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  • 51.
    Högberg, Karin
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Sandman, Lars
    School of Health Sciences, University of Borås.
    Stockelberg, Dick
    Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nyström, Maria
    School of Health Sciences, University of Borås.
    Psychosocial factors associated with anxiety and depression in patients with hematological diseasesManuskript (preprint) (Övrigt vetenskapligt)
  • 52.
    Högberg, Karin
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Stockelberg, Dick
    Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sandman, Lars
    School of Health Sciences, University of Borås.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nyström, Maria
    School of Health Sciences, University of Borås.
    The meaning of web-based communication for support: From the patients' perspective within a hematological healthcare setting2015Ingår i: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 38, nr 2, s. 145-154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Being critically ill with a hematological disease is a challenge, sometimes causing a need for support in the adjustment to the stressful life situation. By providing Web-based communication for support from a nurse, patients get access to an alternative and untraditional way to communicate their issues.

    OBJECTIVE:

    The aim was to describe the meaning of using Web-based communication for support from a patient perspective.

    METHODS:

    A comprehensive randomized pilot study (n = 30) was conducted, allowing 15 patients in the experimental group to have access to the Web-based communication, to evaluate feasibility. Of these 15 participants, 10 were interviewed, focusing on their experiences. An empirical hermeneutical approach was used and the interpretive analysis focused on the meanings.

    RESULTS:

    Web-based communication for support means a space for patients to have their say, consolidation of a matter, an extended caring relationship, access to individual medical assessment, and an opportunity for emotional processing. The main interpretation indicates that the patient's influence on the communication strengthens according to the asynchronous, faceless, and written communication. The increased, and in some sense constant, access to an individual medical and caring assessment, in turn, implies a feeling of safety.

    CONCLUSION:

    Web-based communication for support seems to have the potential to enhance patients' participation on their own terms.

    IMPLICATIONS FOR PRACTICE:

    To achieve the possible advantages of Web-based communication for support, nurses must acquire knowledge about caring writing. It requires respect for the patient and articulated accuracy and attention in the response given.

  • 53.
    Iversen, C.
    et al.
    Uppsala University, Department of Sociology, Uppsala, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Ulander, M.
    Linkoping University Hospital, Department of Clinical Neurophysiology, Linkoping, Sweden.
    ‘No problems when you drive?’ nurses balancing conflicting roles as coaches and state agents when they ask sleepy patients about traffic risk2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S85-S85Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Communication in traffic risk assessment is an understudied area in nursing research. Specifically, no research exists of how clinicians formulate their risk assessment questions in actual practice. Because obstructive sleep apnea (OSA) is associated with an increased risk of traffic accidents, traffic safety authorities demand adherent Continuous Positive Airway Pressure (CPAP) use. Nurses have a key role in both treatment initiation and traffic risk assessment. They act as coaches to achieve treatment adherence, but they are also obliged to act as state agents by asking OSA patients about drowsy driving.

    Aim: We examined how nurses and OSA patients manage traffic risk assessment questions in the relation-building context of treatment initiation consultations.

    Methods: We studied the actual practice of risk assessment questioning in 19 video-recorded initial CPAP treatment consultations with nurses and recently diagnosed OSA patients. To explicate the details of the interactions, we used conversation analysis.

    Results: Nurses ask traffic risk questions in a way that assumes that driving is unproblematic if OSA patients have not previously indicated problems in relation to general daytime sleepiness. Accordingly, by taking a stance to daytime sleepiness prior to the risk question, patients influence how nurses phrase questions about traffic risk. In this sense, traffic risk assessment questioning is coconstructed between nurses and patients.

    Conclusion: It poses a safety problem when nurses, by accepting OSA patients’ prior stance when asking about traffic risk, orient to relationship building rather than task focus. To clarify the difference between their potentially conflicting roles, nurses can refer to legislation when they raise the issue of risk in treatment initiation consultations. Nurses should also ask risk assessment questions in a problem-oriented communicative environment. However, our study suggests that there is a need to develop legislation to acknowledge different clinicians’responsibilities in traffic risk assessment. Furthermore, guidelines and risk assessment tools should be developed to help clinicians manage their different roles with regard to coaching CPAP treatment and assessing traffic risk.Traffic risk assessment is communicatively sensitive but clinically important, as obstructive sleep apnea is a highly prevalent and increasing problem causing excessive sleepiness.

  • 54.
    Iversen, Clara
    et al.
    Uppsala Universitet, Department of Sociology, Uppsala, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ulander, Martin
    Department of Neurosciences and Inflammation, Linköping University, Linköping, Sweden.
    Traffic risk work with sleepy patients: from rationality to practice2018Ingår i: Health, Risk and Society, ISSN 1369-8575, E-ISSN 1469-8331, Vol. 20, nr 1-2, s. 23-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this article, we aim to contribute to the emerging field of risk-work studies by examining the relationship between risk rationality and risk practices in nurses’ conversations with Obstructive Sleep Apnoea patients about traffic risks. Legislation in Sweden towards traffic risk involves clinicians making risk assessment of patients prone to falling asleep while driving. In contrast to an overall care rationale, this means that the health of the patient is not the only risk object in treatment consultations. However, guidelines on how to implement legislation are missing. To examine the practical reality of nurses’ traffic-risk work, we draw on an analysis of data from a Swedish study in 2015. This study included qualitative interviews with specialist nurses and video-recorded interactions between nurses and Obstructive Sleep Apnoea patients. We found that a lack of clarity in traffic-risk guidelines on how risk should be addressed was evident in both interview accounts and in observed practice. While nurses primarily accounted for risk work as treatment-relevant education, they practised risk work as interrogation. Patients also treated nurses’ inquiries as assessment – not education – by responding defensively. We conclude that while confusing risk work and treatment enables clinicians to treat patients as competent actors, it obscures the controlling aspects of traffic-risk questions for individual patients and downplays the implications of drowsy driving for general traffic safety. 

  • 55.
    Jaarsma, Tiny
    et al.
    Linköpings Universitet.
    Strömberg, Anna
    Linköpings Universitet.
    Årestedt, Kristofer
    Linneuniversitetet, Kalmar.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Kärner, Anita
    Linköpings universitet.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Moons, Philip
    Centre for Health Services and Nursing Research, Katholieke Universiteit, Leuven, Belgium .
    Thylen, Ingela
    Linköpings universitet.
    Thompson, David
    Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia .
    A good manuscript review for the European Journal of Cardiovascular Nursing2013Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, nr 2, s. 102-103Artikel i tidskrift (Övrigt vetenskapligt)
  • 56.
    Johansson, Peter A.
    et al.
    Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
    Westas, Mats
    Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Alehagen, Urban
    Department of Medical Health Sciences, Linköping University, Linköping, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Jaarsma, Tiny
    Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
    Mourad, Ghassan
    Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
    Lundgren, Johan
    Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
    An internet-based cognitive behavioral therapy program adapted to patients with cardiovascular disease and depression: Randomized controlled trial2019Ingår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 21, nr 10, s. 1-14, artikel-id e14648Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Depression is a common cause of reduced well-being and prognosis in patients with cardiovascular disease (CVD). However, there is a lack of effective intervention strategies targeting depression.

    Objective: The study aimed to evaluate the effects of a nurse-delivered and adapted internet-based cognitive behavioral therapy (iCBT) program aimed at reducing depression in patients with CVD.

    Methods: A randomized controlled trial was conducted. A total of 144 patients with CVD with at least mild depression (Patient Health Questionnaire–9 [PHQ-9] score ≥5) were randomized 1:1 to a 9-week program of iCBT (n=72) or an active control participating in a Web-based discussion forum (online discussion forum [ODF], n=72). The iCBT program, which included 7 modules, was adapted to fit patients with CVD. Nurses with an experience of CVD care provided feedback and a short introduction to cognitive behavioral therapy. The primary outcome, depression, was measured using PHQ-9. Secondary outcomes were depression measured using the Montgomery-Åsberg Depression Rating Scale–self-rating version (MADRS-S), health-related quality of life (HRQoL) measured using Short Form 12 (SF-12) survey and EuroQol Visual Analogue Scale (EQ-VAS), and the level of adherence. An intention-to-treat analysis with multiple imputations was used. Between-group differences in the primary and secondary outcomes were determined by the analysis of covariance, and a sensitivity analysis was performed using mixed models.

    Results: Compared with ODF, iCBT had a significant and moderate treatment effect on the primary outcome depression (ie, PHQ-9; mean group difference=−2.34 [95% CI −3.58 to −1.10], P<.001, Cohen d=0.62). In the secondary outcomes, compared with ODF, iCBT had a significant and large effect on depression (ie, MADRS-S; P<.001, Cohen d=0.86) and a significant and moderate effect on the mental component scale of the SF-12 (P<.001, Cohen d=0.66) and the EQ-VAS (P<.001, Cohen d=0.62). Overall, 60% (n=43) of the iCBT group completed all 7 modules, whereas 82% (n=59) completed at least half of the modules. No patients were discontinued from the study owing to a high risk of suicide or deterioration in depression.

    Conclusions: Nurse-delivered iCBT can reduce depression and improve HRQoL in patients with CVD, enabling treatment for depression in their own homes and at their preferred time.

  • 57.
    Johansson, Peter
    et al.
    Linkoping University Hospital.
    Alehagen, Urban
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Broström, Anders
    Linkoping University Hospital.
    Clinical characteristics and mortality risk in relation to obstructive and central sleep apnoea in community-dwelling elderly individuals: a 7-year follow-up2012Ingår i: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 41, nr 4, s. 468-474Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: little is known about demographic and clinical characteristics associated with sleep-disordered breathing (SDB) and obstructive sleep apnoea (OSA) or central sleep apnoea (CSA) in community-dwelling elderly. We also examined these (OSA and CSA) associations to all-cause and cardiovascular (CV) mortality.

    METHODS: a total of 331 community-dwelling elderly aged 71-87 years underwent a clinical examination and one-night polygraphic recordings in their homes. Mortality data were collected after seven years.

    RESULTS: a total of 55% had SDB, 38% had OSA and 17% had CSA. Compared with those with no SDB and OSA, more participants with CSA had a left ventricular ejection fraction <50% (LVEF <50%) ischaemic heart disease (IHD) and transient ischaemic attack (TIA)/stroke. There was no difference in the rate of IHD and TIA/stroke between OSA and no SDB, but more LVEF <50% was found in those with OSA. CSA significantly increased the risk for all-cause (P=0.002) and CV mortality (P=0.018) by more than two times. After adjustments for CV disease, diabetes and the biomarker NT-pro-brain natriuretic peptide CSA associations to all-cause mortality and CV mortality lost significance.

    CONCLUSION: OSA, in persons >75 years does not appear to be associated with cardiovascular disease (CVD) disease or mortality, whereas CSA might be a pathological marker of CVD and impaired systolic function associated with higher mortality.

  • 58.
    Johansson, Peter
    et al.
    Linköping University.
    Alehagen, Urban
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Sleep disordered breathing in an elderly community-living population: Relationship to cardiac function, insomnia symptoms and daytime sleepiness.2009Ingår i: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 10, nr 9, s. 1005-1011Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the prevalence of sleep disordered breathing (SDB) and its relationship to systolic function, different insomnia symptoms as well as excessive daytime sleepiness (EDS) in elderly community-living people. This has not been investigated previously.

    METHOD: Three hundred thirty-one subjects (71-87 years) healthy enough to be independently living in their own homes underwent echocardiographic examinations and sleep respiratory recordings. Questionnaires were used to evaluate insomnia symptoms and EDS.

    RESULTS: Mild SDB (AHI 5-15) was found in 32%. Moderate SDB (AHI 15-30) occurred in 16%, and 7% had severe SDB (AHI>30). Median AHI was significantly higher (p<0.001) in those with mildly impaired systolic function (AHI 11.7) and moderately impaired systolic function (AHI 10.9) compared to those with normal systolic function (AHI 5.0). Impaired systolic function was associated with central sleep apnea (CSA) but not with obstructive sleep apnea. Concerning insomnia symptoms and EDS, only difficulties in initiating sleep correlated significantly (p<0.05) with AHI.

    CONCLUSION: SDB is common among the elderly. CSA may be related to impaired systolic function/heart failure. However, detection of SDB in this population may be problematic since insomnia symptoms and EDS correlated poorly with SDB.

  • 59.
    Johansson, Peter
    et al.
    Linköping University.
    Alehagen, Urban
    Linköping University.
    Svensson, Erland
    Swedish Defence Research Agency.
    Svanborg, Eva
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Broström, Anders
    Linköping University.
    Determinants of global perceived health in community-dwelling elderly screened for heart failure and sleep-disordered breathing2010Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 25, nr 5, s. E16-26Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The relationships between heart failure (HF), sleep-disordered breathing (SDB), insomnia, depressive symptoms, and excessive daytime sleepiness (EDS), as well as their relationship to Global Perceived Health (GPH) in an elderly community-dwelling population, have not been explored. Data from 331 community-dwelling elderly (71-87 years old) were collected by echocardiography, polygraphy, and specific questionnaires. Factor analyses and structural equation modeling were used to explore the relationships between HF, SDB, sleep, psychosocial factors, and GPH. Exploratory and confirmatory factor analyses derived a 5-factor model representing SDB, insomnia, systolic function, breathlessness/physical function, and psychosocial function. Structural equation modeling analyses were used to explore the relationships between the 5 factors and to GPH. Sleep-disordered breathing had a weak effect on systolic function, but no effects on any of the other factors or GPH were found. Psychosocial function and breathlessness/physical function directly affected GPH. Indirect effects on GPH, mediated by psychosocial function, were found for breathlessness/physical function and insomnia. Systolic function also had an indirect effect on GPH. The fact that SDB in the elderly has no obvious negative associations to sleep complaints or GPH does not exclude them from being adequately treated for SDB. However, the present study has shown that SDB, by means of self-rated sleep complaints and health-related quality of life, can be problematic to detect. Psychosocial function was the most important factor for perceived GPH as it had a direct effect, as well as mediated the factors breathlessness/physical function and insomnia effects, on GPH. This study indicates that interventions in clinical practice targeting psychosocial dysfunction, such as depressive symptoms, could help to improve GPH in the elderly with or without HF.

  • 60.
    Johansson, Peter
    et al.
    Linköping University.
    Alehagen, Urban
    Linköping University.
    Ulander, Martin
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Sleep disordered breathing in community dwelling elderly: Associations with cardiovascular disease, impaired systolic function, and mortality after a six-year follow-up2011Ingår i: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 12, nr 8, s. 748-53Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Sleep disordered breathing (SDB), cardiovascular disease (CVD) and impaired cardiac function are common in elderly people. We investigated the association of SDB and mortality in a community dwelling elderly population, considering CVD and objectively measured impaired cardiac function have been poorly studied thus far.

    AIM: To investigate whether SDB is a factor that affects mortality in elderly people, with a focus on those with CVD and/or signs of impaired cardiac function.

    METHODS: A prospective cohort design was used and 331 community dwelling elderly aged 71-87 years underwent one-night polygraphic recordings in the subjects' homes. CVD and systolic function were objectively established. Mortality data were collected after 6 years.

    RESULTS: In the total population there were no significant associations between mortality and SDB. In those with CVD and impaired systolic function, as measured by NT-proBNP, oxygen desaturation index (ODI) ≥10 was associated with mortality. The hazard ratio of 3.0 (CI 95% 1.1-8.6, p=0.03) remained statistically significant after adjustments for age, gender, diabetes and plasma values of NT-proBNP.

    CONCLUSION: SDB in community dwelling elderly has no overall association to mortality irrespective of degree of SDB. However, hypoxic events (i.e., ODI ≥10) were associated with mortality in the group who had CVD in combination with impaired systolic function.

  • 61.
    Johansson, Peter
    et al.
    Department of Cardiology, Department of Medical and Health Sciences, Linköping University. Sweden.
    Alehagen, Urban
    Department of Cardiology, Department of Medical and Health Sciences, Linköping University. Sweden.
    Vrethem, Magnus
    Department of Neurology and Neurophysiology Department of Clinical and Experimental Medicine, Linköping University, Sweden.
    Svanborg, Eva
    Department of Neurology and Neurophysiology Department of Clinical and Experimental Medicine, Linköping University, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Difficulties in identification of sleep disordered breathing in an outpatient clinic for heart failure– A case study2014Ingår i: Annals of Nursing and Practice, Vol. 1, nr 3 (1011), s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sleep disordered breathing (SDB) is prevalent in patients with heart failure (HF). The clinical signs of newly diagnosed HF and untreated SDB may overlap and patients in need of SDB treatment can therefore be difficult to identify in patients participating in disease management programmes (DMP). The aim was to describe the care process of two patients with HF involved in a DMP, focusing on the difficulties to identify and initiate treatment of SDB.A prospective case study design was used to follow one male (70 yrs) and one female (74 yrs) patient during 18 months at a Swedish University hospital. It took 5 to 10 months from diagnosis of HF until optimal treatment was reached for their heart conditions and 12 to 17 months until SDB was treated. None of the patients complained of poor sleep, but suffered from fatigue. In the male SDB was detected by the wife’s complaints of her husband’s snoring, apnoeas and restless sleep. In the female, SDB was detected after a detailed assessment of fatigue which was shown to be sleepiness. After optimal treatment of HF but before imitation of SDB treatment both cases cardiac function improved. For the female case improvements also were found in the blood pressure. SDB treatment improved fatigue in both patients. Initiation of HF treatment and self-care routines, as well as identification of SDB is complex and time consuming. Treatment of HF and SDB can improve sleep, cardiac function as well as disturbing associated symptoms.

  • 62.
    Johansson, Peter
    et al.
    Linköping University.
    Arestedt, Kristoffer
    Linköping University.
    Alehagen, Urban
    Linköping University.
    Svanborg, Eva
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Sleep disordered breathing, insomnia, and health related quality of life: a comparison between age and gender matched elderly with heart failure or without cardiovascular disease2010Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 9, nr 2, s. 108-117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The aims of this study are (I) to compare the prevalence of sleep disordered breathing (SDB) and insomnia between elderly with heart failure (HF) and age and gender matched elderly without cardiovascular disease (CVD), and (II) to examine the association between HF, SDB and insomnia, as well as their impact on health related quality of life (Hr-QoL).

    METHODS: Three hundred and thirty-one elderly (71-87 years) community-living individuals underwent sleep recordings and echocardiography. Questionnaires assessed insomnia and Hr-QoL. Comparisons were made between age and gender matched individuals with HF (n=36) and without CVD (n=36).

    RESULTS: The HF group had higher mean apnoea-hypopnoea index (17.6 vs. 6.3, p<0.001). Moderate/severe SDB was found in 42% of those with HF vs. 8% in those without CVD (p=0.001). Those with HF had more difficulties maintaining sleep (DMS) (72% vs. 50%, p=0.05) and excessive daytime sleepiness (EDS) (25% vs. 8%, p=0.05) and scored worse Hr-QoL in five of eight SF-36 domains. In regression analysis SDB had no association to Hr-QoL. DMS associated to the physical-, and non restorative sleep to the mental domain of Hr-QoL. SDB had no correlations to insomnia or EDS.

    CONCLUSIONS: SDB, DMS and EDS are more common in elderly with HF. SDB is not an obvious cause for sleep complaints or poor Hr-QoL in elderly.

  • 63.
    Johansson, Peter
    et al.
    Linköping University Hospital.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Sleep disturbances — a significant problem for cardiovascular nurses in practice and/or research?2010Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 9, nr 2, s. 75-76Artikel i tidskrift (Refereegranskat)
  • 64.
    Johansson, Peter
    et al.
    Linköping University.
    Broström, Anders
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Alehagen, Urban
    Linköping University.
    Global perceived health and health-related quality of life in elderly primary care patients with symptoms of heart failure2008Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, nr 4, s. 269-276Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The aim was to examine whether a single question about global perceived health (GPH) is associated with the domains of health-related quality of life (HR-QoL) as assessed by the SF-36, and whether the scores in these domains differ from the different scores of the GPH in relation to left ventricular ejection fraction (LVEF).

    METHOD: The study included 412 elderly outpatients with symptoms of heart failure (HF). Echocardiography was used to determine their LVEF, and GPH was assessed by the first question on the SF-36.

    RESULTS: The correlations between GPH and the different domains in SF-36 ranged from 0.33 to 0.64 in patients with LVEF>or=50% and was between 0.29 and 0.59 in patients with LVEF<40%. Regression analyses revealed GPH to be the strongest predictor of HR-QoL. Patients with LVEF<40% rating poor GPH differed significantly (p<0.05) from those with good or moderate GPH in six of the eight HR-QoL domains.

    CONCLUSION: One question about GPH gives a good general description of HR-QoL and may therefore be used as a simple tool to assess HR-QoL in elderly outpatients with clinical symptoms of HF.

  • 65.
    Johansson, Peter
    et al.
    Linköping University.
    Broström, Anders
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Alehagen, Urban
    Linköping University.
    Global perceived health and ten-year cardiovascular mortality in elderly primary care patients with possible heart failure.2008Ingår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 10, nr 10, s. 1040-1047Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Although multi-item health-related quality of life (HRQoL) instruments provide prognostic information, they are rarely used in routine clinical practice.

    AIM: To examine whether a single question about global perceived health (GPH) was a prognostic indicator of cardiovascular (CV) mortality over 10 years of follow-up in elderly patients with possible heart failure (HF) in primary care.

    METHOD: GPH was measured using the first question on the Short-Form-36 concerning current health status. Of the 510 patients who underwent baseline evaluation, 448 patients were included.

    RESULTS: Cox proportional regression hazard analysis controlled for age, sex, NYHA class, diabetes, ischaemic heart disease, left ventricular ejection fraction and B-type natriuretic peptide plasma concentrations, showed that patients with GPH rated as "poor" or "good" were at four (HR 4.1 CI 95% 1.8-9.4) and three times (HR 3.4 CI 95% 1.4-7.8) the risk of CV mortality, respectively.

    CONCLUSION: GPH is an independent predictor of CV mortality in elderly patients with possible HF. As a complement to clinical factors when evaluating severity of HF, GPH could be an important tool for identifying patients at risk of adverse CV events and in need of improved treatment.

  • 66.
    Johansson, Peter
    et al.
    Department of Cardiology, and Department of Medicine and Health Sciences, Linköping University, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Sanderman, Robbert
    Department of Health Sciences, University of Groningen, University Medical Centre Groningen, the Netherlands.
    Jaarsma, Tiny
    Department of Medicine and Health Sciences Linköping University, Sweden.
    The course of sleep problems in patients with heart failure and associations to rehospitalizations2015Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 30, nr 5, s. 403-410Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Sleep problems are common in patients with heart failure (HF) and might be associated with patient outcomes. Aims: The aim of this study was to describe the course of sleep problems in HF patients over 1 year and the association between sleep problems and rehospitalization. Methods: Data from 499 HF patients (mean age, 70 years) were used in this analysis. Sleep problems were assessed with the item ‘‘Was your sleep restless’’ from the Center for Epidemiological Studies Depression Scale during hospitalization for HF (baseline) and after 1 year. Results: A total of 43% of patients (n = 215) reported sleep problems at baseline, and 21% of patients (n = 105), after1 year. Among the 215 patients with problems with sleep at baseline, 30% (n = 65) continued to have sleep problems over time. Among the 284 patients without sleep problems at baseline, 14% (n = 40) reported sleep problems after 1 year. After adjustments for potential cofounders, patients with continued sleep problems had an almost 2-fold increased risk for all-cause hospitalizations (hazard ratio, 2.1;P= .002) and cardiovascular hospitalizations (hazard ratio, 2.2;P= .004). Conclusion: One-third of HF patients with sleep problems at discharge experienced persistent sleep problems at follow-up. Continued sleep problems were associated with all-cause and cardiovascular rehospitalizations.

  • 67.
    Johansson, Peter
    et al.
    Linköping University Hospital.
    Dahlström, Ulf
    Linköping University Hospital.
    Broström, Anders
    Linköping University Hospital.
    Consequences and predictors of depression in patients with chronic heart failure: implications for nursing care and future research.2006Ingår i: Progress in Cardiovascular Nursing, ISSN 0889-7204, E-ISSN 1751-7117, Vol. 21, nr 4, s. 202-211Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Depression is common among patients with chronic heart failure (HF) and leads to more symptoms of HF, decreased quality of life, and an increased risk for premature death. Depressed HF patients also use more health care resources, which increases the economic burden on the health care system. The assessment of risk factors of depression such as age younger than 60-65 years, poor physical functioning, previous depression, poor self-efficacy, living alone, and distressful relationships, in combination with the use of depression instruments, can be helpful in detecting depression in HF patients. Unfortunately, interventions on how to relieve depression in patients with HF have not been investigated thoroughly; however, depression agents as well as HF education, social support, exercise therapy, stress management, and relaxation have been shown to be useful interventions. Because of poor outcomes, studies that examine the effectiveness and/or side effects of pharmacologic as well as nonpharmacologic interventions on depressed patients with HF are needed.

  • 68.
    Johansson, Peter
    et al.
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Broström, Anders
    Linköping University.
    Factors and interventions influencing health-related quality of life in patients with heart failure: a review of the literature2006Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, nr 1, s. 5-15Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Because of the lack of a cure for patients with chronic heart failure (HF), there has been a progressive interest in the use of health-related quality of life (Hr-QoL) as complementary end-point to mortality and morbidity.

    AIM: The aim of this review was from a nursing perspective to describe Hr-QoL and the influencing factors of Hr-QoL, as well as to identify interventions aimed at influencing Hr-QoL in HF patients.

    METHOD: Medline, Cinahl and PsycInfo databases were searched from 1995 to 2004. A total of 58 papers were included.

    RESULTS: HF symptoms and activity status influence Hr-QoL negatively. However, several individual characteristics such as personality, gender and age must also be taken into consideration because different values might exist regarding what constitutes a good Hr-QoL. Nurse led interventions based on education, support and exercise can influence Hr-QoL positively. There is also a need of more studies about the effects of depression, sleep disturbances, support as well as education on Hr-QoL. There is also a need of exercise studies with larger sample sizes and older patients in higher NYHA classes.

    CONCLUSION: Several individual factors impact Hr-QoL, therefore, must nursing interventions are individually adapted to the patient's resources.

  • 69.
    Johansson, Peter
    et al.
    Linköping University Hospital.
    Dahlström, Ulf
    Linköping University Hospital.
    Broström, Anders
    Linköping University Hospital.
    The measurement and prevalence of depression in patients with chronic heart failure2006Ingår i: Progress in Cardiovascular Nursing, ISSN 0889-7204, E-ISSN 1751-7117, Vol. 21, nr 1, s. 28-36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Chronic heart failure is a common disease accompanied by poor mental health and depression. The diagnosis of depression is based on the presence of affective, cognitive, and somatic symptoms assessed by categoric or dimensional instruments. Depression is prominent and high rates are found with dimensional instruments in hospitalized heart failure patients. Categoric instruments seem to be more reliable but are more complex to use. Because of poor outcomes, attention should also be paid to subthreshold depression. In screening for such cases, dimensional instruments might be preferable because of the risk for underestimation by categoric instruments. Dimensional instruments might also be easier to implement in daily practice but, to reduce bias, cutoff scores might need refinement according to the clinical setting. Therefore, studies that evaluate different cutoff values are needed to find a critical level of burden from a depressive symptomatology on outcomes such as mortality, hospitalizations, and quality of life.

  • 70.
    Johansson, Peter
    et al.
    Linköping University Hospital.
    Riegel, Barbara
    University of Pennsylvania.
    Svensson, Erland
    Swedish Defence Research Agency.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Linköping University Hospital.
    Alehagen, Urban
    Linköping University Hospital.
    Dahlström, Ulf
    Linköping University Hospital.
    Jaarsma, Tiny
    Faculty of Health Sciences, Norrköping.
    Sickness Behavior in Community-Dwelling Elderly Associations With Impaired Cardiac Function and Inflammation2014Ingår i: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 16, nr 1, s. 105-113Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sickness behavior is a cluster of symptoms that occur as a response to an infection and alterations in the inflammatory response. Under normal circumstances, sickness behavior is fully reversible once the pathogen has been cleared. Aging and chronic illness such as heart failure are associated with enhanced inflammatory activity that lasts for a long duration and no longer represents an adaptive response. The aim of this study was to explore whether inflammation mediates the relationship between impaired cardiac function and a symptom cluster including anhedonia, fatigue, and sleepiness, which might represent sickness behavior in community-dwelling elders. Structural equation modeling (SEM) showed that the factor impaired cardiac function (i.e., N-terminal fragment of pro-brain natriuretic peptide, left ventricular ejection fraction, and the heart failure medications angiotensin converting enzyme inhibitor, angiotensin receptor blockade, β-blocker, and diuretics) was associated with both inflammation (i.e., C-reactive protein; β = .26) and the symptom cluster (β = .31). Inflammation had a significant direct, but smaller, association with the symptom cluster (β = .21). By this pathway, inflammation also mediated an indirect association between impaired cardiac function and the symptom cluster (β = .05). Including creatinine, blood glucose, ischemic heart disease, previous and current tumor, respiratory disease, age, and body mass index in the SEM model did not change these associations. Our results imply that some aspects of the symptom panorama in elderly individuals with impaired cardiac function or heart failure could represent sickness behavior.

  • 71.
    Johansson, Peter
    et al.
    Linköping University.
    Riegel, Barbara
    Linköping University.
    Svensson, Erland
    Swedish Defence Research Agency.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Alehagen, Urban
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Jaarsma, Tiny
    Linköping University.
    The contribution of heart failure to sleep disturbances and depressive symptoms in older adults2012Ingår i: Journal of Geriatric Psychiatry and Neurology, ISSN 0891-9887, E-ISSN 1552-5708, Vol. 25, nr 3, s. 179-187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The aim of this study was to explore the associations between physical symptoms, sleep disturbances, and depressive symptoms in community-dwelling elderly individuals, comparing persons with and without heart failure (HF).

    METHODS: A total of 613 older adults (mean age 78 years) underwent clinical and echocardiographic examinations. Questionnaires were used to evaluate sleep disturbances and depressive symptoms. A model was developed in those with HF (n = 107) and compared with those without HF (n = 506).

    RESULTS: Cardiopulmonary symptoms (ie, dyspnea and nighttime palpitations) and pain had significant direct associations with sleep disturbances, which indirectly affected depressive symptoms. The model was essentially the same in those with and without HF except that the effect of sleep disturbances on depressive symptoms was stronger in those with HF (β = 0.64 vs β = 0.45, P = .006).

    CONCLUSION: In community-dwelling older adults, regardless of their diagnosis, physical symptoms had a direct effect on sleep disturbances and an indirect effect on depressive symptoms.

  • 72.
    Johansson, Peter
    et al.
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Cardiology, County Council of Östergötland, 58185, Linköping, Sweden .
    Svensson, Erland
    Swedish Defence Research Agency, 58111, Linköping, Sweden.
    Alehagen, Urban
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Dahlström, Ulf
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Jaarsma, Tiny
    Department of Social and Welfare Studies, Linköping University, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, County Council of Östergötland, 58185, Linköping, Sweden .
    Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease2015Ingår i: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, nr 1, s. 263-271Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Inflammation can induce a cluster of symptoms, referred to as sickness behaviour (e.g., depressive symptoms, sleep disturbances, pain and fatigue). Cardiovascular disease (CVD) and sleep disordered breathing (SDB) are common in older adults. CVD is associated with an increased inflammatory activity and in SDB, hypoxia can also increase inflammation. The purpose of this study is to explore if SDB-related hypoxia is associated differently with inflammation and the presence of sickness behaviour in older adults with and without CVD.

    METHODS:

    Three hundred and thirty-one older adults, whose mean age is 78 years, underwent one-night polygraphic recording to measure SDB and hypoxia. CVD was established by a clinical investigation. Questionnaires were used to measure sickness behaviour and depressive symptoms. High sensitivity C-reactive protein was used as a marker of inflammation.

    RESULTS:

    Structural Equation Modelling showed that SDB-related hypoxia was associated with inflammation (β > 0.40) which mediated indirect associations with sickness behaviour (β = 0.19) and depressive symptoms (β = 0.11), but only in those with CVD (n = 119). In this model, inflammation had a direct effect on sickness behaviour (β = 0.43) and an indirect effect on depressive symptoms (β = 0.24). Hypoxia had the strongest effect (i.e., β = 0.41; significant) on inflammation, whereas the AHI or ODI had weak and non-significant effects (β = 0.03 and β = 0.15).

    CONCLUSIONS:

    Older adults with CVD and SDB are at a particular risk of developing sickness behaviour and depressive symptoms. The effect of SDB was mainly caused by hypoxia, suggesting that hypoxia is an important marker of SDB severity in older adults with CVD.

  • 73.
    Johansson, Peter
    et al.
    Department of Medicine and Health Sciences, Linköping University, Sweden.
    Svensson, Erland
    Swedish Defence Research Agency, Sweden.
    Alehagen, Urban
    Department of Medicine and Health Sciences, Linköping University, Sweden; Department of Cardiology, Linkoping University, Sweden .
    Jaarsma, Tiny
    Department of Cardiology, Linköping University, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    The contribution of hypoxia to the association between sleep apnoea, insomnia, and cardiovascular mortality in community-dwelling elderly with and without cardiovascular disease2015Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, nr 3, s. 222-231Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: This study explores if nightly hypoxia (i.e. percentage of sleep time with oxygen saturation lower than 90% (SaO2<90%)) contributed to the association between sleep-disordered breathing (SDB) and insomnia in community-dwelling elderly with and without cardiovascular disease (CVD). A second aim was to explore a potential cut-off score for hypoxia to predict insomnia and the association of the cut-off with clinical characteristics and cardiovascular mortality. Method: A total of 331 community-dwelling elderly aged 71-87 years underwent one-night polygraphic recordings. The presence of insomnia was recorded by a self-report questionnaire. The presence of CVD was objectively established and mortality data were collected after three and six years. Results: In both patients with CVD (n=119) or without CVD (n=212) SDB was associated with hypoxia (p<0.005). Only in the patients with CVD was hypoxia associated with insomnia (p<0.001) which mediated an indirect effect (p<0.05) between SDB and insomnia. Hypoxia of more than 1.5% of sleep time with SaO2<90% was found to be a critical level for causing insomnia. According to this criterion 32% (n=39) and 26% (n=55) of those with and without CVD had hypoxia, respectively. These groups did not differ with respect to age, gender, body mass index, diabetes, hypertension, respiratory disease or levels of SDB. However, in the CVD group, hypoxia was associated with cardiovascular mortality at the three-year follow-up (p=0.008) and higher levels of insomnia (p=0.002). Conclusion: In the elderly with CVD, SDB mediated by hypoxia can be associated with more insomnia and a worse prognosis.

  • 74.
    Karlsson, Susanne
    et al.
    Ear Nose and Throat Clinic, Ryhov County Hospital, Jönköping, Sweden.
    Elfström, Maria
    Ear Nose and Throat Clinic, Ryhov County Hospital, Jönköping, Sweden.
    Sunnergren, Ola
    Ear Nose and Throat Clinic, Ryhov County Hospital, Jönköping, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Decisive situations influencing continuous positive airway pressure initiation in patients with obstructive sleep apnea syndrome – A critical incident technique analysis from the personnel’s perspective2015Ingår i: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, Vol. 4, nr 1, s. 16-26Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Continuous positive airway pressure is an effective treatment of obstructive sleep apnea syndrome, but adherence to treatment is low. Interventions such as encouragement, education and cognitive behavioural therapy have affected adherence to continuous positive airway pressure treatment positively. Currently there are no studies regarding the situation for personnel during the initiation process of treatment.

    Purpose: The purpose was to describe situations influencing the initiation of continuous positive airway pressure in patients with obstructive sleep apnea syndrome from a personnel perspective.

    Materials and methods: A qualitative approach using critical incident technique was used. Data were collected through semi structured interviews. Thirty one informants were strategically selected from sixteen centres in Sweden.

    Results: Motivation, a prepared patient, communicational aspects and participation of family were described as pedagogical circumstances. External conditions, practical experience, the patient’s state of health and adaption to the mask were described as practical circumstances. The personnel handled the situations in a theoretical, practical and/or an emotional way.

    Conclusions: A better understanding of situations creating barriers or being facilitators, as well as ways to handle these situations, can be used to develop the role of personnel during the initiation process in order to increase continuous positive airway pressure adherence.

  • 75.
    Lin, C. -Y
    et al.
    Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Potenza, M. N.
    Departments of Psychiatry and Neuroscience and the Child Study Center, School of Medicine, Yale University, New Haven, CT, United States & Connecticut Council on Problem Gambling, Wethersfield, CT, United States & Connecticut Mental Health Center, New Haven, CT, United States.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, S-58185, Sweden.
    Blycker, G. R.
    College of Nursing, University of Rhode Island, Kingston, RI, United States & Hälsosam Therapy, Jamestown, RI, United States.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Mindfulness-based cognitive therapy for sexuality (MBCT-S) improves sexual functioning and intimacy among older women with epilepsy: A multicenter randomized controlled trial2019Ingår i: Seizure, ISSN 1059-1311, E-ISSN 1532-2688, Vol. 73, s. 64-74Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Women with epilepsy (WWE) frequently experience sexual problems, including sexual dysfunction and sexual distress. Therefore, this study aimed to examine the efficacy of a mindfulness-based cognitive therapy for sexuality (MBCT-S) on sexual function and intimacy among older adult WWE in Iran.

    Methods: A multicenter randomized controlled trial was conducted at 15 neurology clinics in three Iranian cities. WWE together with their partners and healthcare providers were randomly assigned in patient and partner (PP; n = 220), patient, partner, and healthcare provider (PPHP; n = 220), or treatment as usual (TAU; n = 220) group. WWE and their partners in both the PP and PPHP groups received eight weeks of MBCT-S sessions. In the PPHP group, three individual sessions on sexual counseling were added for healthcare providers. Self-assessment scales were used at baseline, one month and six months after completing the intervention. Mixed linear regression models were developed to determine differences among the three groups. Multilevel mediation analyses were conducted to understand the mediating effects of mindfulness, intimacy, patient-physicians relationship and sexual counseling barriers.

    Results: Improvements in sexual function, sexual distress, and intimacy were found in both the PP and PPHP groups at one-month and six-month follow-ups. The PPHP group compared with the PP group had greater improvement in intimacy at both follow-ups. Regarding sexual function, the PPHP group performed better than the PP group at the six-month follow-up.

    Conclusions: The MBCT-S appears efficacious in enhancing sexual function and reducing sex-related distress in Iranian older adult WWE. Future studies should examine its efficacy in other populations. 

  • 76.
    Lin, Chung-Yin
    et al.
    Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Strong, Carol
    Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
    Scott, Alexander J.
    School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Webb, Thomas L.
    Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
    A cluster randomized controlled trial of a theory-based sleep hygiene intervention for adolescents2018Ingår i: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 41, nr 11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Objectives: To use theory to design and evaluate an intervention to promote sleep hygiene and health among adolescents.

    Methods: The Theory of Planned Behavior (TPB) and the Health Action Process Approach (HAPA) were used to develop an intervention, which was then evaluated in a cluster randomized trial. Participants were high school students (N = 2,841, M age = 15.12, SD = 1.50). Adolescents in the intervention group received four face-to-face sessions providing behavior change techniques targeting the theoretical determinants of sleep hygiene. Adolescents in the control group only received educational material at the end of the study. The primary outcome was sleep hygiene measured at 1 and 6 months postintervention. A number of secondary outcomes were also measured, including beliefs about sleep, self-regulatory processes, and outcomes related to health and wellbeing.

    Results: Sleep hygiene was improved in the intervention group when compared with the control group at both follow-up points (coefficients = 0.16 and 0.19, 95% CIs = 0.12-0.20 and 0.15-0.23 at 1 and 6 months, respectively, for scores on the Adolescent Sleep Hygiene Scale), as were psychosocial and general aspects of health. Mediation analyses suggested that beliefs about sleep hygiene as specified by the TPB, along with self-regulatory processes from HAPA, both mediated the effect of the intervention on outcomes. In turn, the effects of the intervention on sleep hygiene mediated its impact on general health.

    Conclusions: Healthcare practitioners might consider intervention programs based on the TPB and the HAPA to improve sleep among adolescents.

    Clinical Trial Registration: Clinicaltrials.gov (NCT02551913) https://clinicaltrials.gov/ct2/show/NCT02551913.

  • 77.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Griffiths, Mark D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, United Kingdom.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center (SDH), Qazvin University of Medical Sciences, Qazvin, Iran.
    Psychometric Evaluation of the Persian eHealth Literacy Scale (eHEALS) Among Elder Iranians With Heart Failure2019Ingår i: Evaluation & the Health Professions, ISSN 0163-2787, E-ISSN 1552-3918, artikel-id 163278719827997Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of the present study was to examine the psychometric properties of the eHealth Literacy Scale (eHEALS) using classical test theory and modern test theory among elderly Iranian individuals with heart failure (HF). Individuals with objectively verified HF ( n = 388, 234 males, mean age = 68.9 ± 3.4) completed the (i) eHEALS, (ii) Hospital Anxiety and Depression Scale, (iii) Short Form 12, (iv) 9-item European Heart Failure Self-Care Behavior Scale, and (v) 5-item Medication Adherence Report Scale. Two types of analyses were carried out to evaluate the factorial structure of the eHEALS: (i) confirmatory factor analysis (CFA) in classical test theory and (ii) Rasch analysis in modern test theory. A regression model was constructed to examine the associations between eHEALS and other instruments. CFA supported the one-factor structure of the eHEALS with significant factor loadings for all items. Rasch analysis also supported the unidimensionality of the eHEALS with item fit statistics ranging between 0.5 and 1.5. The eHEALS was significantly associated with all the external criteria. The eHEALS is suitable for health-care providers to assess eHealth literacy for individuals with HF.

  • 78.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nilsen, Per
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Griffiths, Mark D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, United Kingdom.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center (SDH), Qazvin University of Medical Sciences, Shahid Bahonar Blvd, Qazvin, Iran.
    Psychometric validation of the Persian bergen social media addiction scale using classic test theory and Rasch models2017Ingår i: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 6, nr 4, s. 620-629Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: The Bergen Social Media Addiction Scale (BSMAS), a six-item self-report scale that is a brief and effective psychometric instrument for assessing at-risk social media addiction on the Internet. However, its psychometric properties in Persian have never been examined and no studies have applied Rasch analysis for the psychometric testing. This study aimed to verify the construct validity of the Persian BSMAS using confirmatory factor analysis (CFA) and Rasch models among 2,676 Iranian adolescents.

    Methods: In addition to construct validity, measurement invariance in CFA and differential item functioning (DIF) in Rasch analysis across gender were tested for in the Persian BSMAS.

    Results: Both CFA [comparative fit index (CFI) = 0.993; Tucker-Lewis index (TLI) = 0.989; root mean square error of approximation (RMSEA) = 0.057; standardized root mean square residual (SRMR) = 0.039] and Rasch (infit MnSq = 0.88-1.28; outfit MnSq = 0.86-1.22) confirmed the unidimensionality of the BSMAS. Moreover, measurement invariance was supported in multigroup CFA including metric invariance (ΔCFI = .0.001; ΔSRMR = 0.003; ΔRMSEA = .0.005) and scalar invariance (ΔCFI = .0.002; ΔSRMR = 0.005; ΔRMSEA = 0.001) across gender. No item displayed DIF (DIF contrast = .0.48 to 0.24) in Rasch across gender.

    Conclusions: Given the Persian BSMAS was unidimensional, it is concluded that the instrument can be used to assess how an adolescent is addicted to social media on the Internet. Moreover, users of the instrument may comfortably compare the sum scores of the BSMAS across gender.

  • 79.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nilsen, Per
    Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Using extended theory of planned behavior to understand aspirin adherence in pregnant women.2018Ingår i: Pregnancy Hypertension, ISSN 2210-7789, E-ISSN 2210-7797, Vol. 12, s. 84-89Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To use the Theory of Planned Behavior (TPB) combined with action and coping planning plus global relationship with husband to explain the aspirin adherence in a sample of women with high-risk pregnancy.

    METHODS: A total of 535 Iranian women (mean age = 32.29 ± 4.98; year of marriage = 6.89 ± 3.61) completed the study. Each participant filled out several questionnaires on TPB (i.e., a widely applied theory describing how behaviors are influenced by beliefs, attitudes, perceived behavioral control and behavioral intentions), action planning, coping planning and relationship with husband at baseline. Eight weeks later, each participant completed the Five-item Medication Adherence Rating Scale (MARS-5) and underwent the blood test on aspirin serum level to provide the subjective and objective aspirin adherence information, respectively. Structural equation modeling (SEM) was applied to test three proposed models on aspirin adherence.

    RESULTS: The TPB with planning plus relationship with husband was supported (comparative fit index = 0.969; Tucker-Lewis index = 0.950). Behavioral intention was the mediator in the associations of aspirin adherence and the following variables: attitude, perceived behavioral control, and relationship with husband. Action and coping planning mediated the associations of aspirin adherence and the two variables of behavioral intention and perceived behavioral control. Relationship with husband mediated the association of subjective norm and aspirin adherence.

    CONCLUSIONS: The TPB model with (action and coping) planning plus relationship with husband serves a potential mechanism to explain the aspirin adherence for women with high risk of pregnancy. Possible implications are discussed based on our results.

  • 80.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Steinke, Elaine E.
    School of Nursing, Wichita State University, Wichita, KS, USA.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Using extended theory of planned behavior to determine factors associated with help-seeking behavior of sexual problems in women with heart failure: a longitudinal study2019Ingår i: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: This study used extended theory of planned behavior (extended TPB) to understand the underlying factors related to help-seeking behavior for sexual problems among Iranian women with heart failure (HF).

    METHODS: We recruited 758 women (mean age = 61.21 ± 8.92) with HF at three university-affiliated heart centers in Iran. Attitude, subjective norms, perceived behavioral control, behavioral intention, self-stigma of seeking help, perceived barriers, frequency of planning, help-seeking behavior, and sexual function were assessed at baseline. Sexual function was assessed again after 18 months. Structural equation modeling was used to explain change in sexual functioning after 18 months.

    RESULTS: Attitude and perceived behavioral control were positively correlated to behavioral intention. Behavioral intention was negatively and self-stigma in seeking help was positively correlated to perceived barriers. Behavioral intention was positively and self-stigma in seeking help was negatively correlated to frequency of planning. Perceived behavioral control, behavior intention, and frequency of planning were positively and self-stigma in seeking help and perceived barriers were negatively correlated to help-seeking behavior. Help-seeking behavior was positive correlated to the change of FSFI latent score.

    CONCLUSIONS: The extended TPB could be used by healthcare professionals to design an appropriate program to treat sexual dysfunction in women with HF.

  • 81.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Cheng, Andy S. K.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Nejati, Babak
    Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Imani, Vida
    Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Ulander, Martin
    Department of Clinical and Experimental Medicine, Division of Clinical Neurophysiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Browall, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Griffiths, Mark D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, United Kingdom.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    A thorough psychometric comparison between Athens Insomnia Scale and Insomnia Severity Index among patients with advanced cancer2020Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 29, nr 1, artikel-id e12891Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    For patients with cancer, sleep disturbance is commonplace. Using classical test theory and Rasch analyses, the present study compared two commonly used psychometric instruments for insomnia – Athens Insomnia Scale and Insomnia Severity Index – among patients with advanced cancer. Through convenience sampling, patients with cancer at stage III or IV (n = 573; 326 males; mean age = 61.3 years; SD = 10.7) from eight oncology units of university hospitals in Iran participated in the study. All the participants completed the Athens Insomnia Scale, Insomnia Severity Index, Edmonton Symptom Assessment Scale, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. Additionally, 433 participants wore an Actigraph device for two continuous weekdays. Classical test theory and Rasch analysis both supported the construct validity for Athens Insomnia Scale (factor loadings from confirmatory factor analysis = 0.61–0.87; test–retest reliability = 0.72–0.82; infit mean square = 0.81–1.17; outfit MnSq = 0.79–1.14) and for Insomnia Severity Index (factor loadings from confirmatory factor analysis = 0.61–0.81; test–retest reliability = 0.72–0.82; infit mean square = 0.72–1.14; outfit mean square = 0.76–1.11). Both Athens Insomnia Scale and Insomnia Severity Index had significant associations with Edmonton Symptom Assessment Scale, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, as well as having good sensitivity and specificity. Significant differences in the actigraphy measure were found between insomniacs and non-insomniacs based on Athens Insomnia Scale or Insomnia Severity Index score. With promising results, healthcare providers can use either Athens Insomnia Scale or Insomnia Severity Index to understand the insomnia of patients with advanced cancer. 

  • 82.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong.
    Ganji, Maryam
    Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Iran.
    Griffiths, Mark D.
    International Gaming Research Unit, Nottingham Trent University, UK.
    Ernsth-Bravell, Marie
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysioloy, Linköping University Hospital, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Iran.
    Mediated effects of insomnia, psychological distress and medication adherence in the association of eHealth literacy and cardiac events among Iranian older patients with heart failure: a longitudinal study2019Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    Given the importance of improving health for patients with heart failure, the present study examined the temporal associations between eHealth literacy, insomnia, psychological distress, medication adherence, quality of life and cardiac events among older patients with heart failure.

    Methods:

    With a longitudinal design older patients with echocardiography verified heart failure (N=468; 50.4% New York Heart Association class II, mean age 69.3±7.3 years; 238 men) in need of cardiac care at seven Iranian university outpatient clinics went through clinical examinations and completed the following questionnaires at baseline: eHealth literacy scale (eHEALS, assessing eHealth literacy); 5-item medication adherence report scale (MARS-5, assessing medication adherence); Minnesota living with heart failure questionnaire (MLHFQ, assessing quality of life); insomnia severity index (ISI, assessing insomnia); and hospital anxiety and depression scale (HADS, assessing psychological distress). All the patients completed the ISI and HADS again 3 months later; and the MARS-5 6 months later. Also, their cardiac events were collected 18 months later. Three mediation models were then conducted.

    Results:

    eHealth literacy had direct and indirect effects (through insomnia and psychological distress) on medication adherence and quality of life. Moreover, eHealth literacy had protecting effects on cardiac events (hazard ratio (HR) 0.53; 95% confidence interval (CI) 0.37, 0.65) through the mediators of insomnia (HR 0.19; 95% CI 0.15, 0.26), psychological distress (HR 0.08; 95% CI 0.05, 0.12) and medication adherence (HR 0.05; 95% CI 0.04, 0.08).

    Conclusion:

    As eHealth literacy was a protector for patients with heart failure, healthcare providers may plan effective programmes to improve eHealth literacy for the population. Additional benefits of improving eHealth literacy in heart failure may be decreased insomnia and psychological distress, improved quality of life, as well as decreased cardiovascular events.

  • 83.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Ganji, Maryam
    Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
    Pontes, Halley M
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK.
    Imani, Vida
    Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Griffiths, Mark D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Psychometric evaluation of the Persian Internet Disorder Scale among adolescents.2018Ingår i: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 7, nr 3, s. 665-675Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND AIMS: Given the growing epidemiological research interest concerning Internet addiction, brief instruments with a robust theoretical basis are warranted. The Internet Disorder Scale (IDS-15) is one such instrument that can be used to quickly assess the Internet addiction in an individual. However, only two language versions of the IDS-15 have been developed. This study translated the IDS-15 into Persian and examined its psychometric properties using comprehensive psychometric testing.

    METHODS: After ensuring the linguistic validity of the Persian IDS-15, 1,272 adolescents (mean age = 15.53 years; 728 males) completed the IDS-15, Depression Anxiety Stress Scale (DASS), Internet Gaming Disorder Scale - Short Form (IGDS9-SF), and the Bergen Social Media Addiction Scale (BSMAS). Confirmatory factor analysis (CFA), Rasch models, regression analysis, and latent profile analysis (LPA) were carried out to test the psychometric properties of the Persian IDS-15.

    RESULTS: Both CFA and Rasch supported the construct validity of the Persian IDS-15. Multigroup analysis in CFA and differential item functioning in Rasch indicated that male and female adolescents interpreted the IDS-15 items similarly. Regression analysis showed that the IDS-15 correlated with IGDS9-SF and BSMAS (ΔR2 = .12 and .36, respectively) is stronger than the DASS (ΔR2 = .03-.05). LPA based on IDS-15 suggests three subgroups for the sample. Significant differences in depression, anxiety, IGDS9-SF, and BSMAS were found among the three LPA subgroups.

    CONCLUSION: The Persian IDS-15 has robust psychometric properties as evidenced by both classical test theory and Rasch analysis.

  • 84.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Imani, Vida
    Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Huus, Karina
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD.
    Björk, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD.
    Hodges, Eric A.
    School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
    Psychological distress and quality of life in Iranian adolescents with overweight/obesity: mediating roles of weight bias internalization and insomnia2019Ingår i: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To examine whether weight-related self-stigma (aka weight bias internalization) and insomnia are potential predictors of psychological distress and quality of life (QoL) among Iranian adolescents with overweight (OW)/obesity (OB). To examine whether weight-related self-stigma and insomnia are potential mediators in the relationship between excess weight and health outcomes of distress and QoL.

    METHODS: All participants (n = 934; 444 males; mean age = 15.7 ± 1.2 years; zBMI = 2.8 ± 1.0) completed questionnaires on weight-related self-stigma and insomnia at baseline. Six months later, they completed questionnaires on psychological distress and QoL to assess health outcomes. Relationships among variables were tested using mediation analyses with bootstrapping method.

    RESULTS: Weight-related self-stigma significantly mediated the effects of zBMI on psychological distress (effect = 0.22; bootstrapping SE = 0.09; 95% CI = 0.08, 0.45), psychosocial QoL (effect = - 0.64; bootstrapping SE = 0.19; 95% CI = - 1.10, - 0.32), and physical QoL (effect = - 1.35; bootstrapping SE = 0.54; 95% CI = - 2.43, - 0.26). Insomnia also significantly mediated the effects of zBMI on psychological distress (effect = 2.18; bootstrapping SE = 0.31; 95% CI = 1.61, 2.81), psychosocial QoL (effect = - 0.89; bootstrapping SE = 0.33; 95% CI = - 1.60, - 0.28), and physical QoL (effect = - 0.83; bootstrapping SE = 0.42; 95% CI = - 1.69, - 0.02). Full mediations were found in psychosocial QoL; partial mediations were found in psychological distress and physical QoL.

    CONCLUSIONS: Weight-related self-stigma and insomnia were significant mediators in the effects of excess weight on health outcomes. Therefore, it is important to identify and treat weight-related self-stigma and insomnia for adolescents with OW/OB.

    LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

  • 85.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Imani, Vida
    Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nilsen, Per
    Fung, Xavier C. C.
    Griffiths, Mark D.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center (SDH), Qazvin University of Medical Sciences, Qazvin, Iran.
    Smartphone application-based addiction among Iranian adolescents: A psychometric study2019Ingår i: International Journal of Mental Health and Addiction, ISSN 1557-1874, E-ISSN 1557-1882, Vol. 17, nr 4, s. 765-780Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Smartphone Application-Based Addiction Scale (SABAS) can be used in screening for the risk of smartphone addiction. This study aimed to validate a Persian version of the SABAS using confirmatory factor analysis (CFA), Rasch analysis, and latent class analysis (LCA). In a sample of 3807 Iranian adolescents, CFAs were used to confirm the factor structure of SABAS, Rasch models were used to examine the unidimensionality of SABAS, and LCAs were used to classify the adolescents in terms of application preferences and smartphone application-based addiction. The unidimensional structure of SABAS was supported by CFA and Rasch model. LCA classified the sample into three subgroups (i.e., low, medium, high) in terms of risk of smartphone addiction. This study showed the unidimensionality of the Persian SABAS with robust psychometric properties. It can be used by healthcare providers in screening for risk of addiction to smartphone applications and provide early intervention if necessary. 

  • 86.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Imani, Vida
    Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Griffiths, Mark D.
    International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, United Kingdom.
    Evaluating the Psychometric Properties of the 7-Item Persian Game Addiction Scale for Iranian Adolescents.2019Ingår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, artikel-id 149Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The 7-item Gaming Addiction Scale (GAS) is a brief instrument based on DSM criteria to assess gaming addiction. Although the psychometric properties of the GAS have been tested using classical test theory, its psychometric properties have never been tested using modern test theory (e.g., Rasch analysis). The present study used a large adolescent sample in Iran to test the psychometric properties of the Persian GAS through both classical test and modern test theories. Adolescents (n = 4442; mean age = 15.3 years; 50.3% males) were recruited from Qazvin, Iran. In addition to the GAS, all of them completed the following instruments: the nine-item Internet Gaming Disorder Scale-Short Form (IGDS-SF9), Depression Anxiety Stress Scale (DASS), Pittsburgh Sleep Quality Index (PSQI), and a generic quality of life instrument. Two weeks later, all participants completed the GAS again. Confirmatory factor analysis (CFA) and Rasch analysis were used to test the unidimensionality of the GAS. Pearson correlation coefficients were used to test the test-retest reliability, and a regression model was used to test the criterion-related validity of the GAS. Both CFA and Rasch analysis supported the unidimensionality of the GAS. Pearson correlations coefficients showed satisfactory test-retest reliability of the GAS (r = 0.78 to 0.86), and the regression model demonstrated the criterion-related validity of the GAS (β = 0.31 with IGDS-SF9; 0.41 with PSQI). Based on the results, the Persian GAS is a reliable and valid instrument for healthcare providers to assess the level of gaming addiction among Persian-speaking adolescents.

  • 87.
    Lin, Chung-Ying
    et al.
    Faculty of Health and Social Sciences, Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Ou, Huang-Tz
    Department of Pharmacy, National Cheng Kung University, Tainan, Taiwan.
    Nikoobakht, Mehdi
    Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Sweden.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Validation of the 5-Item Medication Adherence Report Scale in Older Stroke Patients in Iran.2018Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, nr 6, s. 536-543Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is a lack of feasible and validated measures to self-assess medication adherence for older patients with stroke. In addition, the potential determinants of medication adherence for older patients with stroke remain unclear.

    OBJECTIVES: The aims of this study were to (1) examine the psychometric properties of a 5-item questionnaire on medication adherence, specifically the 5-item Medication Adherence Report Scale (MARS-5), and (2) explore the determinants of medication adherence.

    METHODS: Stroke patients older than 65 years (N = 523) filled out the MARS-5 and the Hospital Anxiety and Depression Scale. The medication possession rate (MPR) was calculated to measure the objective medication adherence. Several clinical characteristics (stroke types, blood pressure, comorbidity, HbA1c, quantity of prescribed drugs, fasting blood glucose, and total cholesterol) and background information were collected. We used Rasch analysis with a differential item functioning test to examine psychometric properties.

    RESULTS: All 5 items in the MARS-5 fit in the same construct (ie, medication adherence), no differential item functioning items were displayed in the MARS-5 across gender, and the MARS-5 total score was strongly correlated with the MPR (r = 0.7). Multiple regression models showed that the MARS-5 and the MPR shared several similar determinants. In addition, the variance of the MARS-5 (R = 0.567) was more than that of the MPR (R = 0.300).

    CONCLUSIONS: The MARS-5 is a feasible and valid self-assessed medication adherence for older patients with stroke. In addition, several determinants were found to be related to medication adherence for older patients with stroke. Healthcare providers may want to take heed of these determinants to improve medication adherence for this population.

  • 88.
    Lin, Chung-Ying
    et al.
    Faculty of Health and Social Sciences, Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahonar Blvd, Qazvin, Iran.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Jaarsma, Tiny
    Mary MacKillop Institute of Health Research, ACU, Melbourne, Australia.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients.2018Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, nr 3, s. 281-288Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF).

    OBJECTIVE: The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran.

    METHODS: Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA).

    RESULTS: The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legs/feet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47).

    CONCLUSIONS: Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.

  • 89.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Strong, Carol
    Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
    Siu, Andrew M. H.
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Jalilolghadr, Shabnam
    Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Nilsen, Per
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Validating the Persian Adolescent Sleep Hygiene Scale-Revised (ASHSr) using comprehensive psychometric testing methods2018Ingår i: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 50, s. 63-71Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This study translated the Adolescent Sleep Hygiene Scale-revised (ASHSr) into Persian and aimed to validate its psychometric properties using classical test theory and Rasch analyses.

    Methods: Adolescents aged 14–18 (n = 389; 199 males) and their parents in Iran participated in the study. Each adolescent wore a wrist actigraphy device during sleep time and completed the ASHSr, the Depression Anxiety Stress Scale (DASS), the General Health Questionnaire (GHQ), the Pediatric Daytime Sleepiness Scale (PDSS), and the Pittsburgh Sleep Quality Index (PSQI). A parent of each adolescent completed the Sleep Disturbance Scale for Children (SDSC).

    Results: The construct validity of the ASHSr was supported by both classical test theory (factor loadings from confirmatory factor analysis [CFA] = 0.64 to 0.88; corrected item-total correlations = 0.70 to 0.92; test-retest reliability = 0.72 to 0.90) and Rasch analyses (infit mean square = 0.73 to 1.30; outfit mean square = 0.74 to 1.32). ASHSr had significantly negative associations with DASS subscales (β = −0.15 to −0.42, ps < 0.001) and GHQ (β = −0.663, p < 0.001). Known-group validity was demonstrated by the significant differences between poor and good sleep hygiene based on ASHSr in the actigraphy measure and scores of PDSS, PSQI, and SDSC. The multigroup CFA and differential item functioning in Rasch analyses suggested that all the participants interpreted the ASHSr similarly, regardless of their gender or living in a private room.

    Conclusions: The Persian ASHSr demonstrated good reliability and validity in assessing sleep hygiene among Iranian adolescents. Healthcare providers may use it to assess the effectiveness of sleep hygiene programs.

  • 90.
    Lin, Chung-Ying
    et al.
    Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Yaseri, Mehdi
    Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Malm, Dan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Burri, Andrea
    Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
    Webb, Thomas L.
    Department of Psychology, The University of Sheffield, Sheffield, United Kingdom.
    Can a multifaceted intervention including motivational interviewing improve medication adherence, quality of life, and mortality rates in older patients undergoing coronary artery bypass surgery? A multicenter, randomized controlled trial with 18-month follow-up2017Ingår i: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 34, nr 2, s. 143-156Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for extended periods, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence in this patient group is therefore important.

    Objective: The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery.

    Methods: Patients aged over 65 years from 12 centers were assigned to the intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups using cluster randomization at center level. Medication adherence was evaluated using the Medication Adherence Rating Scale (MARS), pharmacy refill rate, and lipid profile; QoL was evaluated using Short Form-36. Data were collected at baseline; 3, 6, and 18 months after intervention. Survival status was followed up at 18 months. Multi-level regressions and survival analyses for hazard ratio (HR) were used for analyses.

    Results: Compared with patients who received TAU, the MARS, pharmacy refill rate, and lipid profile of patients in the EXP group improved 6 months after surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL also increased among patients in the EXP group as compared with those who received TAU at 18 months post-surgery (physical component summary score p = 0.02; mental component summary score p = 0.04). HR in the EXP group compared with the TAU group was 0.38 (p = 0.04).

    Conclusion: The findings suggest that a multifaceted intervention can improve medication adherence in older patients undergoing CABG surgery, with these improvements being maintained after 18 months. QoL and survival rates increased as a function of better medication adherence. ClinicalTrials.gov NCT02109523.

  • 91.
    Lindmark, Ulrika
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ. Centrum för oral hälsa.
    Bülow, Pia H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd). Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Social Work, University of the Free State, Bloemfontein, South Africa.
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Rönning, Helén
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ahlstrand, Inger
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Fransson, Eleonor I.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för naturvetenskap och biomedicin. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Gunnarsson, Nina
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd).
    Henricson, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Kjellström, Sofia
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Sandgren, Anna
    Center for Collaborative Palliative care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review2019Ingår i: Nursing Open, E-ISSN 2054-1058, Vol. 6, nr 3, s. 664-675Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Aims

    To continuing the quest of the concept of transition in nursing research and to explore how the concept of transition is used in occupational therapy, oral health and social work as well as in interdisciplinary studies in health and welfare, between 2003–2013.

    Design

    An integrative literature review.

    Methods

    PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Index and AMED databases from 2003–2013 were used. Identification of 350 articles including the concept of transition in relation to disciplines included. Assessment of articles are in accordance to Meleis' typologies of transition by experts in each discipline. Chosen key factors were entered into Statistical Package for the Social Sciences (SPSS).

    Results

    Meleis' four typologies were found in all studied disciplines, except development in oral health. The health‐illness type was the most commonly explored, whereas in social work and in occupation therapy, situational transitions dominated.

  • 92.
    Neher, M. S.
    et al.
    Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden.
    Johansson, P.
    Linkoping University, Department of Cardiology and Department of Social and Welfare studies, Linkoping, Sweden.
    Nilsen, P.
    Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nygårdh, Annette
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Exploring implementation issues when introducing a novel internet-based intervention to treat cardiovascular disease-associated mental health issues- the Implement-IT project.2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S52-S53Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Mental health (MH) problems such as depression and insomnia are prominent among patients with cardiovascular disease (CVD). They are associated with a negative impact on quality of life, higher health care costs and a poorer prognosis. Despite this most patients with CVD will not receive support or treatment for their MH problems. Studies in other patient groups have described internet based cognitive behavioral treatment (I-CBT) as a promising intervention, but I-CBT has not been tested in CVD patients. The I-CBT HEART research project aims specifically to develop and evaluate I-CBT programs for CVD patients with psychological distress. The programs, both of which are in early stages of clinical evaluation, respectively target patients with depressive symptoms and patients with insomnia. Two randomized controlled trials will be carried out, I-CBT for insomnia (HiT-IT) and I-CBT for depression (DOHART). Implementation research has shown overwhelming evidence of the difficulties that are often encountered in the diffusion and dissemination of novel treatments, such as I-CBT for CVD. To smooth the way for future use of a successful intervention in clinical practice, a better knowledge is needed of the factors that may hinder or support implementation in practice.

    Purpose: The overall aim of the IMPLEMENT-IT study, a part of the I-CBT HEART project, is to achieve a better understanding of potential future implementation issues by exploring barriers and facilitators from different stakeholder perspectives that may be of importance in future implementation.

    Methods: Both qualitative and quantitative data will be collected in conjunction with the RCT studies HiT-IT and DOHART. Interviews with stakeholders at different levels focusing on perceptions of the role of eHealth in traditional healthcare in general, and of the I-CBT HEART intervention in particular. Informants are recruited in groups of healthcare-tasked representatives of political parties at the regional level, local decision-makers in higher healthcare administration, clinical decision-makers, healthcare profe ssionals (providers), as well as patients. Our intention is to measure implementation leadership,empowerment and implementation climate in the clinical contexts, but also to develop valid and reliable instruments to be used in future studies.

    Conclusion: Studying factors that may potentially influence the implementation of a novel I-CBT program for treatment of MH problems in CVD patients through a mixed methods approach may assist the design of future implementation strategies in clinical cardiac care.

  • 93.
    Neher, Margit
    et al.
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Nygårdh, Annette
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Nilsen, Per
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Sweden.
    Johansson, Peter
    Department of Social and Welfare Studies, Linköping University, Sweden.
    Implementing internet-delivered cognitive behavioural therapy for patients with cardiovascular disease and psychological distress: a scoping review2019Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, nr 5, s. 346-357Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    BACKGROUND: Comorbid psychological distress (i.e. insomnia and depression) is experienced by 20-40% of patients with cardiovascular disease. This has a considerable impact on their health and quality of life, leading to frequent re-hospitalisations, higher healthcare costs and a shorter life expectancy. Internet-based cognitive behavioural therapy shows great potential for treating psychological distress in cardiovascular disease. Effective and feasible treatments can, however, only benefit patients if they are fully implemented in clinical care.

    AIM: This scoping review aimed to explore the literature for internet-based cognitive behavioural therapy in cardiovascular disease and for strategies to implement the intervention.

    METHODS: We searched electronic databases, journals and internet sources to find original studies about internet-based cognitive behavioural therapy in cardiovascular disease, adhering to scoping methodology guidelines. After identifying 267 titles, we screened 40 abstracts and chose 11 full-text articles for full-text screening. The results sections in four articles were searched for outcomes that related to the effectiveness and implementation of internet-based cognitive behavioural therapy by directed qualitative content analysis using an implementation framework.

    RESULTS: Three of the four articles fulfilling the inclusion criteria concerned internet-based cognitive behavioural therapy for treating mild to moderate depressive symptoms in cardiovascular disease, and none focused on insomnia. The studies showed evidence for the effectiveness of internet-based cognitive behavioural therapy, and/or described patient factors influencing clinical effectiveness. Our qualitative content analysis showed that many implementation aspects and stakeholder perspectives remain unexplored.

    CONCLUSIONS: Internet-based cognitive behavioural therapy promises to alleviate patient suffering in cardiovascular disease. There is, however, little research about internet-based cognitive behavioural therapy for cardiovascular disease, and about how this evidence-based intervention is implemented.

  • 94.
    Nejati, Babak
    et al.
    Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Lin, Chien-Chin
    Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
    Aaronson, Neil K.
    Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
    Cheng, Andy S. K.
    Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Browall, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Lin, Chung-Ying
    Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Determinants of satisfactory patient communication and shared decision making in patients with multiple myeloma2019Ingår i: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 28, nr 7, s. 1490-1497Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To identify determinants of shared decision making in patients with multiple myeloma (MM) to facilitate the design of a program to maximize the effects of shared decision making.

    METHODS: This prospective longitudinal study recruited 276 adult patients (52% male, mean age 62.86 y, SD 15.45). Each patient completed the eHealth Literacy Scale (eHEALS), Multidimensional Trust in Health Care Systems Scale (MTHCSS), Patient Communication Pattern Scale (PCPS), and 9-Item Shared Decision-Making Questionnaire (SDM-Q-9) at baseline and the SDM-Q-9 again 6 months later. One family member of the patient completed the Family Decision-Making Self-Efficacy (FDMSE) at baseline. Structural equation modeling (SEM) was used to investigate the associations between eHealth literacy (eHEALS), trust in the health care system (MTHCSS), self-efficacy in family decision making (FDMSE), patient communication pattern (PCPS), and shared decision making (SDM-Q-9).

    RESULTS: SEM showed satisfactory fit (comparative fit index = 0.988) and significant correlations between the following: eHealth literacy and trust in the health care system (β = 0.723, P < 0.001); eHealth literacy and patient communication pattern (β = 0.242, P < 0.001); trust in the health care system and patient communication pattern (β = 0.397, P < 0.001); self-efficacy in family decision making and patient communication pattern (β = 0.264, P < 0.001); eHealth literacy and shared decision making (β = 0.267, P < 0.001); and patient communication pattern and shared decision making (β = 0.349, P < 0.001).

    CONCLUSIONS: Patient communication and eHealth literacy were found to be important determinants of shared decision making. These factors should be taken into consideration when developing strategies to enhance the level of shared decision making.

  • 95.
    Nejati, Babak
    et al.
    Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Lin, Chien-Chin
    Department of Laboratory Medicine and Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
    Imani, Vida
    Pediatric Health Research Center, Tabriz University of Medical Sciences Tabriz, Iran.
    Browall, Maria
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Lin, Chung-Ying
    Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Pakpour, Amir H.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
    Validating patient and physician versions of the shared decision making questionnaire in oncology setting2019Ingår i: Health Promotion Perspectives, ISSN 2228-6497, Vol. 9, nr 2, s. 105-114Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This study investigated the psychometric properties of the 9-Item Shared Decision Making Questionnaire (SDM-Q-9) and the 9-Item Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) using comprehensive and thorough psychometric methods in an oncology setting.

    Methods: Cancer survivors (n=1783; 928 [52.05%] males) and physicians (n=154; 121[78.58%] males) participated in this study. Each cancer survivor completed the SDM-Q-9. Physicians completed the SDM-Q-Doc for each of their cancer patient. Confirmatory factor analysis (CFA) and Rasch model were used to test the psychometric properties of SDM-Q-9 and SDM-Q-Doc.

    Results: SDM-Q-9 and SDM-Q-Doc demonstrated unidimensional structure in CFA and Rasch model. In addition, the measurement invariance was supported for both SDM-Q-9 and SDM-Q-Doc across sex using the multigroup CFA. Rash analysis indicates no differential item functioning (DIF) across sex for all the SDM-Q-9 and SDM-Q-Doc items. SDM-Q-9 and SDM-Q-Doc were moderately correlated (r=0.41; P<0.001).

    Conclusion: SDM-Q-9 and SDM-Q-Doc are valid instruments to assess shared decision making in the oncology setting.

  • 96.
    Nilsen, Per
    et al.
    Linköping University.
    Gardner, Benjamin
    University College London.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Accounting for the role of habit in lifestyle intervention research.2013Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, nr 1, s. 5-6Artikel i tidskrift (Övrigt vetenskapligt)
  • 97.
    Nilsen, Per
    et al.
    Linköping University.
    Roback, Kerstin
    Linköping University.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ellström, Per-Erik
    Linköping University.
    Creatures of habit: accounting for the role of habit in implementation research on clinical behaviour change2012Ingår i: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 7, artikel-id 53Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Social cognitive theories on behaviour change are increasingly being used to understand and predict healthcare professionals' intentions and clinical behaviours. Although these theories offer important insights into how new behaviours are initiated, they provide an incomplete account of how changes in clinical practice occur by failing to consider the role of cue-contingent habits. This article contributes to better understanding of the role of habits in clinical practice and how improved effectiveness of behavioural strategies in implementation research might be achieved.

    DISCUSSION: Habit is behaviour that has been repeated until it has become more or less automatic, enacted without purposeful thinking, largely without any sense of awareness. The process of forming habits occurs through a gradual shift in cognitive control from intentional to automatic processes. As behaviour is repeated in the same context, the control of behaviour gradually shifts from being internally guided (e.g., beliefs, attitudes, and intention) to being triggered by situational or contextual cues. Much clinical practice occurs in stable healthcare contexts and can be assumed to be habitual. Empirical findings in various fields suggest that behaviours that are repeated in constant contexts are difficult to change. Hence, interventions that focus on changing the context that maintains those habits have a greater probability of success. Some sort of contextual disturbance provides a window of opportunity in which a behaviour is more likely to be deliberately considered. Forming desired habits requires behaviour to be carried out repeatedly in the presence of the same contextual cues.

    SUMMARY: Social cognitive theories provide insight into how humans analytically process information and carefully plan actions, but their utility is more limited when it comes to explaining repeated behaviours that do not require such an ongoing contemplative decisional process. However, despite a growing interest in applying behavioural theory in interventions to change clinical practice, the potential importance of habit has not been explored in implementation research.

  • 98.
    Nordblom, Ann-Katrin
    et al.
    Skaraborg Hospital of Skövde, Skövde, Sweden .
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. University Hospital, Linköping, Sweden.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Impact on a Person's Daily Life During Episodes of Supraventricular Tachycardia: A Qualitative Content Analysis From a Holistic Perspective2017Ingår i: Journal of Holistic Nursing, ISSN 0898-0101, E-ISSN 1552-5724, Vol. 35, nr 1, s. 33-43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To describe the impact of episodes of supraventricular tachycardia (SVT) on a person’s daily life from a holistic perspective.

    Method: A deductive descriptive design was used. Twenty semistructured interviews (12 women and 8 men) were conducted before planned ablation of SVT and were analyzed using qualitative content analysis.

    Results: Living with SVT had a complex impact on daily life. Initially, the patients described an inhibited existence due to demands to give up things that they had previously been doing, in case the unpredictable episodes of SVT would occur. The episodes caused fatigue and worry, which together created a barrier for living life to the full by making the person give up undertakings. The patients constantly needed to find short-term and long-term strategies to prevent new episodes from happening.

    Conclusion: Episodes of SVT entail a complex life situation as the person’s entire existence is affected in daily life. To understand the impact of SVT on daily life, nurses and other health care professionals need increased knowledge and understanding to be able to provide support through relevant information and take optimal care measures.

  • 99.
    Nygårdh, Annette
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Neher, Margit
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
    Nilsen, Per
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Johansson, Peter
    Department of Cardiology, University Hospital, Linköping, Sweden.
    Towards internet-based cognitive behavioural therapy for patients with cardiovascular disease and comorbid depression and insomnia?2017Ingår i: European Journal of Cardiovascular Nursing, Vol. 16, nr 7, s. 565-566Artikel i tidskrift (Övrigt vetenskapligt)
  • 100.
    Pakpour, Amir H.
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Qazvin University of Medical Sciences, Qazvin, Iran.
    Broström, Anders
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Malm, Dan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Mårtensson, Jan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Saffari, M.
    Baqiyatallah Medical Sciences University, Tehran, Iran.
    Fridlund, Bengt
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    Prospective case-control study of sexual dysfunction in female patients with Takotsubo cardiomyopathy2017Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, nr Suppl. 1, s. S85-S86Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Regarding the lack of earlier studies on sexual function in female patients with Takotsubo cardiomyopathy (TSCM), the current study aimed at an investigation of psychological and quality of life measures associated with sexual function in female patients with TSCM.

    Methods: In this Prospective case-control study, female patients with TSCM from university hospitals in Tehran and Qazvin were enrolled and matched (1:1.1) with acute myocardial infarction (AMI) along with healthy controls (94 patients per group). Data on hospital anxiety and depression scale, SF-12, female sexual function index and female sexual distress scale were assessed at baseline, 6 months and 18 months. Multilevel logistic regressions ought associations between variables.

    Results: Sexual function, anxiety and depression at baseline were different among the groups with worse situations in female patients with TSCM (p < 0.01). Quality of life at baseline was similar among patient groups but at lower state than healthy controls. Overall, quality of life subscales especially among female patients with TSCM showed a downward trend, indicating deterioration overtime. Higher prevalence of sexual dysfunction in TSCM group was seen compared to female patients with AMI and control group over time (OR, 3.10 and 2.28 respectively). Sexual functioning was found to be a mediator between anxiety and quality of life which positively impacts on patient’s quality of life.

    Conclusions: Since the psychological and quality of life measures as well as sexual function indicated a descending trend across time, there is a necessity to intervene for these women by focus on problems like anxiety to control health deterioration.

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