Globally shaded leaves contribute to more than a half of the total increase in gross primary production (GPP; 7.6 Pg C) for 1982–2016. During 1982–2016, the fraction of shaded GPP increases by 1.1% (p < 0.01) in tropical forests and decreases by 1.4% (p < 0.01) and 1.8% (p < 0.01) in evergreen needleleaf and deciduous needleleaf boreal forests, respectively, suggesting an ecological niche of certain canopy structure for ecosystems to achieve maximum GPP. Unlike transpiration from sunlit leaves that has a turning point in the trend in 2003, global transpiration from shaded leaves steadily increased at the rate of 34 km3/year (p < 0.0001) during 1982–2016. Our study therefore suggests that shaded leaves have an increasing role in buffering the adverse impact of climate change and extremes. Further studies are still needed to reduce the uncertainties in reported trends arisen from climate forcing data, leaf area index, and land cover and land change products.
Aims
To explore the role of self‐efficacy (SE) in the effect of patient empowerment on self‐management behaviours among patients with chronic illness and to investigate the moderating effect of three types of health locus of control (HLC) in this moderated mediation model.
Design
Cross‐sectional design.
Methods
Data were collected in a general tertiary hospital, and a sample of 254 patients was recruited between August and October 2020. The effect of moderation and mediation was tested by the PROCESS macro (Model 4 and Model 8) for SPSS 25.0 by Hayes using 5000 bootstrap samples.
Results
Self‐efficacy significantly mediated the relationship between patient empowerment and self‐management behaviour with a 95% confidence interval excluding zero. The chance HLC demonstrated a moderating effect, and the interaction effect on SE and self‐management behaviour was significant.
Conclusion
Patient empowerment may improve confidence and adherence to self‐management among people with chronic illness, and such benefits were conditional on the HLC of patients.
Impact
This study addresses the relationship between patient empowerment and self‐management behaviour in patients with different personality characteristics. This result indicated that classifying the type of HLC may enable the identification of subgroups of patients who may subsequently benefit from patient empowerment. In a patient‐centred programme, nurses and other healthcare professionals correctly identifying patients’ HLC type and understanding the implications and then providing appropriate health care plans for patients with different health beliefs may be useful to tailor the decision‐making process.
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