Purpose The treatment of chronic kidney disease aims to delay dialysis and prevent progression to end-stage health complications. This study aimed to validate the Korean version of the Chronic Kidney Disease Self-Care (CKDSC-K) scale, which is used to measure self-care behaviors in patients with chronic kidney disease.
Methods Data from 285 participants were collected between August and November 2020. Validity was assessed in terms of content, construct, and concurrence through the content validity index and exploratory and confirmatory factor analyses. The reliability of the CKDSC-K was examined using internal consistency.
Results The final instrument consisted of 15 items across five factors (medication adherence, diet control, exercise, smoking behaviors, and blood pressure monitoring). The content validity index of the CKDSC-K was ≥.80. Confirmatory factor analysis indicated that factor loadings for the five factors ranged from .41 to .99, which explains the total variance of 75.3%. The internal reliability of the instrument was .81.
Conclusion The CKDSC-K scale has demonstrated acceptable reliability and validity and can be utilized to assess self-care behaviours in patients with chronic kidney disease. Additional research is recommended to expand the psychometric evaluation of the CKDSC-K.
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LITERASI KESEHATAN BERHUBUNGAN DENGAN SELF CARE MANAGEMENT PASIEN PENYAKIT GINJAL KRONIK YANG MENJALANI HEMODIALISIS Ferlan Ansye Pondaag, Dina Mariana, Musfirah Ahmad JURNAL KEPERAWATAN TROPIS PAPUA.2024; 7(1): 8. CrossRef
Purpose The purpose of this study was to develop the Osteoporosis Self-Care Scale (OSCS-13) and verify its validity and reliability.
Methods The subjects were 445 patients with osteoporosis who visited the hospital. They were randomly assigned into two groups as follows: 220 patients for exploratory factor analysis and 225 patients for confirmatory factor analysis. The OSCS-13’s construct validity, convergent-discriminant validity, structure validity, group validity, consistency reliability and test-retest reliability were evaluated.
Results This study examined four factors and 13 items scored on a 5-point likert scale. The confirmatory factor analysis showed adequate model fit indices (Minimum/Degree of Freedom [CMIN/DF]=1.70, Root Mean Residual [RMR] =.03, Root Mean Square Error of Approximation [RMSEA]=.06, Comparative Fit Index [CFI]=.97, Tucker-Lewis Index [TNI]=.96, Incremental Fit Index [IFI]=.97). Convergent-discriminative validity and convergent validity were demonstrated using measures of defining issue. Internal consistency reliability and test-retest reliability were found to be acceptable, as indicated by a Cronbach’s α of .65~.92 and an intraclass correlation coefficient of .65~.80.
Conclusion The OSCS-13 is a valid and reliable instrument. Hence, it is expected that this tool can be used to measure the level of self-care for patients with osteoporosis.
Purpose The purpose of this study was to examine the mediating effects of uncertainty appraisal and self-care behavior on uncertainty and the physiological indexes of hemodialysis patients.
Methods This study used a descriptive correlation design. The participants were 140 patients receiving hemodialysis treatment. Data were collected from July 16 to August 20, 2020. Measurements included Mishel’s uncertainty in illness scale, the uncertainty appraisal scale, and the self-care behavior scale. Data were analyzed using descriptive statistics. The mediating effects were verified by the bootstrapping method using the PROCESS macro for SPSS.
Results The mean scores for uncertainty, uncertainty danger appraisal, uncertainty opportunity appraisal, and self-care behavior, respectively, 2.67±0.42 (range 1~5), 1.34±1.02, 2.17±1.12 (range 0~5), 3.58±0.45 (range 1~5). Uncertainty did not have a direct effect on physiological indexes. However, uncertainty opportunity appraisal and self-care behavior had serial mediating effects on the relationship between uncertainty and physiological indexes of serum phosphate and interdialytic weight gain.
Conclusion To the control physiological indexes of hemodialysis patients, it is necessary to develop a nursing intervention program that can lower the this uncertainty and increase self-care behavior by considering uncertainty to be an opportunity.
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Purpose This study aims to evaluate the Korean revised version of the Self-Care Behaviors Scale’s (SCBS-K19) validity and reliability. Methods The data of 203 rheumatoid arthritis patients at a university hospital in D metropolitan city in South Korea were collected from July to August 2020, using a convivence sampling method. The SCBS-K19 was analyzed utilizing SPSS 26.0 and AMOS 23.0 programs. The SCBS-K19’s content validity, structure validity, item-convergent/discriminant validity, convergent validity, and internal consistency and reliability were evaluated. Results Among the items in original version, the items with a ceiling or floor effect of 30% or more were deleted, thus, resulting in a revised version with five sub-areas and 19 questions. The confirmatory factor analysis’ results showed adequate model fit indices (c2/df=2.29, GFI=.85, RMR=.06, RMSEA=.08, CFI=.91, TLI=.89, IFI=.91). The items’ convergence and discrimination validity were verified using the extracted mean variance (.52~.66) and composition reliability (.80~.90). The convergent validity was satisfactory as shown by its correlation with the Self-as Carer Inventory (SCI) (r=.60, p<.001). The Cronbach’s ⍺ for the overall scale was .88, and that of five subscales ranged from .77 to .90. Conclusion The SCBS-K19 is a valid and reliable instrument. Therefore it is expected that this tool can be used to measure the level of self-care in Korean patients with rheumatoid arthritis.
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Purpose This study aimed to identify subjective health status and specific self-efficacy, and their mediating effects on the relationship between health literacy and self-care behavior in stomach cancer patients following gastrectomy. Methods A descriptive survey design was used. Data were collected from 131 gastric cancer patients between 17 February and 10 September, 2020 at a cancer center in Gyeonggi-Do. The participants responded to a self-reporting questionnaire. Data were analyzed using descriptive statistics and the bootstrapping method with SPSS/WIN 25.0 and PROCESS macro program. Results The mean score for self-care behavior was 66.78±8.36. Self-care behavior was significantly associated with health literacy, subjective health status, and specific self-efficacy. The mediating effect of specific self-efficacy on the impact of health literacy on self-care behavior was confirmed. Conclusion The impact of health literacy on self-care behavior was mediated by specific self-efficacy in stomach cancer patients following gastrectomy. Further, the results suggest that specific self-efficacy needs to be considered in developing nursing interventions to enhance health literacy and improve self-care behavior for stomach cancer patients after gastrectomy.
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Purpose The purpose of this study was to verify the mediating effect of self-care performance between Self-Care Efficacy (SCE) and Health-Related Quality of Life (HRQoL) among patients on primary treatment for pulmonary tuberculosis. Methods A structured self-report survey was conducted with 143 patients on primary treatment for pulmonary tuberculosis. The collected data were analyzed using descriptive statistics, analysis of variance, Pearson correlation coefficient, hierarchical multiple linear regression, and Sobel test. Results There were significant correlations between participants’ SCE and self-care performance (r=.62, p<.001), SCE and HRQoL (r=.44, p<.001), and self-care performance and HRQoL (r=.54, p<.001). Self-care performance completely mediated the relationship between SCE and HRQoL (z=3.72, p<.001). Conclusion It is necessary to develop interventions for reinforcing SCE, focusing on low self-care groups, to ultimately improve the HRQoL of patients on primary treatment for pulmonary tuberculosis.
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PURPOSE This study was to develop the patient-tailored education and counseling program (PTECP) for patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), and to identify the effects of PTECP on awareness of risk factors, knowledge, self-efficacy, self-care behavior, and blood cholesterol profile (BCP). METHODS A non-equivalent control group pre-post design was used. Sixty patients who were newly diagnosed with CAD and treated PCI were recruited and participated either in an intervention group or a control group, thirty each. The PTECP focused on managing their own risk factors consisted of two individual educations, two individual counselings, three telephone counselings, and two short message services for eight weeks. Data were collected two times at baseline and 8 weeks after beginning of the program. RESULTS After eight weeks, the patients' awareness of risk factor (p < .001), knowledge (p=.015), self-efficacy (p < .001), and self-care behavior (p < .001) in the intervention group were significantly different from those of the control group. However, no difference in BCP was found between the groups. CONCLUSION The PTECP was effective in improving the patients' awareness of CAD risk factors, knowledge, self-efficacy, and self-care behavior. Successful PTECP might lead to better health outcome in patients with CAD through effective self-management.
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PURPOSE The objective of this study was to identify factors related to self-care adherence in symptomatic patients with heart failure (HF). METHODS Using a cross-sectional design, a convenience sample 209 outpatient clinic patients were recruited at two medical centers. Between October 2011 and August 2012, data were collected using the structured questionnaire. Factors related to self-care adherence were examined using hierarchical multiple regression. RESULTS Mean age of participants was 67.71 years and a half of them (53.6%) were female. They showed relatively low self-care adherence with mean scores of 61.88±12.92. Lower self-care adherence was reported in asking for low sodium items, weighing oneself, checking for ankle edema, and exercising for 30 minutes. The overall model significantly explained 23.9% of variance in self-care adherence. Among the predictors, education, New York Heart Association functional classification, and social support were statistically significant in influencing self-care adherence. The variable of negative emotional status such as anxiety and depression were not found to be significant. CONCLUSION These findings demonstrate that social support could help self-care adherence among symptomatic patients with HF. Thus, programs targeting self-care adherence in this population should consider the strategies improving social support.
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PURPOSE This study was designed to construct a predictive model to explain quality of life of stomach cancer patients with gastrectomy. METHODS Data were collected from July 10 to August 30, 2013 through survey using self-reported questionnaires. A total of 218 patients with gastrectomy was recruited from three different hospitals. Outcome variables were exogenous ones (self efficacy and social support) and endogenous ones (depression, perceived health status, self care behavior, and quality of life). RESULTS Goodness-of-fit of the hypothetical model was chi2=143.37, RMSEA=.07 CFI=.95, TLI=.93 SRMR=.05. Self care behavior, depression and perceived health status had significant direct effects on quality of life. Self efficacy and social support were affected quality of life indirectly. These variables explained 67.9% of total variance of quality of life, and self-care behavior was the most influential factor for quality of life. CONCLUSION The findings of this study suggested that self care behavior must be considered as an intervention strategy to improve quality of life. Also a development of a specific intervention program to promote self efficacy and control depression for patients with gastrectomy is essential to facilitate their self care behaviors.
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PURPOSE The purpose of this study was to investigate the effects of an individualized cardiac health education on self-care behavior and serum cholesterol levels patients with coronary artery disease. METHODS Twenty-two patients in the intervention group and 22 in the control group were assigned randomly in this study. The intervention group received an individualized cardiac health education program which consisted of four different sessions for a total of four sessions. Specifically, two sessions occurred during the patients' hospitalization with a third session at the time of discharge with a fourth session scheduled via telephone one week post discharge. Data were collected through a questionnaire for self-care behavior and a blood test for total cholesterol at the time of admission and the two weeks after discharge. The questionnaire for self-care behavior was a standardized instrument and serum cholesterol was measured by Accutrend GC (Roche, Germany). RESULTS Self-care behavior scores included diet, medication, exercise, risk factor, blood pressure measurement, and visits to hospital were significantly more in the experimental group compared to the control group. CONCLUSION The above findings indicate that the individualized cardiac health education was effective in increasing of self-care behavior.
PURPOSE This study was to identify the mental health and self-care activities according to perceived stress level in type 2 diabetic patients with metabolic syndrome. METHODS The descriptive survey design was conducted using a convenient sample. One hundred and fifty-two diabetic participants with metabolic syndrome were recruited in a university hospital. The data were analyzed using descriptive statistics, Students' t-test, and ANOVA with SPSS/WIN 12.0. RESULTS The high, moderate, and low stress groups according to perceived stress score consisted of 30.9%, 38.2%, and 30.9%, respectively. Differences of mental health and total self-care activities among the three groups were statistically significant. Depression (F=46.73, p<.001), trait anger (F=5.75, p<.01), and anger expression-in (F=4.60, p<.01) of participants in the high stress group were higher than other groups, whereas the total of self-care activities (F=2.85, p<.05) and exercise (F=3.49, p<.05) were lower than other groups. CONCLUSION This study concluded that type 2 diabetic patients with metabolic syndrome with a high stress level were low in self-care activities along with elevated depression and anger.
PURPOSE This study was to identify the relationship between knowledge, self efficacy, and self care behavior regarding foot care among elderly diabetes mellitus (DM) patients. METHODS The subjects consisted of 146 elderly with DM. The data collected from February to October 2008 were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and stepwise multiple regression. RESULTS The mean scores of knowledge (13.21 +/- 1.99), self efficacy (2.23 +/- 0.54), and self care behavior (2.29 +/- 0.51) regarding foot care were moderate. The level of knowledge was significantly different according to education about DM (p = .012) and drinking (p = .007). Self efficacy was significantly different according to gender (p = .019), educational level (p = .014), spouse (p = .048), disease period (p = .000), admission of DM (p = .000), complication of DM (p = .001), education of DM (p = .023). Self care behavior was significantly different according to educational state (p = .003), disease period (p = .039), and other disease (p = .000). Significant correlations were found between knowledge and self care behavior (p = .001), self efficacy and self care behavior (p = .000), knowledge and self efficacy(p = .012). Knowledge and self efficacy were a predictor of self care behavior (18.2%). CONCLUSION These findings indicate that perceived knowledge and self efficacy may be necessities to improve self care behavior regarding foot care among elderly DM patients. The above mentioned results will be reflected in developing patient educational programs.
PURPOSE The purpose of this study was to examine the effects of resistance exercise program for elders with type 2 Diabetes on the self care, stress and HbA1c. METHODS: Thirty three elders with type 2 Diabetes(18 experimental and 15 control subjects) were selected conveniently among the aged who had been enrolled in a community senior center. The subjects in experimental group participated in a resistance exercise program for 8 weeks. Data were analyzed using the SPSS/Win 12.0. RESULTS: The resistance exercise program showed a statistical difference in self care(t=-4.39, p=.000) and stress(t=2.22, p=.034). However, there was not a statistical difference in HbA1c (F=.556, p=.557), but experimental group had decreased continuously in HbA1c after the program. CONCLUSION: The resistance exercise program improved self care and reduced the stress in the elders with type 2 Diabetes. Therefore, resistance exercise program can be applied as an effective nursing intervention to promote self care, decrease the stress and to prevent complication for the elders with type 2 Diabetes.
PURPOSE This study aimed to define the relationship among self-care, symptom experiences, and health-related quality of life(HRQoL) according to the severity of disease in chronic obstructive pulmonary disease(COPD) patients. METHODS The participants, 195 COPD patients, were recruited at a pulmonology clinic of a universityaffiliated medical center in B metropolitan city. Inclusion criteria were patients who were diagnosed as COPD and had less than 0.7 of FEV1/FVC(Forced Expiratory Volume for 1 second/Forced Vital Capacity) ratio. The severity was classified with GOLD(Global initiative for Obstructive Lung Disease) stages, FEV1% predicted value from mild to very severe. The data were gathered by the medical records and self-reported questionnaires. RESULTS The self-care, symptom experience, and HRQoL were all significantly different by COPD severity based on pulmonary function(p<.05). There were significant moderate negative relationships between symptom experiences and self-care(r=-.54, p<.001) and between symptom experiences and HRQoL(r=-.64, p<.001). There was a moderate positive correlation between self-care and HRQoL(r=.63, p<.001). CONCLUSION It suggests that the assessment of disease severity based on pulmonary function and subjective symptom experience in patients with COPD may be a key component to develop a tailored self-management program and to improve their quality of life.
PURPOSE The purpose of this study was to examine self care behaviors according to the risk levels of vascular complications in elderly women with hypertension. METHODS The subjects of this study were 162 women living in the community who had been diagnosed with hypertension in clinics. The data were analysed by the SPSS 10.0 program using descriptive statistics, t-test, and ANOVA with Scheff. post-hoc test. RESULTS The average self care behavior score of the elderly women was 2.79. Total self care behavior was significantly different depending on the risk levels of vascular complications such as systolic blood pressure, diastolic blood pressure, ankle-brachial index, and the framingham point score. Among sub-scores of self care behaviors, exercise management was the poorest performance compared with other self care behaviors. CONCLUSION This study proved the differences in self care behaviors according to the risk levels of vascular complications. To decrease the prevalence of vascular complication, it is necessary to develop programs specifically to enhance self care behaviors of elderly women with hypertension.
PURPOSE The purpose of this study was to examine the effects of a cognitive behavioral stress management program on diabetic self-care and glycemic control with type 2 diabetic patients. METHODS Thirty three diabetic patients who were older than 40 were recruited from a public health center and conveniently assigned into both experimental(n=16) and control groups(n=17). Participants in the experimental group had attended the weekly cognitive behavioral program for 8 weeks. Data were collected from June 2005 to August 2006 and analyzed by independent t-test using the SPSS WIN program. RESULTS After an 8 week intervention, participants in the experimental group reported on increasement of diabetic self-care behaviors and an increasement of blood glucose levels, which were significantly different from those in the control group. CONCLUSION On the basis of those findings, we concluded that the cognitive behavioral stress management program has positive effects on diabetic self-care and glycemic control for the patients with DM. Further research is needed to identify the long-term effects of the cognitive behavioral program.
PURPOSE The purpose of this study was to examine the degree of self-care, symptom experience and disease state among the patients with liver cirrhosis and to identify its correlation. METHODS The subjects were 220 patients with liver cirrhosis who were treated in D-university hospital in Busan. The instruments used for study were the self-care inventory, the symptom experience inventory and modified childpugh classification scale. RESULTS The average points of the patient's self-care performance, symptom experience, and disease status were 3.67, 29.10 and 6.12 respectively. Their self care was negatively correlated to symptom experience, and symptom experience was positively correlated to disease state. CONCLUSION This research findings suggested that active self-care by patients with liver cirrhosis might contribute to reduce various symptoms they can undergo and to prevent aggravation of disease state. Therefore, patients with liver cirrhosis have to carry out self care actively in daily life and discreet nursing intervention should be offered to facilitate their self-care.
PURPOSE The purpose of this study was to identify effects of a self-management program on symptom and functional status, health perception, and quality of life(QOL) of patients with CHF. METHODS Patients with CHF as defined through clinical judgment using the Framingham criteria and EF<50% were enrolled in the study (experimental: 21, control: 20). The symptom focused self-management program consisted of coping behaviors for symptoms including dyspnea, chest discomfort/pain, dizziness, ankle edema, and basic self-management including medications, diets, activity, lifestyle changes. Experimental group received an educational booklet after survey, and periodic telephone follow-up by a trained nurse. Data were collected the 3rd day after admission and at 1 month, 3 months, and 6 months after discharge using questionnaires. RESULTS Significant differences were found in the presence of symptoms, health perception, and QOL between groups during follow-up. Although no significant difference was found in functional status, the experimental group reported better functional status than the control group. CONCLUSION By facilitating self-management of CHF using tailored interventions including education programs and telephone monitoring, it is expected that patients will be able to monitor their symptoms routinely, adhere to therapeutic regimen, and have a better QOL.
PURPOSE The purpose of this study was to explore the predictors of cardiovascular risk factors among type 2 diabetic patients. METHOD Data were collected from November, 2003 to June, 2004 using a physiological index and questionnaires. Patients(N=159) aged 40 and above were conveniently recruited from health care centers in B city. Data were analyzed with descriptive statistics, Pearson correlation and stepwise multiple regression using SPSS WIN 10.0 program. RESULTS The cardiovascular risk factors were negatively related with female gender, household monthly income, educational experience about diabetes, physical activity, self-care, self-efficacy and problem oriented coping, while positively related with the duration of diabetes, diabetic family history and depression. Self-care, diabetic family history, female gender, monthly household income, self-efficacy, affective-oriented coping and physical activity predicted 41.5% of the variance in cardiovascular risk factors of diabetic patients. CONCLUSION According to the findings of this study, we concluded that cardiovascular risk factors of type 2 diabetic patients are related to the modifiable and non-modifiable variables. Self-care, self-efficacy, affective- oriented coping, and physical activity were identified as modifiable variables. Intervention programs to increase those variables are warranted to reduce cardiovascular risk factors among type 2 diabetic patients.
PURPOSE This study was to identify the relationship between family support, self-efficacy and self-care performance in patients with chronic illness. METHODS: The subjects were 100 in-and out-patients who were diagnosed with chronic illness at university hospital in Cheonan. The data analyzed using descriptive statistics, Pearson correlation coefficient and stepwise multiple regression with SPSS WIN 12.0. RESULTS: The level of family support, self-efficacy and self-care performance were high. The family support in patients with chronic illness indicated a significant positive correlation to self-care performance but no significant correlation to self-efficacy. The self-efficacy in patients with chronic illness indicated a significant positive correlation to self-care performance. Family support and self-efficacy account for 24.4% of variance of the self-care performance. The most significant predictor which influenced self-care performance in patients with chronic illness was family support. CONCLUSION: The results of this study showed that family support and self-efficacy are very important variables in explaining the self-care performance. Therefore, these variables should be considered in nursing intervention development and education.
PURPOSE To describe the performance in the health-promoting lifestyle and to identify the major factors affecting the health-promoting relationships between self care behaviors and health promoting lifestyle profile in patients with pulmonary tuberculosis. METHOD: A convenience sample for this study was 172 pulmonary tuberculosis patients who have taken TB medications in urban city. The HPLP-ll was selected to measure the concept of health- promoting lifestyle because of the number of research studies conducted using both the original HPLP and the revised HPLP-ll. The statistical methods used in this study were t-test, ANOVA, Pearson correlations, and multiple regression. RESULT: The differences of the HPLP-ll were found to have a significance of age, marital status, education level, and health service center. The level of self care behaviors was related positively to the level of health promoting lifestyle and their subcategories. Based on stepwise multiple regression analysis, the model that predicted factors included self care behaviors, age, health service center and education. CONCLUSION: After decades of decreasing rates, TB has reemerged as a serious national problem in Korea. The careful clinical management and more national concern of TB may help to improve the outcomes of many patients. The findings of this study suggest that TB patients who are more fulfilled in health-promoting lifestyles and self-care behaviors may be able to make better decisions regarding positive health-promoting behaviors.
PURPOSE The purpose of this study was to identify effects of a self-management program on self-efficacy and compliance in patients with CHF. Hypothesis: 1) Patients with CHF who are provided with a self-management program will show higher self-efficacy scores than a control group. 2) Patients who are provided with a self-management program will show higher compliance scores than a control group. METHOD: This study was designed as a nonequivalent non-synchronized pre-posttest control group. There were eight patients in the experimental group, and twelve in the control group. According to NYHA classification, all patients belonged under the classesl to lV. Data were collected using the instruments developed by the researchers. Data were analyzed using descriptive statistics and Mann Whitney U test. RESULT: There were significant differences in self-efficacy scores and compliance scores between the experimental and control group. CONCLUSION: By utilizing the program, patients were able to monitor their symptoms routinely, comply with therapeutic regimen, and feel better able to positively influence their disease. Therefore, better compliance means fewer readmissions of patients with CHF.
PURPOSE The purpose of this study was to identify the effects of self-efficacy promoting program on self-efficacy, self-care, and anxiety in cancer patients receiving chemotherapy. METHOD: A quasi-experimental nonequivalent control group pre and post design was used. Subjects were 52 cancer patients who received chemotherapy in a hospital. Twenty-six patients were assigned to the experimental and the control groups, respectively. For the experimental group, the CD image for fifteen minutes and two consultations for about ten minutes each were applied. For the control group, ordinary hospital care was applied. The data was collected before and 2 weeks after chemotherapy. RESULT: The scores of self-efficacy and self-care of the experimental group was higher than those of the control group while the state of anxiety of the experimental group was not lower than that of the control group at posttest. CONCLUSION: The self-efficacy promoting program about prevention of infection and hemorrhage increased cancer patients' self-efficacy and self-care but did not decrease anxiety. Further study is needed to find other factors to decrease anxiety and nurses need to consider the concept of self-efficacy in cancer patients receiving chemotherapy when they plan to increase cancer patients' self-care.
The purpose of this study was to identify the effect of structured information provided on knowledge and self-care behavior. The subjects of this study were both hospitalized patients and outpatients in K university hospital. The instrument use for this study were the knowledge assessment tool and self-care behavior assessment tool by Eom Soon-Ja(1998) and they were modified for liver cirrhosis patients. The data were analyzed by t-test, Chi-square test, Pearson correlation coefficients using SAS program. The results of this study were as follows. The experimental group which had received structured information provided showed greater increased knowledge of liver cirrhosis(P=.001). The experimental group which had received the structured information provided indicated increased self-care performance rate, especially after information about diet(P=.001), activity and bed rest(P=.001), drug therapy and visiting the hospital(P=.001), prevention of a complication and observation(P=.001). In conclusion, structured information provided showed increased in the degree of knowledge and self-care behavior, so information showing is an effective nursing intervention. It is much needed to employ information showing for chronic patients.
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