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Cultural differences in self-care self-efficacy in patients with chronic illnesses

Cultural differences in self-care self-efficacy in patients with chronic illnesses. Elise L. Lev, Ed.D ., RN Rutgers University, College of Nursing, Newark, NJ USA. Co-Authors and Affiliations. Semiha Akin, PhD, BSc, RN. & Zehra Durna , PhD, BSc, RN 1 Lucille S. Eller, PhD, RN 2

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Cultural differences in self-care self-efficacy in patients with chronic illnesses

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  1. Cultural differences in self-care self-efficacy in patients with chronic illnesses Elise L. Lev, Ed.D., RN Rutgers University, College of Nursing, Newark, NJ USA.

  2. Co-Authors and Affiliations • Semiha Akin, PhD, BSc, RN. & ZehraDurna, PhD, BSc, RN 1 • Lucille S. Eller, PhD, RN 2 • HuijuanQian, MA, RN 3 • Changrong Yuan, PhD 4 • MiklosZrinyi, PhD, RN 5 • 1. Bahcesesehir University, Besiktas, Istanbul,Turkey. • 2. Rutgers Univerisity, Newark, NJ, USA • 3. Shanghai JiaoTong University, Shanghai, China • 4. Shanghai Second Military Medical University, Shanghai, China. • 5. Nyiregyhaza, University of Debrecen, Hungary.

  3. Background • Health care professionals seek to increase quality of life (QOL) in survivors of chronic illnesses. • Self-care self-efficacy influences QOL as efficacy expectations exert a causal influence on behavior. • Culture in this study refers to values that are learned, shared, and transmitted from one generation to the next in a specific group. • Previous researchers reported decreased self-efficacy in Chinese population vs. Western cultures. • Establishing psychometric equivalence across languages is necessary to study self-efficacy across cultures.

  4. Processes effecting self-care • Social learning theory used to explain health related behavior (Bandura, 1997). People’s functioning is facilitated by a personal sense of control. People who believe they can take action to solve a problem are more inclined to so do. • People from different cultures view self-care differently (Garcia, 2006). • Culturally-competent decision-making involves encouraging patients’ participation while respecting cultural factors and respect for individual’s preferences (Dy & Purnell, 2012).

  5. Aims • To compare how people in various cultures perceive their ability to care for their health during treatment for chronic illnesses. • To use Strategies Used by People to Promote Health (SUPPH) to assess patients’ confidence in carrying out self-care strategies. • To assess self-care self-efficacy of patients with chronic illnesses in various cultures using Strategies Used by People to Promote Health (SUPPH) in multi-countries cross-sectional survey studies. • To compare how people in various cultures perceive their ability to care for their health during treatment for chronic illnesses.

  6. SUPPH • Measures patients’ confidence in performing self-care strategies. • Each item rated on a 5-point scale from 1=very little confidence to 5=quite a lot of confidence. • Subscales: Positive Attitude; Decision-Making; and Stress Reduction. • Reliability and validity evidence given in each of the studies.

  7. Methodology • Participants were diagnosed with either cancer or ESRD. • Participants completed the SUPPH in their native language in • China (n=764); • Hungary (n=68); • Turkey (n=141); • US three studies (n=33; n=185; n=129).

  8. Procedures • Researchers in each setting received institutional review board or ethical approval. • Subjects were recruited during regularly scheduled visits to the health care setting. • Patients in each setting gave informed consent for their participation. • After completing questionnaires, participants returned them to the researcher. • Translations on the SUPPH (when needed) included forward translation, backward translation and cultural adaptations that were congruent with the theoretical construct of self-efficacy.

  9. Measurements of SUPPH in various populations

  10. Evidence of validity of SUPPH • Content validity index (CVI) of Turkish version of SUPPH is 91%. • Significant positive correlations with QOL • Significant negative correlations • depression, • anxiety, • symptoms.

  11. Confirmatory factor analysis (CFA) • Testing the congruence of the item pattern across groups can be performed by CFA. • Multi-lingual equivalence was supported by confirmatory factor analysis in several studies.

  12. Means of SUPPH in different populations

  13. Findings & Discussion • The pattern of correlations with other psychological variables is congruent with self-efficacy theory. • Some researchers reported that respondents had difficulty answering questions on the decision-making scale. • Individual decision-making may not be relevant in cultures with strong reliance on authority figures. • Decision-making in ESRD patients may be lower than in patients with cancer because there are fewer choices. • Low mean levels of participants’ perceived self-efficacy in non-Western cultures could indicate less individualism than in Western cultures.

  14. Recommendations • Focus groups in different cultures may yield information regarding respondents’ interpretation of stress reduction, decision-making, and positive attitude. • Health care strategies need to be based on knowledge of cultural effects and adapted to individual’s situation—including their culture. • Cultural competence of health providers is necessary to influence patients’ self-care behaviors.

  15. Implications for nursing • Using specific assessments to identify gaps in QOL outcomes is critical to early detection of psychological distress. • Nurses can deliver targeted interventions that can impact patients’ psychological problems, increase self-care self-efficacy and improve QOL.

  16. Conclusions • Activities for promoting self-care require an understanding that culture is a powerful determinant of health behaviors. • Western concepts of self-care can be taught to people in cultures that do not share that value. • Efficacy enhancing interventions enhance patients’ QOL and decrease patients’ symptoms. • Efficacy enhancing interventions may assist people to have a more positive attitude, reduce stress, and make decisions regarding their health.

  17. References • Akin, S, Can, G, Durna, Z et al. (2008). The quality of life and self-efficacy of Turkish breast cancer patients undergoing chemotherapy. European Journal of Oncology Nursing. 12, 443-456. • Bandura, A. (1997). Self-efficacy: the exercise of control. New York: WH Freeman & Co. • Dy, SM. & Purnell, TS. (2012). Key concepts relevant to quality of complex and shared decision-making in health care: A literature review. Social Science and Medicine. 74, 582-7. • Garcia, A. (2006). Is health promotion relevant across cultures and socioeconomic spectrum? Family & Community Health. 29(1), 20S-27S. • Lev, E. (1996). A measure of self-care self-efficacy. Research in Nursing and Health. 19, 421-9. • Lev, EL, Eller, LS, Gejerman, G et al. (2009). Quality of life of men treated for localized prostate cancer. Supportive Care in Cancer. 17(5), 509-517. • Quian, H & Yuan, C. (2012). Factors associated with self-care self-efficacy among gastric and colorectal cancer patients. Cancer Nursing. 35(3), E22-31.

  18. Acknowledgement and thanks • To the researchers in each study; • To the participants in each study; • To the funding agencies supporting the various studies; • To this audience for your attention.

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