This paper investigates the impact of community home‐based care (CHBC) on self‐management outcomes for chronically ill patients in rural Malawi. A pre‐ and post‐evaluation survey was administered ...among 140 chronically ill patients with HIV and non‐communicable diseases, newly enrolled in four CHBC programmes. We translated, adapted and administered scales from the Stanford Chronic Disease Self‐Management Programme to evaluate patient's self‐management outcomes (health status and self‐efficacy), at four time points over a 12‐month period, between April 2016 and May 2017. The patient's drop‐out rate was approximately 8%. Data analysis included descriptive statistics, tests of associations, correlations and pairwise comparison of outcome variables between time points, and multivariate regression analysis to explore factors associated with changes in self‐efficacy following CHBC interventions. The results indicate a reduction in patient‐reported pain, fatigue and illness intrusiveness, while improvements in general health status and quality of life were not statistically significant. At baseline, the self‐efficacy mean was 5.91, which dropped to 5.1 after 12 months. Factors associated with this change included marital status, education, employment and were condition‐related; whereby self‐efficacy for non‐HIV and multimorbid patients was much lower. The odds for self‐efficacy improvement were lower for patients with diagnosed conditions of longer duration. CHBC programme support, regularity of contact and proximal location to other services influenced self‐efficacy. Programmes maintaining regular home visits had higher patient satisfaction levels. Our findings suggest that there were differential changes in self‐management outcomes following CHBC interventions. While self‐management support through CHBC programmes was evident, CHBC providers require continuous training, supervision and sustainable funding to strengthen their contribution. Furthermore, sociodemographic and condition‐related factors should inform the design of future interventions to optimise outcomes. This study provides a systematic evaluation of self‐management outcomes for a heterogeneous chronically ill patient population and highlights the potential and relevant contribution of CHBC programmes in improving chronic care within sub‐Saharan Africa.
Nursing education as a part of the higher education system is developing in recent years in the world,and the competence of the graduates in response to the needs of society is one of the main goals ...ofthe nursing education curriculum.1 Over the coming years, the health system will be influenced byvarious factors such as the aging of the population and the issue of epidemiological displacement,emergence of re-emerging and emerging diseases, and, as a result, increased health care costs.2 Forcost-effective care, several health care interventions can be effectively performed in society or athome.3 During the COVID-19 pandemic, the need for home care increased. Despite many challengesthat the COVID-19 pandemic imposed on the health systems, the pandemic was an opportunity thatled to the development of some capabilities in many countries, including the development of homecare services. Home care services can act as a support for health services and reduce the burden onthe health system.4
AimTo appraise and synthesize empirical literature on implementation of evidence within community nursing. To explore the use of implementation theory and identify the strategies required for, and ...the barriers and facilitators to, successful implementation within this context.
There is an international consensus that evidence-based practice can improve outcomes for people using health and social care services. However, these practices are not always translated into care delivery. Community nursing is a relatively understudied area; little is known about how innovations in practice are implemented within this setting.
Systematic mixed-studies review, synthesizing quantitative and qualitative research. The electronic databases AMED, PsycINFO, Ovid Medline, CINAHL Plus, ASSIA, British Nursing Index and EMBASE were used. Two grey literature databases were also searched: OpenGrey and EThOS. English language, peer-reviewed papers published between January 2010 and July 2017 were considered. Criteria included implementation of an innovation and change to practice within adult community nursing. An approach called Critical Interpretive Synthesis was used to integrate the evidence from across the studies into a comprehensible theoretical framework.
In total, 22 papers were reviewed. Few studies discussed the use of theory when planning, guiding and evaluating the implementation of the innovation (n=6). A number of implementation strategies, facilitators and barriers were identified across the included studies, highlighting the interplay of both service context and individual factors in successful implementation.
Implementation is an expanding area of research; yet is challenged by a lack of consistency in terminology and limited use of theory. Implementation within community nursing is a complex process, requiring both individual and organizational adoption, and managerial support. Successful adoption of evidence-based practice however, is only possible if community nurses themselves deem it useful and there is evidence that it could have a positive impact on the patient and/or their primary carer.
The global leadership initiative on malnutrition (GLIM) proposed the first international standards (GLIM criteria) for malnutrition diagnosis. Early screening using nutritional tools is recommended ...to improve the prognosis of older patients. The association between Mini Nutritional Assessment-Short Form (MNA
-SF) and Geriatric Nutritional Risk Index (GNRI) and prognosis has been reported, but there is insufficient evidence to develop the GLIM criteria for older inpatients. We aimed to evaluate the MNA
-SF, GNRI, and GLIM criteria to determine their contribution to the prognosis prediction of hospitalized older patients at 1 year after discharge.
This study included 386 patients hospitalized between September 2014 and October 2015, and May and December 2019. After excluding 17 patients who died at the time of initial hospitalization, 23 who were lost to follow-up after 1 year, and 28 who had missing data on admission, only 318 were included in the final analysis. The primary outcome was death within 1 year after discharge, assessed using the MNA®-SF, GNRI, and GLIM criteria, and survival analysis was conducted. Multivariate Cox proportional hazards analysis was performed to identify the nutritional assessment tools that contributed to the prognosis prediction.
A total of 43 patients died within 1 year. Of them, 58.1% had malnutrition and 37.2% were at risk of malnutrition, assessed using the MNA
-SF; 27.9% had severely malnourished assessed using the GNRI; and 58.1% had severely malnourished assessed using the GLIM criteria. The proportions of malnourished and severely malnourished patients were significantly higher in the mortality group than in the survival group. Multivariate Cox proportional hazards analysis showed hazard ratios of 1.06 (95% confidence interval CI: 0.24-4.71) for at risk and 2.17 (95% CI: 0.48-9.84) for malnutrition (MNA
-SF); 5.68 (95% CI: 2.74-11.80) for moderately malnourished and 7.69 (95% CI: 3.13-18.91) for severely malnourished (GNRI); and 1.47 (95% CI: 0.48-4.50) for moderately malnourished and 2.45 (95% CI: 1.22-4.93) for severely malnourished (GLIM criteria); GNRI had the most significant contribution to prognosis prediction.
GNRI significantly contributed to the prognosis prediction 1 year after hospital discharge of older patients.
Abstract Background With an intensified aging population and an associated upsurge of informal care need in China, there is an ongoing discussion around what factors influence this need among older ...adults. Most existing studies are cross-sectional and do not focus on older people living in the community. Conversely, this study empirically explores the factors that affect informal care need of Chinese community-dwelling older individuals based on longitudinal data. Methods This study constructed panel data using the China Health and Retirement Longitudinal Research Study (CHARLS) from 2011 to 2018 for analysis. Generalized linear mixed models were used to analyze the factors affecting reception of informal care, and linear mixed models were used to analyze the factors affecting informal care sources and intensity. Results During the follow-up period, 7542, 6386, 5087, and 4052 older adults were included in 2011–2018, respectively. The proportion receiving informal care increased from 19.92 to 30.78%, and the proportion receiving high-intensity care increased from 6.42 to 8.42% during this period. Disability ( estimate = 4.27, P < 0.001) and living arrangement ( estimate = 0.42, P < 0.001) were the critical determinants of informal care need. The rural older adults reported a greater tendency to receive informal care ( estimate = 0.14, P < 0.001). However, financial support from children did not affect informal care need ( P > 0.05). Conclusions At present, there is a great demand for the manpower and intensity of informal care, and the cost of informal care is on the rise. There are differences in informal care needs of special older groups, such as the oldest-old, living alone and severely disabled. In the future, the region should promote the balance of urban and rural care service resources, rationally tilt economic support resources to rural areas, reduce the inequality of long-term care resources, improve the informal care support system, and provide a strong community guarantee for the local aging of the older adults.
Objective This study aimed to evaluate the integration of the Hospital-Community-Home (HCH) model with the Self-Mutual-Group (SMG) health management model for high-risk populations with ...cardiovascular disease in the Yuhua community of Shijiazhuang city. The study focused on implementing care interventions (HCH, SMG) with a specific emphasis on SMG to promote beneficial views/behaviors, enhance self-efficacy/agency, and address detrimental determinants of health, ultimately leading to durable changes and healthier lifestyles. Comparing the HCH model with the combined SMG model helps to comprehensively assess the strengths and weaknesses of different health management approaches. This comparison contributes to theoretical innovation and practical development in the field of health management, as well as improving patients' health outcomes and quality of life. Methods This study employed a quasi-experimental design. Using stratified sampling, individuals who underwent health examinations in Community A and Community B from Shijiazhuang city between May 2023 and August 2023 were randomly selected. After informing the participants about the study and obtaining informed consent via telephone, high-risk patients with cardiovascular disease were screened based on their medical examination reports. Data on lifestyle behaviors, self-efficacy, medical responses, quality of life, and readmission rates were collected and compared before and after the intervention. Results A total of 526 eligible participants were included, with 241 in the control group and 285 in the study group. After the intervention, there was no significant change in the proportions of smokers, alcohol consumers, and individuals engaging in leisure exercises in the control group. However, in the study group, the proportions of smokers and alcohol consumers significantly decreased, while the proportion of individuals engaging in leisure exercises significantly increased. After the intervention, both the study group and the control group showed significant increases in scores on the General Self-Efficacy Scale—Schwarzer (GSES) and the Seattle Angina Questionnaire (SAQ), with the study group scoring significantly higher than the control group. Avoidance and surrender scores significantly increased after the intervention, with the study group scoring significantly lower than the control group. Confrontation scores significantly increased after the intervention, with the study group scoring significantly higher than the control group. During the follow-up period, the study group had a significantly lower readmission rate than the control group. Conclusion The integration of HCH with SMG health management model can significantly improve lifestyle behaviors, optimize medical responses, enhance self-efficacy and quality of life, and significantly reduce readmission rates among high-risk populations with cardiovascular disease.
Population aging has become a major challenge for the Chinese government. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018, this study adopts the propensity score matching ...(PSM) method to assess the effect of community home-based elderly care services (CHECS) on the life satisfaction of the elderly in China. The results demonstrate that CHECS can improve their life satisfaction. Compared with life care services (LCS) and medical care services (MCS), the positive effect of spiritual and cultural services (SCS) and reconciliation and legal services (RLS) is more obvious. Moreover, the heterogeneity test demonstrates that the effect is more significant for the elderly who live with their families, whose activities of daily living are unrestricted, and whose depression levels are lower. The results obtained indicate that CHECS need precise policies for different elderly groups, attention to the positive impact of SCS and RLS on the life satisfaction of the elderly, and the substantive effectiveness of LCS and MCS.
Background
The rapid population aging in China, characterized by a higher prevalence of illnesses, earlier onset of diseases, and longer durations of living with ailments, substantially engenders ...challenges within the domain of older adults’ healthcare. Community home-based elderly care services (CHECS) are a feasible solution to solve the problem of older adults’ care and protect older adults’ health. The aim of this study is to investigate the relationship, heterogeneity effects and influential mechanisms between older adults’ use of CHECS and their self- reported health.
Methods
The study employs the Instrumental Variable technique and empirically investigates the relationship, heterogeneity effects and influential mechanisms between older adults using CHECS and their self-reported health using data from the China Longitudinal Aging Social Survey from 2018.
Results
The findings indicate, firstly, that using CHECS considerably improves older adults’ self-reported health. Secondly, the heterogeneity test reveals that the effect is more pronounced for older adults who are under the age of 80, have functional disabilities, are free of chronic diseases, have never attended school, reside in lower-income households, are single, rarely interact with their children, and live in central urban or city/county regions. Thirdly, the mechanism test reveals that the “social network effect” and “family care effect” are the key influence channels of using CHECS.
Conclusion
An empirical foundation for the policy reform of community home-based care for seniors is provided by this study with the limitations to discuss the other socioeconomic aspects such as government health expenditure and discuss the specific services aspects such as health care. The findings carry substantial implications for improving the health of older individuals and provide suggestions for establishing a socialized aged care system in China.
A mobile social network (MSN) is a special delay tolerant network (DTN) composed of mobile nodes with social characteristics. Mobile nodes in MSNs generally visit community homes frequently, while ...other locations are visited less frequently. We propose a novel zero-knowledge MSN routing algorithm, homing spread (HS). The community homes have a higher priority to spread messages into the network. Theoretical analysis shows that the proposed algorithm can spread a given number of message copies in an optimal way when the inter-meeting times between any two nodes and between a node and a community home follow exponential distributions. We also calculate the expected delivery delay of HS. In addition, extensive simulations are conducted. Results show that community homes are important factors in efficient message spreading. By using homes to spread messages faster, HS achieves a better performance than existing zero-knowledge MSN routing algorithms, including Epidemic, with a given number of copies, and Spray&Wait.
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