BackgroundThe use of alternative health care among people with diabetes remains widespread, especially in rural areas of West Kalimantan, Indonesia. In the Malay ethnic community, alternative health care is not just an issue of access but also deeply rooted in cultural and spiritual practices. However, limited research has explored the symbolic meanings and socio-cultural dynamics that underlie the consistent use of alternative health care by people with diabetes.ObjectiveThis study aimed to explore the cultural recognition and socio-cultural meanings embedded in the use of AHC among Malays with diabetes in West Kalimantan, Indonesia.MethodsA focused ethnography was conducted from July to November 2024 using in-depth interviews, focus group discussions (FGDs), observations, and field notes. A total of 45 participants took part in interviews, including people with diabetes, healthcare providers, traditional healers (Tabib), family members, healthcare volunteers, and community leaders. FGDs comprised five groups, and observations included nine participants. Data were analyzed through content, typology, and matrix analysis. To ensure trustworthiness, triangulation and member checking were employed. The study was guided by three theoretical frameworks: Symbolic Interactionism, Cultural Theory, and Critical Social Theory.FindingsFour main themes emerged: (1) cultural logic and illness meaning, in which illness was viewed as a spiritual and moral imbalance; (2) symbolic meanings in alternative health care practices, highlighting ritual healing and spiritual faith; (3) social structures as pillars of healing, where family and community roles legitimized alternative health care; and (4) social processes that created cultural recognition through intergenerational transmission and community validation.ConclusionRecognizing AHC culturally is essential for understanding the illness experiences of people with diabetes. For nursing practice, these findings emphasize the importance of providing culturally respectful care, fostering open communication between healthcare providers and people with diabetes, and incorporating alternative healthcare approaches into safe, evidence-based health education.

BackgroundChronic pain is a common and burdensome condition among older adults, significantly impacting their quality of life and increasing interest in complementary and alternative medicine (CAM) approaches to pain management.ObjectivesThis study aimed to describe the prevalence of CAM use and attitudes toward CAM for self-managing chronic pain among older adults, and to examine the associations between chronic pain characteristics, CAM use, and attitudes toward CAM.MethodsA cross-sectional study was conducted among 289 hospitalized patients aged ≥60 years with chronic pain at a general hospital in Da Nang, Vietnam, in 2025. Data were collected using a structured questionnaire that included the Pain Disability Index (PDI) and the Attitudes towards CAM scale. Statistical analyses included t-tests, ANOVA, chi-square tests, and Pearson’s correlation.ResultsCAM use was reported by 92.7% of participants, with biologically based therapies (e.g., herbal remedies) being the most common (81.3%). The average attitude score toward CAM was 28.7 (SD = 3.2), indicating generally favorable views. CAM use was more frequently reported among participants experiencing pain in specific anatomical locations, including the arm/hand, neck, upper back, and lower back (all p <0.008 after Bonferroni correction). Attitudes toward CAM were modestly associated with perceived pain control ability (p = 0.031) and with the impact of chronic pain on daily life (r = 0.206; p <0.001), while other pain characteristics showed no significant associations.ConclusionCAM is widely used and positively perceived among older Vietnamese adults with chronic pain. Associations were observed between certain pain characteristics and CAM use, as well as between pain-related interference and attitudes toward CAM. These findings highlight the importance of routinely assessing CAM use in older adults and providing guidance on safe, evidence-based options within comprehensive pain management, while recognizing the observational nature of the data.

Strengthening the quality of midwifery education is crucial to equip future midwives with the competencies required for contemporary practice. Continuity of Care (CoC) learning requires structured learning strategies, appropriate media, and effective evaluation mechanisms based on students' needs. In this context, mobile applications can support CoC learning through flexible documentation and reporting systems. This study aimed to identify learning and competency needs for technology-enhanced CoC education among midwifery students. A convergent mixed-methods design was employed with midwifery students in the Bandung Metropolitan Raya region, West Java, Indonesia, in 2024. Purposive sampling was used to select 310 students for quantitative analysis using STATA 16.0. Qualitative data from online focus group discussions (FGDs) with 34 students were analyzed using NVivo 1.6.1. Quantitative analysis identified learning strategy as the strongest predictor of CoC competency (r = 0.790, p < 0.001). Qualitative findings revealed two main themes: CoC Competencies (with subthemes of CoC Competency Objectives and CoC Core Competencies) and integrated CoC learning components (learning strategy, learning media, and learning evaluation). This study identified four essential components of mobile-based CoC learning, with learning strategies emerging as the strongest predictor of competency. These findings indicate that, although mobile technology enables efficient recording and reporting, it must be integrated with structured learning strategies to effectively strengthen midwifery competencies.

Indonesia's rapidly aging demographic presents significant challenges, particularly in dementia among older people in resource-limited settings, such as nursing homes. However, there are limited reports on the deterioration of cognitive function and risk factors of dementia among older people in nursing homes. Early identification of dementia is essential for timely intervention and management. This study aimed to investigate and follow up on the cognitive function and risk factors of dementia among older people living in nursing homes. An observational cohort study was conducted over 6 months (April to October 2024) involving 162 participants from government (n = 83) and private nursing homes (n = 79). Implementation of early dementia screening was carried out using the Montreal Cognitive Assessment in the Indonesian version (MoCA INA) instrument to indicate cognitive function impairment. In addition, the Self-reporting of Physical Activity Questionnaire Indonesia (SPAQ-I) was used to identify physical activity. Descriptive statistics, McNemar, Chi-square, Fisher's Exact, Independent t-test, and multivariate regression were then used to analyze data. Older individuals did not differ in terms of gender, age, education, or length of stay. However, residents of the private nursing home had significantly higher physical activity levels (t = -2.04, p = 0.040), and a greater proportion engaged in adequate activity (65.8% vs. 50.6%, χ2 = 4.23, p = 0.040). Over a six-month period, cognitive function significantly declined among residents in the government nursing home (normal: p = 0.021; mild: p = 0.012; moderate: p = 0.003), whereas no significant change was observed among residents in the private nursing home. At the endpoint, mean cognitive function scores were slightly higher in the private nursing home (20.23 ± 3.45) than in the government nursing home (19.70 ± 4.39), with a very small effect size (Cohen's d = 0.13). Multiple regression analysis revealed that older age (β = -0.396, p <0.001) and lower levels of physical activity (β = 0.163, p = 0.030) were significantly associated with lower cognitive scores. Dementia screening can enhance care planning for age-related cognitive impairment by enabling early identification and management. Early detection allows nurses to implement more effective care strategies. Additionally, higher physical activity levels were associated with better cognitive function, highlighting a modifiable factor that may help maintain cognitive health among older adults in nursing homes.

BackgroundThe relationship between self-care behaviors, physiological indicators, and quality of life (QoL) in Type 2 Diabetes Mellitus (T2DM) remains underexplored in Indonesian populations. Understanding these factors is crucial for designing culturally appropriate interventions.ObjectiveTo examine the direct effects of four self-care domains on QoL and the potential mediating roles of HbA1c, blood pressure, and BMI among Indonesian patients with T2DM.MethodsA cross-sectional exploratory study was conducted August to September 2022 among 128 purposively selected patients from community health centers. Self-care (SCODI) and QoL (DQOL) were measured using validated questionnaires, and HbA1c, blood pressure, and BMI were obtained from clinical records. Structural equation modeling (SEM) was conducted using IBM AMOS version 24.ResultsThe SEM analysis yielded an overidentified model (df = 1578) with acceptable fit indices (CFI = 0.908, RMSEA = 0.082, CMIN/df = 1.851). Self-maintenance significantly predicted QoL, HbA1c, and blood pressure. Self-monitoring reduced blood pressure and BMI but was negatively associated with QoL. Self-management improved HbA1c but increased blood pressure and BMI, with a borderline positive effect on QoL. Self-confidence was positively associated with BMI but not with QoL, HbA1c, or blood pressure. Among physiological indicators, only HbA1c significantly predicted QoL.ConclusionThe direct effects of self-care behaviors on quality of life were more significant than the indirect effects mediated by clinical indicators, emphasizing the importance of strengthening daily self-care skills as a core strategy to enhance well-being in patients with T2DM. Given the exploratory cross-sectional design, findings should be interpreted as associative rather than causal. Future longitudinal research should validate these pathways and develop culturally sensitive intervention models that empower patients to sustain effective self-care behaviors over time.

BackgroundPre-eclampsia and eclampsia remain major causes of maternal morbidity and mortality. Healthcare providers’ knowledge and attitudes are critical for effective management.ObjectiveThis study aimed to assess healthcare providers’ knowledge and attitudes regarding the management of pre-eclampsia and eclampsia in Jordan.MethodsA cross-sectional study was conducted from September to October 2024 among 147 healthcare providers from seven public hospitals across three regions in Jordan. Data were collected via a structured questionnaire and analyzed using descriptive statistics, bivariate tests, and multivariate logistic regression.ResultsOverall, 88% demonstrated adequate knowledge of pre-eclampsia, and 83% demonstrated adequate knowledge of eclampsia. In bivariate analysis, knowledge was associated with educational program and training attendance. However, after adjusting for other variables in the multivariate model, only education and gender remained significant, while training was no longer associated with knowledge. For attitudes, 78% had a positive attitude. Although gender and education were associated with attitudes in bivariate analyses, these associations did not remain statistically significant in the multivariate model.ConclusionHealthcare providers showed generally adequate knowledge and predominantly positive attitudes toward managing pre-eclampsia and eclampsia. Higher educational attainment independently predicted knowledge, while no independent predictors of attitude were identified. The study highlighted the need for continuous, focused educational training programs, particularly for nurses and midwives. The modest sample size and focus on public hospitals should be considered when interpreting the results.

BackgroundHealthy aging is a key goal of global public health and aging policy initiatives. Understanding its prevalence and associated determinants is essential for designing targeted interventions and promoting well-being among older adults.ObjectiveThis study aimed to estimate the global prevalence of healthy aging and to identify its associated factors across different countries.MethodsA systematic review and meta-analysis were conducted. A comprehensive literature search was conducted in Web of Science, PubMed, EBSCO Discovery Service (EDS), Scopus, and ProQuest from database inception to February 2025. Two independent reviewers screened articles, extracted data, and assessed study quality using the Newcastle-Ottawa Quality Assessment Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) Methodology Checklist. Eligible studies were included in a meta-analysis using Stata 18.0 and R version 4.5.0.ResultsA total of 39 studies involving 300,624 participants were included. The pooled prevalence of healthy aging was 23.0% (95% CI: 18%–27%). After adjusting for publication bias using the trim-and-fill method, the estimate decreased to 15.6% (95% CI: 11.0%–20.1%), suggesting possible overestimation in the original estimate. Significant associations with healthy aging were found for age (≥75 years), gender, marital status, educational level, economic level, social participation, employment status, economy, smoking status, alcohol consumption, physical activity, body mass index (BMI), and self-rated health.ConclusionsThe findings indicate that fewer than one in four older adults meet the criteria for healthy aging globally, with substantial variation across regions. A wide range of sociodemographic, behavioral, and health-related factors influence this outcome. These results underscore the importance of addressing modifiable determinants in future public health efforts to promote healthy aging.RegistryPROSPERO [CRD42024542942]

BackgroundPatients with a history of traumatic life events who enter the healthcare system are especially vulnerable, often posing greater challenges to care delivery. However, little is known about the capacity of nursing staff, especially nursing students, to deliver trauma-informed care (TIC).ObjectiveThis study aimed to assess the knowledge, attitude, and practice of trauma-informed care among Chinese nursing students.MethodsA cross-sectional study was employed to survey undergraduate nursing students from a medical college in eastern China. Data were collected using an established self-administered questionnaire on TIC knowledge, attitude, and practice (KAP) consisting of 21 items. The content validity scale-level CVI was 0.950, and the reliability with Cronbach’s α coefficient was 0.963.ResultsA total of 118 undergraduate nursing students, ranging from first to fourth year, participated in the survey, and ultimately, 117 students were included in the study, yielding an effective response rate of 99.15%. The average scores for KAP were 70.83±14.58, 77.78±11.11, and 66.67±16.67; however, the good levels of KAP accounted for 16.2%, 45.3% and 6.0%, respectively. Additional analysis showed a weak positive correlation between knowledge and attitude (rs = 0.211, p = 0.022), while there was a moderate positive correlation between knowledge and practice, attitude and practice (rs = 0.309, p < 0.001; rs = 0.310, p < 0.001). Univariate analysis indicated that year of study and experience in caring for trauma patients were significantly related to practice (p = 0.039, p = 0.002).ConclusionThe students’ KAP on trauma-informed care was not at a good level, especially regarding practice and knowledge, and required further strengthening. The findings provide baseline information for further development of a KAP-TIC comprehensive course and exploration of practice ability-centered TIC education for nursing students. Assessing the effectiveness of the newly developed TIC course and learning outcomes in clinical practice is also recommended.

BackgroundMetabolic syndrome (MetS) is a cluster of chronic conditions, including obesity, hyperglycemia, hypertension, and dyslipidemia, known to significantly increase the risk of cardiovascular diseases (CVDs). Effective interventions are needed to control the progression of MetS.ObjectiveThis study aimed to determine the effectiveness of the Self-Efficacy Enhancement (SEE) program on health behaviors and clinical outcomes in individuals with Metabolic Syndrome (MetS).MethodsA quasi-experimental study with a two-group pretest-posttest design was conducted from September 2023 to January 2024. A purposive sample of 70 participants with MetS was recruited from two healthcare settings in Thailand. Participants were divided into two groups: an experimental group (n = 35) and a control group (n = 35). The experimental group received the SEE program based on Self-Efficacy Theory, while the control group received only routine nursing care for 12 weeks. Data were collected using a Personal Information questionnaire, a Health Behavior questionnaire, and clinical outcome assessments, including waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL cholesterol), and non-high-density lipoprotein cholesterol (non-HDL cholesterol), before and after the 12-week program. Data were analyzed using descriptive statistics, paired t-test, independent t-test, Wilcoxon signed-rank test, Mann-Whitney U-test, and ANCOVA.ResultsFollowing the SEE program, the experimental group exhibited significant improvements in health behaviors (t = -12.830, p <0.001), a reduction in WC (t = 3.809, p <0.001), decreased SBP (z = -4.554, p <0.001) and DBP (t = -5.178, p <0.001), and an increase in HDL cholesterol (z = -3.193, p <0.001) compared to baseline measures. Furthermore, compared to the control group, the experimental group demonstrated significantly improved health behaviors (F = 193.86, p <0.001), lower WC (F = 19.58, p <0.001), lower FPG (F = 12.39, p <0.001), lower SBP (F = 25.04, p <0.001), lower DBP (F = 19.49, p <0.001), and lower non-HDL cholesterol (F = 8.49, p <0.01). Partial eta-squared (η2) indicated large effects for health behaviors, WC, FPG, SBP, DBP, TC, and HDL cholesterol; non-HDL cholesterol showed a medium effect. TC and HDL cholesterol showed no significant change after completing the program.ConclusionThe SEE program improved health behaviors and clinical outcomes, supporting its integration into standard MetS care in nursing practice. Through e-health, education, exercise guidance, role modeling, and support, the program can boost confidence in adopting healthier behaviors and reduce CVD risk. Future studies should explore extending the program duration, as the 12-week period may have been insufficient to observe significant changes.Trial Registry Number: Thai Clinical Trials Registry (TCTR20250218014)

BackgroundFamily caregivers play a crucial role in providing continuous support to individuals with chronic illnesses. Their responsibilities extend beyond the well-being of patients, influencing both patient health outcomes and their own. Caregiving entails significant responsibilities and sacrifices, requiring caregivers to navigate evolving roles and care needs over time. Existing literature highlights the emotional and psychological challenges faced by caregivers, including role transitions and stress. However, most studies focus on caregiving experiences rather than the specific transitional phases caregivers undergo after assuming their responsibilities.ObjectiveThis study aimed to explore the transitional phases experienced by caregivers of chronically ill patients using an inductive approach, specifically grounded theory methodology.MethodsThis study employed a grounded theory (GT) approach involving 33 participants, including 24 caregivers and nine professional helpers. Data collection and analysis were carried out between April 2022 and January 2024. Participants were recruited through snowball sampling based on predetermined criteria. Data were collected using semi-structured interviews and memos and analyzed using NVivo 12 software. Several measures were undertaken to ensure the validity and reliability of the data.ResultsFindings yielded five stages of life transition, namely, (1) confusion, (2) conflict, (3) consideration, (4) adjustment, and (5) acceptance.ConclusionThis study contributes to the literature by providing new insight into the life transition phases experienced by family caregivers. It offers meaningful implications for nursing practice, particularly in providing holistic support to family caregivers of individuals with chronic illness. It helps nurses to design more targeted, phase-specific interventions that focus on caregivers’ psychosocial needs at each phase. The final model provides a beneficial premise for the development of clinical guidelines and support frameworks that are more responsive to the real experiences of caregivers.