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  • 1.
    Andreae, Christina
    et al.
    Linköping University;Uppsala University.
    Stromberg, Anna
    Linköping University;Univ Calif Irvine, USA.
    Chung, Misook L.
    Univ Kentucky, USA.
    Hjelm, Carina
    Linköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University;Kalmar County Hospital.
    Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure2018In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 2, p. E15-E20Article in journal (Refereed)
    Abstract [en]

    Background: Decreased appetite and depressive symptoms are clinical problems in patients with heart failure. Both may result in impaired health status. Objective: The aims of this study were to investigate the association between appetite and health status in patients with heart failure and to explore whether depressive symptoms moderate this association. Methods: In this cross-sectional study, patients with heart failure (n = 186; mean age, 71 years), New York Heart Association class II to IV, participated. Data on appetite (Council of Nutrition Appetite Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and health status (EQ-5D 3-level scale [EQ-5D-3L] descriptive system, EQ-5D-3L index, and EQ Visual Analog Scale) were collected by self-rating questionnaires. Pearson correlation was used to investigate the association between appetite and health status. Multiple regression was performed to examine whether depressive symptoms moderate the association between appetite and health status. Results: There was a significant association between appetite and health status for EQ-5D-3L descriptive system, mobility (P < .001), pain/discomfort (P < .001), and anxiety/depression (P < .001). This association was also shown in EQ-5D-3L index (P < .001) and EQ Visual Analog Scale (P < .001). Simple slope analysis showed that the association between appetite and health status was only significant for patients without depressive symptoms (B = 0.32, t = 4.66, P < .001). Conclusions: Higher level of appetite was associated with better health status. In moderation analysis, the association was presented for patients without depressive symptoms. Decreased appetite is an important sign of poor health status. To improve health status, health professionals should have greater attention on appetite, as well on signs of depressive symptoms.

  • 2.
    Dalteg, Tomas
    et al.
    Jönköping University.
    Benzein, Eva
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sandgren, Anna
    Jönköping University.
    Fridlund, Bengt
    Jönköping University.
    Malm, Dan
    Jönköping University.
    Managing uncertainty in couples living with atrial fibrillation2014In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 3, p. E1-E10Article in journal (Refereed)
    Abstract [en]

    Background: Living with a chronic disease such as atrial fibrillation (AF) not only affects the patient but also has implications for the partner. There is a lack of research on couples living with AF and, in particular, how they experience and deal with the disease.

    Objective: The aim of this study was to explore couples’ main concerns when one of the spouses is afflicted with AF and how they continually handle it within their partner relationship.

    Methods: Classical grounded theory was used throughout the study for data collection and analysis. Interviews were conducted with 12 couples (patient and partner together). There were follow-up interviews with 2 patients and 2 partners separately.

    Results: Couples living with AF experience uncertainty as a common main concern. This uncertainty was fundamentally rooted in not knowing the cause of AF and apprehension about AF episodes. Couples managed this uncertainty by either explicitly sharing concerns related to AF or through implicitly sharing their concerns. Explicit sharing incorporated strategies of mutual collaboration and finding resemblance, whereas implicit sharing incorporated strategies of keeping distance and tacit understanding. Time since diagnosis and time being symptom-free were factors influencing afflicted couples’ shifting between implicit and explicit sharing.

    Conclusions: Atrial fibrillation affects the partner relationship by bringing uncertainty into couples’ daily lives. Even though this study shares similarities with previous studies on couples living with chronic disease, it contributes to the existing knowledge by presenting a set of strategies used by couples in managing uncertainty when living with AF.

  • 3.
    Lin, Chung-Ying
    et al.
    Hong Kong Polytech Univ, Peoples Republic of China.
    Ou, Huang-tz
    Natl Cheng Kung Univ, Taiwan.
    Nikoobakht, Mehdi
    Iran Univ Med Sci, Iran.
    Broström, Anders
    Jönköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital.
    Pakpour, Amir H.
    Jönköping University;Qazvin Univ Med Sci, Iran.
    Validation of the 5-Item Medication Adherence Report Scale in Older Stroke Patients in Iran2018In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 6, p. 536-543Article in journal (Refereed)
    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-2 = 0.567) was more than that of the MPR (R-2 = 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.

  • 4.
    Lin, Chung-Ying
    et al.
    Hong Kong Univ Sci & Technol, Peoples Republic of China.
    Pakpour, Amir H.
    Qazvin Univ Med Sci, Iran;Jönköping University.
    Brostrom, Anders
    Jönköping University.
    Fridlund, Bengt
    Jönköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Strömberg, Anna
    Linköping University.
    Jaarsma, Tiny
    Linköping University;ACU, Mary MacKillop Inst Hlth Res, Australia.
    Martensson, Jan
    Jönköping University.
    Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients2018In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 3, p. 281-288Article in journal (Refereed)
    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 legstfeet 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.

  • 5. Rönning, Helén
    et al.
    Årestedt, Kristofer
    Linköpings universitet.
    Erik Nielsen, Niels
    Swahn, Eva
    Strömberg, Anna
    Development and psychometric evaluation of the knowledge scale for adults with congenitally malformed hearts.2013In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 28, no 3, p. 228-237Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND RESEARCH OBJECTIVE: Adults with congenitally malformed hearts have knowledge gaps regarding their heart condition, and their level of knowledge is not routinely assessed during follow-up. One reason for this is that there are few validated, user-friendly questionnaires to assess knowledge about congenital heart disease and its effects on daily life. Failure to identify low levels of knowledge could lead to less motivated and insecure individuals not actively involved in treatment and care of their heart condition. Therefore, the objective of this study was to develop and test a knowledge scale for adults with congenitally malformed hearts.

    PARTICIPANTS AND METHODS: The development and psychometric evaluation of the Knowledge Scale for Adults With Congenitally Malformed Hearts (KnoCoMH) followed 2 phases: (1) development and evaluation of the initial version, with face validity and content validity assessed by experts and adults with congenitally malformed hearts, and (2) evaluation and refinement of the KnoCoMH in adults with congenitally malformed hearts, including item difficulty level, internal consistency, and test-retest reliability.

    RESULTS: The development and evaluation of a knowledge scale for adults with congenitally malformed hearts resulted in the KnoCoMH including 46 items in 4 domains: General Knowledge, with a Kuder-Richardson formula 20 (KR-20) value of 0.68; Medical Treatment, with a KR-20 value of 0.74; Endocarditis Prophylaxis, with a KR-20 value of 0.90; and Contraceptives and Pregnancy, with a KR-20 value of 0.65. Test-retest evaluation showed significant correlations between 0.50 and 0.67 (P < .01) in all 4 domains. There was good variation in item difficulty, with a mean value of 0.56 in General Knowledge, 0.62 in Medical Treatment, 0.33 in Endocarditis Prophylaxis, and 0.48 in Contraceptives and Pregnancy.

    CONCLUSIONS: The KnoCoMH has acceptable psychometric properties for most of the knowledge domains included. It can be used for evaluating knowledge among adults with congenitally malformed hearts and its associations with other outcomes. However, further studies are advisable to test construct validity, predictive validity, and responsiveness.

  • 6.
    Ulla, Walfridsson
    et al.
    Linköping Univ.
    Anna, Strömberg
    Linköping Univ.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköpings Universitet, Ersta Sköndal Univ Coll.
    Development and Validation of an Arrhythmia-Specific Scale in Tachycardia and Arrhythmia With Focus on Health-Related Quality of Life2015In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 30, no 2, p. 98-108Article in journal (Refereed)
    Abstract [en]

    Arrhythmias can cause a profoundly negative impact on a person's daily life, leading to impaired health-related quality of life (HRQOL). Assessment of HRQOL can provide valuable information before, during, and after healthcare interventions for arrhythmias. Objective: The aim was to develop and validate a disease-specific scale evaluating HRQOL in patients with different forms of arrhythmia. Methods: The Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA HRQOL) was developed from a literature review, patient interviews, and expert panel evaluations. This version was then psychometrically evaluated in patients treated with radiofrequency catheter ablation because of different forms of arrhythmias and patients who sought emergency care because of atrial fibrillation. Construct validity was evaluated with item-total correlations, confirmatory factor analyses, and convergent and discriminant validity. Internal consistency was evaluated using Cronbach's alpha. Results: All items reached the expected level of item-total correlations of greater than 0.3 for the total scale. The content validity index was sufficient for all items, as was the total scale (0.86-1.0). The 2-factor confirmatory factor analysis model that included the physical and mental factors showed a better fit between model and data than the 1-factor model did (P < .001). Convergent and discriminant validities were evaluated in the correlation analyses between the ASTA HRQOL subscales and SF-36 physical and mental dimensions. A strong correlation was found between the hypothesized physical and mental scales. Internal consistency was satisfactory with a lower bound confidence interval (95%) for Cronbach's alpha .70 or greater for all the ASTA HRQOL scales. Conclusions: The ASTA HRQOL questionnaire can be a valuable contribution to HRQOL assessments in patients with different forms of arrhythmia. Until there is more evidence regarding validity and reliability, using both the total and subscale scores is recommended.

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