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

Yoon Sun Kim; Young Sook Tae; Kwuy-Im Jung

doi:10.4040/jkan.2019.49.4.472

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Kim, Tae, and Jung: The Development and Evaluation of a Health Literacy-Adapted Self-Management Intervention for Elderly Cancer Patients Undergoing Chemotherapy

Original Article

J Korean Acad Nurs 2019;49(4):472-485.

Published online: 15 January 2019

DOI: https://doi.org/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

Yoon Sun Kim¹, Young Sook Tae², Kwuy-Im Jung^3,

¹Education & Training Team, Dongnam Institute of Radiological & Medical Sciences, Busan

²College of Nursing, Kosin University, Retired, Busan

³College of Nursing, Kosin University, Busan, Korea

Address reprint requests to : Jung, Kwuy-Im College of Nursing, Kosin University, 262 Janggiryeo-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-3951 Fax: +82-51-990-3031 E-mail: cgi@kosin.ac.kr

Received 4 January 2019 Revised 19 June 2019 Accepted 20 June 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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.

Keywords: Health Literacy, Drug Therapy, Aged, Neoplasm, Self-Management

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Figure 1.

Conceptual framework of the study.

Figure 2.

Interventional strategies for each section of self-management education.

Table 1.

Homogeneity Tests of Characteristics between Experimental and Control Groups (N=52)

Characteristics	Categories	Exp. (n=26)	Cont. (n=26)	χ²-test/Fisher's exact	p
Characteristics	Categories	n (%)	n (%)	χ²-test/Fisher's exact	p
Gender	Male	16 (61.5)	16 (61.5)	0.00	>.999
	Female	10 (38.5)	10 (38.5)
Age(yr)	65~69	19 (73.1)	19 (73.1)	0.00	>.999
M±SD=68.13±3.44	≥70	7 (26.9)	7 (26.9)
Marital status	Married	18 (69.2)	17 (65.4)	0.09	.768
	Bereavement, Divorce	8 (30.8)	9 (34.6)
Coresidence with	Alone	4 (15.4)	6 (23.1)	0.53	.769
	Spouse	17 (65.4)	15 (57.7)
	Offspring	5 (19.2)	5 (19.2)
Past experience with chemotherapy	Yes	2 (7.7)	1 (3.8)	0.35	>.999
education^†	No	24 (92.3)	25 (96.2)
Educational level	≤Elementary school	6 (23.0)	4 (15.4)	0.50	.779
	Middle school	8 (30.8)	9 (34.6)
	≥High school	12 (46.2)	13 (50.0)
Occupation	Yes	10 (38.5)	8 (30.8)	0.34	.560
	No	16 (61.5)	18 (69.2)
Monthly income degree (10,000 won)^†	<100	10 (38.5)	14 (53.8)	2.67	.342
	100≤~<200	10 (38.5)	10 (38.5)
	≥200	6 (23.0)	2 (7.7)
Months since diagnosed (month)^†	<1	10 (38.5)	5 (19.2)	4.81	.215
	1~<3	9 (34.6)	11 (42.3)
	3~<12	3 (11.5)	8 (30.8)
	≥12	4 (15.4)	2 (7.7)
Type of cancer treatment in the past^†	Operation	15 (57.7)	14 (53.8)	0.60	.859
	Operation+Chemotherapy	3 (11.5)	5 (19.2)
	None	8 (30.8)	7 (27.0)
Cancer progression^†	Metastasis	7 (26.9)	5 (19.2)	1.65	.520
	Recurrence	2 (7.7)	5 (19.2)
	None	17 (65.4)	16 (61.6)
K-MMSE (0~30 score)	24~26	6 (23.1)	10 (38.5)	1.44	.229
M±SD=27.08±1.22	27~29	20 (76.9)	16 (61.5)
Health literacy test score (0~8)	≤4	11 (42.5)	9 (34.6)	0.33	.569
M±SD=5.04±1.39	5~7	15 (57.5)	17 (65.4)

Exp.=Experimental group; Cont.=Control group; K-MMSE=Korea-Mini-Mental Status Examination; M=Mean; SD=Standard deviation.

^† Fisher’s exact test.

Table 2.

Homogeneity Tests for Dependent Variables between Experimental and Control Groups at Pretest (N=52)

Variables	Exp.(n=26)	Cont.(n=26)	t or U	p
Variables	M±SD	M±SD	t or U	p
Self-management knowledge	18.65±2.81	19.42±2.47	1.05	.300
Self-efficacy	33.85±4.49	32.96±4.72	-0.69	.492
Self-management behavior	57.12±13.89	53.50±17.63	268.00^†	.200^†
Symptom experience	50.54±16.97	55.65±12.66	251.00^†	.113^†
Distress	6.31±1.16	6.04±1.46	-0.74	.464

Exp.=Experimental group; Cont.=Control group; M=Mean; SD=Standard deviation.

^† Mann-Whitney U test.

Table 3.

Effects of on Self-Management Knowledge, Self-Efficacy, Self-Management Behavior, Symptom Experience, Distress (N=52)

Variables	Group	Pre-test	Post-test	t/z	p	Mean differences (Post-Pre)	t/z	p
Variables	Group	M±SD	M±SD	t/z	p	M±SD	t/z	p
Self-management knowledge	Exp.	18.65±2.81	25.85±2.11	12.20^†	<.001	7.19±3.01	-5.78^††	<.001
	Cont.	19.42±2.47	22.19±1.98	5.68^†	<.001	2.76±2.49
Self-efficacy	Exp.	33.85±4.49	42.12±4.02	11.69^†	<.001	8.27±3.61	-9.76^††	<.001
	Cont.	32.96±4.72	31.46±2.96	-2.12^†	.022	-1.50±3.61
Self-management behavior	Exp.	57.12±13.89	99.50±1.90	-4.46^§	<.001	42.38±13.69	-5.68^\|\|	<.001
	Cont.	53.50±17.63	63.69±10.41	-3.39^§	<.001	10.19±14.93
Symptom experience	Exp.	50.54±16.97	52.19±11.15	-0.57^§	.286	1.65±12.68	-1.71^\|\|	.044
	Cont.	55.65±12.66	63.27±11.16	-2.56^§	.006	7.62±13.33
Distress	Exp.	6.31±0.23	3.46±0.19	-15.01^†	<.001	-2.85±0.97	4.83^††	<.001
	Cont.	6.04±0.29	4.96±0.23	-3.44^†	.001	-1.08±1.60

Exp.=Experimental group; Cont.=Control group; M=Mean; SD=Standard deviation.

^† Paired t-test;

^†† Independent t-test;

^§ Wilcoxon signed rank test;

^|| Mann-Whitney U test.

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