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r
e
d
u
cin
g
t
h
e
r
ate
o
f
tr
ea
t
m
e
n
t
f
a
ilu
r
e
e
v
e
n
th
o
u
g
h
f
a
m
il
y
m
e
m
b
er
s
ca
n
n
o
t
r
ep
lace
th
e
p
r
o
f
es
s
io
n
al
e
x
p
er
tis
e
o
f
h
ea
l
th
w
o
r
k
er
s
[
1
1
]
.
T
h
er
e
ar
e
s
o
m
e
ef
f
o
r
ts
t
o
i
m
p
r
o
v
e
f
a
m
il
y
s
u
p
p
o
r
t.
On
e
o
f
th
e
e
f
f
o
r
ts
th
a
t
ca
n
b
e
d
o
n
e
to
in
cr
ea
s
e
f
a
m
il
y
s
u
p
p
o
r
t is f
a
m
il
y
e
m
p
o
w
er
m
e
n
t
[
1
2
]
.
T
h
e
c
o
n
c
e
p
t
o
f
f
am
i
ly
em
p
o
w
e
r
m
en
t
h
as
b
e
en
u
s
e
d
in
c
ar
e
w
i
th
ch
i
l
d
r
en
w
ith
d
is
a
b
i
li
ti
e
s
.
F
am
il
y
em
p
o
w
e
r
m
en
t
i
s
th
e
f
am
i
ly
'
s
ab
i
l
i
ty
t
o
w
o
r
k
t
o
g
e
th
e
r
w
ith
e
lem
en
ts
o
u
t
s
i
d
e
t
h
e
s
c
o
p
e
o
f
l
if
e
t
o
c
a
r
e
f
o
r
f
am
i
ly
m
em
b
e
r
s
w
h
o
a
r
e
s
i
ck
[
1
3
]
.
F
am
i
ly
em
p
o
w
e
r
m
en
t
in
t
h
e
li
f
es
ty
le
o
f
h
ea
r
t
f
ai
lu
r
e
p
at
i
en
t
s
s
h
o
w
s
s
ig
n
if
i
ca
n
t
r
e
s
u
l
ts
,
n
am
e
ly
m
o
r
e
p
o
s
i
t
iv
e
c
h
an
g
es
in
th
ei
r
l
if
es
ty
le
,
e
s
p
ec
i
a
l
ly
i
n
t
e
r
m
s
o
f
n
u
t
r
i
t
i
o
n
,
s
p
ir
i
t
u
a
l
g
r
o
w
th
,
s
t
r
es
s
m
an
ag
em
en
t
,
p
h
y
s
i
c
a
l
a
c
t
iv
i
ty
,
i
n
te
r
p
e
r
s
o
n
a
l
c
o
m
m
u
n
i
c
at
i
o
n
,
a
n
d
r
es
p
o
n
s
i
b
i
li
ty
f
o
r
h
e
a
l
th
[
1
4
]
.
P
atien
ts
w
it
h
h
ea
r
t
f
ail
u
r
e
h
a
v
e
to
tak
e
ca
r
e
o
f
t
h
e
m
s
el
v
es
,
esp
ec
iall
y
w
h
e
n
it
co
m
es
to
s
elf
-
ca
r
e
m
an
a
g
e
m
e
n
t.
Fa
m
il
y
e
m
p
o
w
e
r
m
en
t
is
al
s
o
i
m
p
o
r
tan
t
to
in
c
r
ea
s
e
th
e
f
a
m
il
y
's
ab
ilit
y
to
d
o
s
elf
-
ca
r
e
w
h
ile
at
h
o
m
e.
T
h
e
p
u
r
p
o
s
e
o
f
th
i
s
s
t
u
d
y
w
as
to
d
eter
m
in
e
t
h
e
co
r
r
elatio
n
b
et
w
ee
n
f
a
m
i
l
y
e
m
p
o
w
er
m
e
n
t
a
n
d
th
e
ab
ilit
y
o
f
f
a
m
ilies
to
d
o
s
elf
-
c
ar
e
f
o
r
h
ea
r
t f
ail
u
r
e
p
atien
ts
i
n
th
e
in
ter
m
ed
iate
ca
r
e
r
o
o
m
i
n
Ma
lan
g
.
2.
M
E
T
H
O
D
Th
is
s
tu
d
y
w
a
s
c
o
n
d
u
ct
e
d
i
n
a
c
r
o
s
s
-
s
ec
t
i
o
n
a
l
a
p
p
r
o
a
ch
w
ith
a
c
o
n
s
e
cu
t
iv
e
s
am
p
l
in
g
t
ec
h
n
i
q
u
e
.
T
h
e
s
am
p
l
e
in
th
e
s
tu
d
y
w
as
1
0
0
p
e
o
p
l
e
.
T
h
e
p
o
p
u
l
a
t
i
o
n
in
th
i
s
s
tu
d
y
w
e
r
e
f
am
i
li
es
w
h
o
w
e
r
e
w
a
it
in
g
in
th
e
i
n
te
r
m
e
d
i
a
t
e
c
a
r
e
r
o
o
m
in
Ma
l
a
n
g
.
R
es
p
o
n
d
en
ts
w
h
o
t
o
o
k
p
a
r
t
in
th
is
s
tu
d
y
w
e
r
e
in
clu
d
e
d
i
n
th
e
in
c
lu
s
i
o
n
c
r
i
t
e
r
i
a
s
e
t b
y
t
h
e
r
e
s
e
a
r
ch
e
r
,
n
am
ely
:
ag
e
o
f
r
es
p
o
n
d
en
ts
≥
1
8
y
e
a
r
s
,
a
b
l
e
t
o
c
o
m
m
u
n
i
c
a
t
e
an
d
c
o
o
p
e
r
a
t
i
v
e
in
th
e
s
tu
d
y
,
f
am
il
i
es
w
i
th
b
l
o
o
d
r
e
l
at
i
o
n
s
/l
if
e
p
a
r
tn
e
r
s
an
d
l
iv
e
in
o
n
e
h
o
u
s
e
/
w
h
o
li
v
e
c
l
o
s
e
t
o
th
e
p
a
t
i
e
n
t'
s
h
o
u
s
e
an
d
a
r
e
d
i
r
e
c
tly
in
v
o
lv
e
d
i
n
c
a
r
e
.
D
a
t
a
c
o
l
l
e
ct
i
o
n
u
s
e
d
a
f
am
ily
em
p
o
w
e
r
m
en
t
s
ca
le
(
F
E
S
)
q
u
es
t
i
o
n
n
a
i
r
e
c
o
n
t
a
in
in
g
3
4
q
u
e
s
t
i
o
n
s
[
1
5
]
a
n
d
co
n
tr
ib
u
tio
n
ca
r
eg
i
v
er
s
el
f
-
ca
r
e
h
ea
r
t
f
a
ilu
r
e
in
d
e
x
(
C
C
SH
F
I
)
,
a
to
t
a
l
o
f
2
2
q
u
e
s
t
i
o
n
s
[
1
6
]
.
T
h
e
Pe
a
r
s
o
n
c
o
r
r
e
l
a
ti
o
n
te
s
t
w
as
u
ti
l
i
ze
d
a
s
t
h
e
s
t
a
t
is
t
ic
al
a
n
aly
s
i
s
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Dem
o
g
ra
ph
ic
cha
ra
ct
er
is
t
ics
T
ab
le
1
d
escr
ib
es
th
e
d
e
m
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
o
f
t
h
is
s
t
u
d
y
.
T
h
e
Mi
n
is
tr
y
o
f
Hea
lth
R
ep
u
b
lic
o
f
I
n
d
o
n
esia
clas
s
i
f
icatio
n
s
y
s
te
m
is
u
s
ed
to
s
ep
ar
ate
th
e
a
g
e
g
r
o
u
p
s
[
1
7
]
.
B
ased
o
n
T
a
b
le
1
,
m
o
s
t
o
f
th
e
r
esp
o
n
d
en
ts
a
g
ed
3
6
-
4
5
y
ea
r
s
o
ld
(
2
7
%)
,
w
h
er
e
th
e
a
g
es
ar
e
ad
u
lts
.
I
n
ad
u
lt
h
o
o
d
,
in
d
iv
id
u
al
s
ar
e
ab
le
to
m
ak
e
w
is
e
d
ec
is
io
n
s
,
b
eg
i
n
t
o
ig
n
o
r
e
p
er
s
o
n
al
d
esire
s
a
n
d
p
r
io
r
itize
f
a
m
il
y
[
1
8
]
.
B
esid
es
th
at,
t
h
e
f
a
m
i
l
y
r
elatio
n
s
h
ip
s
t
h
at
m
o
s
tl
y
ca
r
e
d
f
o
r
th
e
p
atie
n
ts
in
t
h
i
s
s
t
u
d
y
w
er
e
t
h
e
w
i
f
e
4
6
%
a
n
d
ch
il
d
r
en
2
6
%.
Fa
m
il
ies
w
h
o
ca
r
e
f
o
r
n
o
t
o
n
l
y
s
p
o
u
s
e
s
b
u
t
also
ch
ild
r
en
,
w
h
er
e
t
h
e
f
a
m
il
y
i
s
an
i
m
p
o
r
tan
t
p
ar
t
o
f
th
e
p
atie
n
t
's
s
el
f
-
ca
r
e
[
1
9
]
.
T
h
e
f
a
m
il
y
p
la
y
s
a
r
o
le
as
th
e
m
ain
p
illar
,
th
e
m
o
s
t
i
m
p
o
r
tan
t
in
s
o
ciet
y
,
is
r
e
s
p
o
n
s
ib
le
f
o
r
p
r
o
v
id
in
g
ad
eq
u
ate
ca
r
e
an
d
h
as a
n
i
m
p
o
r
ta
n
t r
o
le
in
t
h
e
p
r
ev
en
t
io
n
an
d
tr
ea
t
m
e
n
t o
f
d
is
ea
s
e
[
2
0
]
.
T
h
e
g
en
d
er
o
f
th
e
m
o
s
t
r
esp
o
n
d
en
t
s
in
t
h
i
s
s
t
u
d
y
w
er
e
w
o
m
en
(
7
2
.
0
%),
w
it
h
a
m
ar
r
ied
s
tatu
s
o
f
9
4
p
eo
p
le
(
9
4
.
0
%)
an
d
5
4
p
e
o
p
le
(
5
4
.
0
%)
w
o
r
k
in
g
.
T
h
is
i
s
in
ac
co
r
d
an
ce
w
it
h
th
e
c
u
ltu
r
e
th
a
t
ex
i
s
ts
i
n
I
n
d
o
n
esia
n
s
o
ciet
y
w
h
ich
p
la
ce
s
th
e
r
o
le
o
f
w
o
m
e
n
in
th
e
f
a
m
il
y
as
t
h
o
s
e
w
h
o
tak
e
ca
r
e
o
f
th
eir
f
a
m
il
y
m
e
m
b
er
s
[
2
1
]
.
Hea
r
t
f
ailu
r
e
it
s
elf
h
as
a
n
e
g
ati
v
e
i
m
p
ac
t
o
n
a
w
aiti
n
g
f
a
m
il
y
,
esp
ec
iall
y
f
o
r
a
w
o
m
an
b
ec
au
s
e
h
er
r
o
les
ar
e
d
u
al,
n
a
m
el
y
as
a
m
o
t
h
er
an
d
also
as
th
e
h
ea
d
o
f
th
e
f
a
m
il
y
r
ep
laci
n
g
h
er
h
u
s
b
an
d
's
r
o
le
w
h
ic
h
h
as a
n
i
m
p
ac
t o
n
p
h
y
s
ical
an
d
e
m
o
tio
n
al
c
h
an
g
e
s
.
T
h
e
h
ig
h
e
s
t
lev
e
l
o
f
ed
u
ca
tio
n
is
s
e
n
io
r
h
ig
h
s
c
h
o
o
l
(
3
8
%)
.
T
h
e
lev
el
o
f
f
a
m
il
y
ed
u
ca
ti
o
n
is
also
in
v
o
l
v
ed
as
a
p
r
ed
icto
r
o
f
t
h
e
b
u
r
d
en
o
f
p
r
o
v
id
in
g
ca
r
e
[
2
2
]
.
Fa
m
ilies
w
it
h
g
r
ea
ter
le
v
els
o
f
ed
u
ca
tio
n
f
ee
l
o
f
ca
r
in
g
f
o
r
s
ic
k
f
a
m
il
y
m
e
m
b
e
r
s
as
a
g
o
o
d
ex
p
er
ien
ce
,
b
u
t
f
a
m
ilie
s
w
ith
lo
w
er
lev
el
s
o
f
ed
u
ca
tio
n
s
ee
it
as
a
b
u
r
d
en
b
ec
au
s
e
to
a
lack
o
f
i
n
f
o
r
m
at
io
n
an
d
a
w
ar
en
e
s
s
o
f
th
e
is
s
u
es t
h
e
y
co
n
f
r
o
n
t
[
2
3
]
.
3
.
2
.
F
a
m
ily
e
m
po
w
er
m
ent
T
ab
le
2
s
h
o
w
s
th
e
m
ea
n
v
al
u
e
o
f
th
e
co
m
p
o
n
e
n
ts
o
f
f
a
m
il
y
e
m
p
o
w
er
m
e
n
t.
B
ased
o
n
T
ab
le
2
,
it
s
h
o
w
s
t
h
at
t
h
e
k
n
o
w
led
g
e
co
m
p
o
n
en
t
h
a
s
th
e
h
i
g
h
e
s
t
m
ea
n
v
alu
ea
n
d
th
e
e
f
f
icie
n
c
y
o
f
t
h
e
co
m
p
o
n
e
n
t
h
as
t
h
e
lo
w
es
t
m
ea
n
v
al
u
e.
Fa
m
il
y
e
m
p
o
w
er
m
e
n
t
is
a
co
m
b
in
at
io
n
o
f
attr
ib
u
tes,
att
itu
d
es,
a
n
d
b
eh
av
io
r
s
t
h
at
e
n
ab
le
f
a
m
ilies
a
n
d
h
ea
lt
h
-
ca
r
e
p
r
o
v
id
er
s
to
m
ee
t
t
h
e
n
ee
d
s
o
f
s
ic
k
f
a
m
il
y
m
e
m
b
er
s
i
n
w
a
y
s
t
h
at
b
en
ef
it
e
v
er
y
o
n
e
in
v
o
l
v
ed
,
s
u
c
h
as
in
cr
ea
s
in
g
f
a
m
il
y
i
n
v
o
l
v
e
m
en
t
i
n
ca
r
e,
i
m
p
r
o
v
in
g
f
a
m
il
y
an
d
p
atie
n
t
p
s
y
c
h
o
lo
g
y
,
an
d
in
cr
ea
s
i
n
g
s
er
v
ice
s
ati
s
f
ac
t
io
n
[
2
4
]
.
T
h
e
w
r
o
n
g
f
a
m
il
y
as
s
u
m
p
tio
n
ca
n
h
a
v
e
a
f
a
tal
i
m
p
ac
t
o
n
t
h
e
p
atie
n
t,
w
o
r
s
e
n
i
n
g
t
h
e
p
atien
t
's
q
u
alit
y
o
f
li
f
e.
T
o
an
ticip
ate
th
is
,
th
e
r
ig
h
t
an
d
g
o
o
d
w
a
y
is
to
p
r
o
v
id
e
ed
u
ca
tio
n
to
f
a
m
ilies
[
2
5
]
.
E
d
u
ca
tio
n
i
s
a
co
m
p
o
n
e
n
t
o
f
t
h
e
f
a
m
il
y
e
m
p
o
w
er
m
e
n
t
i
n
ter
v
en
t
io
n
m
o
d
el,
w
h
ic
h
ai
m
s
to
i
m
p
r
o
v
e
f
a
m
il
y
k
n
o
w
led
g
e
s
o
th
at
t
h
e
y
ca
n
b
etter
ca
r
e
f
o
r
p
a
tien
t
s
[
2
6
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
n
t J
P
u
b
lic
Hea
lth
Sci
,
Vo
l.
1
1
,
No
.
1
,
M
ar
ch
20
22
:
2
4
8
-
25
3
250
E
m
p
o
w
er
m
en
t
is
a
lear
n
i
n
g
co
n
ce
p
t,
an
d
th
r
o
u
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lear
n
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g
,
a
p
er
s
o
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ex
p
ec
ted
to
b
e
in
d
ep
en
d
en
t
i
n
d
o
in
g
s
o
m
et
h
in
g
to
ac
h
ie
v
e
g
o
als.
Fo
r
th
at
w
e
n
ee
d
co
n
f
id
en
ce
f
r
o
m
th
e
f
a
m
il
y
to
b
e
ab
le
to
h
elp
r
ec
o
v
er
y
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r
p
atien
t
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h
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e.
T
h
e
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i
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te
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ce
o
f
f
a
m
il
y
s
el
f
-
e
f
f
icac
y
s
u
p
p
o
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t,
an
d
m
ild
to
s
tr
o
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g
s
el
f
-
co
n
f
id
e
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ce
in
t
h
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m
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elp
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ti
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y
th
e
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d
ca
r
e
n
ee
d
ed
b
y
f
a
m
ilies
a
n
d
p
atien
ts
[
2
7
]
.
T
ab
le
1
.
Dem
o
g
r
ap
h
ic
d
i
s
tr
ib
u
tio
n
C
h
a
r
a
c
t
e
r
i
st
i
c
s
n
%
A
g
e
17
-
2
5
y
e
a
r
s o
l
d
(
l
a
t
e
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d
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l
e
sce
n
c
e
)
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4
.
0
26
-
3
5
y
e
a
r
s o
l
d
(
e
a
r
l
y
a
d
u
l
t
h
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o
d
)
14
1
4
.
0
36
-
4
5
y
e
a
r
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l
d
(
l
a
t
e
a
d
u
l
t
h
o
o
d
)
27
2
7
.
0
46
-
5
5
y
e
a
r
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l
d
(
e
a
r
l
y
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l
d
a
g
e
)
26
2
6
.
0
56
-
6
5
y
e
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r
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l
d
(
l
a
t
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d
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g
e
)
22
2
2
.
0
>
6
5
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r
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(
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g
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)
6
6
.
0
Gend
e
r
M
a
l
e
28
2
8
.
0
F
e
mal
e
72
7
2
.
0
E
d
u
c
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t
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o
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11
1
1
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0
El
e
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o
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12
1
2
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0
Ju
n
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o
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g
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sc
h
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14
1
4
.
0
S
e
n
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r
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g
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s
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l
38
38
.0
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o
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a
g
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25
2
5
.
0
J
o
b
st
a
t
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s
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a
w
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r
k
46
4
6
.
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W
o
r
k
54
5
4
.
0
M
a
r
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t
a
l
st
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t
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s
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e
6
6
.
0
M
a
r
r
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e
d
94
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4
.
0
R
e
l
a
t
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o
n
sh
i
p
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t
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t
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H
u
sb
a
n
d
17
1
7
.
0
W
i
f
e
46
4
6
.
0
C
h
i
l
d
26
2
6
.
0
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r
a
n
d
c
h
i
l
d
1
1
.
0
O
t
h
e
r
10
1
0
.
0
T
ab
le
2
.
Fam
il
y
e
m
p
o
w
er
m
en
t c
o
m
p
o
n
e
n
t
C
o
mp
o
n
e
n
t
o
f
f
a
m
i
l
y
e
mp
o
w
e
r
me
n
t
M
e
a
n
S
D
±
A
d
v
o
c
a
c
y
3
1
.
7
6
4
.
0
7
3
K
n
o
w
l
e
d
g
e
4
1
.
4
8
4
.
8
7
3
C
o
mp
e
t
e
n
c
y
3
0
.
6
4
3
.
6
7
5
Ef
f
i
c
a
c
y
2
3
.
1
5
2
.
0
8
6
3.
3
.
T
he
a
bil
it
y
o
f
a
pa
t
ient
'
s
f
a
m
ily
t
o
pro
v
ide self
-
ca
re
in hea
rt
f
a
ilu
re
T
ab
le
3
s
h
o
w
s
t
h
e
m
ea
n
v
alu
e
o
f
th
e
co
m
p
o
n
en
t
s
el
f
-
ca
r
e.
B
ased
o
n
th
e
d
ata
f
r
o
m
T
ab
le
3
,
it
s
h
o
ws
th
at
t
h
e
co
m
p
o
n
e
n
t
w
i
th
t
h
e
h
ig
h
e
s
t
m
ea
n
v
alu
e
is
t
h
e
s
el
f
ca
r
e
m
ai
n
te
n
an
ce
an
d
th
e
c
o
m
p
o
n
en
t
w
it
h
t
h
e
lo
w
es
t
v
al
u
e
i
s
th
e
s
el
f
-
ca
r
e
m
an
a
g
e
m
e
n
t
i
n
d
icato
r
.
Fac
to
r
s
th
at
in
f
l
u
en
ce
th
e
m
ea
n
v
al
u
e
in
th
e
d
o
m
a
in
o
f
s
elf
-
ca
r
e
m
ai
n
ten
a
n
ce
ar
e
f
a
m
ilie
s
w
h
o
th
in
k
t
h
at
t
h
er
e
i
s
n
o
n
ee
d
to
r
e
m
i
n
d
t
h
eir
f
a
m
ilie
s
to
m
ea
s
u
r
in
g
w
ei
g
h
t,
d
o
p
h
y
s
ica
l
ac
tiv
it
y
,
r
ed
u
ce
s
alt,
tak
e
m
ed
icat
io
n
,
co
n
tr
o
l
d
o
cto
r
s
b
ec
au
s
e
o
f
th
eir
w
r
o
n
g
u
n
d
er
s
ta
n
d
in
g
,
b
ec
a
u
s
e
p
atien
ts
d
o
n
o
t
f
ee
l
t
h
er
e
ar
e
co
m
p
l
ain
ts
a
n
d
h
a
v
e
h
i
g
h
b
lo
o
d
p
r
ess
u
r
e.
W
h
er
ea
s
in
s
elf
-
ca
r
e
m
a
n
a
g
e
m
e
n
t,
f
a
m
i
lie
s
also
th
i
n
k
t
h
at
th
er
e
is
n
o
n
e
ed
to
r
ed
u
ce
d
r
in
k
in
g
w
ater
b
ec
au
s
e
d
r
in
k
in
g
lo
ts
o
f
w
ater
i
s
g
o
o
d
f
o
r
h
ea
lth
,
a
n
d
th
e
an
s
w
er
s
o
f
r
esp
o
n
d
en
t
s
o
n
av
er
ag
e
n
ev
er
ta
k
e
ad
d
itio
n
al
d
r
u
g
s
,
n
a
m
e
l
y
f
u
r
o
s
e
m
id
e
w
h
e
n
t
h
e
p
atie
n
t
ex
p
er
ien
ce
s
ti
g
h
t
n
e
s
s
,
s
w
elli
n
g
i
n
t
h
e
leg
s
b
ec
au
s
e
t
h
e
y
d
o
n
o
t
co
n
s
u
l
t.
W
ith
a
d
o
cto
r
f
ir
s
t,
t
h
e
a
v
er
ag
e
f
a
m
i
l
y
i
m
m
ed
iatel
y
b
r
o
u
g
h
t
t
h
e
p
a
tien
t
to
t
h
e
h
o
s
p
ital
a
n
d
n
e
v
er
ca
lled
/co
n
s
u
lted
a
n
u
r
s
e/d
o
cto
r
to
ask
f
o
r
d
ir
ec
tio
n
s
.
Facto
r
s
t
h
at
i
n
f
lu
e
n
ce
s
el
f
-
ca
r
e
in
cl
u
d
e
ex
p
er
ien
ce
a
n
d
s
k
il
ls
,
m
o
t
iv
at
io
n
,
h
ab
its
,
b
elief
s
an
d
c
u
lt
u
r
al
v
al
u
es a
n
d
s
u
p
p
o
r
t f
r
o
m
f
a
m
il
y
[
6
]
.
T
ab
le
3
.
Self
-
ca
r
e
co
m
p
o
n
e
n
t
C
o
mp
o
n
e
n
t
o
f
se
l
f
-
c
a
r
e
M
e
a
n
S
D
±
S
e
l
f
-
c
a
r
e
mai
n
t
e
n
a
n
c
e
2
0
.
3
4
5
.
2
3
0
S
e
l
f
-
c
a
r
e
man
a
g
e
me
n
t
1
1
.
6
9
2
.
8
1
3
S
e
l
f
-
c
a
r
e
c
o
n
f
i
d
e
n
c
e
1
6
.
2
5
3
.
0
2
0
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J
P
u
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8806
F
a
mily
emp
o
w
ermen
t a
n
d
fa
m
ily
a
b
ilit
y
to
s
elf
ca
r
e
fo
r
h
ea
r
t fa
ilu
r
e
p
a
tien
ts
in
… (
A
lfr
in
a
Ha
n
y
)
251
Fa
m
il
y
p
la
y
s
an
i
m
p
o
r
tan
t
r
o
le
in
s
u
p
p
o
r
tin
g
th
e
s
u
cc
e
s
s
an
d
ef
f
ec
tiv
e
n
e
s
s
o
f
s
e
lf
-
ca
r
e
in
h
ea
r
t
f
ail
u
r
e
p
atien
t
s
[
8
]
.
I
n
p
atien
ts
w
it
h
h
ea
r
t
f
ail
u
r
e,
it
is
d
i
f
f
ic
u
lt
to
d
o
s
elf
-
ca
r
e
in
d
ep
en
d
en
tl
y
b
ec
a
u
s
e
t
h
e
di
s
ea
s
e
r
eq
u
ir
es
f
a
m
il
y
s
u
p
p
o
r
t.
Su
p
p
o
r
t
f
r
o
m
a
p
ar
tn
er
is
w
h
at
th
e
p
atie
n
t
n
ee
d
s
,
w
h
ic
h
is
s
ee
n
f
r
o
m
t
h
e
in
ter
v
ie
w
r
es
u
lt
s
o
f
a
m
a
n
with
h
ea
r
t
f
ail
u
r
e
a
g
ed
5
8
y
ea
r
s
o
ld
w
h
o
s
aid
h
is
w
i
f
e
al
wa
y
s
h
elp
ed
h
i
m
i
n
p
r
ep
ar
in
g
m
ed
ici
n
e
b
e
f
o
r
eh
a
n
d
s
o
th
at
h
is
m
o
ti
v
at
io
n
f
o
r
s
elf
-
ca
r
e
i
n
cr
ea
s
ed
[
2
8
]
.
Fa
m
il
y
i
s
a
n
i
n
s
ep
ar
ab
le
p
ar
t
ac
co
r
d
in
g
to
th
e
f
a
m
i
l
y
ce
n
ter
co
n
ce
p
t
th
at
th
e
f
a
m
il
y
is
a
n
ac
tiv
e
co
llab
o
r
ato
r
,
co
g
n
iti
v
e
s
u
p
p
o
r
t
in
cl
u
d
in
g
p
ar
ticip
ato
r
y
in
f
o
r
m
atio
n
s
h
ar
i
n
g
an
d
f
a
m
il
y
e
d
u
ca
tio
n
w
ill
i
m
p
r
o
v
e
f
a
m
i
l
y
co
p
in
g
d
u
r
in
g
th
e
d
is
ea
s
e
e
x
p
er
ien
ce
[
2
9
]
.
Nu
r
s
es
h
a
v
e
a
r
o
le
to
co
n
ti
n
u
e
to
i
m
p
r
o
v
e
f
a
m
il
y
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f
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ca
r
e
i
n
t
h
e
d
o
m
ai
n
s
o
f
s
el
f
-
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m
ain
ten
a
n
ce
,
s
el
f
-
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r
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m
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a
g
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m
e
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t
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d
s
elf
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c
o
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id
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ce
.
Sel
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-
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eh
a
v
io
r
is
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m
p
o
r
tan
t
f
o
r
m
ai
n
tai
n
in
g
cli
n
ical
s
tab
ilit
y
a
n
d
p
r
ev
en
ti
n
g
th
e
i
n
cid
en
ce
o
f
r
ec
u
r
r
en
t h
o
s
p
italiza
tio
n
s
[
3
0
]
.
3.
4
.
Co
rr
el
a
t
io
n f
a
m
ily
e
m
p
o
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h a
bil
it
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re
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ab
le
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s
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h
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co
r
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elatio
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p
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m
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m
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ies
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ased
o
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T
ab
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4
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p
-
v
alu
e
i
s
0
.
0
0
0
<0
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0
5
,
w
h
ic
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ea
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s
ig
n
i
f
ican
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r
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p
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5
2
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*
*
.
B
ased
o
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h
e
p
r
in
cip
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o
f
th
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f
a
m
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's
ab
ili
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to
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all
asp
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o
f
em
p
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w
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en
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i
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m
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u
all
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f
l
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ce
an
d
in
f
lu
e
n
ce
s
el
f
-
ca
r
e.
T
ab
le
4
.
C
o
r
r
elatio
n
f
a
m
il
y
e
m
p
o
w
er
m
e
n
t
w
it
h
ab
ilit
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f
a
m
i
lies
to
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o
s
elf
-
ca
r
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F
a
mi
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mp
o
w
e
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me
n
t
T
h
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a
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o
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se
l
f
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F
a
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e
mp
o
w
e
r
me
n
t
P
e
a
r
so
n
c
o
r
r
e
l
a
t
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n
1
.
5
2
2
*
*
S
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(
2
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t
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)
.
0
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1
0
0
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T
h
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a
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i
t
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s d
o
se
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f
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c
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P
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a
r
so
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o
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a
t
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5
2
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*
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(
2
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0
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P
r
o
f
ess
io
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al
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r
s
e
s
m
u
s
t
b
e
ab
le
to
ass
ess
p
atien
t
s
n
o
t
o
n
l
y
b
ased
o
n
th
e
illn
e
s
s
b
u
t
al
s
o
s
ee
th
e
p
r
esen
ce
o
f
t
h
e
f
a
m
i
l
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h
at
ca
n
af
f
ec
t
t
h
e
p
atie
n
t
'
s
co
n
d
itio
n
[
3
1
]
.
Nu
r
s
in
g
i
n
ter
v
en
t
io
n
s
a
r
e
o
f
f
er
ed
n
o
t
o
n
l
y
to
p
atien
t
s
,
b
u
t
also
to
t
h
eir
f
a
m
ilie
s
,
i
n
o
r
d
er
f
o
r
f
a
m
ilie
s
to
i
m
p
r
o
v
e
t
h
eir
ab
ilit
ie
s
to
ca
r
e
f
o
r
p
atie
n
ts
[
3
2
]
.
Fa
m
il
y
e
m
p
o
w
er
m
e
n
t
a
s
r
ef
er
r
ed
to
in
th
is
s
tu
d
y
is
a
f
o
r
m
o
f
f
a
m
il
y
p
ar
ticip
atio
n
to
as
s
is
t
p
atien
t
s
e
lf
-
ca
r
e
i
n
th
e
f
o
r
m
o
f
p
h
y
s
ical
co
m
p
ete
n
ce
an
d
k
n
o
w
led
g
e.
E
m
p
o
w
e
r
m
en
t
is
a
p
r
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ce
s
s
,
th
r
o
u
g
h
t
h
is
p
r
o
ce
s
s
f
a
m
ilies
ca
n
a
n
al
y
ze
th
e
r
ea
l
ca
u
s
es
o
f
t
h
e
p
r
o
b
le
m
,
t
h
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y
ar
e
r
ea
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y
to
s
o
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v
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b
le
m
s
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is
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l
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s
h
ar
e
k
n
o
w
led
g
e
an
d
s
k
il
ls
w
i
th
h
ea
lt
h
w
o
r
k
er
s
[
3
3
]
.
Fa
m
il
y
e
m
p
o
w
er
m
e
n
t
h
elp
s
f
a
m
ilie
s
t
h
r
o
u
g
h
t
h
e
p
r
o
ce
s
s
o
f
ch
a
n
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t
h
at
w
il
l
b
e
ca
r
r
ied
o
u
t,
b
u
ild
in
g
f
a
m
i
l
y
r
es
ilie
n
ce
an
d
ad
ap
tatio
n
,
ex
p
lo
r
in
g
a
n
d
in
cr
ea
s
i
n
g
t
h
e
p
o
ten
tial,
r
o
les
an
d
f
u
n
ctio
n
s
th
at
t
h
e
f
a
m
il
y
h
as
[
3
4
]
.
E
m
p
o
w
er
m
e
n
t
o
f
f
a
m
i
li
es
w
it
h
f
a
m
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m
e
m
b
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s
w
h
o
ex
p
er
ien
ce
c
h
r
o
n
ic
d
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s
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d
o
n
e
b
y
p
r
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v
id
i
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co
m
p
lete
an
d
ac
c
u
r
ate
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f
o
r
m
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ab
o
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t
d
is
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s
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co
n
d
iti
o
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s
a
n
d
tr
ea
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m
en
t
m
an
a
g
e
m
e
n
t,
p
r
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m
o
ti
n
g
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m
p
ath
y
a
n
d
s
h
o
w
i
n
g
g
e
n
u
in
e
c
o
n
ce
r
n
,
th
i
s
ca
n
i
n
cr
ea
s
e
f
a
m
il
y
co
m
p
eten
ce
i
n
ca
r
in
g
f
o
r
s
ick
f
a
m
il
y
m
e
m
b
er
s
[
3
5
]
.
T
h
e
s
ig
n
i
f
ican
ce
o
f
f
a
m
il
y
ed
u
ca
tio
n
r
e
g
ar
d
in
g
h
ea
r
t
f
a
ilu
r
e
th
er
ap
y
m
a
y
b
e
ac
co
m
p
li
s
h
ed
th
r
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u
g
h
f
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m
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e
m
p
o
w
e
r
m
en
t
w
h
ile
i
n
t
h
e
h
o
s
p
ital,
w
h
ich
w
ill
e
n
h
an
ce
f
a
m
il
y
a
n
d
p
atien
t
k
n
o
w
led
g
e
i
n
s
el
f
-
ca
r
e,
an
d
f
a
m
ilies
w
ill
b
e
ab
le
to
r
eg
u
la
te
t
h
e
s
i
g
n
s
a
n
d
s
y
m
p
to
m
s
t
h
at
p
atie
n
ts
w
il
l
e
n
co
u
n
t
er
.
I
n
t
h
e
s
el
f
-
ca
r
e
p
r
ac
tice
o
f
h
ea
r
t
f
ail
u
r
e
p
atien
ts
,
t
h
er
e
is
a
n
ee
d
f
o
r
"
m
u
lt
ip
le
p
lay
er
s
"
(
s
u
ch
a
s
f
a
m
i
l
y
m
e
m
b
er
s
)
o
n
t
h
e
p
atien
t
'
s
s
u
cc
es
s
i
n
s
el
f
-
ca
r
e
b
eh
av
io
r
s
th
at
r
eq
u
ir
e
b
as
ic
k
n
o
w
led
g
e
to
i
m
p
r
o
v
e
ad
h
er
e
n
ce
(
h
o
w
to
p
r
ep
ar
e
lo
w
-
s
o
d
iu
m
f
o
o
d
s
)
[
3
6
]
.
T
h
er
e
is
e
v
id
en
ce
t
h
at
s
elf
-
ca
r
e
m
an
ag
e
m
e
n
t
p
r
o
g
r
a
m
s
in
h
ea
r
t
f
ail
u
r
e
p
atien
ts
ca
n
b
e
m
o
r
e
s
u
cc
e
s
s
f
u
l
w
h
e
n
k
n
o
w
led
g
e
o
f
h
ea
r
t
f
ail
u
r
e
m
a
n
ag
e
m
e
n
t
a
n
d
f
a
m
il
y
i
n
v
o
lv
e
m
en
t
in
cr
ea
s
e
s
[
1
9
]
.
Hav
i
n
g
e
f
f
ec
tiv
e
s
el
f
-
ca
r
e
f
o
r
h
ea
r
t
f
ail
u
r
e
p
atien
ts
h
as
t
h
e
p
o
ten
tial
to
in
cr
ea
s
e
clin
ical
en
d
p
o
in
ts
s
u
c
h
as
a
lo
w
er
r
is
k
o
f
r
ep
ea
ted
h
o
s
p
italizatio
n
s
[
3
0
]
.
T
h
er
ef
o
r
e,
w
it
h
th
e
e
m
p
o
w
er
m
e
n
t,
it
i
s
h
o
p
ed
th
at
f
a
m
ilie
s
w
il
l
b
e
ab
le
to
ca
r
r
y
o
u
t
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n
d
ep
en
d
en
t
ca
r
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w
h
ile
a
t
h
o
m
e,
i
m
p
r
o
v
e
h
ea
lt
h
o
u
tco
m
es,
i
n
cr
ea
s
e
s
atis
f
ac
tio
n
,
an
d
g
et
ad
h
er
en
ce
in
tr
ea
t
m
e
n
t o
f
h
ea
r
t f
ail
u
r
e
p
atien
t
s
.
4.
CO
NCLU
SI
O
N
I
n
h
ea
r
t
f
ail
u
r
e
p
atien
t
s
,
th
er
e
is
a
h
i
g
h
co
r
r
elatio
n
b
et
w
ee
n
f
a
m
il
y
s
u
p
p
o
r
t
an
d
th
eir
ab
ili
t
y
to
s
el
f
-
ca
r
e.
T
h
e
lack
o
f
f
a
m
i
l
y
e
m
p
o
w
er
m
en
t
an
d
s
elf
-
ca
r
e
i
s
ca
u
s
e
d
b
y
m
u
ltip
le
f
ac
to
r
s
.
L
ac
k
o
f
k
n
o
w
led
g
e
ab
o
u
t
h
ea
r
t
f
ail
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r
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tr
ea
t
m
en
t
s
ca
n
b
e
f
atal
f
o
r
h
ea
r
t
f
ail
u
r
e
p
atien
t
s
.
T
h
e
im
p
o
r
tan
ce
o
f
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u
ca
tio
n
in
f
a
m
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h
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p
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t
s
el
f
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s
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to
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m
p
r
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v
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q
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alit
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o
f
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f
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p
r
ev
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t
r
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o
s
p
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.
T
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e
r
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le
o
f
n
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r
s
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in
p
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v
id
in
g
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u
ca
tio
n
to
p
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t
s
an
d
f
a
m
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to
ca
r
r
y
o
u
t in
d
ep
en
d
e
n
t c
ar
e
at
h
o
m
e.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8806
I
n
t J
P
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b
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Hea
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Sci
,
Vo
l.
1
1
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No
.
1
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M
ar
ch
20
22
:
2
4
8
-
25
3
252
RE
F
E
R
E
NC
E
S
[
1
]
P
.
P
o
n
i
k
o
w
sk
i
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a
l
.
,
“
H
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p
p
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:
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f
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.
1
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.
[
2
]
M
.
G
h
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,
M
.
V
a
d
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2
7
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.
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R
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[
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P
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.
A
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S
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