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EDITORIAL12-08-2024
Ibero-American nursing context: constructing and sharing knowledge
Revista Brasileira de Enfermagem. 2024;77(1):e770101
Abstract
EDITORIALIbero-American nursing context: constructing and sharing knowledge
Revista Brasileira de Enfermagem. 2024;77(1):e770101
DOI 10.1590/0034-7167.2024770101
Views0Next week, two major scientific events will take place in Madrid and Granada (Spain). These will be international, specific activities in a very special way, although not exclusive to the Ibero-American field, organized and developed by two very important scientific nursing societies, such as Community Nursing Association (AEC) and Latin American Association of Schools and […]See more -
EDITORIAL12-08-2024
Contexto ibero-americano da enfermagem: construindo e compartilhando conhecimento
Revista Brasileira de Enfermagem. 2024;77(1):e770101
Abstract
EDITORIALContexto ibero-americano da enfermagem: construindo e compartilhando conhecimento
Revista Brasileira de Enfermagem. 2024;77(1):e770101
DOI 10.1590/0034-7167.2024770101pt
Views0Na próxima semana, acontecerão dois grandes eventos científicos em Madri e Granada (Espanha). Serão atividades internacionais, específicas e de forma muito especial, embora não exclusivas do campo ibero-americano, organizadas e desenvolvidas por duas sociedades científicas de enfermagem muito importantes, como a Associação de Enfermagem Comunitária (AEC) e a Associação Latino-Americana de Escolas e Faculdades de […]See more -
REVIEW11-29-2024
Assessment of knowledge in oncology about care for transgender people: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20230532
Abstract
REVIEWAssessment of knowledge in oncology about care for transgender people: a scoping review
Revista Brasileira de Enfermagem. 2024;77:e20230532
DOI 10.1590/0034-7167-2023-0532
Views0ABSTRACT
Objective:
to identify evidence available in the literature on instruments and methodologies used to assess healthcare professionals’ knowledge about cancer care for the transgender population.
Methods:
a scoping review was conducted in seven databases, including studies that answered the question: what is the healthcare professionals’ level of knowledge about cancer care for the transgender population?
Results:
forty-one articles were selected that dealt specifically with healthcare professionals’knowledge in relation to care for the LGBTQIAPN+ population, especially the transgender population. Eighteen studies assessed patients’ perceptions of professionals’knowledge, whereas other studies used their own assessment tools, considering the global context of LGBTQIAPN+ health.
Conclusions:
there is no tested and validated instrument that assesses the knowledge about the transgender population’s oncological health, highlighting the need to construct and validate an instrument focused on this population’s needs.
Keywords:Health Services for Transgender PeopleNeoplasmsOncologyProfessional TrainingTransgender PeopleSee more -
ORIGINAL ARTICLE11-22-2024
Interpersonal violence in the state of Espírito Santo: analysis of mandatory notifications between 2011 and 2018
Revista Brasileira de Enfermagem. 2024;77(5):e20230081
Abstract
ORIGINAL ARTICLEInterpersonal violence in the state of Espírito Santo: analysis of mandatory notifications between 2011 and 2018
Revista Brasileira de Enfermagem. 2024;77(5):e20230081
DOI 10.1590/0034-7167-2023-0081
Views0See moreABSTRACT
Objective:
To identify the frequency of notifications of interpersonal violence in Espírito Santo from 2011 to 2018, and the factors associated with this issue.
Methods:
This is a cross-sectional study in which all cases of interpersonal violence from the Information System for Notifiable Diseases in the state of Espírito Santo during the period from 2011 to 2018 were analyzed. Absolute and relative frequencies and 95% confidence intervals were calculated, as well as Poisson regression.
Results:
During the analyzed period, 27,277 cases were reported in Espírito Santo (P: 75%; 95% CI: 74.5-75.4), being more prevalent among females, children, and the elderly, individuals of black/mixed race, people without disabilities, and residents of urban areas. Regarding the perpetrator, there was a higher prevalence of individuals aged 25 years and older, males, with a current or former intimate partner relationship with the victim, and suspected alcohol use at the time of the aggression. In terms of the characteristics of the aggression, there was a higher prevalence of repeat violence, involving a single aggressor, and occurring in the residence.
Conclusions:
The notification of interpersonal violence in Espírito Santo showed a high prevalence and was associated with characteristics of the victim, aggressor, and event. This scenario reinforces the need for interventions such as professional qualification, expansion of intersectoral actions, and reformulation of public policies.
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ORIGINAL ARTICLE11-22-2024
Prevalence of prescription and effectiveness of analgesia for treating vaginal delivery pain
Revista Brasileira de Enfermagem. 2024;77(5):e20230327
Abstract
ORIGINAL ARTICLEPrevalence of prescription and effectiveness of analgesia for treating vaginal delivery pain
Revista Brasileira de Enfermagem. 2024;77(5):e20230327
DOI 10.1590/0034-7167-2023-0327
Views0See moreABSTRACT
Objectives:
to assess pain management during labor.
Methods:
a cross-sectional study was carried out by reviewing medical records and conducting postpartum interviews. Prevalence and effectiveness of analgesia were assessed.
Results:
the prevalence of non-pharmacological analgesia was 61.86% of 215 women in labor in Obstetric Center and 82.51% of 62 in midwife-led unit. Prevalence of severe pain, on the Visual Analogue Scale, before and after non-pharmacological analgesia, was from 92.16% to 64.04% (p=0.00) in Obstetric Center and from 85.96% to 52.63% (p=0.01) in midwife-led unit. Prevalence of pharmacological analgesia in Obstetric Centers was 15.81%, with no variation in severe pain (p=0.57). Patients’ request for analgesia was associated with education (p=0.00) and pain intensity (p=0.02).
Conclusions:
non-pharmacological analgesia improved pain intensity. Prevalence of pharmacological analgesic prescription was lower than that identified in developed countries. Pain management needs to consider the preferences and needs of women in labor.
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ORIGINAL ARTICLE11-22-2024
Knowledge sharing: nurse managers’ practices
Revista Brasileira de Enfermagem. 2024;77(5):e20230287
Abstract
ORIGINAL ARTICLEKnowledge sharing: nurse managers’ practices
Revista Brasileira de Enfermagem. 2024;77(5):e20230287
DOI 10.1590/0034-7167-2023-0287
Views0ABSTRACT
Objective:
To analyze how management practices for sharing knowledge are developed in public hospitals in the context of nursing.
Methods:
Qualitative research, carried out with 15 nurse managers from six public hospitals, from July to September 2022. Data were collected through semi-structured interviews and analyzed according to content analysis and in a model for sharing knowledge at work.
Results:
Knowledge sharing in nursing occurs through intraand extra-organizational training (training, courses and events), use of digital communication tools (media and social networks) and individual and collective contact between professionals during the service (experiences, exchange of experiences and assessment feedback).
Final considerations:
Sharing knowledge is relevant to nursing work. To improve it, it must be understood that effective sharing occurs from person to person, in their daily practices, and must be conducted as a strategically planned process by nurse managers.
Keywords:Health Information ManagementHealth Services AdministrationKnowledge ManagementNursing Service, HospitalNursing Staff, HospitalSee more -
ORIGINAL ARTICLE11-22-2024
Transitions experienced by people living with limitations resulting from leprosy: a research-care study
Revista Brasileira de Enfermagem. 2024;77(5):e20230229
Abstract
ORIGINAL ARTICLETransitions experienced by people living with limitations resulting from leprosy: a research-care study
Revista Brasileira de Enfermagem. 2024;77(5):e20230229
DOI 10.1590/0034-7167-2023-0229
Views0See moreABSTRACT
Objective:
to understand the transitional processes that affect the adaptation of people who live with limitations resulting from leprosy.
Methods:
This is a qualitative study based on the precepts of Transition Theory, mediated by care-research, with 24 people with limitations resulting from leprosy in an ex-hospital colony in Piauí. Semi-structured interviews were carried out. The interviews were analyzed using Iramuteq software.
Results:
the researched-caregivers experienced the four types of transitions, including feelings of fear, worry, loneliness, hopelessness, guilt and a tendency to hide the diagnosis. Breakdowns and resignation were revealed, with spirituality, adaptation to the new life situation and acceptance as facilitating conditions for coping with the transitional process, with a consequent improvement in quality of life.
Final considerations:
the transitional processes had a positive significance, since they contributed to adaptation and the achievement of quality of life.
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ORIGINAL ARTICLE10-01-2022
Self-care of elderly people with diabetes mellitus and the nurse-patient interpersonal relationship
Revista Brasileira de Enfermagem. 2022;75(1):e20201257
Abstract
ORIGINAL ARTICLESelf-care of elderly people with diabetes mellitus and the nurse-patient interpersonal relationship
Revista Brasileira de Enfermagem. 2022;75(1):e20201257
DOI 10.1590/0034-7167-2020-1257
Views1INTRODUCTIONChronic non-communicable diseases are the main causes of death and health problems in the world, causing about 41 million deaths each year, which corresponds to approximately 71% of all deaths. Among these diseases, diabetes mellitus has stood out due to the increase in its incidence and prevalence().Estimates indicate that 463 million people live with diabetes […]See more -
ORIGINAL ARTICLE03-27-2023
Adaptation and validation of an adult patient classification instrument with emphasis on the family dimension
Revista Brasileira de Enfermagem. 2023;76(2):e20220530
Abstract
ORIGINAL ARTICLEAdaptation and validation of an adult patient classification instrument with emphasis on the family dimension
Revista Brasileira de Enfermagem. 2023;76(2):e20220530
DOI 10.1590/0034-7167-2022-0530
Views1ABSTRACT
Objectives:
to adapt and validate an instrument for classifying adult patients that emphasizes the family support network in the demand for nursing care.
Methods:
methodological study, carried out in three phases: adaptation of an instrument considering the reality of adult patients; content validation with seven experts and assessment of measurement properties (construct validity and internal consistency) with 781 hospitalized patients.
Results:
in content validation, the indicators reached the values established for the Content Validity Index (0.85-1.00). In the confirmatory factor analysis, the 11 indicators were distributed in three domains and presented average variance extracted and factor loading greater than 0.5. Composite reliability was greater than 0.7.
Conclusions:
the present study adapted and made available, with evidence of validity and reliability, an instrument for classifying adult patients that considers the family support network in the demand for nursing care.
Keywords:Factor AnalysisFamilyHospital Organization and AdministrationPatient-Centered CareValidation StudiesSee more -
ORIGINAL ARTICLE10-17-2022
Ethics, COVID-19 and nursing vulnerability: analysis of photographs released by the media
Revista Brasileira de Enfermagem. 2022;75:e20210960
Abstract
ORIGINAL ARTICLEEthics, COVID-19 and nursing vulnerability: analysis of photographs released by the media
Revista Brasileira de Enfermagem. 2022;75:e20210960
DOI 10.1590/0034-7167-2021-0960
Views1See moreABSTRACT
Objectives:
to analyze nursing vulnerability through photos released by the media amidst the COVID-19 pandemic.
Methods:
a documentary study, with a qualitative approach. The object of analysis were photographic images selected between January 2020 and March 2021, published by the main news portals in countries such as Brazil, the United States, France, Spain, England and Germany. Thematic categorical analysis was the method of analysis used.
Results:
we found 74 photographs that portrayed nursing professionals in different work situations. It was possible to identify stigma and social devaluation about this class’s representation and professional attribution. Moreover, we found an underrepresentation of black professionals in Brazilian portals and the man as the prominent figure in the spaces of claims.
Final Considerations:
the photographs represented an important tool for the social analysis of nursing vulnerability, favoring the unveiling of situations that may go unnoticed by nursing and society.
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ORIGINAL ARTICLE07-29-2022
Effects of guided imagery relaxation in hematopoietic stem-cell transplantation patients: a quasi-experimental study
Revista Brasileira de Enfermagem. 2022;75(5):e20220114
Abstract
ORIGINAL ARTICLEEffects of guided imagery relaxation in hematopoietic stem-cell transplantation patients: a quasi-experimental study
Revista Brasileira de Enfermagem. 2022;75(5):e20220114
DOI 10.1590/0034-7167-2022-0114
Views1ABSTRACT
Objective:
To analyze the effects of the technique of virtual reality guided imagery in the vital signs of hematopoietic stem-cell transplantation patients.
Method:
Quasi-experimental study with 35 participants who received an intervention using virtual reality guided imagery with progressive muscle relaxation, applied three times a week for four weeks in a referral hospital for transplants in the south of Brazil. Data collected included: temperature, arterial pressure, respiratory rate, heart rate, pain, and oxygen saturation, before and after each intervention. The comparisons were analyzed using Wilcoxon’s test.
Results:
There was a clinical significance between the mean measurements before and after for respiratory rate (p=0.00) in all stages, and for the variables Heart rate, Temperature, and Oxygen saturation from the 1st to the 12th measurements (p=0.05).
Conclusion:
The intervention was low cost, easy to apply, and showed positive effects, presenting itself as an option for patient-focused care.
Keywords:Bone Marrow TransplantationHematopoietic Stem Cell TransplantationImageryPsychotherapyRelaxation TherapyVital SignsSee more -
ORIGINAL ARTICLE08-15-2022
Construction and validation of an educational video for patients in the perioperative period of robotic surgery
Revista Brasileira de Enfermagem. 2022;75(5):e20210952
Abstract
ORIGINAL ARTICLEConstruction and validation of an educational video for patients in the perioperative period of robotic surgery
Revista Brasileira de Enfermagem. 2022;75(5):e20210952
DOI 10.1590/0034-7167-2021-0952
Views1See moreABSTRACT
Objectives:
to build and validate educational technology, of the video type, aimed at teaching about the perioperative period of robotic surgery.
Methods:
methodological development study, following the integrative review phases: pre-production, production, post-production, and validation. The video was evaluated for content and appearance by 14 judges. Content validity (CVI) and appearance (AVI) and agreement (CI) indices were calculated, and the exact binomial test was applied, considering p>0.05 and a proportion of 0.80 of agreement.
Results:
the video included 13 themes, with a duration of seven minutes and 33 seconds. The items of the three dimensions evaluated presented excellent CVI, ranging between 0.86 and 1.00 (p>0.05), with a total CVI of 0.95, VAT of 0.94 and CI equal to 61.5%.
Conclusions:
the video included 13 themes, with a duration of seven minutes and 33 seconds. The items of the three dimensions evaluated presented excellent CVI, ranging between 0.86 and 1.00 (p>0.05), with a total CVI of 0.95, VAT of 0.94 and CI equal to 61.5%.
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ORIGINAL ARTICLE09-24-2022
Nurses’ performance in palliative care: spiritual care in the light of Theory of Human Caring
Revista Brasileira de Enfermagem. 2022;75(1):e20210029
Abstract
ORIGINAL ARTICLENurses’ performance in palliative care: spiritual care in the light of Theory of Human Caring
Revista Brasileira de Enfermagem. 2022;75(1):e20210029
DOI 10.1590/0034-7167-2021-0029
Views1See moreABSTRACT
Objectives:
to analyze nurses’ role in assisting patients in palliative care, with emphasis on the spiritual dimension, in the light of Theory of Human Caring.
Methods:
this is an exploratory, qualitative study, carried out in a hospital in João Pessoa, Paraíba, between August and December 2019, with 10 nurses. For data collection, semi-structured interviews were used. For analysis, we opted for content analysis.
Results:
the spiritual dimension of care is contemplated by several religious and spiritual practices. These are respected and encouraged by nurses, although there is difficulty in providing care for the spiritual dimension.
Final Considerations:
nurses have attitudes consistent with Jean Watson’s Theory and apply the Caritas Process elements during assistance to patients’ spiritual dimension in palliative care.
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Evolution of nursing teaching in the use of education technology: a scoping review
Revista Brasileira de Enfermagem. 2021;74:e20200422
Abstract
Evolution of nursing teaching in the use of education technology: a scoping review
Revista Brasileira de Enfermagem. 2021;74:e20200422
DOI 10.1590/0034-7167-2020-0422
Views1See moreABSTRACT
Objective:
To identify and map the technological tools of information and communication to support the teaching learning process in Nursing teaching courses.
Methods:
This is a scoping review whose search was carried out in seven databases and in grey literature. After an initial analysis of the selection, 88 texts were read integrally, and 29 made up the final sample.
Results:
Virtual learning environment and object, simulation, hypermedia, and software or cellphone applications were the tools the nursing professors used the most. Studies highlight that the application of technology was important in the teaching-learning process, since it encouraged teaching based on safe care, motivating and developing abilities/competences, supported on significant, effective, flexible, and autonomous learning.
Conclusion:
The contribution of the technology for nursing formation stands out, but it should be highlighted that its employment must be critical, reflective, based on pedagogical theories and developed by trained professors.
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Pregnant women’s contribution in the construction and evaluation of an educational technology: the “Comics for Pregnant Women”
Revista Brasileira de Enfermagem. 2021;74:e20201243
Abstract
Pregnant women’s contribution in the construction and evaluation of an educational technology: the “Comics for Pregnant Women”
Revista Brasileira de Enfermagem. 2021;74:e20201243
DOI 10.1590/0034-7167-2020-1243
Views1See moreABSTRACT
Objectives:
to describe the contribution of pregnant women to the construction and evaluation of educational technology.
Methods:
a participatory study developed in three stages, which occurred between March 2018 and June 2019 for identifying the content, construction, and evaluation of the comic. Non-directive interviews were conducted in educational groups with 34 pregnant women. After the comic was built by a team, including a designer, an instrument was applied to 41 pregnant women to evaluate the items Objectives, Organization, Writing style, Appearance, and Motivation.
Results:
the comic contains 40 pages of contents, illustrations, and quizzes (word search, cross-puzzle, seven mistakes, etc). The pregnant women evaluated it as easy to understand, self-explanatory, aesthetically attractive, and capable of motivating good care practices during pregnancy, obtaining a minimum agreement of 92.1%.
Final Considerations:
the innovation of the educational technology consisted of incorporating the voices of pregnant women in prenatal care, with the potential to stimulate reflections and the learning process of this target audience.
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ORIGINAL ARTICLE10-21-2019
Being an institutionalized elderly person: meaning of experiences based on Heidegger’s phenomenology
Revista Brasileira de Enfermagem. 2019;72(6):1632-1638
Abstract
ORIGINAL ARTICLEBeing an institutionalized elderly person: meaning of experiences based on Heidegger’s phenomenology
Revista Brasileira de Enfermagem. 2019;72(6):1632-1638
DOI 10.1590/0034-7167-2018-0763
Views0See moreABSTRACT
Objective:
Analyze the meaning of being an elderly person living in a long-term institution.
Method:
Qualitative study based on Martin Heidegger’s thought. Twelve phenomenological interviews were conducted with people aged over 60 years living in a long-term institution for the elderly in the city of Itabuna, Bahia, Brazil.
Results:
The units of meaning identified were: experience of progressive loss of autonomy and independence, perception of living in an institution as an inevitable circumstance; and being-with becoming being-alone/being-lonely. After the identification of ontic aspects and hermeneutical understanding, the unit of meaning was constructed: meaning of being an elderly person living in a long-term institution.
Final considerations:
The ontological needs referring to being an elderly person remain forgotten. As we are ontic and ontological, limited care to the ontic instance indicates deficiencies in institutionalization. Improvements are required to ensure the right to age with quality of life to this population.
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ORIGINAL ARTICLE09-21-2020
Adaptive problems arising out of the progenitor’s abandonment after Zika Congenital Syndrome
Revista Brasileira de Enfermagem. 2020;73:e20190602
Abstract
ORIGINAL ARTICLEAdaptive problems arising out of the progenitor’s abandonment after Zika Congenital Syndrome
Revista Brasileira de Enfermagem. 2020;73:e20190602
DOI 10.1590/0034-7167-2019-0602
Views0See moreABSTRACT
Objective:
to reveal the adaptive problems of the woman abandoned by the child’s parent after Congenital Zika Syndrome, in the light of Roy’s Adaptation Model.
Method:
a qualitative, descriptive study, based on Roy’s Adaptation Model, developed with six women abandoned by their child’s parent after Zika Congenital Syndrome diagnosis, through interview and Content Analysis technique.
Results:
adaptive problems appeared in nutrition, activity, rest, and protection patterns, due to limitations in self-care; self-concept, related to dissatisfaction with body image and personal being; in the role of transition role, through difficulties in taking over new roles and in interdependence, related to changes in affective needs.
Final considerations:
the overload of care for children with Congenital Zika Syndrome, added to the challenges of the abandoned woman by her child’s parent, led to adaptive problems, showing their main difficulties of coping.
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REVIEW04-16-2021
Nursing assistance in patient care with external ventricular drain: a scoping review
Revista Brasileira de Enfermagem. 2021;74(2):e20190796
Abstract
REVIEWNursing assistance in patient care with external ventricular drain: a scoping review
Revista Brasileira de Enfermagem. 2021;74(2):e20190796
DOI 10.1590/0034-7167-2019-0796
Views0See moreABSTRACT
Objectives:
to map the available evidence about nursing care aimed at adult patients using external ventricular drain.
Methods:
this is a review using the scoping review method.
Results:
Initially, 965 studies were identified and, after the eligibility criteria, a sample of 54 publications was obtained. Each of them was assessed according to GRADE, resulting in three studies with high quality; 14 with moderate quality; 32 with low quality; and five with very low quality. It was highlighted 20 nursing care subdivided into nine categories, namely: drainage system; bed positioning and mobilization; catheter care; monitoring of intracranial pressure; and medication administration.
Conclusions:
the scoping review made it possible to identify the main nursing care directed to adult patients undergoing placement of external ventricular drain from the evidence available to date.
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REFLECTION11-11-2020
Children with special needs in health: challenges of the single health system in the 21st century
Revista Brasileira de Enfermagem. 2020;73:e20190037
Abstract
REFLECTIONChildren with special needs in health: challenges of the single health system in the 21st century
Revista Brasileira de Enfermagem. 2020;73:e20190037
DOI 10.1590/0034-7167-2019-0037
Views0See moreABSTRACT
Objective:
Reflect on the gaps in the care of Children with Special Needs in Health that demand complex clinical care with dependence on technological support for the maintenance of life, in the Unified Health System.
Methods:
This is a reflection study based on recent policies and literature related to the theme.
Discussion:
Despite the advances achieved with the Unified Health System with regard to access to health services and the expansion of Primary Care, with the aim of reorienting health, it can be said that the health care model for CSHCN in Brazil is still centered on the hospital and medical knowledge.
Final considerations:
There are gaps in the policies for children aimed at the new paediatric profile, and little is discussed about its implications for the Unified Health System.
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Resilience in elderly people: factors associated with sociodemographic and health conditions
Revista Brasileira de Enfermagem. 2021;74:e20200171
Abstract
Resilience in elderly people: factors associated with sociodemographic and health conditions
Revista Brasileira de Enfermagem. 2021;74:e20200171
DOI 10.1590/0034-7167-2020-0171
Views0See moreABSTRACT
Objective:
to describe the sociodemographic and health characteristics of elderly people, measure the score of total resilience and by sex and verify the association of sociodemographic and health variables with total resilience and by sex.
Methods:
this is a household survey with 808 elderly people, assessed by validated instruments. Student’s t test and multiple linear regression (p<0.05).
Results:
most were female, 60|-|79 years old. The total resilience score was 78.06, for men 81.53 and for women, 76.32. Total resilience was associated with males; positive self-perceived health; greater participation in Advanced Activities of Daily Living; fewer morbidities; absence of depressive symptoms. Among men and women, resilience was associated with greater participation in Advanced Activities of Daily Living and absence of depressive symptoms and, specifically, among women, positive self-perceived health.
Conclusion:
these results contribute to nursing care, aiming to encourage resilience.
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ORIGINAL ARTICLE04-15-2022
Nursing diagnoses in elderly people with diabetes mellitus according to Orem’s Self-Care Theory
Revista Brasileira de Enfermagem. 2022;75:e20201171
Abstract
ORIGINAL ARTICLENursing diagnoses in elderly people with diabetes mellitus according to Orem’s Self-Care Theory
Revista Brasileira de Enfermagem. 2022;75:e20201171
DOI 10.1590/0034-7167-2020-1171
Views0See moreABSTRACT
Objective:
To identify nursing diagnoses and conditioning factors of self-care in older adults with diabetes mellitus, in the light of Orem’s Theory of Self-Care.
Methods:
Exploratory, descriptive study with a qualitative approach, conducted with the theoretical framework of Orem’s Theory of Self-Care. It was developed with 12 older people with diabetes, in a country’s southern municipality, between October and November 2019. For data collection, it was used individual interviews and focus groups. The data was submitted to thematic and content analysis directed to taxonomy II of NANDA International.
Results:
Twenty nursing diagnoses related to universal self-care requirements and health deviations were identified. All diagnoses were anchored in the supportive-education nursing system.
Final considerations:
The development of the disease and the consequences of chronic hyperglycemia were poorly recognized by the elderly, interfering with low adherence to self-care practices and disease control.
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