Purpose
This descriptive correlational study aimed to evaluate the impact of patient activation on self-management and explore the mediating role of shared decision-making (SDM) among patients on hemodialysis.
Methods
A cohort of 136 participants was recruited from hemodialysis units in Gwangju, South Korea, between August 9 and 22, 2024. Patient activation, self-management, and SDM were assessed using the Patient Activation Measure (PAM-13), the Hemodialysis Self-Management Instrument (HDMI-K), and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9), respectively. Descriptive statistics, Pearson’s correlation analysis, and mediation analysis using the PROCESS macro were conducted to analyze the data.
Results
Patient activation, SDM, and self-management were positively correlated with one another. Mediation analysis showed that patient activation significantly predicted both SDM and self-management. SDM also significantly predicted self-management, confirming its partial mediating effect. The final model explained 54.5% of the variance in self-management. The indirect effect of patient activation on self-management through SDM was statistically significant (indirect effect=0.05, 95% confidence interval [CI]=0.02–0.10). The indirect effect of patient activation on self-management through SDM was statistically significant (indirect effect=0.05, 95% CI=0.02–0.10).
Conclusion
Patient activation directly and indirectly enhances self-management through SDM, verifying the partial mediating role of SDM. Integrating SDM into nursing interventions is essential for effectively supporting self-management in patients undergoing hemodialysis.

Purpose
This study was conducted to develop a conceptual framework for understanding non-adherence to self-management among patients with Chronic Obstructive Pulmonary Disease (COPD). This was accomplished through a literature review, in-depth interviews with patients, and a survey of healthcare professionals featuring semi-structured open-ended questions.
Methods
First, a systematic literature review was conducted across five databases. Next, 25 patients with COPD participated in detailed interviews that included seven semi-structured questions. Subsequently, 15 healthcare professionals completed a survey about factor categories and specific factors associated with non-adherence to COPD self-management. Categories and factors identified at least once across these three methods were documented. Finally, two researchers conducted preliminary mapping of the relationships between factor categories and individual factors, which was assessed for face validity by a third researcher. All processes were conducted from March 28, 2022, and January 30, 2023.
Results
The research revealed eight factor categories and 53 individual factors associated with non-adherence to COPD self-management. The categories encompassed personal, socioeconomic, disease-related, functional, treatment- related, health system-related, and environmental characteristics. The literature review, patient interviews, and survey of healthcare professionals yielded 35, 19, and 44 factors, respectively. Twelve factors were identified using all three sources. All processes were conducted from March 28, 2022, and January 30, 2023.
Conclusion
In this study, quantitative and qualitative methods were employed to develop a conceptual framework for non-adherence to COPD self-management. The findings indicate that effective self-management of this condition requires not only patient effort but also adaptations to complex treatment regimens, societal perceptions, and workplace environments.

Citations

• Development of a deep learning model to predict smoking status in patients with chronic obstructive pulmonary disease: A secondary analysis of cross-sectional national survey
  Sudarshan Pant, Hyung Jeong Yang, Sehyun Cho, EuiJeong Ryu, Ja Yun Choi
  DIGITAL HEALTH.2025;[Epub]     CrossRef
• Factors Associated with Non-Adherence to Self-Management Among Patients with Chronic Obstructive Pulmonary Disease: A Survey Using the Delphi Technique and Analytic Hierarchy Process
  Ja Yun Choi, Eui Jeong Ryu
  International Journal of Chronic Obstructive Pulmonary Disease.2024; Volume 19: 1247.     CrossRef

Purpose
This study aims to identify factors affecting the Health-Related Quality of Life (HRQoL) in patients with atrial fibrillation.
Methods
The study subjects were 158 outpatients with atrial fibrillation at a university hospital in Metropolitan City B. Data were collected from March 18, 2022 to July 1, 2022 and were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson’s correlation coefficient, and hierarchical multiple regression with SPSS 22.
Results
Self-management behaviors (β=.27, p<.001), self-efficacy (β=.30, p<.001), and grit (β=.33, p<.001) were found to have statistically significant effects on HRQoL. Hierarchical regression analysis showed that age, employment status, and monthly household income explained 23.6% of the variance in HRQoL, while subjective health status and perceived stress added 18.6% of the variance. Self-management behaviors, self-efficacy, and grit had an explanatory power of 32.4%, and the overall explanatory power was 74.6%.
Conclusion
Self-management behaviors, self-efficacy, and grit were identified as factors affecting HRQoL in patients with atrial fibrillation. These results will be used as important fundamental data to develop nursing interventions in order to improve the HRQoL of patients with atrial fibrillation.

Purpose
This study aimed to evaluate the validity and reliability of the revised Korean version of the Chronic Hepatitis B Self-Management Scale-K16 (CHBSMS-K16). Methods Using the convenience sampling method, the data of chronic hepatitis B patients (N=200) were collected from August to October 2021. The participants were recruited from two hospitals in D metropolitan city and 3 internet cafes for hepatitis patients. The data were analyzed using SPSS 26.0 and AMOS programs. The content, structure, item-convergent/discriminant, and convergent validities and internal consistency were evaluated. Results Based on the statistical analysis, 9 items from the original version were excluded-resulting in 4 subscales with a total of 16 items. The confirmatory factor analysis demonstrated adequate model fit indices. The items convergence and discrimination validity were verified using extracted mean variance (.46~.65) and composition reliability (.81~.88). The convergent validity was satisfactory, as demonstrated by its correlation with the New General Self Efficacy scale (r=.63, p<.001). The Cronbach’s α for the overall scale was .88, and that of the four subscales ranged from .63 to .74. Conclusion The CHBSMS-K16 is a valid and reliable instrument. Therefore, this tool can be used to measure the level of self-management of Korean patients with chronic hepatitis B. Additionally, this scale can be used in clinical settings as well as in educational and research settings.

Purpose
The study aimed to develop a Healthcare Empowerment Program for patients with Temporary Ileostomy (HCEP-TI) and evaluate its effectiveness.
Methods
The HCEP-TI was developed based on Johnson’s model of healthcare empowerment by reviewing relevant literature, identifying patients’ needs through in-depth interviews, and testing content validity. The study was conducted at K University D hospital from June 2019 to September 2020 using a randomized controlled trial with a pretest-posttest design. The subjects were randomly assigned to two groups: experimental (n=15), which participated in HCEP-TI once a week for seven weeks, and control (n=15), which participated in conventional ileostomy care. Data were analyzed using linear by linear association, MannWhitney U, and Wilcoxon signed-rank tests.
Results
There were significant differences between the experimental and control groups in healthcare empowerment, self-management knowledge and behavior, and degree of peristomal skin damage. However, there was no significant difference between the groups regarding dehydration.
Conclusion
The HCEP-TI including engaged, informed, collaborative, committed, and tolerant of uncertainty intervention is effective in improving healthcare empowerment, self-management knowledge and behavior, and the degree of peristomal skin damage. This program can help patients with temporary ileostomy improve their empowerment, self-management, and stoma conditions.

PURPOSE
This study aimed to identify the associations among psychological insulin resistance, diabetes self-efficacy, and diabetes self-care management in Korean patients with type 2 diabetes requiring insulin therapy.
METHODS
This study was a part of a parent study, for which data were collected from December 2015 to March 2016. Participants were 192 patients with type 2 diabetes who were recommended insulin therapy but were either not taking insulin or had been taking it for less than one year. Data were analyzed using descriptive statistics and Pearson's correlation coefficient. To identify the predictors of diabetes self-care management, sociodemographic and disease-related characteristics, psychological insulin resistance, and diabetes self-efficacy were entered into the hierarchical multiple regression model.
RESULTS
The mean age of participants was approximately 63 years, and 56.3% were men. A significant negative correlation was found between diabetes self-care management and psychological insulin resistance (r=−.19, p=.010), whereas self-care management and diabetes self-efficacy were positively correlated (r=.56, p < .001). In the hierarchical multiple regression model, psychological insulin resistance and diabetes self-efficacy were both strong predictors of diabetes self-care management after controlling for covariates such as education and economic status.
CONCLUSION
The levels of both psychological resistance and diabetes self-efficacy should be considered when educating and counseling patients in order to promote diabetes self-care management. Further research is needed on what type of intervention will improve self-care management in terms of reducing psychological insulin resistance and improving self-efficacy.

Citations

• Factors influencing self-management and health-related quality of life in low-income patients with diabetes: a predictive model
  Jihyon Pahn, Youngran Yang, Sun Hee Kim
  International Journal of Nursing Studies Advances.2025; 8: 100349.     CrossRef
• Factors Influencing the Subjective Health Status of Men with Insulin-treated Type 2 Diabetes Mellitus: A Secondary Analysis Using Quantile Regression Analysis
  Kang Sun Lee, Hyuk Joon Kim, Young Man Kim, Hye Young Kim
  Journal of Korean Academy of Fundamentals of Nursing.2023; 30(4): 530.     CrossRef
• Factors affecting the health status of patients with type 2 diabetes mellitus receiving insulin treatments: A multi‐mediation path analysis
  Kang Sun Lee, Hye Young Kim, Heung Young Jin
  Journal of Clinical Nursing.2022; 31(9-10): 1285.     CrossRef
• Evaluation of the effect of training given according to Pender's Health Promotion Model on psychological insulin resistance
  Ezgi Bağrıaçık, Nurhan Bayraktar
  Human Nutrition & Metabolism.2022; 29: 200153.     CrossRef
• Diyabetli Hastalarda Psikolojik İnsülin Direnci Ölçeğinin Türkçeye Uyarlanması
  Kevser IŞIK, Hilal YILDIRIM, Zeliha CENGİZ
  Turkish Journal of Family Medicine and Primary Care.2021; 15(4): 726.     CrossRef
• Influences of Patient Activation on Diabetes Self-Care Activities and Diabetes-Specific Distress
  Sookyung Choi, Su Hyun Kim
  Korean Journal of Adult Nursing.2020; 32(1): 10.     CrossRef
• Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP)
  Patrick Ngassa Piotie, Paola Wood, Elizabeth M. Webb, Tessa S. Marcus, Paul Rheeder
  Diabetes Research and Clinical Practice.2020; 168: 108366.     CrossRef

PURPOSE
The purpose of this study was to identify factors associated with family caregivers' self-management of acute stroke survivors.
METHODS
The study participants were 130 stroke survivors and their caregivers. Data on participant characteristics, depression, task difficulty, survivor memory and behavioral problem, and self-management were collected from July 1 to September 30, 2017 using a structured questionnaire. Data were analyzed with the SPSS/WIN 23.0 program for descriptive statistics, using independent t-test, one-way analysis of variance, Pearson's correlation coefficient and enter multiple regression analysis.
RESULTS
Significant factors associated with self-management for family caregivers were survivors' age, the presence of comorbidities, the relationship between caregivers and survivors, and the presence of an alternative caregiver. Self-management has negative correlations with depression, task difficulty, and the occurrence of survivor memory and behavioral problems. The determining factors affecting caregiver self-management were caregiver depression (β=−.46, p < .001) and survivor age (β=.32, p=.004), and their explanation power was about 37%.
CONCLUSION
The results suggest that caregiver depression and survivor age should be considered in developing the nursing interventions to improve family caregiver self-management. Furthermore, findings underscore the importance of early screening and ongoing psychological assessments for depression in family caregivers of stroke survivors.

PURPOSE
The purpose of this study was to develop a Self-Management Scale for Hemodialysis Patients on Arteriovenous Fistula (SMHDP) and to verify its validity and reliability.
METHODS
Items for the preliminary instrument of the SMHDP-scale were created through a literature review and in-depth interviews with hemodialysis patients and hemodialysis unit nurses. A convenient sample was utilized for this study. The questionnaire was distributed to 200 hemodialysis patients with arteriovenous fistula. Content validity, construct validity, criterion validity, convergent validity, and discriminative validity were evaluated respectively. Cronbach's α was used to evaluate the reliability of the SMHDP-scale.
RESULTS
Five factors were identified through factor analysis. The factors included dietary knowledge of hemodialysis (8 items), compliance with hemodialysis (7 items), knowledge of hemodialysis (6 items), dietary compliance of hemodialysis (6 items), and compliance with hemodialysis order (3 items).These five factors explained 58.9% of the total variance. The correlation coefficient between criterion instrument and SMHDP-scale was .66 Reliability analysis showed Cronbach's α coefficient was .90.
CONCLUSION
Results show that the SMHDP-scale had good reliability and validity and thus SMHDP-scale may be a useful scale for clinical practices and for research as a measure of self-management of hemodialysis patient on arteriovenous fistula.

Citations

• Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis
  Haegyeong Lee, Gyuli Baek, Eunju Lee
  Osong Public Health and Research Perspectives.2023; 14(4): 279.     CrossRef

PURPOSE
The purpose of the study was to understand what are the experiences and management of type 2 diabetes in everyday lives among Korean people.
METHODS
A grounded theory method was utilized to explore how people with type 2 diabetes to experience and manage their disease under the Korean socio-cultural context. The data were collected via narrative in-depth interviews with 21 people with type 2 diabetes during 2010-2011 and all interviews were transcribed for verbatim analysis.
RESULTS
The core category was 'Rearranging everyday lives by accepting diabetes as lifelong annoying companion.' Four stages were identified: ignoring; struggling compromising and conciliating. Each stage illustrates major problems and/or strategies that the participants face in dealing with diabetes. The process illustrates the transference from their ordinary life, in which diabetes or health was ignored, to the health-oriented life, within which diabetes is integrated into their lives. The most difficult barriers they faced in everyday lives include social stigma of diabetes and collectivistic culture in Korea. Within the culture, the group goals are concerned over individual ones, making it harder for the participants to take care of their own health.
CONCLUSION
The findings of the study imply that health care professionals may consider the influence of social stigma in caring diabetic patients. Also, the intervention study is warranted to educate Korean people with diabetes to get aware of the sociocultural context and stigma as well as personal difficulties in self-caring diabetes.

Citations

• The Mediating Effect of Acceptance Action in the Relationship between Diabetes Distress and Self-stigma among Old Adults with Diabetes in South Korea
  Hyesun Kim, Kawoun Seo
  Journal of Korean Academy of Community Health Nursing.2022; 33(4): 446.     CrossRef
• Association among Lifestyle Factors, Obesity, C-peptide Secretion, Metabolic Syndrome, and Cardiovascular Risk in Adults with Newly Diagnosed Type 2 Diabetes Mellitus: A Case Study
  Sun-Young Kwon, Hye-Ja Park
  Journal of Health Informatics and Statistics.2019; 44(2): 125.     CrossRef
• Samoan migrants’ perspectives on diabetes: A qualitative study
  Yasin Shahab, Olataga Alofivae‐Doorbinnia, Jennifer Reath, Freya MacMillan, David Simmons, Kate McBride, Penelope Abbott
  Health Promotion Journal of Australia.2019; 30(3): 317.     CrossRef
• A Review of Qualitative Research in Korea: The Life Experiences of Diabetes Patients
  Been Yoo
  The Journal of Korean Diabetes.2017; 18(4): 270.     CrossRef

PURPOSE
The purpose of this study was to investigate the level of self management of patients with poorly controlled type 2 diabetes, and to investigate the factors influencing self management.
METHODS
The subjects consisted of 117 diabetes patients who visited the outpatient department of a university hospital from March to August 2008. Data were collected by asking the subjects to answer a 54-item questionnaire and were analyzed using the SPSS/WIN 14.0 program.
RESULTS
The total mean score of the patients in self -management was 4.38 out of 7. Medication adherence obtained the highest score under self-management, and the self-monitoring of blood glucose obtained the lowest score. Family support, self-efficacy, severity, and depression were found to be significantly correlated with self-management. In stepwise multiple regression analysis a total of 44.5% of the variance in self management was accounted for by family support, self-efficacy, severity, and depression.
CONCLUSION
Therefore, a diabetic intervention program should be designed and provided for increasing family support, self efficacy, and severity and for reducing depression of patients with poorly controlled type 2 diabetes.