), where there is no proven pharmacological treatment.

Change in Physical Activity after Diagnosis of Diabetes or Hypertension: Results from an Observational Population-Based Cohort Study

Background: Chronic diseases like diabetes mellitus or hypertension are a major public health challenge. Irregular physical activity (PA) is one of the most important modifiable risk factors for chronic conditions and their complications. However, engaging in regular PA is a challenge for many individuals. The literature suggests that a diagnosis of a disease might serve as a promising point in time to change health behavior. This study investigates whether a diagnosis of diabetes or hypertension is associated with changes in PA. Methods: Analyses are based on 4261 participants of the population-based KORA S4 study (1999–2001) and its subsequent 7-and 14-year follow-ups. Information on PA and incident diagnoses of diabetes or hypertension was assessed via standardized interviews. Change in PA was regressed upon diagnosis with diabetes or hypertension, using logistic regression models. Models were stratified into active and inactive individuals at baseline to avoid ceiling and floor effects or regression to the mean. Results: Active participants at baseline showed higher odds (OR = 2.16 [1.20;3.89]) for becoming inactive after a diabetes diagnosis than those without a diabetes diagnosis. No other significant association was observed. Discussion: As PA is important for the management of diabetes or hypertension, ways to increase or maintain PA levels in newly-diagnosed patients are important. Communication strategies might be crucial, and practitioners and health insurance companies could play a key role in raising awareness.

‘Motivational work’: a qualitative study of preventive health dialogues in general practice

Background While treatment plays an important role in general practice, primary and secondary prevention of so-called health behavior diseases has become an urgent issue of health politics as well as an important task in general practice. Through an analytical lens of ‘motivational work’, we explore how preventive health dialogues unfold in Danish general practices, with the purpose of understanding the social interactions and temporal complexities embedded in preventive health dialogues. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues and 18 semi-structured interviews with patients and general practitioners. The TOF pilot study in 2016 made it possible to explore preventive health dialogues between GPs and patients in general practice. The intervention addressed early detection and prevention in general practice through an approach of population-based risk stratification. Results We found that both GPs and patients—in an interplay—affected motivational work in the health dialogues to occur as one-way communication characterized by biomedically based guidance, information, suggestions, and advice on risk factors. Our findings illustrate a tendency among GPs to do motivational work without facilitating dialogue, concerning neither the underlying social causes of the behavior nor the patients’ possibilities to change their health behavior. We furthermore found that patients took part in reproducing the biomedical and treatment-oriented focus in the clinical encounter. Patients’ perspectives and expectations with regard to the structure and content of the health dialogues influenced whether and how GPs sought to promote and awaken patients’ motivation to change health behavior. Conclusion Overall, our findings point to a discrepancy between a biomedical action perspective and the temporality of prevention, with the former lessening the dialogue and interaction between GP and patient.

UTILIZATION OF TECHNOLOGY IN THE HEALTH OF COMMUNITY HEALTH

The era of globalization is now progressing very rapidly. One of the advances in information technology penetrated the health field. Use and utilization of this technology is one of the right solutions for problem solving public services. At least utilization of it will address the geographical, time and socioeconomic issues. Some research mentioned that the utilization of technology in the field of health can improve health service and can change health behavior. Information is a very important thing, because all things related to public health is information that is well managed and safe, so it takes a safe and smooth system for all information obtained can be used for the benefit of health services more optimal and can benefit the entire community

Magatartás-változtatás az egészségügyben: a motivációs interjú

Public health data show that early mortality in Hungary could be prevented by smoking cessation, reduced alcohol consumption, regular exercise, healthy diet and increased adherence. Doctor–patient encounters often highlight these aspects of health behavior. There is evidence that health behavior change is driven by internal motivation rather than external influence. This finding has led to the concept of motivational interview, which is a person-centered, goal-oriented approach to counselling. The doctor asks targeted questions to elicit the patient’s motivations, strengths, internal resources, and to focus the interview around these. The quality and quantity of the patient’s change talk is related to better outcomes. In addition, the interview allows the patient to express ambivalent feelings and doubts about the change. The doctor should use various communication strategies to resolve this ambivalence. Furthermore, establishing a good doctor–patient relationship is the cornerstone of the motivational interview. An optimal relationship can evoke change talk and reduce the patient’s resistance, which can also result in a better outcome. The goal of the motivational interview is to focus on the ‘why’ to change health behavior rather than the ‘how’, and to utilize internal motivation instead of persuasion. This is the reason why motivational interview has become a widely-accepted evidence based approach. Orv Hetil. 2017; 158(34): 1331–1337.