Terapias de rescate: ventilación en decúbito prono

1.12. INSUFICIENCIA RESPIRATORIA AGUDA EN PACIENTES CON GRIPE. PAPEL DEL SOPORTE RESPIRATORIO

1.12.4. Terapias de rescate: ventilación en decúbito prono

This dissertation project is comprised of three complementary studies to address gaps in knowledge on illness perceptions and self-management in late-life chronic disorders. Findings are documented in the following three manuscripts:

Manuscript 1. Illness Perceptions and Self-management among Older Adults with Mild

Cognitive Impairment

Manuscript 2. Illness Perceptions, Self-efficacy, and Medication Adherence among Older

Adults with Type 2 Diabetes

Manuscript 3. Illness Perceptions in Type 2 Diabetes and Mild Cognitive Impairment

Although each manuscript described a study with a unique purpose, the findings together advance understanding of illness perceptions and self-management among older adults with chronic disorders by highlighting the influence of disease characteristics, specifically whether the condition represents a physical [T2DM] or mental [MCI] disorder. I adapted Leventhal’s (1984, 2003) Common Sense Model (CSM) of Self-Regulation as a conceptual framework for this set of studies. The rationale for selecting this framework is that, unlike other models, the CSM framework places illness perceptions into the center of the process around the performance of health behaviors. Below is a summary of the key messages embedded within this framework.

First, illness perceptions can independently, or through their interactions with sociodemographic characteristics/comorbid conditions, be associated with either self- efficacy or self-management among older adults with chronic disorders. For example, in our

sample of persons with MCI, a trend in the association between illness perceptions and self- management was only observed when considering sociodemographic characteristics or the number

and medication adherence among older adults with T2DM, which suggests that beliefs about T2DM may play an important role in managing T2DM (manuscript 2). Taken together, these findings confirm previous research that not only illness perceptions, but sociodemographics and comorbid conditions may also affect self-management practices to prevent or delay disease progression among older adults with chronic disorders. This finding holds true regardless of one’s disease characteristics. A recent meta-analysis suggests that certain dimensions of illness perceptions, such as perceived controllability and illness coherence, are associated with either coping strategies or well-being among persons with chronic disorders (Hagger et al., 2017). Indeed, nurses and other health care professionals who are counseling older adults with chronic disorders should consider patients’ perceptions about their health conditions together with sociodemographic characteristics and comorbid conditions.

Another core message from this dissertation project is that patients’ disease characteristics (physical [T2DM] or mental [MCI]) play a critical role in how older adults formulate perceptions about health conditions affecting them. Specifically, our tests of effect

of disease characteristics (T2DM or MCI) revealed significant differences in illness perceptions between T2DM and MCI participants after controlling for covariates (manuscript 3). Although both T2DM and MCI participants believed that their conditions will be long-lasting, our participants with T2DM were more likely than those with MCI to view their condition as being controllable and understandable. This may reflect distinct differences in disease characteristics between late-life physical and mental disorders. For example, stigma associated with late-life cognitive changes and the fact that there is no curative treatment for MCI may contribute to lower levels of perceived controls over and understanding of a health condition among our participants with MCI. While illness perceptions may affect subsequent self-management behaviors in chronic

disorders (Leventhal et al., 2016), other factors such as sociodemographics and comorbid conditions may also serve as facilitators or barriers to self-management in chronic disorders (Schulman-Green, Jaser, Park, & Whittemore, 2016). Therefore, understanding patients’ unique illness perceptions based on their disease characteristics (physical or mental) as well as other factors (sociodemographics and comorbid conditions) is a first step to improve self-management in late-life chronic disorders.

In sum, this dissertation advances the current state of scientific knowledge with regard to illness perceptions and self-management as well as self-efficacy within the context of late-life physical [T2DM] and mental [MCI] disorders. Knowledge obtained from this dissertation project suggests direction of future research including:

1) Longitudinal investigations exploring the causal relationship between illness perceptions and self-management in late-life chronic disorders.

2) Identifying a mediating role of self-efficacy in the relationship between illness perceptions and self-management.

3) Testing a full CSM process in which associations between illness perceptions, self- management, and health outcomes are considered.

4) Validating and extending findings in samples comprised of persons experiencing other late-life physical and mental disorders.

Appendix A: Study Instruments and Assessments

Brief Illness Perception Questionnaire (Brief IPQ)

For the following questions, please circle the number that best corresponds to your views:

(Note. The term “your illness” was replaced with “diabetes” or “your memory difficulties/MCI” in the parent studies)

1.How much does your illness affect your life?

0 1 2 3 4 5 6 7 8 9 10

no affect severely

at all affects my life

2.How long do you think your illness will continue?

0 1 2 3 4 5 6 7 8 9 10

a very forever

short time

3.How much control do you feel you have over your illness?

0 1 2 3 4 5 6 7 8 9 10

absolutely extreme amount

no control of control

4.How much do you think your treatment can help your illness?

0 1 2 3 4 5 6 7 8 9 10

not at all extremely

helpful

5.How much do you experience symptoms from your illness?

0 1 2 3 4 5 6 7 8 9 10

no symptoms many severe

at all symptoms

6.How concerned are you about your illness?

0 1 2 3 4 5 6 7 8 9 10

no at all extremely

7.How well do you feel you understand your illness?

0 1 2 3 4 5 6 7 8 9 10

don’t understand understand

at all very clearly

8.How much does your illness affect you emotionally? (e.g., does it make you angry, scared, upset or depressed?)

0 1 2 3 4 5 6 7 8 9 10

no at all extremely

affected emotionally affected

emotionally

9.Please list in rank-order the three most important factors that you believe caused your illness.

The most important causes for me:

1.________________________ 2.________________________ 3.________________________

Illness Perception Questionnaire-R (IPQ-R): Illness Coherence and Causality Subscales Illness Coherence Subscale

The following are five statements about how you view your memory or thinking difficulties. Although these statements may seem similar, it is important I read all of them and ask you to rate how much you agree or disagree with each one.

Please indicate how much you agree or disagree with the following statements about your illness by ticking the appropriate box.

Views About Your Illness

Strongly Disagree Disagree Neither Agree nor Disagree

Agree Strongly _Agree

The symptoms of my memory or thinking difficulties are puzzling to

me     

My memory or thinking difficulties

are a mystery to me     

I don’t understand my memory or

thinking difficulties     

My memory or thinking difficulties

doesn’t make any sense to me     

I have a clear picture or understanding of my memory or

Causality Subscale

We are interested in what you consider may have been the cause of your memory or thinking difficulties. As people are very different, there is no correct answer for this question. We are most interested in your own views about the factors that caused your memory or thinking difficulties rather than what others including doctors or other family may have suggested to you.

Please list in rank‐order the three most important factors that you believe caused your memory or thinking difficulties.

The most important causes for me…

Cause 1:

Cause 2:

Assessment of Intention to Perform Health Behaviors

(Notes. This questionnaire was used in the first set of MCI parent study. The data will be manually recoded to address the items assess by the REVEAL Health Behavior measure [Chao et al., 2008], which is provided on the next page.)

Interview Instructions: Introduce this assessment by informing the participant that the following set of questions focuses on his or her plans to perform health-related activities that may have been discussed at his or her last clinic visit (use Recommendation Form responses to identify action for insertion below). Instruct the participant to select the response that best describes his or her intentions.

Section A:

1. How likely are you to within the next six months?

Very likely Somewhat

likely Not sure

Somewhat

unlikely Very unlikely

2. How likely are you to within the next six months?

Very likely Somewhat

likely Not sure

Somewhat

unlikely Very unlikely

3. How likely are you to within the next six months?

Very likely Somewhat

likely Not sure

Somewhat

unlikely Very unlikely

4. How likely are you to within the next six months?

Very likely Somewhat

likely Not sure

Somewhat

unlikely Very unlikely

5. How likely are you to within the next six months?

Very likely Somewhat

likely Not sure

Somewhat

unlikely Very unlikely

6. How likely are you to within the next six months?

Very likely Somewhat

likely Not sure

Somewhat

unlikely Very unlikely

Section B:

What, if any, other changes will you make as a result of being diagnosed with mild cognitive impairment?

Health Behavior Assessment

Are you currently taking any steps to help prevent further memory problems or the onset of Alzheimer's disease?

Yes No

This lists some categories of health or behavior changes that apply to some people.

As we run down this list, let me know which categories apply to the changes you have made, and then specifically what change was made.

What types of preventative measure are you taking? Since your diagnosis, have you made any…

Preventative Measures

Yes Please Specify

1. Dietary changes

o

2. Physical activities

o

3. Medications

o

4. Vitamins

o

5. Herbal Supplements

o

6. Activities to reduce stress

o

7. Mental activities (e.g., crossword

puzzles, luminosity)

o

8. Other life style changes (e.g., alcohol

Self-Efficacy for Managing Chronic Disease (SEMCD)

We would like to know how confident you are in doing certain activities. For each of the following questions, please choose the number that corresponds to your confidence that you can do the tasks regularly at the present time.

1. How confident are you that you can keep the fatigue caused by your diabetes from interfering with the things you want to do?

Not at all