J Korean Acad Nurs.  2019 Aug;49(4):472-485. 10.4040/jkan.2019.49.4.472.

The Development and Evaluation of a Health Literacy-Adapted Self-Management Intervention for Elderly Cancer Patients Undergoing Chemotherapy

• Kim YS
• Tae YS
• Jung KI

• KMID: 2456150
• DOI: http://doi.org/10.4040/jkan.2019.49.4.472

Abstract

PURPOSE
This study aimed to develop and evaluate the effectiveness of an adapted health literacy self-management intervention for elderly cancer patients undergoing chemotherapy.
METHODS
The intervention in this study was systematically developed through the six stages of Intervention Mapping Protocol and was based on Fransen et al's causal pathway model. A quasi-experimental trial was conducted on a total of 52 elderly patients (26 in an experimental group and 26 in a control group) undergoing chemotherapy in Korea. The intervention consisted of seven sessions over 5 weeks. The experimental tool for this study was an adapted health literacy self-management intervention, which was designed to promote a reduction in the symptom experience and distress of elderly cancer patients through the promotion of self-management behavior. To develop efficient educational materials, the participants' health literacy was measured. To educate participants, clear communication and the teach-back method were used. In addition, for the improvement of self-efficacy, four sources were utilized. For the promotion of self-management behavior, five self-management skills were strengthened. Data were collected before and after the intervention from June 4 to September 14, 2018. The data were analyzed with SPSS/WIN 21.0.
RESULTS
Following the intervention, self-management knowledge and behavior and, self-efficacy significantly improved in experimental group. Symptom experience and distress decreased in the experimental group compared to the control group.
CONCLUSION
The self-management intervention presented in this study was found to be effective in increasing self-management knowledge and behavior and, self-efficacy, and ultimately in reducing symptom experience and distress for elderly patients undergoing chemotherapy.

Keyword

Health Literacy; Drug Therapy; Aged; Neoplasm; Self-Management

MeSH Terms

Aged*
Drug Therapy*
Health Literacy
Humans
Korea
Methods
Self Care*

Figure

• 

  Figure 1. Conceptual framework of the study.

• 

  Figure 2. Interventional strategies for each section of self-management education.

Reference

References

1. Statistics Korea. 2016 Korean statistical information service [Internet]. Daejeon: Statistics Korea;c2016. [cited 2019 Apr 23]. Available from:. http://kostat.go.kr/.

2. European Society for Medical Oncology (ESMO). ESMO handbook of cancer in the senior patient [Internet]. Lugano: ESMO;c2016. [cited 2017 Mar 18]. Available from:. http://on-cologypro.esmo.org/Education-Library/Handbooks/Cancer-in-the-Senior-Patient.

3. Ko SM, Seong MH, Cho YM, Sok S. Effects of individual education for cancer patients and their family about chemotherapy on the SelfCare knowledge, SelfCare performance, family support, and anxiety. Journal of Korean Clinical Nursing Research. 2018; 24(1):1–9.

4. Kim YS, Tae YS, Nam GH. Distress and quality of life among elderly patients with gastric cancer: The mediating effect of social support. Korean Journal of Adult Nursing. 2017; 29(5):536–546. https://doi.org/10.7475/kjan.2017.29.5.536.

5. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine. 2011; 155(2):97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005.

6. Smith CA, Chang E, Gallego G, Balneaves LG. An education intervention to improve health literacy and decision making about supporting self-care among older Australians: A study protocol for a randomised controlled trial. Trials. 2017; 18:441. https://doi.org/10.1186/s13063-017-2182-2.

7. Lorig K, Holman H, Sobel D, Laurent D, González V, Minor, M. Living a healthy life with chronic conditions: Self-management of heart disease, arthritis, diabetes, depression, asthma, bronchitis, emphysema and other physical and mental health conditions. 4th ed. Boulder (CO): Bull Publishing Company;2012. p. 1–343.

8. Fransen MP, von Wagner C, Essink-Bot ML. Diabetes self-management in patients with low health literacy: Ordering findings from literature in a health literacy framework. Patient Education and Counseling. 2012; 88(1):44–53. https://doi.org/10.1016/j.pec.2011.11.015.

9. Husson O, Mols F, Fransen MP, van de Poll‐Franse LV, Ezendam NPM. Low subjective health literacy is associated with adverse health behaviors and worse health‐related quality of life among colorectal cancer survivors: Results from the profiles registry. Psycho-Oncology. 2015; 24(4):478–486. https://doi.org/10.1002/pon.3678.

10. Rigdon AS. Development of patient education for older adults receiving chemotherapy. Clinical Journal of Oncology Nursing. 2010; 14(4):433–441. https://doi.org/10.1188/10.CJON.433-441.

11. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods. 2009; 41(4):1149–1160. https://doi.org/10.3758/BRM.41.4.1149.

12. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale (NJ): Lawrence Erlbaum Associates;1988. p. 1–66.

13. Lee SJ. The developments and evaluations of a health literacy considered diabetes self-management program for older adults [dissertation]. Seoul: Seoul National University;2016. p. 1–144.

14. Bartholomew LK, Parcel GS, Kok G, Gottlieb NH, Fernán-dez ME. Planning health promotion programs: An intervention mapping approach. 3rd ed. San Francisco (CA): Jossey-Bass;2011. p. 209–597.

15. Whittemore R, Knafl K. The integrative review: Updated methodology. Journal of Advanced Nursing. 2005; 52(5):546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x.

16. Aspinall EE, Beschnett A, Ellwood AF. Health literacy for older adults: Using evidence to build a model educational program. Medical Reference Services Quarterly. 2012; 31(3):302–314. https://doi.org/10.1080/02763869.2012.698174.

17. Kim JH, Ham BJ, Yoo ES, Kim HK, Lee MS, Sim EJ. Development of recommendations for distress management toward improvement of quality of life in cancer patients. Seoul: Ministry for Health & Welfare;2009. May. Report No.: 0830690-1.

18. van Waart H, Stuiver MM, van Harten WH, Geleijn E, Kieffer JM, Buffart LM, et al. Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: Results of the PACES randomized clinical trial. Journal of Clinical Oncology. 2015; 33(17):1918–1927. https://doi.org/10.1200/JCO.2014.59.1081.

19. Ream E, Gargaro G, Barsevick A, Richardson A. Management of cancer-related fatigue during chemotherapy through telephone motivational interviewing: Modeling and randomized exploratory trial. Patient Education and Counseling. 2015; 98(2):199–206. https://doi.org/10.1016/j.pec.2014.10.012.

20. National Cancer Information Center. Recommendations for distress management in cancer patients version 1 [Internet]. Goyang: National Cancer Information Center;c2010. [cited 2017 May 11]. Available from:. https://www.cancer.go.kr/lay1/bbs/S1T674C680/B/26/view.do?article_seq=19644.

21. Sung NJ, Lee DU, Park KH. Suitability assessment of patients’ education materials made by Korean Academy of Family Medicine. Journal of the Korean Academy of Family Medicine. 2004; 25(9):669–677.

22. Jo YG. Korean language readability formula. Journal of Reading Research. 2016; 41:73–92. https://doi.org/10.17095/JRR.2016.41.3.

23. National Health Insurance Service. Health [Internet]. Wonju: National Health Insurance Service;c2016. [cited 2017 Mar 18]. Available from:. http://hi.nhic.or.kr/cd/ggpcd006/ggpcd006_m01.do.

24. Bandura A. Self-efficacy: Toward a unifying theory of be- havioral change. Psychological Review. 1977; 84(2):191–215. https://doi.org/10.1037/0033-295X.84.2.191.

25. Jacobsen PB, Phillips KM, Jim HSL, Small BJ, Faul LA, Meade CD, et al. Effects of self‐directed stress management training and home‐based exercise on quality of life in cancer patients receiving chemotherapy: A randomized controlled trial. Psycho-Oncology. 2013; 22(6):1229–1235. https://doi.org/10.1002/pon.3122.

26. Lynn MR. Determination and quantification of content validity. Nursing Research. 1986; 35(6):382–386. https://doi.org/10.1097/00006199-198611000-00017.

27. Kim SH. Validation of the short version of Korean functional health literacy test. International Journal of Nursing Practice. 2017; 23(4):e12559. https://doi.org/10.1111/ijn.12559.

28. Kim TY. The effect of reaction management education on knowledge and self care in cancer patient undergoing chemotherapy [master's thesis]. Jeonju: Chonbuk National University;2008. p. 1–85.

29. Park YS, Kim UC. The quality of life and interpersonal relationships among Korean adolescents. The Korean Journal of Educational Psychology. 2008; 22(4):801–836.

30. Kim JH. The influence of self-efficacy and social support on life-satisfaction: Comparative analysis of cancer patients and hospital employees [master's thesis]. Incheon: Inha University;2008. p. 1–65.

31. Oh PJ, Lee EO, Tae YS, Um DC. Effects of a program to promote self-efficacy and hope on the self: Care behaviors and the quality of life in patients with leukemia. The The Journal of Nurses Academic Society. 1997; 27(3):627–638. https://doi.org/10.4040/jnas.1997.27.3.627.

32. Wang XS, Williams LA, Eng C, Mendoza TR, Shah NA, Kirkendoll KJ, et al. Validation and application of a module of the M. D. Anderson Symptom Inventory for measuring multiple symptoms in patients with gastrointestinal cancer (the MDASI‐ GI). Cancer. 2010; 116(8):2053–2063. https://doi.org/10.1002/cncr.24920.

33. Liu YB, Li YF, Liu L, Chen YL. Effectiveness of the teach‐ back method for improving the health literacy of senior citizens in nursing homes. Japan Journal of Nursing Science. 2018; 15(3):195–202. https://doi.org/10.1111/jjns.12192.