Till Örebro universitet

AIM AND OBJECTIVES: To acquire knowledge regarding the contents to be implemented in an interactive ICT-platform perceived to be relevant to health and self-care among older persons based on the literature, healthcare professionals and the older persons themselves.

BACKGROUND: The growing ageing population places demands on the healthcare system to promote healthy ageing and to strengthen the older person's self-care ability. This requires innovative approaches to facilitate communication between the older person and healthcare professionals, and to increase the older person's participation in their care. An information and communication technology-platform (ICT-platform) could be used for this purpose, but the content needs to be relevant to both the older persons and the healthcare professionals.

DESIGN: Descriptive qualitative design.

METHODS: This study was based on three samplings: a scoping review of the literature (n=20 articles), interviews with healthcare professionals (n=5), and a secondary analysis of interviews with older persons (n=8) and nursing assistants (n=7). The data were analysed using qualitative content analysis.

RESULTS: Four areas were identified to be of relevance to older persons' perceived health: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care. Self-care was described in the literature and by the healthcare professionals more than by the older persons.

CONCLUSIONS: The results show a concordance in the data samplings that give a clear indication of the areas relevant to older persons' health and self-care that can be integrated in an interactive ICT-platform for use in regular daily care assessments. Descriptions of self-care was limited indicating a possible gap in knowledge that requires further research.

RELEVANCE TO CLINICAL PRACTICE: Areas relevant to older persons' health and self-care could be used for regular assessment to support and promote healthy ageing.

Purpose: The sense of coherence (SOC) scale is widely used and has an extensive history in research. The psychometric properties of the SOC scale have been investigated using classic test theory, but modern test theory enables a more multifaceted investigation of the properties of the SOC scale. The aim of this study was to explore the measurement properties of the SOC scale using the Rasch measurement model.

Methods: SOC questionnaires from a sample of 623 healthy adults were analysed using Rasch analysis. Aspects analysed were rating scale functioning, item fit, unidimensionality, differential item functioning (DIF), targeting, and reliability.

Results: Rating scale analysis showed that the seven scale steps were not utilized in the intended manner and that a shortening to five categories would be beneficial. Twelve out of the 13 items showed acceptable goodness-of-fit and 43 % of the variance was explained by the SOC dimension in the principal components analysis. There was no DIF between subgroups in the sample. The items were well targeted to the sample SOC level with no ceiling or floor effects. Item and person reliability were good and the person separation index was 2.05 indicating that the scale can separate three different levels of SOC, which corresponds well to its theoretical base.

Conclusions: The SOC scale is generally well functioning; however, the three components of SOC seem to influence the PCA results. The scale would benefit from a reduction from seven to five scale steps, which would need to be investigated further.

Introduction: For immediate and continuous dialogue between patients and caregivers new approaches in modern technology are encouraged today. In cooperation with a Swedish health management company, we developed an interactive mobile phone application for the assessment of symptom distress, evidence-based self-care advice and an alerting function of severe symptoms with instant access to professionals in real time. By using this technique patients can communicate symptoms with instant support while cared for out-side hospital but at the same time reassured that their condition is monitored by the professionals. The objective of this study was to evaluate the feasibility and acceptability of the application for patients with prostate cancer during radiotherapy and for the involved health care staff.

Material and Methods: Evidence-based symptoms and related selfcareadvices were implemented in the application after literature review and interviews with patients and health care professionals. Nine patients diagnosed with prostate cancer undergoing radiotherapy treatment were recruited to test the application for two weeks. The patients reported in the electronic symptom questionnaire daily. After the two weeks they were interviewed about their experience. Nurses directly involved in the care and treatment of the participating patients were interviewed at the end of study.

Results: Overall, patients and nurses reported positive experiences of using the mobile phone system. The patients considered the application helpful and easy to use although there were some suggestions for further development of the electronic questionnaire. Most of the patients had read the self-care advice and found them useful. The alerting system was activated in several cases; the nurses found it useful to identify and manage problematic symptoms early and the patients felt safe and well cared for. Some of the nurses considered the monitoring system time-consuming and made suggestions for improvement.

Conclusions: Both patients and nurses could see the potential for using the mobile application in clinical practice. The system enables the involvement of the patients and the alerts showed problematic symptoms promoting timely interventions. The results support further development and testing of the system in full-scale.

Background: In the front line in cancer care is to systematically integratepatient reported outcomes (PRO) in clinical practice. The development ofthis research program is based on The Participatory Care Model, and buildson how patients can be integrated in their care. The aim is to evaluate the effects of an interactive e-health solution for assessment of symptom burden, generating instant self-care advice and instant access to health care professionals.

Methods: The hypothesis is that the intervention promotes safe and participatory care and thereby improves clinical management and health care costs. The experimental multicenter studies incorporate a mixedmethod approach. Ongoing studies include patients with pancreatic and prostate cancer using the mobile phone application in comparison to control groups in standard care. Outcomes are collected before and after treatment by questionnaires concerning capacity to understand, communicate health needs and promote healthy behaviors (health literacy), symptom burden and management and quality of life and from records and registers about disease progress and health care costs. Interviews concern participatory and meaningful care. Studies are ongoing for patients with prostate and pancreatic cancer and elderly populations living at home or in care homes.

Results: By using technology patients are able to communicate symptoms and receive instant support while cared for on an outpatient basis and at the same time feel reassured that their condition is monitored by health care professionals facilitating safe and participatory care.

Mothers’ perception of their relationship with their baby might affect sensitive parenting. This study aimed to explore first time mothers’ feelings for and their relation to the baby associated with how they responded to the “mother to infant relation and feelings (MIRF) scale” as a step in the validation process of the scale. Interviews with ten first-time mothers, three days after birth, were performed, using open questions followed by questions directly from the MIRF scale items. An inductive and deductive approach inspired by the “Think aloud” method guided the study. Results describe main category; New mothers bewilderment and anticipation which contained four categories; Natural and great but mixed, Maternal instinct and kinship, Ability and expectations and Not yet for real. When mothers responded to MIRF scale items they describe talking to their baby which they did not in their open answers. Answering the MIRF scale helped mothers in differentiating between their own mixed feelings of becoming mothers and their relation to and feelings for the baby. The MIRF scale appears valid in reflecting important aspects of mothers’ feelings for and relation to their baby. The MIRF scale could be used in research and when evaluating care routines as well as in dialogue with new mothers to support mother-to-infant interactions. 

Background: Breast cancer challenges not only the patients who suffer from the disease but also their family caregivers. Little is known about how Iranian family caregivers are influenced.

Objective: The objective of the study was to describe quality of life (QoL), well-being, sense of coherence (SOC), spirituality, and religious coping in family caregivers of patients with breast cancer at the time of diagnosis (T1) and 6 months after diagnosis (T2) and identify predictive factors of change in QoL.

Methods: Data were collected from 150 family caregivers. The Persian version of Caregiver Quality of Life Index-Cancer, Sense of Coherence Scale, Spirituality Perspective Scale, Religious Coping Scale, and the Health Index were used at T1 and T2.

Results: The results showed significant increase in overall QoL (P = .00) and well-being (P = .03) at T2. However, ratings of their SOC (P = .03), spirituality (P = .01), and negative religious coping (P = .00) decreased. Multiple regression analyses revealed the rating of QoL at T1 as the strongest predictor in the rating of quality-of-life change at T2 followed by the degree of SOC, negative religious coping, and patients having more severe breast cancer (R-2 = 0.64).

Conclusion: Despite improved QoL in the sample from diagnosis to 6 months, family caregivers struggle to cope with the situation.

Implications for Practice: It is suggested to develop and investigate the effects of support programs targeting coping ability in Iranian family caregivers to women with breast cancer.

Aim: To translate and test the reliability and validity of the Persian version of the Caregiver Quality of Life Index-Cancer scale.

Background: Research across many countries has determined quality of life of cancer patients, but few attempts have been made to measure the quality of life of family caregivers of patients with breast cancer. The Caregiver Quality of Life Index-Cancer scale was developed for this purpose, but until now, it has not been translated into or tested in the Persian language.

Design: Methodological research design. Methods. After standard translation, the 35-item Caregiver Quality of Life Index-Cancer scale was administered to 166 Iranian family caregivers of patients with breast cancer. A confirmatory factor analysis was carried out using LISREL to test the scale's construct validity. Further, the internal consistency and convergent validity of the instrument were tested. For convergent validity, four instruments were used in the study: sense of coherence scale, spirituality perspective scale, health index and brief religious coping scale.

Results: The confirmatory factor analysis resulted in the same four-factor structure as the original, though, with somewhat different item loadings. The Persian version of the Caregiver Quality of Life Index-Cancer scales had satisfactory internal consistency ( 0 72-0 90). Tests of convergent validity showed that all hypotheses were confirmed. A hierarchical multiple regression analysis additionally confirmed the convergent validity between the total Caregiver Quality of Life Index-Cancer score and sense of coherence ((beta) over cap = 0 34), negative religious coping ((beta) over cap = -0 21), education ((beta) over cap = 0 24) and the more severe stage of breast cancer ((beta) over cap = 0 23), in total explaining 41% of the variance.

Conclusion: The Persian version of the Caregiver Quality of Life Index-Cancer scale could be a reliable and valid measure in Iranian family caregivers of patients with breast cancer.

Relevance to clinical practice: The Persian version of the Caregiver Quality of Life Index-Cancer scale is simple to administer and will help nurses to identify the nursing needs of family caregivers.

Objective: To investigate the prevalence of self-rated dizziness/unsteadiness and health as well as to estimate the proportion of participants with peripheral vestibular disorders. Methods: Altogether, 2547 participants (66%) participated in an epidemiological cross-sectional study, including self-rated questions about dizziness/unsteadiness, concomitant auditory symptoms and self-rated general, psychosocial and mental health. Results: The overall prevalence of dizziness was 21% and higher among women (27%) than men (14%) (p < 0.001). Dizziness, provoked by the movement of lying-down (benign paroxysmal positional vertigo), was noted in 5% of the participants with the symptom occurring more often in women than in men (p < 0.001). Twenty-four percent of the men and 21% of the women with dizziness simultaneously experienced a sense of rotation and loss of hearing and tinnitus. Fifteen percent reported falls because of dizziness. Both men and women suffering from dizziness symptoms perceived worse self-rated health generally, psychosocially and mentally than those without symptoms of dizziness (p < 0.001). Conclusion: Dizziness-related symptoms are common in all age groups and may manifest worse self-rated health. About 50% of the participants had symptoms indicating origin of peripheral vestibular disorders. Self-rated questions seem capable of identifying patients for referral to clinical examinations and subsequently those who can be successfully treated.

PURPOSE: This study aimed to explore the predictive value of systematic inflammatory and metabolic markers in head and neck (H&N) cancer patients during radiotherapy (RT). METHODS: Twenty-seven patients were evaluated. The protocol included serial blood tests [highly sensitive C-reactive protein (hsCRP), albumin, insulin-like growth factor 1 (IGF-1), IGF binding protein 1 (IGFBP-1) and ghrelin], measurements of body weight and assessment of oral mucositis. RESULTS: The mean nadir of weight loss was observed at the end of RT. At the time of diagnosis, mean hsCRP was 5.2 +/- 1.0 mg/L. HsCRP significantly increased during RT and decreased during the post-RT period. Mean maximum hsCRP was 35.8 +/- 8.5 mg/L, with seven patients reaching >40 mg/L. A numerical decrease of albumin (by 18.2%) and only small changes in IGF-1, IGFBP-1 and ghrelin levels were observed. None of the metabolic parameters was significantly associated with weight loss. CONCLUSIONS: HsCRP increased in response to RT for H&N cancer as a sign of irradiation-induced inflammation. Weight loss was not preceded by changes of the metabolic parameters, indicating that assessment of the blood markers used in this study is of little value. Regular body weight measurement and assessment of oral mucositis are feasible, cheap and important procedures to control the metabolic homeostasis during RT.