FACTORS INFLUENCING SELF-CARE AMONG PATIENTS AFTER CATARACT SURGERY WITH INTRAOCULAR LENS IMPLANTATION DURING HOME RECOVERY: A MULTIVARIATE ANALYSIS
DOI:
https://doi.org/10.18623/rvd.v22.n3.3308Resumen
Cataract surgery with intraocular lens implantation requires comprehensive post-operative self-care during home recovery, yet the multivariate relationships between patient factors and self-care behaviors remain inadequately understood. This cross-sectional study examined factors influencing self-care among 111 post-cataract surgery patients at Nakhon Phanom Hospital, Thailand, from May 2023 to January 2024. Data were collected using validated questionnaires that measured demographic characteristics, postoperative symptoms, self-care behaviors, and anxiety levels. Multiple linear regression analysis identified six significant predictors explaining 98.8% of the variance in self-care behaviors: education level (the most potent positive predictor), anxiety levels (the strongest negative predictor), age, healthcare entitlement, post-operative symptoms, and operated eye. Self-care behaviors in post-cataract surgery patients are multifactorially determined, with education level and anxiety being the most influential factors. These findings support the development of comprehensive, individualized care models that address both clinical and psychosocial factors during home recovery, enabling healthcare providers to implement systematic assessment protocols and tailor interventions for optimal patient outcomes.
Citas
[1] Strategic Development Working Group, Ministry of Public Health. (2022). Annual cataract patient statistics 2022. Ministry of Public Health. Retrieved from https://spd.moph.go.th/wp-content/uploads/2024/01/ill_2023_full_30012567.pdf
[2] National Eye Health Data Center. (2023). Annual eye health situation report 2023. Department of Medical Services, Ministry of Public Health. Retrieved from https://vision2020thailand.org/home.php
[3] Wonghakaew, M. (2016). Nursing Care In Endophthalmitis Post Cataract Surgery : Case Study
3 Cases. Mahasarakham hospital journal (3)3: 61-70. https://he02.tci-
thaijo.org/index.php/MKHJ/article/view/197704/137643
[4] Shoss, B. L., & Tsai, L. M. (2013). Postoperative care in cataract surgery. Current opinion in ophthalmology, 24(1), 66-73. https://doi.org/ 10.1097/ICU.0b013e32835b0716
[5] Zhang, A., Feng, X., & Qiu, C. (2021). Discharge teaching, readiness for hospital discharge and post‐discharge outcomes in cataract patients: A structural equation model analysis. Journal of nursing management, 29(3), 543-552. https://doi.org/10.1111/jonm.13169
[6] Wang, C., Kuo, H. C., Cheng, S. F., Hung, J. L., Xiong, J. H., & Tang, P. L. (2020). Continuity of care and multiple chronic conditions impact frequent use of outpatient services. Health informatics journal, 26(1), 318-327. https://doi.org/10.1177/1460458218824720
[7] Jeawkok, J., Mudadum, S., & Kammaluan, K. (2015). Family Competency in Postoperative Care of Senile Cataracts Patients. Hatyai Journal 13(1), 35-45. https://so01.tci-thaijo.org/index.php/HatyaiAcademicJournal/article/view/82461/65538
[8] Elgazar, W., Mohamed, A., Fayed, A., & Mohamed, R. (2017). Developing Postoperative Self Care Guideline for Patient Undergoing Cataract Surgery. Mansoura Nursing Journal, 4(1), 255-265. https://mnj.journals.ekb.eg/article_176440.html
[9] Keogh, B., Callaghan, P., & Higgins, A. (2015). Managing preconceived expectations: mental health service users experiences of going home from hospital: a grounded theory study. Journal of psychiatric and mental health nursing, 22(9), 715-723. https://doi.org/10.1111/jpm.12265
[10] Jarujit, S., Aramsin, R., & Prachanno, W. (2019). Home Visit Model for Bedridden Patients Based on the Problems and Needs of Caregivers. Journal of Phrapokklao Nursing College, Chanthaburi, 30(1), 54–68. https://he01.tci-thaijo.org/index.php/pnc/article/view/167752
[11] Creswell, J. W., & Clark, V. L. P. (2017). Designing and conducting mixed methods research. Sage publications. https://www.cambridgeenglish.org/Images/735110-studies-in-language-testing-volume-43.pdf
[12] Cohen, J. (1994). The earth is round (p < .05). American Psychologist, 49(12), 997–1003. https://doi.org/10.1037/0003-066X.49.12.997
[13] Liu, Y. C., Wilkins, M., Kim, T., Malyugin, B., & Mehta, J. S. (2017). Cataracts. The Lancet, 390(10094), 600-612. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30544-5/fulltext
[14] Strategic Planning and Project Working Group. (2022). Master plan for development of medicine and public health in ophthalmology. Department of Medical Services. Retrieved from https://spd.moph.go.th/wp-content/uploads/2023/05/edit-ops_plan-66-70-for-web.pdf
[15] World Health Organization. Management of Cataract in primary health care services. 2nd ed. Geneva: World Health Organization; 1996. https://iris.who.int/bitstream/handle/10665/41877/9241544996.pdf
[16] Olson, R. J., Braga-Mele, R., Chen, S. H., Miller, K. M., Pineda, R., Tweeten, J. P., & Musch, D. C. (2017). Cataract in the adult eye preferred practice pattern®. Ophthalmology, 124(2), P1-P119. https://www.aaojournal.org/article/S0161-6420(16)31418-X/fulltext
[17] Porela‐Tiihonen, S., Kokki, H., Kaarniranta, K., & Kokki, M. (2016). Recovery after cataract surgery (Doctoral dissertation). https://doi.org/10.1111/aos.13055
[18] Qiu, C., Feng, X., Zeng, J., Luo, H., & Lai, Z. (2019). Discharge teaching, readiness for discharge, and post-discharge outcomes in cataract patients treated with day surgery: a cross-sectional study. Indian journal of ophthalmology, 67(5), 612-617. https://pubmed.ncbi.nlm.nih.gov/31007219/
[19] Beyene, A. M., Eshetie, A., Tadesse, Y., & Getnet, M. G. (2021). Time to recovery from cataract and its predictors among eye cataract patients treated with cataract surgery: A retrospective cohort study in Ethiopia. Annals of Medicine and Surgery, 65, 102275. https://doi.org/10.1016/j.amsu.2021.102275
[20] Parulekar, M. V. (2008). Complications following cataract surgery. In Cataract (pp. 141-182). Butterworth-Heinemann.
[21] Orem, D. E., Taylor, S. G., & Renpenning, K. M. (2001). Nursing: Concepts of practice (6th ed.). Mosby.
[22] Queirós, P. J. P., Vidinha, T. S. S., & Almeida Filho, A. J. (2014). Self-care: Orem's theoretical contribution to the nursing discipline and profession. Revista de Enfermagem Referência, 4(2), 157-163. https://doi.org/10.12707/RIV14081
[23] Tedros AG, Swaminathan S. WHO guideline on self-care interventions for health and well-being, 2022 revision. Geneva: World Health Organization; 2022. https://iris.who.int/bitstream/handle/10665/357828/9789240052192-eng.pdf
[24] Desoky, G. M., Ebraheim, M. N., & Abd El Hafeez, N. A. (2024). Effect of Nursing Intervention Guidelines on Knowledge and Self-care Practices among Adult Patients Undergoing Cataract Surgery. Egyptian Journal of Nursing and Health Sciences, 5(1), 30-47. https://journals.ekb.eg/article_347644_45c307193d039de258b10ee762ae339f.pdf
[25] Zarifsanaiey, N., Hedayat, M., Mehrabi, M., & Bagheri, Z. (2022). Video-based versus educational booklet training on self-care performance of patients with cataract. Bangladesh Journal of Medical Science, 21(3), 601-609. https://doi.org/10.3329/bjms.v21i3.59574
[26] Khowaja, R., Syed, B. M., Khowaja, S., Sarwar, S., Qureshi, I., & Ali, D. N. (2025). Effects of Counseling on Post-Operative Cataract Discharge Care in Promoting Self-Care Compliance Behavior: A Quasi-Experimental Design. Indus Journal of Bioscience Research, 3(6), 367-371. https://doi.org/10.70749/ijbr.v3i6.1475
[27] Cao, X., Tang, X., Li, Y., Guo, L., Jia, T., & Shi, J. (2024). Construction of Preoperative Assessment Program for Day Surgery in Geriatric Cataract Patients: An Evidence-Based Delphi Study. Journal of PeriAnesthesia Nursing. https://doi.org/10.1016/j.jopan.2024.07.018
[28] Kobayashi, L. C., Wardle, J., Wolf, M. S., & Von Wagner, C. (2016). Aging and functional health literacy: a systematic review and meta-analysis. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71(3), 445-457. https://doi.org/10.1093/geronb/gbu161
[29] Bambara, J. K., Owsley, C., Wadley, V., Martin, R., Porter, C., & Dreer, L. E. (2009). Family caregiver social problem-solving abilities and adjustment to caring for a relative with vision loss. Investigative ophthalmology & visual science, 50(4), 1585-1592. https://doi.org/10.1167/iovs.08-2744
[30] Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., ... & Bindman, A. B. (2002). Association of health literacy with diabetes outcomes. Jama, 288(4), 475-482. https://jamanetwork.com/journals/jama/fullarticle/195143#google_vignette
[31] Freeman, J. D., Kadiyala, S., Bell, J. F., & Martin, D. P. (2008). The causal effect of health insurance on utilization and outcomes in adults: a systematic review of US studies. Medical care, 46(10), 1023-1032. DOI: 10.1097/MLR.0b013e318185c913
[32] Freeman, J. D., Kadiyala, S., Bell, J. F., & Martin, D. P. (2008). The causal effect of health insurance on utilization and outcomes in adults: a systematic review of US studies. Medical care, 46(10), 1023-1032. https://doi.org/10.1097/MLR.0b013e318185c913
[33] Rush, S. W., Huseman, S., & Rush, R. B. (2023). Timing of the initial postoperative care after cataract
surgery: a patient’s perspective. Clinical Ophthalmology, 1475-1479.
https://doi.org/10.2147/OPTH.S413602
[34] Moshirfar, M., Stoakes, I. M., Theis, J. S., Porter, K. B., Santos, J. M., Martheswaran, T., ... & Hoopes, P. C. (2023). Assessing visual outcomes: A comparative study of US-FDA premarket approval data for multifocal and EDOF Lens implants in cataract surgery. Journal of Clinical Medicine, 12(13), 4365. https://doi.org/10.3390/jcm12134365
[35] Munteanu, M., Mocanu, V., & Preda, A. (2024). Ophthalmological pathology and medical and surgical management in eye disease cataract. In Clinical ophthalmology: a guide to diagnosis and treatment (pp. 225-247). Cham: Springer Nature Switzerland. https://link.springer.com/chapter/10.1007/978-3-031-68453-1_9
[36] Papa-Vettorazzi, R., Shorstein, N. H., Peterson, B., Yee Melgar, M., Silva Linares, L., & O’Brien, K. S. (2025). Comparison of Subconjunctival Triamcinolone with Topical Prednisolone for Routine Anti-Inflammatory Prophylaxis in Manual Small Incision Cataract Surgery: A Single-Center, Randomized Controlled Trial Pilot Protocol. Clinical Ophthalmology, 2091-2105. https://doi.org/10.2147/OPTH.S527039
[37] Tomás, M. A. R., & Rebelo, M. T. D. S. (2022). Everyday life after the first psychiatric admission: a portuguese phenomenological research. Journal of Personalized Medicine, 12(11), 1938. https://doi.org/10.3390/jpm12111938
[38] Kain, Z. N., Sevarino, F., Alexander, G. M., Pincus, S., & Mayes, L. C. (2000). Preoperative anxiety and postoperative pain in women undergoing hysterectomy: A repeated-measures design. Journal of psychosomatic research, 49(6), 417-422. https://doi.org/10.1016/S0022-3999(00)00189-6
[39] Casteli, C. P. M., Mbemba, G. I. C., Dumont, S., Dallaire, C., Juneau, L., Martin, E., ... & Gagnon, M. P. (2020). Indicators of home-based hospitalization model and strategies for its implementation: a systematic review of reviews. Systematic Reviews, 9(1), 172. https://link.springer.com/article/10.1186/s13643-020-01423-5
[40] Levine, S. A., Boal, J., & Boling, P. A. (2003). Home care. Jama, 290(9), 1203-1207. doi:10.1001/jama.290.9.1203
[41] Cohen, J. (2016). The earth is round (p<. 05). What if there were no significance tests?, 69-82. https://www.taylorfrancis.com/chapters/edit/10.4324/9781315629049-14/earth-round-05-jacob-cohen
[42] Ray, R. (2007). Designing and conducting mixed methods research. Qualitative Research Journal, 7(2), 90-92. https://link.gale.com/apps/doc/A179076997/AONE?u=anon~b3f777bf&sid=googleScholar&xid=900b78a3
[43] Greene, J. C., Caracelli, V. J., & Graham, W. F. (1989). Toward a conceptual framework for mixed-method evaluation designs. Educational evaluation and policy analysis, 11(3), 255-274. https://doi.org/10.3102/016237370110032
[44] McGhee, C. N., Zhang, J., & Patel, D. V. (2020). A perspective of contemporary cataract surgery: the most common surgical procedure in the world. Journal of the Royal Society of New Zealand, 50(2), 245-262. https://doi.org/10.1080/03036758.2020.1714673
[45] Strategic Planning and Project Working Group. (2022). Master plan for development of medicine and public health in ophthalmology. Department of Medical Services. Retrieved from https://www.dms.go.th/backend//Content/Content_File/Map_Strategic/Attach/25660919144848PM_เล่มแผนปฏิบัติราชการ%20กรมการแพทย์%20ระยะ%205%20ปี%20(new19sep).pdf
[46] Almalki, Z. S., Alahmari, A. K., Alajlan, S. A., Alqahtani, A., Alshehri, A. M., Alghamdi, S. A., ... & Ahmed, N. (2023). Continuity of care in primary healthcare settings among patients with chronic diseases in Saudi Arabia. SAGE Open Medicine, 11, 20503121231208648. https://doi.org/10.1177/20503121231208648
[47] Metwally Sorour, D., Ahmed Rashad Elsakka, E., Ahmed Lotfy, N., & Samir Dawood, S. (2024). Impact of Incorporating a Self-care Management Program with Telephone Follow-up on Geriatric Patients’ Self-care Compliance and Coping Post Cataract Surgery. Egyptian Journal of Health Care, 15(2), 1624-1641. https://ejhc.journals.ekb.eg/article_377098.html
[48] Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods, 39(2), 175-191. https://link.springer.com/article/10.3758/BF03193146
[49] Muller, K. (1989). Statistical Power Analysis for the Behavioral Sciences. Technometrics, 31(4), 499–500. https://doi.org/10.1080/00401706.1989.10488618
[50] Ali, A. S. (2025). Patients Self-Care Practices after Cataract Surgery at Giza Memorial Institute for Ophthalmic Research. Helwan International Journal for Nursing Research and Practice, 4(9), 133-145.
DOI: 10.21608/hijnrp.2025.357267.1277
[51] Cramer, D. (2003). Fundamental statistics for social research: step-by-step calculations and computer techniques using SPSS for Windows. Routledge. https://doi.org/10.4324/9780203360613
[52] Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. psychometrika, 16(3), 297-334. DOI: https://doi.org/10.1007/BF02310555
[53] Elifson, K. W., Runyon, R. P., & Haber, A. (1998). Fundamentals of social statistics (3rd ed.). McGraw-Hill.
[54] Beauchamp, T. L., & Childress, J. F. (1994). Principles of biomedical ethics. Edicoes Loyola. https://www.allisonkrilethornton.com/wp-content/uploads/Medical_Ethics_Readings/BandC-Moral-Dilemmas.pdf
[55] Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health promotion international, 15(3), 259-267. https://doi.org/10.1093/heapro/15.3.259
[56] Wolf, M. S., Gazmararian, J. A., & Baker, D. W. (2005). Health literacy and functional health status among older adults. Archives of Internal Medicine, 165(17), 1946-1952. https://doi.org/10.1001/archinte.165.17.1946
[57] Bodenheimer, T., Lorig, K., Holman, H., & Grumbach, K. (2002). Patient self-management of chronic disease in primary care. JAMA, 288(19), 2469-2475. https://doi.org/10.1001/jama.288.19.2469
[58] Abhishek, H. N., & Akhilan, S. (2024). Effectiveness of Preoperative Anxiolytic Medications on Surgical Outcomes and Patient Satisfaction. European Journal of Cardiovascular Medicine, 14(6). https://openurl.ebsco.com/EPDB%3Agcd%3A8%3A12292504/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A183513506&crl=c&link_origin=scholar.google.com
[59] Maiye, S. E., & Dal Yılmaz, Ü. (2022). Assessment of preoperative anxiety among surgical patients. Midwifery, 2(2), 53-61. https://docs.neu.edu.tr/library/8897173672.pdf
[60] Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36(1), 1-10. https://doi.org/10.2307/2137284
[61] Sommers, B. D., Gawande, A. A., & Baicker, K. (2017). Health insurance coverage and health—what the recent evidence tells us. New England Journal of Medicine, 377(6), 586-593. https://doi.org/10.1056/NEJMsb1706645
[62] Singh, K., Misbah, A., Saleem, S. M., & Golding, J. (2019). Systematic review of factors influencing treatment adherence and outcomes in cataract surgery. Clinical Ophthalmology, 13, 2369-2378. https://doi.org/10.2147/OPTH.S220900
[63] Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., Palacios, J., Sullivan, G. D., & Bindman, A. B. (2002). Association of health literacy with diabetes outcomes. JAMA, 288(4), 475-482. https://doi.org/10.1001/jama.288.4.475
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
I (we) submit this article which is original and unpublished, of my (our) own authorship, to the evaluation of the Veredas do Direito Journal, and agree that the related copyrights will become exclusive property of the Journal, being prohibited any partial or total copy in any other part or other printed or online communication vehicle dissociated from the Veredas do Direito Journal, without the necessary and prior authorization that should be requested in writing to Editor in Chief. I (we) also declare that there is no conflict of interest between the articles theme, the author (s) and enterprises, institutions or individuals.
I (we) recognize that the Veredas do Direito Journal is licensed under a CREATIVE COMMONS LICENSE.
Licença Creative Commons Attribution 3.0



