Preparing Chinese patients with comorbid heart disease and diabetes for home management: a mixed methods study.

Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE

Original Publication: [London] : BMJ Publishing Group Ltd, 2011-

Acute Coronary Syndrome/*therapy ; Diabetes Mellitus, Type 2/*therapy ; Health Education/*organization & administration ; Self-Management/*education; Acute Coronary Syndrome/epidemiology ; Adult ; Aged ; Aged, 80 and over ; China ; Comorbidity ; Coronary Care Units ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/epidemiology ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Inpatients/education ; Interviews as Topic ; Male ; Middle Aged ; Self Efficacy ; Surveys and Questionnaires

Objective: To explore how health education received by patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) influences patients' self-efficacy and self-management and changes in behaviour at, and following, hospital discharge.
Design: This study used a convergent mixed methods design.
Participants: Twenty-one participants with completed surveys and interviews at discharge and home follow-up were included in the analysis.
Setting: At a coronary care unit of a major hospital in Shanghai, China.
Results: Most participants (n=17) did not perceive they had sufficient education or ability to manage both conditions. More concerning was that most participants (n=16) reported low self-efficacy in the management of ACS symptoms. Three major themes were identified: self-management of ACS and T2DM represents a complex interplay between individual self-efficacy, knowledge and skills, as individuals navigate shifting self-management priorities due to perceived condition severity; the social environment is integral to lifestyle and behaviour change and managing multiple health conditions requires body and mind systems' harmony.
Conclusions: The inpatient education received did not enhance participants' confidence to manage either condition on discharge. While an unhealthy lifestyle was embedded within social roles and norms, some social activities, such as square dancing, positively influenced health behaviour. Culturally appropriate education for Chinese people with diabetes and ACS should contain information on maintaining mind and body harmony. Family members should be involved in formal education.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Southeast Asian J Trop Med Public Health. 2010 Jul;41(4):943-51. (PMID: 21073070)
J Acad Nutr Diet. 2015 Aug;115(8):1323-34. (PMID: 26054423)
Diabetes Educ. 2009 Nov-Dec;35(6):995-1003. (PMID: 19776334)
BMC Fam Pract. 2013 Sep 04;14:131. (PMID: 24007205)
Clin Rehabil. 2014 Dec;28(12):1172-9. (PMID: 24849796)
J Egypt Public Health Assoc. 2010;85(3-4):113-30. (PMID: 21244813)
Med J Islam Repub Iran. 2016 May 14;30:368. (PMID: 27493912)
Int J Nurs Stud. 2016 Sep;61:29-51. (PMID: 27267181)
Int Nurs Rev. 2009 Sep;56(3):396-9. (PMID: 19702817)
Diabetes Res Clin Pract. 2014 Apr;104(1):1-52. (PMID: 24508150)
Diabetes Educ. 2017 Feb;43(1):40-53. (PMID: 28118121)
J Aging Health. 2009 Feb;21(1):38-62. (PMID: 19144968)
J Adv Nurs. 2015 Dec;71(12):2834-45. (PMID: 26358863)
Contemp Nurse. 2012 Feb;40(2):147-59. (PMID: 22554209)
Eur J Cardiovasc Nurs. 2017 Aug;16(6):511-521. (PMID: 28198635)
Ann N Y Acad Sci. 2015 Sep;1353:89-112. (PMID: 26250784)
Ann Behav Med. 2003 Aug;26(1):1-7. (PMID: 12867348)
J Health Commun. 2016;21(sup2):45-53. (PMID: 27661472)
J Health Commun. 2016 Jul;21(7):755-64. (PMID: 27232655)
Diabetes Educ. 2010 Mar-Apr;36(2):258-67. (PMID: 20103618)
JAMA. 2007 Aug 15;298(7):765-75. (PMID: 17699010)
Rev Port Cardiol. 2015 Jan;34(1):43-50. (PMID: 25578946)
Health Educ Res. 2018 Oct 1;33(5):389-401. (PMID: 30085026)
JAMA Intern Med. 2014 Nov;174(11):1822-30. (PMID: 25265319)
Prim Care Diabetes. 2014 Oct;8(3):195-206. (PMID: 24389352)
BMC Geriatr. 2011 Aug 18;11:47. (PMID: 21851629)
J Eval Clin Pract. 2012 Jun;18(3):695-7. (PMID: 21332607)
BMC Health Serv Res. 2011 Apr 11;11:74. (PMID: 21481274)
JAMA. 2013 Nov 27;310(20):2191-4. (PMID: 24141714)
BMC Health Serv Res. 2017 Feb 2;17(1):109. (PMID: 28153000)
Res Nurs Health. 2007 Dec;30(6):584-94. (PMID: 18022812)
Nurs Health Sci. 2013 Sep;15(3):398-405. (PMID: 23480423)
Soc Sci Med. 2017 Mar;176:25-33. (PMID: 28126586)
Prev Med. 2004 Oct;39(4):746-52. (PMID: 15351541)
J Immigr Minor Health. 2017 Dec;19(6):1404-1411. (PMID: 26872641)
BMC Endocr Disord. 2008 Jun 24;8:6. (PMID: 18573221)
Health (London). 2007 Jul;11(3):401-15. (PMID: 17606701)
Ann Saudi Med. 2013 Jul-Aug;33(4):339-46. (PMID: 24060711)
Diabetes Res Clin Pract. 2017 Sep;131:179-186. (PMID: 28756132)
Int J Mol Sci. 2016 Sep 06;17(9):. (PMID: 27608015)
Health Expect. 2014 Oct;17(5):637-50. (PMID: 22809132)
Eur Heart J. 2013 Aug;34(31):2436-43. (PMID: 23641007)
Patient Prefer Adherence. 2016 Nov 09;10:2323-2332. (PMID: 27877024)
J Clin Nurs. 2008 Mar;17(5A):16-24. (PMID: 17931377)
J Clin Nurs. 2017 Jun;26(11-12):1458-1472. (PMID: 27486677)
Int Nurs Rev. 2012 Sep;59(3):345-52. (PMID: 22897185)
J Mix Methods Res. 2010 Sep 20;4(4):342-360. (PMID: 22167325)
Diabetes Obes Metab. 2017 Mar;19(3):364-374. (PMID: 27862801)
Can Fam Physician. 2014 Dec;60(12):1123-33. (PMID: 25642490)
J Educ Health Promot. 2013 Jul 31;2:36. (PMID: 24083286)
J Diabetes Complications. 2012 Jan-Feb;26(1):10-6. (PMID: 22226484)
Int J Nurs Stud. 2008 Apr;45(4):534-42. (PMID: 17055509)
Health Serv Res. 2013 Dec;48(6 Pt 2):2134-56. (PMID: 24279835)
BMC Health Serv Res. 2015 Aug 01;15:303. (PMID: 26231178)
Biol Res Nurs. 2014 Oct;16(4):357-67. (PMID: 24413898)

Keywords: China; acute coronary syndrome; health education; mixed methods study; type 2 diabetes mellitus

Date Created: 20190919 Date Completed: 20201028 Latest Revision: 20201028

20240628

PMC6756451

10.1136/bmjopen-2019-029816

31530604