Continuity of Care and Self-Management among Patients with Stroke: A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Measurement
2.3. Data Collection
2.4. Data Analysis
3. Results
3.1. General Status of the Basic Demographic Data, Health Status, Continuity of Care, and Self-Management of Patients with Stroke
3.2. Relationship between the Basic Demographic Data, Health Status, and Continuity of Care of Patients with Stroke and Self-Management
3.3. Important Predictors Affecting the Self-Management of Patients with Stroke
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Item Number and Description | Strongly Agree | Agree | Neutral | Disagree | Strongly Disagree |
---|---|---|---|---|---|
I. Relationships with Providers in Hospital | |||||
1. The medical providers understood my expectation, beliefs and preferences | |||||
2. I felt the medical providers knew me for the care required | |||||
3. I have confidence in my current medical providers which continued to care for me after my discharge | |||||
4. I am satisfied with information from present providers | |||||
5. I am satisfied with emotional support from present providers | |||||
Π. Information Transfer to Patients | |||||
6. I was provided with clear information on my diagnosis | |||||
7. I was provided with clear information on my prognosis | |||||
8. I was told about nonurgent symptoms that may occur and how I should cope with these | |||||
9. I was given information on symptoms that may signal a need to seek urgent medical attention and whom to contact for these symptoms | |||||
10. I was informed about the clinical conditions that may affect my personal health or care in the future | |||||
11. I was provided with complete information on my prescribed medications | |||||
12. I was given dietary instructions |
Item Number and Description | Strongly Agree | Agree | Neutral | Disagree | Strongly Disagree |
---|---|---|---|---|---|
I. Medical Management | |||||
1. I had good knowledge of my disease (such as symptom management, diets, medication, rehabilitation) | |||||
2. I was well aware of the method to treat my disease | |||||
3. For my decision-making ability on disease self-management, I completely listened to the physician | |||||
4. I cooperated with the appointment arranged by the physician and make a return visit as scheduled | |||||
5. When I could not cooperate with the appointment arranged, I would make another appointment to reschedule the return visit | |||||
6. I followed the physician’s instruction to take medicine on schedule | |||||
7. As for my disease, I could understand why I had to observe, measure and record related symptoms, such as high blood pressure, low blood pressure, high blood sugar, low blood sugar | |||||
8. When there were symptoms of stroke or when symptoms worsen, I knew how to deal with it (eg. contact medical staff for medical consultation, call the hospital for help, go to ER directly) | |||||
9. Symptoms such as high blood pressure and headache meant that my health condition was changing | |||||
10. I discussed with medical staff on how to control the health condition after a stroke | |||||
11. I had confidence in getting the information I need from the medical staff | |||||
12. I believed that the medical staff could answer my questions concerning the progression or prognosis of my stroke | |||||
13. I was full of confidence in the discussion with the physician for any suggestions related to the disease | |||||
Π. Role Management | |||||
1. When stroke-related symptoms appeared, I could actually make observation, measurement and recording of the severity of the symptoms | |||||
2. I strove to change bad living habits for my health | |||||
3. I could not decide what was the best way for self-management of a stroke (such as changing living habits, participating in daily activities) | |||||
4. I would strive to do something positive to manage my health (such as controlling high blood pressure, high blood sugar, high blood cholesterol, weight) | |||||
5. I would actively search for useful information or suggestions in regard to stroke management | |||||
6. I would arrange my day and would not get tired of what needed to be done every day | |||||
7. I had confidence that my family could do something important for my health | |||||
8. I was glad to let my friend help me with something that was meaningful to my health | |||||
9. I would try different ways to adapt to the disease until I found the right method that suits me | |||||
10. I obtained some ideas from other stroke patients that are beneficial to the disease and could help with my recovery | |||||
11. I would follow professional advice from medical professionals (diet, smoking cessation, giving up drinking, engaging in rehabilitation activities) | |||||
12. I believe that if I get the help from medical professionals, my stroke condition will get better | |||||
III. Emotional Management | |||||
1. If things did not go well, it was hard for me to keep positive, and I would be pessimistic and feel frustrated | |||||
2. It was hard for me to be motivated to seek solutions to problems related to stroke (activity of daily living, daily emotions) | |||||
3. I found it hard to tell healthcare professionals what I wanted or needed, and I felt frustrated or helpless | |||||
4. If I worried about my condition, I knew how to get help | |||||
5. I was worried that if there was no guidance from a medical professional, I could not effectively control the condition of my stroke |
References
- Virani, S.S.; Alonso, A.; Benjamin, E.J.; Bittencourt, M.S.; Callaway, C.W.; Carson, A.P.; Chamberlain, A.M.; Chang, A.R.; Cheng, S.; Delling, F.N. Heart disease and stroke statistics—2020 update: A report from the American Heart Association. Circulation 2020, 141, e139–e596. [Google Scholar] [CrossRef]
- World Stroke Organization. Learn about Stroke. Available online: https://www.world-stroke.org/world-stroke-day-campaign/why-stroke-matters/learn-about-stroke (accessed on 26 June 2021).
- Davies, F.; Wood, F.; Bullock, A.; Wallace, C.; Edwards, A. Shifting mindsets: A realist synthesis of evidence from self-management support training. Med. Educ. 2018, 52, 274–287. [Google Scholar] [CrossRef] [PubMed]
- Maredza, M.; Bertram, M.Y.; Tollman, S.M. Disease burden of stroke in rural South Africa: An estimate of incidence, mortality and disability adjusted life years. BMC Neurol. 2015, 15, 1–12. [Google Scholar] [CrossRef] [Green Version]
- Damush, T.M.; Mackey, J.; Saha, C.; Slaven, J.; Myers, L.; Lincoln, F.; Nicholas, G.; Blackwell, L.; Fleck, J.; Thomas, K. Abstract TMP46: Stroke Self-management Effectiveness Trial. Stroke 2018, 49 (Suppl. 1), ATMP46. [Google Scholar] [CrossRef]
- Chen, H.M.; Chen, C.M. A Chinese version of the Patient Continuity of Care Questionnaire: Reliability and validity assessment. J. Clin. Nurs. 2017, 26, 1338–1350. [Google Scholar] [CrossRef]
- Chen, H.M.; Tu, Y.H.; Chen, C.M. Effect of continuity of care on quality of life in older adults with chronic diseases: A meta-analysis. Clin. Nurs. Res. 2017, 26, 266–284. [Google Scholar] [CrossRef]
- Hadjistavropoulos, H.; Biem, H.; Sharpe, D.; Bourgault-Fagnou, M.; Janzen, J. Patient perceptions of hospital discharge: Reliability and validity of a Patient Continuity of Care Questionnaire. Int. J. Qual. Health Care 2008, 20, 314–323. [Google Scholar] [CrossRef] [PubMed]
- Boger, E.J.; Hankins, M.; Demain, S.H.; Latter, S.M. Development and psychometric evaluation of a new patient-reported outcome measure for stroke self-management: The Southampton Stroke Self-Management Questionnaire (SSSMQ). Health Qual. Life Outcomes 2015, 13, 1–9. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Corbin, J.M.; Strauss, A. Unending Work and Care: Managing Chronic Illness at Home; Jossey-Bass: Washington, DC, USA, 1988. [Google Scholar]
- Lorig, K.R.; Holman, H.R. Self-management education: History, definition, outcomes, and mechanisms. Ann. Behav. Med. 2003, 26, 1–7. [Google Scholar] [CrossRef] [PubMed]
- Audulv, Å.; Ghahari, S.; Kephart, G.; Warner, G.; Packer, T.L. The taxonomy of everyday self-management strategies (TEDSS): A framework derived from the literature and refined using empirical data. Patient Educ. Couns. 2019, 102, 367–375. [Google Scholar] [CrossRef]
- Been-Dahmen, J.M.; Dwarswaard, J.; Hazes, J.M.; van Staa, A.; Ista, E. Nurses’ views on patient self-management: A qualitative study. J. Adv. Nurs. 2015, 71, 2834–2845. [Google Scholar] [CrossRef]
- Lin, M.Y.; Liu, M.F.; Hsu, L.F.; Tsai, P.S. Effects of self-management on chronic kidney disease: A meta-analysis. Int. J. Nurs. Stud. 2017, 74, 128–137. [Google Scholar] [CrossRef]
- Pal, K.; Dack, C.; Ross, J.; Michie, S.; May, C.; Stevenson, F.; Farmer, A.; Yardley, L.; Barnard, M.; Murray, E. Digital health interventions for adults with type 2 diabetes: Qualitative study of patient perspectives on diabetes self-management education and support. J. Med. Internet Res. 2018, 20, e40. [Google Scholar] [CrossRef] [PubMed]
- Chen, L.; Xiao, L.D.; De Bellis, A. First-time stroke survivors and caregivers’ perceptions of being engaged in rehabilitation. J. Adv. Nurs. 2016, 72, 73–84. [Google Scholar] [CrossRef]
- Pindus, D.M.; Mullis, R.; Lim, L.; Wellwood, I.; Rundell, A.V.; Abd Aziz, N.A.; Mant, J. Stroke survivors’ and informal caregivers’ experiences of primary care and community healthcare services—A systematic review and meta-ethnography. PLoS ONE 2018, 13, e0192533. [Google Scholar] [CrossRef] [Green Version]
- Lennon, O.; Blake, C.; Booth, J.; Pollock, A.; Lawrence, M. Interventions for behaviour change and self-management in stroke secondary prevention: Protocol for an overview of reviews. Syst. Rev. 2018, 7, 1–9. [Google Scholar] [CrossRef] [PubMed]
- Beck, J.; Greenwood, D.A.; Blanton, L.; Bollinger, S.T.; Butcher, M.K.; Condon, J.E.; Cypress, M.; Faulkner, P.; Fischl, A.H.; Francis, T. 2017 National standards for diabetes self-management education and support. Diabetes Educ. 2018, 44, 35–50. [Google Scholar] [CrossRef] [PubMed]
- Sakakibara, B.M.; Chakrabarti, S.; Krahn, A.; Mackay, M.H.; Sedlak, T.; Singer, J.; Whitehurst, D.G.; Lear, S.A. Delivery of peer support through a self-management mHealth intervention (Healing Circles) in patients with cardiovascular disease: Protocol for a randomized controlled trial. JMIR Res. Protoc. 2019, 8, e12322. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fryer, C.E.; Luker, J.A.; McDonnell, M.N.; Hillier, S.L. Self management programmes for quality of life in people with stroke. Cochrane Database Syst. Rev. 2016, 8. [Google Scholar] [CrossRef]
- Sakakibara, B.M.; Kim, A.J.; Eng, J.J. A systematic review and meta-analysis on self-management for improving risk factor control in stroke patients. Int. J. Behav. Med. 2017, 24, 42–53. [Google Scholar] [CrossRef] [Green Version]
- Faul, F.; Erdfelder, E.; Buchner, A.; Lang, A. G∗ Power Version 3.1. 9.2 [Computer Software]; Uiversität Kiel: Kiel, Germany, 2014. [Google Scholar]
- Cohen, J. Statistical Power Analysis for the Behavioral Sciences; Academic Press: New York, NY, USA; San Francisco, CA, USA; London, UK, 2013. [Google Scholar]
- Cao, X.Y.; Tian, L.; Chen, L.; Jiang, X.L. Effects of a hospital–community partnership transitional program in patients with coronary heart disease in Chengdu, China: A randomized controlled trial. Jpn. J Nurs. Sci. 2017, 14, 320–331. [Google Scholar] [CrossRef] [Green Version]
- Mahoney, F.I.; Barthel, D.W. Functional evaluation: The Barthel Index: A simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Md. Med. J. 1965, 14, 61–65. [Google Scholar]
- Lawton, M.; Brody, E.; Médecin, U. Instrumental activities of daily living (IADL). Gerontologist 1969, 9, 179–186. [Google Scholar] [CrossRef]
- Ghose, S.K.; Ahmed, K.G.U.; Chowdhury, A.H.; Hasan, A.H.; Saha, K.; Mahmud, R.; Joy, N.I.; Biswas, R.; Sarkar, M.S.R.; Rahman, M.M. Assessment of Initial Stroke Severity by National Institute Health Stroke Scale (NIHSS) Score at Admission. J. Dhaka Med. College 2017, 26, 90–93. [Google Scholar] [CrossRef] [Green Version]
- Banks, J.L.; Marotta, C.A. Outcomes validity and reliability of the modified Rankin scale: Implications for stroke clinical trials: A literature review and synthesis. Stroke 2007, 38, 1091–1096. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lin, S.; Lin, S.; Wu, Y.; Chang, C.; Wu, H. Validity and reliability of a chinese translation of a perceived diabetes self-management scale. J Nurs. Healthc. Res. 2011, 7, 198–206. [Google Scholar] [CrossRef]
- Song, Y.; Lin, C. The development and testing of a new hemodialysis self-management instrument (HD-SMI). J. Nurs. Healthc. Res. 2009, 51, 51–59. [Google Scholar] [CrossRef]
- Battersby, M.W.; Ask, A.; Reece, M.M.; Markwick, M.J.; Collins, J.P. The Partners in Health scale: The development and psychometric properties of a generic assessment scale for chronic condition self-management. Aust. J. Prim. Health 2003, 9, 41–52. [Google Scholar] [CrossRef]
- Guan, F.G.; Wang, M.; Lian, X.-Q. The status quo and influence of self-management behaviors in convalescent stroke patients. Front. Nurs. 2018, 5, 119–125. [Google Scholar] [CrossRef] [Green Version]
- Upoyo, A.S.; Setyopranoto, I.; Pangastuti, H.S. The modifiable risk factors of uncontrolled hypertension in stroke: A systematic review and meta-analysis. Stroke Res. Treat. 2021, 2021, 6683256. [Google Scholar] [CrossRef]
- Brauer, S.G.; Kuys, S.S.; Paratz, J.D.; Ada, L. Improving physical activity after stroke via treadmill training and self management (IMPACT): A protocol for a randomised controlled trial. BMC Neurol. 2018, 18, 1–8. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ruksakulpiwat, S.; Zhou, W.-D. Self-management interventions for adults with stroke: A scoping review. Chronic Dis. Transl. Med. 2021, 7, 1–10. [Google Scholar] [CrossRef]
- Singh, P.; Jayakaran, P.; Mani, R.; Hale, L. The experiences of Indian people living in New Zealand with stroke. Disabil. Rehabil. 2021, 1–9. [Google Scholar] [CrossRef]
- Spoorenberg, S.L.; Wynia, K.; Uittenbroek, R.J.; Kremer, H.P.; Reijneveld, S.A. Effects of a population-based, person-centred and integrated care service on health, wellbeing and self-management of community-living older adults: A randomised controlled trial on Embrace. PLoS ONE 2018, 13, e0190751. [Google Scholar] [CrossRef]
- Hagberg, G.; Fure, B.; Sandset, E.C.; Thommessen, B.; Ihle-Hansen, H.; Øksengård, A.R.; Nygård, S.; Wyller, T.B.; Ihle-Hansen, H. Long-term effects on survival after a 1-year multifactorial vascular risk factor intervention after stroke or TIA: Secondary analysis of a randomized controlled trial, a 7-year follow-up study. Vasc. Health Risk Manag. 2019, 15, 11. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ministry of Health and Welfare. Integrated Care Plan for Acute and Advanced Diseases. Available online: https://www.nhi.gov.tw/Content_List.aspx?n=5A0BB383D955741C&topn=5FE8C9FEAE863B46 (accessed on 26 June 2021).
- Lindblom, S.; Ytterberg, C.; Elf, M.; Flink, M. Perceptive Dialogue for Linking Stakeholders and Units During Care Transitions–A Qualitative Study of People with Stroke, Significant Others and Healthcare Professionals in Sweden. Int. J. Integr. Care 2020, 20, 1–11. [Google Scholar] [CrossRef] [PubMed]
- Säfström, E.; Nasstrom, L.; Liljeroos, M.; Nordgren, L.; Årestedt, K.; Jaarsma, T.; Stromberg, A. Patient continuity of care questionnaire in a cardiac sample: A confirmatory factor analysis. BMJ Open 2020, 10, 1–10. [Google Scholar] [CrossRef] [PubMed]
- Su, S.-F.; Chang, M.-Y.; He, C.-P. Social support, unstable angina, and stroke as predictors of depression in patients with coronary heart disease. J. Cardiovasc. Nurs. 2018, 33, 179–186. [Google Scholar] [CrossRef] [PubMed]
Variables | n | % | |
---|---|---|---|
Sociodemographic Characteristics | |||
Gender | Female | 43 | 28.7 |
Male | 107 | 71.3 | |
Marital status | Unmarried/widowed/divorced | 37 | 24.7 |
Married | 113 | 75.3 | |
Religious belief | No | 133 | 88.7 |
Yes | 17 | 11.3 | |
Smoking status | Non-smoker | 71 | 41.3 |
Smoker | 79 | 58.7 | |
Time affected by stroke | Within 1 month | 146 | 97.3 |
2–6 months | 4 | 2.7 | |
Educational level | Under elementary school | 57 | 38.0 |
Junior to senior high school | 68 | 45.3 | |
College and above | 25 | 16.7 | |
Main source of income | Children/older siblings/spouse/parents | 31 | 20.7 |
Pension/government subsidy | 43 | 28.7 | |
Work salary | 76 | 50.7 | |
Income | Somewhat insufficient/extremely insufficient | 45 | 30 |
Generally sufficient | 99 | 66 | |
Sufficient with surplus | 6 | 4.0 | |
Frequency of exercise | Never | 86 | 57.3 |
1–2 times/week | 25 | 16.7 | |
More than 3 times/week | 39 | 26.0 | |
Age | Mean (SD) = 65.15 (13.30) | ||
Total number of chronic diseases | Mean (SD) = 2.35 (1.35) | ||
ADLs IADLs | Mean (SD) = 87.10 (18.86) Mean (SD) = 19.85 (5.71) | ||
NIHSS | Mean (SD) = 1.89 (1.68) | ||
mRS | Mean (SD) = 1.82 (1.00) |
Variables | Mean | SD | Score Indicator |
---|---|---|---|
Continuity of care scale (12–60) | 46.61 | 8.99 | 77.68 |
Relationships with providers in hospital (5–25) | 19.46 | 3.82 | 77.84 |
Information transfer to patients (7–35) | 27.14 | 5.35 | 77.54 |
Self-management (30–150) | 110.50 | 15.12 | 73.67 |
Medical management (13–65) | 51.74 | 6.80 | 79.60 |
Role management (12–60) | 42.58 | 7.93 | 70.97 |
Emotional management (5–25) | 16.18 | 3.33 | 64.72 |
Variables | Self-Management | Medical | Role | Emotional |
---|---|---|---|---|
Gender a | 1.226 | 0.481 | 1.071 | 1.920 |
Female | ||||
Male | ||||
Marital status a | −0.194 | −0.038 | −0.249 | −0.207 |
Unmarried/widowed/divorced | ||||
Married | ||||
Religious belief a | ||||
No | 1.702 | 1.847 | 1.744 | 0.924 |
Yes | ||||
Smoking status a | 0.734 | 0.593 | 0.553 | 0.800 |
Non-smoker Smoker | ||||
Time affected by stroke a | −2.560 * | −2.112 * | −2.311 * | −3.815 |
Within 1 month 2–6 months | ||||
Educational level b | 17.152 *** | 14.533 *** | 20.303 *** | 2.097 |
Under elementary school Junior to senior high school College and above | ||||
Main source of income b | 3.422 * | 3.016 | 5.306 ** | 0.376 |
Children/older sib-lings/spouse/parents Pension/government subsidy Work salary Scheffe post-comparison | ||||
Income b | 1.352 | 1.612 | 2.847 | 2.491 |
Somewhat insufficient/extremely insufficient | ||||
Generally sufficient | ||||
Sufficient with surplus | ||||
Frequency of exercise b | 3.883 * | 3.022 | 5.093 * | 1.429 |
Never 1–2 times/week More than 3 times/week Scheffe post-comparison | ||||
Age c | −0.359 ** | −0.307 ** | −0.393 ** | −0.066 |
Total number of chronic diseases c | −0.111 | −0.057 | −0.134 | −0.069 |
ADLs c IADLs c | 0.273 ** 0.277 ** | 0.277 ** 0.274 ** | 0.287 ** 0.282 ** | 0.011 0.034 |
NIHSS c | −0.181 * | −0.151 | −0.222 ** | −0.018 |
mRS c | −0.323 ** | −0.306 ** | −0.347 ** | −0.012 |
Variables | Self-Management | Medical | Role | Emotional |
---|---|---|---|---|
Continuity of care scale | 0.545 ** | 0.650 ** | 0.467 ** | 0.034 |
Relationships with providers in hospital | 0.520 ** | 0.597 ** | 0.473 ** | 0.015 |
Information transfer to patients | 0.544 ** | 0.666 ** | 0.447 ** | 0.046 |
Variables | Self-Management | ||||||
---|---|---|---|---|---|---|---|
B | SE | Beta | Adjusted R2 | t | 95%CI | p | |
Educational level (reference group: under elementary school) | 12.751 | 2.489 | 0.315 | 0.108 | 5.122 | (7.831, 17.672) | 0.001 *** |
College and above | |||||||
Frequency of exercise (reference group: never exercising) | 6.449 | 2.485 | 0.159 | 0.021 | 2.596 | (1.539, 11.360) | 0.01 ** |
1–2 times/week | 16.548 | 5.737 | 0.177 | 0.024 | 2.884 | (5.208, 27.888) | 0.01 ** |
Time since stroke (reference group: within 1 month) 2–6 months | 0.847 | 0.103 | 0.504 | 0.292 | 8.208 | (0.643, 1.050) | 0.001 *** |
Continuity of care | 12.751 | 2.489 | 0.315 | 0.108 | 5.122 | (7.831, 17.672) | 0.001 *** |
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Kuo, N.-Y.; Lin, Y.-H.; Chen, H.-M. Continuity of Care and Self-Management among Patients with Stroke: A Cross-Sectional Study. Healthcare 2021, 9, 989. https://doi.org/10.3390/healthcare9080989
Kuo N-Y, Lin Y-H, Chen H-M. Continuity of Care and Self-Management among Patients with Stroke: A Cross-Sectional Study. Healthcare. 2021; 9(8):989. https://doi.org/10.3390/healthcare9080989
Chicago/Turabian StyleKuo, Nai-Yu, Yu-Huei Lin, and Hsiao-Mei Chen. 2021. "Continuity of Care and Self-Management among Patients with Stroke: A Cross-Sectional Study" Healthcare 9, no. 8: 989. https://doi.org/10.3390/healthcare9080989