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Development and Application of a Health Management Checklist for Older Adults with Chronic Disease-Related Disability Based onFitch’s Supportive Care Theory

This study developed and preliminarily validated a systematic, evidence-based health management checklist for elderly patients with chronic disease-related disabilities, grounded in Fitch's Supportive Care Theory, which demonstrated strong scientific rigor and clinical practicality in a small-scale application.

Original authors: Dongyu Hu, Yu-meng Gong, Xiumu Yang, Jiajia Chen, Juanjuan Wang, Yongli Duan

Published 2026-06-30

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CC BY 4.0

Original authors: Dongyu Hu, Yu-meng Gong, Xiumu Yang, Jiajia Chen, Juanjuan Wang, Yongli Duan

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine you are trying to navigate a complex, multi-story building where the lights are flickering, the stairs are slippery, and you have a heavy backpack you can't put down. This is what life can feel like for an older adult living with chronic diseases that limit their ability to move and care for themselves. They need a map, a guide, and a checklist to help them and their families get through the day safely and comfortably.

This research paper is about building that specific map.

The Problem: A Scattered Toolkit

Currently, if an older person with chronic disabilities needs help, the advice they get is often like having a toolbox with only a hammer or only a screwdriver. Some guides focus only on taking pills (the hammer), while others focus only on preventing falls in the house (the screwdriver). There was no single, comprehensive "master guide" that covered everything: medical needs, daily living, emotional support, and safety all in one place.

The Blueprint: Fitch's Supportive Care Theory

To build this new guide, the researchers used a specific architectural blueprint called Fitch's Supportive Care Theory. Think of this theory as a philosophy that says: "A person isn't just a body that is sick; they are a whole person who needs support in five different ways: physical comfort, clear information, emotional reassurance, social connection, and practical help."

The team, led by nurses and students from Fuyang People's Hospital and Bengbu Medical University, used this theory to design a Health Management Checklist.

Building the Checklist: The "Expert Taste Test"

You wouldn't build a house without an architect, and you wouldn't build a medical checklist without experts.

The Draft: The team first looked at hundreds of scientific studies (like gathering the best recipes from around the world) to create a rough draft of the checklist.
The Taste Test (Delphi Method): They invited 14 senior experts (doctors and head nurses with decades of experience) to review this draft. They asked two main questions: "Is this important?" and "Can we actually do this in real life?"
- Round 1: The experts said, "This part is too complicated," or "We missed something important like checking if the patient can swallow safely." The team went back to the drawing board, merging similar sections and adding missing pieces.
- Round 2: The experts tasted the revised recipe again. This time, everyone agreed. The checklist was solid, reliable, and ready to serve.

What's Inside the Checklist?

The final product is a structured menu with four main courses (domains) and 34 specific items to check off:

Medical Assistance (The Doctor's Orders): This isn't just about pills. It includes checking how well the patient can move, assessing their nutrition, checking their memory, and making sure they have a plan for emergency visits. It's like a regular health "system check."
Daily Care (The Home Manager): This covers the basics of living. How do we help them eat? How do we keep their skin from getting sore (bedsores)? How do we manage their bathroom needs? It turns complex nursing tasks into simple instructions for family caregivers.
Recreational Support (The Soul Nourisher): This is the part often forgotten. It includes psychological counseling for the patient and their spouse or caregiver. It suggests organizing community art groups or simple games to keep the mind active and the heart happy. It acknowledges that caring for a sick relative is stressful and needs emotional support too.
Assistive Device Services (The Safety Gear): This guides families on how to use walkers, hearing aids, and other tools correctly. It also checks the "environment," suggesting things like adding non-slip mats or fixing bad lighting to prevent accidents.

The First Test Run

In May 2025, the team tried this checklist out on 20 older patients in a hospital in Fuyang.

The Nurses' Verdict: They found the checklist to be a "systematic" and "comprehensive" tool. It felt like they finally had a complete instruction manual rather than just a few sticky notes.
The Patients' Verdict: The patients and their families felt the checklist was practical. It helped them understand their condition better and feel more confident about managing their care at home.

The Conclusion

The paper concludes that they have successfully built a "master map" (the checklist) that is scientifically sound and ready to use. It covers the physical, emotional, and practical needs of older adults with chronic disabilities.

However, the authors are honest about the limits of their test. They only tried this map on 20 people in one city. While the map looks perfect on paper and worked well in this small test, they admit that before it becomes the standard guide for everyone, it needs to be tested on a much larger crowd to prove it works everywhere.

In short: The researchers took a complex theory, gathered expert advice, and created a single, easy-to-use checklist that helps older adults and their families manage the messy, multi-faceted reality of living with chronic disability. It's a tool designed to turn confusion into clarity.

Technical Summary: Development and Application of a Health Management Checklist for Older Adults with Chronic Disease-Related Disability

Problem Statement
The study addresses the critical gap in health management tools for older adults in China suffering from chronic disease-related disabilities. While the aging population and the prevalence of multimorbidity are well-documented, existing management checklists are often fragmented, focusing narrowly on single aspects such as medication optimization or specific daily care risks (e.g., fall prevention). There is a lack of comprehensive, standardized tools that simultaneously integrate health assessment, care guidance, psychological support, and continuous management. Furthermore, older adults with disabilities face specific challenges, including reduced functional independence, high dependence on long-term care, and difficulties in accessing health information, which place sustained burdens on families and the social care system.

Methodology
The research followed a rigorous, multi-stage development process grounded in Fitch's Supportive Care Theory, which posits that individuals have multidimensional needs (physical, informational, emotional, psychosocial, and practical) throughout their disease trajectory.

Evidence-Based Drafting: A research team of 12 nursing and medical experts conducted a systematic literature review (2019–2024) across major databases (e.g., PubMed, CNKI, Cochrane Library) following the "6S" model. From an initial pool of over 42,000 studies, 32 high-quality sources (including RCTs, guidelines, and systematic reviews) were synthesized to create a preliminary checklist draft.
Expert Consultation (Delphi Method): Two rounds of consultation were conducted with 14 experts in geriatric clinical treatment and nursing (all with ≥10 years of experience and intermediate titles or higher).
- Metrics: Experts evaluated items based on importance and operability using a 5-point Likert scale.
- Criteria: Items were retained if the mean importance score was ≥4.00 and the coefficient of variation (CV) was ≤0.25.
- Authority: The authority coefficient ($Cr$) was calculated to ensure expert reliability.
Preliminary Application: In May 2025, the finalized checklist was applied to 20 older adults with chronic disease-related disabilities in a tertiary hospital in Fuyang. Trained nurses and health managers implemented the checklist, collecting feedback from both healthcare providers and patients regarding its comprehensiveness, professionalism, and practicality.
Statistical Analysis: Data were analyzed using SPSS 26.0, focusing on response rates, authority coefficients, Kendall's coefficient of concordance ( $W$ ), and coefficients of variation ($CV$).

Key Contributions and Results
The study successfully developed a structured Health Management Checklist comprising:

4 First-Level Domains: Medical Assistance, Daily Care, Recreational Support, and Assistive Device-Related Services.
13 Second-Level Indicators: Including specific areas like health assessment, skin care, and psychological support for caregivers.
34 Third-Level Indicators: Detailed operational items (e.g., specific scales for fall risk like FraSE, nutritional assessment via MNA-SF, and emergency first aid guidance).

Expert Consultation Outcomes:

Response Rates: 93.33% in the first round and 100% in the second round.
Authority: Expert authority coefficients were high, reaching 0.82 in the first round and 0.86 in the second round ( $Cr \ge 0.8$ ).
Consensus: Kendall's $W$ values for importance and feasibility were statistically significant ( $P < 0.001$ ) in both rounds, indicating strong agreement. The CV for all items was controlled below 0.25 in the second round, demonstrating convergence of expert opinion.
Refinements: The process involved significant revisions, such as merging overlapping items, adding specific risk assessments (cognitive, swallowing, fall risk), and adjusting exercise duration recommendations to be more suitable for the elderly (≥30 minutes).

Preliminary Application Findings:
Feedback from the 20 participants and the implementing staff indicated that the checklist was:

Systematic and Comprehensive: Covering the full spectrum of needs from medical to psychosocial.
Practical: Deemed operable by nurses and helpful for patients in understanding disease management and family caregiving.
Scientifically Rigorous: The structure was validated as professionally sound.

Significance and Claims
The paper claims that this study provides a practical, standardized tool for the health management of older adults with chronic disease-related disabilities. By translating Fitch's Supportive Care Theory into 34 specific, actionable indicators, the checklist moves beyond single-disease management to a holistic care model. The authors assert that the tool demonstrates good scientific rigor, feasibility, and clinical practicality, offering a reference for standardizing continuous health management in this vulnerable population.

However, the authors maintain a modest stance regarding the study's scope. They explicitly acknowledge that due to the limited sample size (20 participants) and the specific setting of the preliminary application, the actual effectiveness and long-term impact of the checklist require further verification through studies involving larger, more diverse samples. The tool is presented as a foundational reference rather than a definitive, universally proven solution at this stage.