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Kamath D, Abdullakutty J, Granger B, Kulkarni S, Bhuvana K, Salazar L, Shifra S, Idiculla J, Narendra J, Varghese K, Xavier D. A randomized controlled trial evaluating a theory driven, complex intervention centered on task sharing and mobile health to improve selfcare and outcomes in heart failure - The PANACEA-HF RCT: Design and rationale. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 34:100310. [PMID: 38510948 PMCID: PMC10945930 DOI: 10.1016/j.ahjo.2023.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/15/2023] [Accepted: 07/15/2023] [Indexed: 03/22/2024]
Abstract
Background We developed a three-pronged complex intervention to improve selfcare and deliver whole person care for patients with heart failure, underpinned by the 'extant cycle' theory - a theory based on our formative work. Methods This is a 3 centre, 2-arm, 1:1, open, adaptive stratified, randomized controlled trial. We included patients aged ≥ 18 years with heart failure, taking any of the key guideline directed medical treatments, with a history of or currently on a high ceiling diuretic. We excluded end stage renal disease, clinically diagnosed severe mental illness or cognitive dysfunction and having no caregivers. Interventions included, (i) trained hospital based lay health worker mediated assessment of patients' current selfcare behaviour, documenting barriers and facilitators and implementing a plan to 'transition' the patient toward optimal selfcare. (ii) m-health mediated remote monitoring and (iii) dose optimization through a 'physician supervisor'. Results We recruited 301 patients between Jan 2021 and Jan 2022. Mean age was 59.8 (±11.7) years, with 195 (64.8 %) from rural or semi-urban areas and 67.1 % having intermediate to low health literacy. 190 (63.1 %) had an underlying ischemic cardiomyopathy. In the intervention arm, 142 (94.1 %) had a Selfcare in Heart Failure Index (SCHFI) score of ≤70, with significant barriers being 'lack of knowledge' 105 (34.5 %) and 'behavioural passivity' 23 (7.5 %). Conclusion This is the first South Asian trial evaluating a complex intervention underpinned by behaviour change theory for whole person heart failure care. These learnings can be applied to heart failure patient care in other resource constrained health systems.
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Affiliation(s)
- D.Y. Kamath
- Pharmacology, St. John's Medical College, Bengaluru, India
| | | | - B.B. Granger
- Duke University School of Nursing, Durham, NC, USA
| | - S. Kulkarni
- Medicine, St. John's Medical College, Bengaluru, India
| | - K.B. Bhuvana
- Pharmacology, St. John's Medical College, Bengaluru, India
| | - L.J. Salazar
- Psychiatry, St. John's Medical College, Bengaluru, India
| | - S. Shifra
- Pharmacology, St. John's Medical College, Bengaluru, India
| | - J. Idiculla
- Internal Medicine, St. John's Medical College, Bengaluru, India
| | - J. Narendra
- Cardiology, Nanjappa Hospital, Shivamogga, Karnataka, India
| | - K. Varghese
- Cardiology, St. John's Medical College, Bengaluru, India
| | - D. Xavier
- Pharmacology, St. John's Medical College, Bengaluru, India
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Lukey A, Mackay M, Hasan K, Rush KL. A Pre-Post, Mixed-Methods Study to Pilot Test a Gamified Heart Failure Self-Care Education Intervention. Games Health J 2023; 12:385-396. [PMID: 37582271 DOI: 10.1089/g4h.2022.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Objective: Self-care is essential to improving heart failure patient outcomes. However, the knowledge and behaviours necessary for self-care decision making, such as symptom perception and management, are complex and require patient education. The objective of this study was to test the feasibility, acceptability, and potential effectiveness of a web-based, gamified heart failure patient education solution, Heart Self-Care Patient Education (HeartSCaPE), that used narrative and virtual reward gamification techniques. Materials and Methods: This mixed-methods study used a pre-post-test design with an embedded explanatory qualitative phase. Patients completed the Self-Care of Heart Failure Index, that measured self-care behaviour change and the Dutch Heart Failure Knowledge Scale, used to measure heart failure knowledge. Usability measures of HeartSCaPE were tracked using Google Analytics and the System Usability Scale. Results: Nineteen patients completed the study, with a subset of six participating in semi-structured interviews. We found increases in HF knowledge despite high baseline knowledge scores. Post-intervention self-reported HF self-care behaviours (maintenance, management and confidence), as measured by the Self-Care of Heart Failure Index, were also improved. Knowledge and self-care scores were not correlated. Participants also scored HeartSCaPE as highly usable. In interviews, participants described valuing the opportunity to practice self-care decision-making. There were mixed opinions regarding the use of virtual rewards. Conclusion: We found that a gamified web-based solution that uses narrative and reward-based gamification techniques has the potential to improve HF patient knowledge and self-care. Further research is needed to confirm the study's clinical benefits and address technology literacy inequities.
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Affiliation(s)
- Alexandra Lukey
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Martha Mackay
- School of Nursing, University of British Columbia, Vancouver, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, Canada
| | - Khalad Hasan
- Computer Science, University of British Columbia Okanagan, Kelowna, Canada
| | - Kathy L Rush
- School of Nursing, University of British Columbia Okanagan, Kelowna, Canada
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Xiong J, Qin J, Zheng G, Gao Y, Gong K. The relationship between symptom perception and fear of progression in patients with chronic heart failure: a multiple mediation analysis. Eur J Cardiovasc Nurs 2023; 22:638-646. [PMID: 36748202 DOI: 10.1093/eurjcn/zvad024] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023]
Abstract
AIMS Studies have shown that symptom perception is associated with fear of progression (FOP) in many diseases and regulated by psychological factors. Whether the association also occurs in patients with chronic heart failure (HF) remains unclear, as do the specific mechanisms involved. This study aimed to explore the multiple mediation effects of self-care confidence and mental resilience on the relationship between symptom perception and FOP in Chinese patients with chronic HF. METHODS AND RESULTS A cross-sectional study was conducted on 247 patients with chronic HF recruited from two hospitals in Yangzhou, China. The sociodemographic and clinical data and self-reported questionnaires including heart failure somatic perception, fear of progression, self-care confidence, and mental resilience were collected. Data analysis relating to correlations and mediating effects was carried out by SPSS 26.0 and PROCESS v3.3 macro. Fear of progression was positively correlated with symptom perception (r = 0.599, P < 0.01), but negatively correlated with self-care confidence (r = -0.663, P < 0.01), mental resilience-strength (r = -0.521, P < 0.01), and mental resilience-toughness (r = -0.596, P < 0.01). The relationship between symptom perception and FOP was mediated by self-care confidence [effect = 0.095, 95% confidence interval (CI) (0.054-0.142)] and mental resilience-toughness [effect = 0.033, 95% CI (0.006-0.074)], respectively, and together in serial [effect = 0.028, 95% CI (0.011-0.050)]. The proportion of the mediating effect accounting for the total effect was 31.0%. CONCLUSION Self-care confidence and mental resilience-toughness were multiple mediators of the association between symptom perception and FOP in patients with chronic HF. Interventions targeted at strengthening self-care confidence and mental resilience may be beneficial for the reduction of FOP, especially with regard to toughness.
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Affiliation(s)
- Juanjuan Xiong
- Department of Cardiology, Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Middle Road, Yangzhou, Jiangsu 225000, China
- School of Nursing, Yangzhou University, No. 136, Jiangyang Middle Road, Yangzhou, Jiangsu 225000, China
| | - Jingwen Qin
- Department of Cardiology, Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Middle Road, Yangzhou, Jiangsu 225000, China
| | - Guixiang Zheng
- Department of Cardiology, Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Middle Road, Yangzhou, Jiangsu 225000, China
| | - Ya Gao
- Department of Cardiology, Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Middle Road, Yangzhou, Jiangsu 225000, China
| | - Kaizheng Gong
- Department of Cardiology, Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Middle Road, Yangzhou, Jiangsu 225000, China
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Cheng M, Zhu C, Ge Y, Ke Y, Shi Y, Su Y, Ma T, Chi M, Wang N, Lu B, Hou Y. The impact of informal caregivers' preparedness on short-term outcomes of heart failure patients with insufficient self-care. Eur J Cardiovasc Nurs 2023; 22:628-637. [PMID: 36306414 DOI: 10.1093/eurjcn/zvac102] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 09/06/2023]
Abstract
AIMS Even though self-care is essential in the long-term management of heart failure (HF), it is often not performed adequately in HF populations. Mobilizing informal caregivers may be one way to help patients perform self-care, support individual needs, and maintain health. However, informal caregivers often face insufficient preparation for providing long-term care. This insufficient caregiver preparedness may lead to a decline in caregiver contributions and affect the outcomes of care in patients with HF. This study aimed to explore whether informal caregivers' preparedness is a predictor that influences short-term outcomes of HF patients; to analyse whether caregiver contribution to self-care of HF (CC-SCHF) plays a mediating role between informal caregivers' preparedness and HF short-term outcomes. METHODS AND RESULTS A prospective observational study was conducted in China. After controlling for covariates, higher levels of informal caregivers' preparedness were significantly associated with lower 3-month mortality [odds ratio (OR) = 0.919, 95% confidence interval (CI) = (0.855-0.988), P = 0.022] and 3-month readmission rate [OR = 0.883, 95% CI = (0.811-0.961), P = 0.004] and shorter length of hospital stay (β = -0.071, P < 0.001). The informal caregiver's preparedness was positively associated with CC-SCHF maintenance (r = 0.708, P < 0.01), CC-SCHF management (r = 0.431, P < 0.01), and CC-SCHF confidence (r = 0.671, P < 0.01). The CC-SCHF management was a mediator in the relationship between informal caregivers' preparedness and 3-month readmission rate [effect 95% CI = (-0.054 to -0.001)] and length of hospital stay [effect 95% CI = (-0.235 to -0.042)]. CONCLUSION A higher level of informal caregivers' preparedness is associated with better short-term outcomes of HF patients with insufficient self-care.
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Affiliation(s)
- Ming Cheng
- Department of Cardiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, China
- School of Nursing, Suzhou Medical College of Soochow University, No. 1 Shizi Street, Suzhou, Jiangsu, China
| | - Chenya Zhu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, China
- School of Nursing, Suzhou Medical College of Soochow University, No. 1 Shizi Street, Suzhou, Jiangsu, China
| | - Yingying Ge
- School of Nursing, Suzhou Medical College of Soochow University, No. 1 Shizi Street, Suzhou, Jiangsu, China
| | - Yufei Ke
- School of Nursing, Suzhou Medical College of Soochow University, No. 1 Shizi Street, Suzhou, Jiangsu, China
| | - Yixing Shi
- School of Nursing, Suzhou Medical College of Soochow University, No. 1 Shizi Street, Suzhou, Jiangsu, China
| | - Yue Su
- School of Nursing, Suzhou Medical College of Soochow University, No. 1 Shizi Street, Suzhou, Jiangsu, China
| | - Tianyu Ma
- School of Nursing, Suzhou Medical College of Soochow University, No. 1 Shizi Street, Suzhou, Jiangsu, China
| | - Meixuan Chi
- School of Nursing, Suzhou Medical College of Soochow University, No. 1 Shizi Street, Suzhou, Jiangsu, China
| | - Naijuan Wang
- School of Nursing, Suzhou Medical College of Soochow University, No. 1 Shizi Street, Suzhou, Jiangsu, China
| | - Bingqing Lu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, China
| | - Yunying Hou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, China
- School of Nursing, Suzhou Medical College of Soochow University, No. 1 Shizi Street, Suzhou, Jiangsu, China
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De Maria M, Erba I, Ferro F, Ausili D, Matarese M, Vellone E. The influence of dyad sex combination on patient self-care and caregiver contribution to self-care in multiple chronic conditions: An observational study. J Nurs Scholarsh 2023; 55:1008-1019. [PMID: 37721456 DOI: 10.1111/jnu.12895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION We know that patient and caregiver sex influence patient self-care and caregiver contribution to self-care in multiple chronic conditions. However, the role of dyad sex combination (e.g., male patient and female caregiver, female patient and male caregiver, male patient and caregiver, and female patient and caregiver) in influencing patient self-care and caregiver contribution to self-care remains unexplored. Our aim was to investigate the relationship between patient and caregiver sex combination and patient self-care and caregiver contribution to self-care in multiple chronic conditions. DESIGN Multicentre cross-sectional study. METHODS We enrolled patients with multiple chronic conditions and caregiver dyads in outpatient and community settings from April 2017 to December 2019. We used the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory that measure, from the patient and caregiver perspective, self-care maintenance (i.e., behaviors to maintain illness stability), self-care monitoring (i.e., monitoring of illness signs and symptoms), and self-care management (i.e., behaviors to manage signs and symptoms). We used multivariate analysis of covariance to evaluate the association between sex and self-care and caregiver contribution to self-care. RESULTS We recruited 540 patient-caregiver dyads. Male patients cared by female caregivers performed higher self-care maintenance compared to female patients cared by female caregivers. Female caregivers caring for female patients performed higher caregiver contribution to self-care monitoring compared to male caregivers caring for female or male patients. CONCLUSIONS Clinicians should consider the influence of patient and caregiver sex combination on self-care and caregiver contribution to self-care in multiple chronic conditions to provide tailored interventions. CLINICAL RELEVANCE Healthcare professionals should consider the patient and caregiver sex combination in the dyad to tailor better interventions aimed at improving patient self-care and caregiver contribution to self-care in multiple chronic conditions.
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Affiliation(s)
- Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Erba
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federico Ferro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Matarese
- School of Nursing, Campus Bio-Medico of Rome University, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Freedland KE, Skala JA, Carney RM, Steinmeyer BC, Rich MW. Treatment of depression and inadequate self-care in patients with heart failure: One-year outcomes of a randomized controlled trial. Gen Hosp Psychiatry 2023; 84:82-88. [PMID: 37406374 DOI: 10.1016/j.genhosppsych.2023.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Both depression and inadequate self-care are common in patients with heart failure. This secondary analysis examines the one-year outcomes of a randomized controlled trial of a sequential approach to treating these problems. METHODS Patients with heart failure and major depression were randomly assigned to usual care (n = 70) or to cognitive behavior therapy (n = 69). All patients received a heart failure self-care intervention starting 8 weeks after randomization. Patient-reported outcomes were assessed at Weeks 8, 16, 32, and 52. Data on hospital admissions and deaths were also obtained. RESULTS One year after randomization, Beck Depression Inventory (BDI-II) scores were - 4.9 (95% C.I., -8.9 to -0.9; p < .05) points lower in the cognitive therapy than the usual care arm, and Kansas City Cardiomyopathy scores were 8.3 (95% C.I., 1.9 to 14.7; p < .05) points higher. There were no differences on the Self-Care of Heart Failure Index or in hospitalizations or deaths. CONCLUSIONS The superiority of cognitive behavior therapy relative to usual care for major depression in patients with heart failure persisted for at least one year. Cognitive behavior therapy did not increase patients' ability to benefit from a heart failure self-care intervention, but it did improve HF-related quality of life during the follow-up period. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02997865.
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Affiliation(s)
- Kenneth E Freedland
- Department of Psychiatry, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, United States of America.
| | - Judith A Skala
- Department of Psychiatry, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, United States of America
| | - Robert M Carney
- Department of Psychiatry, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, United States of America
| | - Brian C Steinmeyer
- Department of Psychiatry, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, United States of America
| | - Michael W Rich
- Cardiovascular Division of the Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
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Bunsuk C, Suwanno J, Klinjun N, Kumanjan W, Srisomthrong K, Phonphet C, Mayurapak C, Dansuwan C, Suwanno J, Chramnanpho P, Kamlungdee U, Arab W, Ninla-aesong P, Hamilton SS, Thiamwong L. Cross-cultural adaptation and psychometric evaluation of the Thai version of Self-Care of Chronic Illness Inventory Version 4.c. Int J Nurs Sci 2023; 10:332-344. [PMID: 37545777 PMCID: PMC10401351 DOI: 10.1016/j.ijnss.2023.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/28/2023] [Accepted: 06/24/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives To translate and validate the Thai Self-Care of Chronic Illness Inventory version 4.c (Thai SC-CII v4.c) in individuals with chronic illnesses. Methods A scale translation and cross-sectional validation study was conducted. The English version was translated for Thai involved nine steps: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing and finalization, and proofreading. A cross-sectional study was conducted from July to November 2022 at 16 primary care centers in southern Thailand, involving 410 participants with at least one chronic condition. Validity assessments included structural, convergent, and discriminant validity. Concurrent validity examined correlations between SC-CII v4.c with the Self-Care Self-Efficacy Scale (SCSES) and self-perceived health. Internal coherence reliability was calculated using Cronbach's α coefficient, item-total correlation coefficients, and the composite reliability (CR) index. Results Thai SC-CII v4.c demonstrated excellent translational validity (κ = 0.99). The specified Self-Care Maintenance model fit well, with minor differences in health promoting behavior and illness-related behavior items compared to the original model. The original Self-Care Monitoring, and Self-Care Management models fit well with Thai data. Simultaneous confirmatory factor analysis confirmed a satisfactory fit of the full SC-CII v4.c. Convergent validity had partial support (average variance extracted = 0.23-0.51), and discriminant validity was established (heterotrait-monotrait ratios = 0.37-0.88). Concurrent validity was supported by positive correlations between each scale and overall SC-CII v.4c with SCSES (r = 0.25-0.65) and self-perceived health (r = 0.09-0.35). The Cronbach's α coefficient were adequate for all scales except the Self-Care Maintenance scale (Cronbach's α = 0.68), but the CR estimate improved the reliability of all three scales (ranging 0.80-0.82). All items had satisfactory item-total correlation coefficients (ranging 0.34-0.71), except the one pertaining to sleep. Conclusions The Thai SC-CII v4.c is valid and reliable for assessing self-care in various chronic illnesses. Further testing is recommended for patients with specific diseases.
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Affiliation(s)
- Chonchanok Bunsuk
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- The Excellent Center of Community Health Promotion, Walailak University, Thailand
| | - Jom Suwanno
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- The Excellent Center of Community Health Promotion, Walailak University, Thailand
| | - Nuntaporn Klinjun
- Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand
| | - Wanna Kumanjan
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- The Excellent Center of Community Health Promotion, Walailak University, Thailand
| | - Kannika Srisomthrong
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- The Excellent Center of Community Health Promotion, Walailak University, Thailand
| | - Chennet Phonphet
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- The Excellent Center of Community Health Promotion, Walailak University, Thailand
| | - Chidchanok Mayurapak
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- The Excellent Center of Community Health Promotion, Walailak University, Thailand
| | - Chutiporn Dansuwan
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- The Excellent Center of Community Health Promotion, Walailak University, Thailand
| | - Juk Suwanno
- Stroke Center, Hat Yai Hospital, Songkhla, Thailand
| | | | | | - Wichai Arab
- Baan Huainang Subdistrict Health Promotion Hospital, Trang, Thailand
| | | | - Sadee Saithong Hamilton
- Boromarajonani College of Nursing Sanpasithiprasong, Faculty of Nursing, Praboromarajchanok Institute, Ubon Ratchathani, Thailand
| | - Ladda Thiamwong
- College of Nursing, University of Central Florida, Orlando, FL, USA
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Lawless MT, Tieu M, Chan RJ, Hendriks JM, Kitson A. Instruments Measuring Self-Care and Self-Management of Chronic Conditions by Community-Dwelling Older Adults: A Scoping Review. J Appl Gerontol 2023; 42:1687-1709. [PMID: 36880688 PMCID: PMC10262344 DOI: 10.1177/07334648231161929] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 03/08/2023] Open
Abstract
Given the high prevalence of chronic conditions and multimorbidity in older adults, there is a need to better conceptualize and measure self-care and self-management to promote a person-centered approach. This scoping review aimed to identify and map instruments measuring self-care and self-management of chronic conditions by older adults. We searched six electronic databases, charted data from the studies and tools and reported the results in accordance with the PRISMA-ScR guidelines. A total of 107 articles (103 studies) containing 40 tools were included in the review. There was substantial variation in the tools in terms of their aims and scope, structure, theoretical foundations, how they were developed, and the settings in which they have been used. The quantity of tools demonstrates the importance of assessing self-care and self-management. Consideration of the purpose, scope, and theoretical foundation should guide decisions about tools suitable for use in research and clinical practice.
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Affiliation(s)
- Michael T. Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Matthew Tieu
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, SA, Australia
| | - Raymond J. Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Jeroen M. Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Schäfer-Keller P, Graf D, Denhaerynck K, Santos GC, Girard J, Verga ME, Tschann K, Menoud G, Kaufmann AL, Leventhal M, Richards DA, Strömberg A. A multicomponent complex intervention for supportive follow-up of persons with chronic heart failure: a randomized controlled pilot study (the UTILE project). Pilot Feasibility Stud 2023; 9:106. [PMID: 37370176 DOI: 10.1186/s40814-023-01338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a progressive disease associated with a high burden of symptoms, high morbidity and mortality, and low quality of life (QoL). This study aimed to evaluate the feasibility and potential outcomes of a novel multicomponent complex intervention, to inform a future full-scale randomized controlled trial (RCT) in Switzerland. METHODS We conducted a pilot RCT at a secondary care hospital for people with HF hospitalized due to decompensated HF or with a history of HF decompensation over the past 6 months. We randomized 1:1; usual care for the control (CG) and intervention group (IG) who received the intervention as well as usual care. Feasibility measures included patient recruitment rate, study nurse time, study attrition, the number and duration of consultations, intervention acceptability and intervention fidelity. Patient-reported outcomes included HF-specific self-care and HF-related health status (KCCQ-12) at 3 months follow-up. Clinical outcomes were all-cause mortality, hospitalization and days spent in hospital. RESULTS We recruited 60 persons with HF (age mean = 75.7 years, ± 8.9) over a 62-week period, requiring 1011 h of study nurse time. Recruitment rate was 46.15%; study attrition rate was 31.7%. Follow-up included 2.14 (mean, ± 0.97) visits per patient lasting a total of 166.96 min (mean, ± 72.55), and 3.1 (mean, ± 1.7) additional telephone contacts. Intervention acceptability was high. Mean intervention fidelity was 0.71. We found a 20-point difference in mean self-care management change from baseline to 3 months in favour of the IG (Cohens' d = 0.59). Small effect sizes for KCCQ-12 variables; less IG participants worsened in health status compared to CG participants. Five deaths occurred (IG = 3, CG = 2). There were 13 (IG) and 18 (CG) all-cause hospital admissions; participants spent 8.90 (median, IQR = 9.70, IG) and 15.38 (median, IQR = 18.41, CG) days in hospital. A subsequent full-scale effectiveness trial would require 304 (for a mono-centric trial) and 751 participants (for a ten-centre trial) for HF-related QoL (effect size = 0.3; power = 0.80, alpha = 0.05). CONCLUSION We found the intervention, research methods and outcomes were feasible and acceptable. We propose increasing intervention fidelity strategies for a full-scale trial. TRIAL REGISTRATION ISRCTN10151805 , retrospectively registered 04/10/2019.
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Affiliation(s)
- Petra Schäfer-Keller
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland.
- Cardiology, HFR Fribourg - Hôpital Cantonal, Fribourg, Switzerland.
| | - Denis Graf
- Cardiology, HFR Fribourg - Hôpital Cantonal, Fribourg, Switzerland
| | - Kris Denhaerynck
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Gabrielle Cécile Santos
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Josepha Girard
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Marie-Elise Verga
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Kelly Tschann
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Grégoire Menoud
- Institute of Applied Research in Health, School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Anne-Laure Kaufmann
- Data Acquisition Unit, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland
| | | | - David A Richards
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden
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Upshaw JN, Parker S, Gregory D, Koethe B, Vest AR, Patel AR, Kiernan MS, DeNofrio D, Davidson E, Mohanty S, Arpin P, Strauss N, Sommer C, Brandon L, Butler R, Dwaah H, Nadeau H, Cantor M, Konstam MA. The effect of tablet computer-based telemonitoring added to an established telephone disease management program on heart failure hospitalizations: The Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) III Randomized Controlled Trial. Am Heart J 2023; 260:90-99. [PMID: 36842486 PMCID: PMC11195537 DOI: 10.1016/j.ahj.2023.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Mobile health applications are becoming increasingly common. Prior work has demonstrated reduced heart failure (HF) hospitalizations with HF disease management programs; however, few of these programs have used tablet computer-based technology. METHODS Participants with a diagnosis of HF and at least 1 high risk feature for hospitalization were randomized to either an established telephone-based disease management program or the same disease management program with the addition of remote monitoring of weight, blood pressure, heart rate and symptoms via a tablet computer for 90 days. The primary endpoint was the number of days hospitalized for HF assessed at 90 days. RESULTS From August 2014 to April 2019, 212 participants from 3 hospitals in Massachusetts were randomized 3:1 to telemonitoring-based HF disease management (n = 159) or telephone-based HF disease management (n = 53) with 98% of individuals in both study groups completing the 90 days of follow-up. There was no significant difference in the number of days hospitalized for HF between the telemonitoring disease management group (0.88 ± 3.28 days per patient-90 days) and the telephone-based disease management group (1.00 ± 2.97 days per patient-90 days); incidence rate ratio 0.82 (95% confidence interval, 0.43-1.58; P = .442). CONCLUSIONS The addition of tablet-based telemonitoring to an established HF telephone-based disease management program did not reduce HF hospitalizations; however, study power was limited.
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Affiliation(s)
- Jenica N Upshaw
- The CardioVascular Center, Tufts Medical Center, Boston, MA.
| | - Susan Parker
- New England Quality Care Alliance, Braintree, MA
| | | | - Benjamin Koethe
- Biostatics, Epidemiology, and Research Design Center, Tufts Medical Center, Boston MA
| | - Amanda R Vest
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Ayan R Patel
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | | | - David DeNofrio
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | | | | | - Patrick Arpin
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Nicole Strauss
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Crystal Sommer
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | | | - Rita Butler
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Henry Dwaah
- Tufts University School of Medicine, Boston, MA
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Stahlman S, Huizar-Garcia S, Lipscomb J, Frei C, Oliver A. Implementation of a heart failure educational intervention for patients with recent admissions for acute decompensated heart failure. Front Cardiovasc Med 2023; 10:1133988. [PMID: 37215545 PMCID: PMC10196446 DOI: 10.3389/fcvm.2023.1133988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose This study examined whether implementation of a heart failure (HF) education class targeted at patients and their caregivers decreased worsening HF, emergency department (ED) visits and hospital admissions, and improved patient quality of life and confidence in disease state management. Methods Patients with HF and a recent hospital admission for acute decompensated heart failure (ADHF) were offered an educational course covering HF pathophysiology, medications, diet, and lifestyle modifications. Patients completed surveys before and 30 days after completion of the educational course. Outcomes of participants at 30 and 90 days after class completion were compared against outcomes for the same patients at 30 and 90 days prior to course attendance. Data was collected using electronic medical records, in-person during the class, and during a phone follow-up. Results The primary outcome was a composite of hospital admission, ED visit, and/or outpatient visit for HF at 90 days. A total of twenty-six patients attended classes between September 2018 and February 2019 and were included in the analysis. Median age was 70 years, and most patients were white. All patients were American College of Cardiology/American Heart Association (ACC/AHA) Stage C and a majority had New York Heart Association (NYHA) Class II or III symptoms. Median left ventricular ejection fraction (LVEF) was 40%. The primary composite outcome occurred significantly more frequently in the 90 days prior to class attendance than in the 90 days following attendance (96% vs. 35%, p < 0.01). Likewise, the secondary composite outcome occurred significantly more frequently in the 30 days before class attendance than in the 30 days following (54% vs. 19%, p = 0.02). These results were driven by a decrease in admissions and ED visits for HF symptoms. Survey scores related to patient HF self-management practices and patient confidence in ability to self-manage HF increased numerically from baseline to 30 days after class attendance. Conclusion Implementation of an educational class for HF patients improved patient outcomes, confidence, and ability to self-manage HF. Hospital admissions and ED visits also decreased. Adoption of such a course might help to decrease overall health care costs and improve patient quality of life.
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Affiliation(s)
- Sarah Stahlman
- South Texas Veterans Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, San Antonio, TX, United States
- College of Pharmacy, The University of Texas at Austin, Austin, TX, United States
- School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Stephanie Huizar-Garcia
- South Texas Veterans Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, San Antonio, TX, United States
- College of Pharmacy, The University of Texas at Austin, Austin, TX, United States
- School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Justina Lipscomb
- South Texas Veterans Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, San Antonio, TX, United States
- College of Pharmacy, The University of Texas at Austin, Austin, TX, United States
- School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Christopher Frei
- South Texas Veterans Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, San Antonio, TX, United States
- College of Pharmacy, The University of Texas at Austin, Austin, TX, United States
- School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Ashley Oliver
- South Texas Veterans Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, San Antonio, TX, United States
- College of Pharmacy, The University of Texas at Austin, Austin, TX, United States
- School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, TX, United States
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Liu X, Liu L, Li Y, Cao X. The association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:205. [PMID: 37087429 PMCID: PMC10122378 DOI: 10.1186/s12872-023-03247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/18/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Patients with heart failure frequently report inadequate self-care behaviours. Physical symptoms can impact patients' ability to perform self-care behaviours. However, studies investigating the association between physical symptoms and heart failure self-care behaviours have produced inconsistent findings, potentially due to variations in the determinants of self-care behaviours among patients with differing levels of self-care proficiency. Understanding the association between physical symptoms and self-care behaviours in heart failure patients with inadequate self-care behaviours could improve care for this subpopulation. The study aimed to explore the association between physical symptoms and self-care behaviours in Chinese heart failure patients with inadequate self-care behaviours. METHODS This analysis was based on primary data from a cross-sectional study that aimed to investigate factors associated with self-care in heart failure patients. Physical symptoms were measured using the Heart Failure Somatic Perception Scale. Self-care behaviours (i.e., self-care maintenance and management) of heart failure were measured using the Self-Care of Heart Failure Index (version 6.2). Patients who reported scores < 70 on both self-care maintenance and management behaviours were eligible and included in the analysis. Hierarchical regression analysis was performed to explore the association between physical symptoms and self-care behaviours. RESULTS A total of 189 patients were included in the analysis, with a mean age of 65 years and a median duration of living with heart failure of 24 months. Most participants were classified as New York Heart Association class III or IV. Dyspnoea symptoms were the most frequently reported physical symptoms. The results of the hierarchical regression analysis showed that the severity of physical symptoms was positively associated with self-care management behaviours (β = 0.157, 95% CI: 0.010, 0.368, p = 0.039) but not significantly associated with self-care maintenance behaviours (β = -0.133, 95% CI: -0.316, 0.026, p = 0.097). CONCLUSIONS Based on the data collected in Changsha, China, we found that patients with HF with poor self-care experienced more dyspnoea symptoms. Severe HF physical symptoms might serve as drivers for better self-care management in patients with inadequate self-care behaviours. Effective care and support should be provided when physical symptoms worsen to facilitate patients' engagement in self-care behaviour in this subpopulation.
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Affiliation(s)
- Xu Liu
- Department of Infectious Disease, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Li Liu
- Xiangya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong S.A.R, China
| | - Xi Cao
- School of Nursing, Sun Yat-Sen University, NO. 74, Zhongshan 2nd Rd., Guangzhou, 510080, China.
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Stawnychy MA, Ringel JB, Riegel B, Sterling MR. Better Preparation and Training Determine Home Care Workers' Self-Efficacy in Contributing to Heart Failure Self-Care. J Appl Gerontol 2023; 42:651-659. [PMID: 35801567 PMCID: PMC9825674 DOI: 10.1177/07334648221113322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Identify determinants of home care workers' (HCW) self-efficacy in contributing to heart failure (HF) self-care. METHODS Secondary analysis of a survey (n = 328) examining characteristics of HCWs caring for adults with HF in New York. Self-efficacy assessed using Caregiver Self-Efficacy in Contributing to Self-Care Scale. Standardized scores range 0-100; ≥ 70 points indicate adequate self-efficacy. Characteristics determined by self-efficacy (low vs. adequate). Prevalence ratios with 95% confidence intervals (PR [95% CI]) were estimated using multivariable Poisson regression with robust standard errors. RESULTS Home care workers with adequate self-efficacy had at least some prior HF training (55% vs. 17%, p < .001) and greater job satisfaction (90% vs. 77%, p = .003). Significant determinants for adequate self-efficacy were employment length (1.02 [1.00-1.03], p = .027), preparation for caregiving (3.10 [2.42-3.96], p < .001), and HF training (1.48 [1.20-1.84], p < .001). CONCLUSION Home care agencies and policy-makers can target caregiving preparation and HF training to improve HCWs' confidence in caring for adult HF patients.
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Affiliation(s)
- Michael A. Stawnychy
- Robert Wood Johnson Foundation Future of Nursing Scholar
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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Howie-Esquivel J, Bidwell JT. A State-of-the-Art Review of Teach-Back for Patients and Families With Heart Failure: How Far Have We Come? J Cardiovasc Nurs 2023; 38:00005082-990000000-00070. [PMID: 36881405 PMCID: PMC10480340 DOI: 10.1097/jcn.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND Heart failure (HF) prevalence has risen for more than a decade. Effective patient and family education strategies for HF are needed on a global scale. One widely used method of education is the teach-back method, where learners are provided information, then their understanding assessed by "teaching it back" to the educator. PURPOSE This state-of-the-art review article seeks to examine the evidence focusing on the teach-back method of patient education and patient outcomes. Specifically, this article describes (1) the teach-back process, (2) teach-back's effect on patient outcomes, (3) teach-back in the context of family care partners, and (4) recommendations for future research and practice. CONCLUSIONS Study investigators report the use of teach-back, but few describe how teach-back was utilized. Study designs vary widely, with few having a comparison group, making conclusions across studies challenging. The effect of teach-back on patient outcomes is mixed. Some studies showed fewer HF readmissions after education using teach-back, but different times of measurement obscure understanding of longitudinal effects. Heart failure knowledge improved across most studies after teach-back interventions; however, results related to HF self-care were mixed. Despite family care partner involvement in several studies, how they were included in teach-back or the associated effects are unclear. CLINICAL IMPLICATIONS Future clinical trials that evaluate the effect of teach-back education on patient outcomes, such as short- and long-term readmission rates, biomarkers, and psychological measures, are needed, as patient education is the foundation for self-care and health-related behaviors.
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Association Between Self-care and Resilience: A Cross-sectional Study in Heart Failure Patients. J Cardiovasc Nurs 2023; 38:E70-E77. [PMID: 35389927 DOI: 10.1097/jcn.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Self-care (SC) is a cornerstone in heart failure management and is related to patient outcomes. The continuous and complex demands of SC can be experienced as stressful and may require patients to apply resilient behaviors as they manage their conditions. Resilience may be a helpful factor in performing SC. OBJECTIVE The aim of this study was to determine the association between resilience and SC in patients with heart failure. METHODS A cross-sectional study was performed between January 2020 and January 2021. Participants were asked to complete a questionnaire addressing baseline characteristics, the 2-item Patient Health Questionnaire, the Resilience Evaluation Scale, and the Self-Care of Chronic Illness Inventory, which measures 3 concepts of SC: SC maintenance, SC monitoring, and SC management. Multiple regression analysis was performed to determine whether resilience was associated with SC. RESULTS Eighty-six patients were included, and 74 patients completed the questionnaire. In the univariate analysis, an association was found between resilience and SC maintenance, resulting in an increase in SC for patients with higher resilience (β = 0.24; 95% confidence interval, 0.03-0.96). In the multivariate analysis adjusted and corrected for confounders, no significant associations between resilience and all SC scales were found. CONCLUSION This study could not demonstrate significant associations between resilience and all SC scales. This study contributes to the body of knowledge on factors that can mediate or moderate SC. Further longitudinal research should be performed to study cause-effect relationships.
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Lukitasari M, Nafista UF. Patient’s knowledge, gender, and physical activity level as the predictors of self-care in heart failure patients. HEALTHCARE IN LOW-RESOURCE SETTINGS 2023. [DOI: 10.4081/hls.2023.11179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Introduction: Self-care management is the fundamental approach for Heart Failure (HF) management and is influenced by patient ability in preventing rehospitalization, mortality, and morbidity. Therefore, this study aims to investigate the predictors of a patient’s ability in HF self-care management.
Design and Methods: A cross-sectional study was carried out on 96 patients with HF. The data were collected through interviews using questionnaires on demographic characteristics, physical activity (IPAQ), knowledge (Dutch Heart Failure Knowledge Score), and self-care management (Self Care Heart Failure Index). Subsequently, the data were analyzed using logistic regression analysis, and the best fit model for predicting self-care management in HF patients was generated.
Results: The proportion of samples was 56.3% female, with mostly primary school (50%) as their education level. Furthermore, the proportion of patients with adequate HF self-care management was only 21% of the total participant. Based on the results, the patient’s physical activity level, HF knowledge, and gender were verified as a predictor of self-care management.
Conclusions: The HF knowledge level, physical activity level, and gender were the predictors of HF self-care management.
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The Influence of Informal Caregivers' Preparedness on Psychological Symptoms and Quality of Life Among Patients With Heart Failure And Insufficient Self-care. J Cardiovasc Nurs 2023; 38:224-236. [PMID: 36745758 DOI: 10.1097/jcn.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Most patients with heart failure find self-care difficult to perform and rely on family caregivers for support. Informal caregivers, however, often face insufficient psychological preparation and challenges in providing long-term care. Insufficient caregiver preparedness not only results in psychological burden for the informal caregivers but may also lead to a decline in caregiver contributions to patient self-care that affects patient outcomes. OBJECTIVE Our objective was to test (1) the association of baseline informal caregivers' preparedness with psychological symptoms (anxiety and depression) and quality of life 3 months after baseline among patients with insufficient self-care and (2) the mediating effects of caregivers' contributions to self-care of heart failure (CC-SCHF) on the relationship of caregivers' preparedness with patients' outcomes at 3 months. METHODS A longitudinal design was used to collect data between September 2020 and January 2022 in China. Data analyses were conducted using descriptive statistics, correlations, and linear mixed models. We used model 4 of the PROCESS program in SPSS with bootstrap testing to evaluate the mediating effect of CC-SCHF of informal caregivers' preparedness at baseline with psychological symptoms or quality of life among patients with HF 3 months later. RESULTS Caregiver preparedness was positively associated with CC-SCHF maintenance (r = 0.685, P < .01), CC-SCHF management (r = 0.403, P < .01), and CC-SCHF confidence (r = 0.600, P < .01). Good caregiver preparedness directly predicted lower psychological symptoms (anxiety and depression) and higher quality of life for patients with insufficient self-care. The associations of caregiver preparedness with short-term quality of life and depression of patients with HF with insufficient self-care were mediated by CC-SCHF management. CONCLUSIONS Enhancing the preparedness of informal caregivers may improve psychological symptoms and quality of life of heart failure patients with insufficient self-care.
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Hosseini SA, Karampourian A, Shamsizadeh M, Mohammadi Y. Application of Haddon strategy training on self-care behavior and disease consequences in heart failure. JOURNAL OF VASCULAR NURSING 2023. [DOI: 10.1016/j.jvn.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Leung T, Shin S, Kim S, Lee E. The Relation Between eHealth Literacy and Health-Related Behaviors: Systematic Review and Meta-analysis. J Med Internet Res 2023; 25:e40778. [PMID: 36716080 PMCID: PMC9926349 DOI: 10.2196/40778] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/09/2022] [Accepted: 12/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND With widespread use of the internet and mobile devices, many people have gained improved access to health-related information online for health promotion and disease management. As the health information acquired online can affect health-related behaviors, health care providers need to take into account how each individual's online health literacy (eHealth literacy) can affect health-related behaviors. OBJECTIVE To determine whether an individual's level of eHealth literacy affects actual health-related behaviors, the correlation between eHealth literacy and health-related behaviors was identified in an integrated manner through a systematic literature review and meta-analysis. METHODS The MEDLINE, Embase, Cochrane, KoreaMed, and Research Information Sharing Service databases were systematically searched for studies published up to March 19, 2021, which suggested the relationship between eHealth literacy and health-related behaviors. Studies were eligible if they were conducted with the general population, presented eHealth literacy according to validated tools, used no specific control condition, and measured health-related behaviors as the outcomes. A meta-analysis was performed on the studies that could be quantitatively synthesized using a random effect model. A pooled correlation coefficient was generated by integrating the correlation coefficients, and the risk of bias was assessed using the modified Newcastle-Ottawa Scale. RESULTS Among 1922 eHealth literacy-related papers, 29 studies suggesting an association between eHealth literacy and health-related behaviors were included. All retrieved studies were cross-sectional studies, and most of them used the eHealth Literacy Scale (eHEALS) as a measurement tool for eHealth literacy. Of the 29 studies, 22 presented positive associations between eHealth literacy and health-related behaviors. The meta-analysis was performed on 14 studies that presented the correlation coefficient for the relationship between eHealth literacy and health-related behaviors. When the meta-analysis was conducted by age, morbidity status, and type of health-related behavior, the pooled correlation coefficients were 0.37 (95% CI 0.29-0.44) for older adults (aged ≥65 years), 0.28 (95% CI 0.17-0.39) for individuals with diseases, and 0.36 (95% CI 0.27-0.41) for health-promoting behavior. The overall estimate of the correlation between eHealth literacy and health-related behaviors was 0.31 (95% CI 0.25-0.34), which indicated a moderate correlation between eHealth literacy and health-related behaviors. CONCLUSIONS Our results of a positive correlation between eHealth literacy and health-related behaviors indicate that eHealth literacy can be a mediator in the process by which health-related information leads to changes in health-related behaviors. Larger-scale studies with stronger validity are needed to evaluate the detailed relationship between the proficiency level of eHealth literacy and health-related behaviors for health promotion in the future.
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Affiliation(s)
| | - Sangyoon Shin
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Seungyeon Kim
- College of Pharmacy, Dankook University, Cheonan, Republic of Korea
| | - Euni Lee
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Republic of Korea
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Taking Care of Us© (TCU) study protocol: feasibility and acceptability of a dyadic intervention for couples living with heart failure. Pilot Feasibility Stud 2023; 9:16. [PMID: 36698174 PMCID: PMC9875187 DOI: 10.1186/s40814-023-01249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There are more than 1 million hospital admissions and 3 million emergency visits for heart failure in the USA annually. Although spouse/partners make substantial contributions to the management of heart failure and experience poor health and high levels of care strain, they are rarely the focus of heart failure interventions. This protocol describes a pilot randomized controlled trial that tests the feasibility, acceptability, and preliminary change in outcomes of a seven-session couple-based intervention called Taking Care of Us© (TCU). The TCU© intervention is grounded in the theory of dyadic illness management and was developed to promote collaborative illness management and better physical and mental health of adults with heart failure and their partners. METHODS A two-arm randomized controlled trial will be conducted. Eligible adults with heart failure and their co-residing spouse/partner will be recruited from a clinical site in the USA and community/social media outreach and randomized to either the TCU© intervention or to a control condition (SUPPORT©) that offers education around heart failure management. The target sample is 60 couples (30 per arm). TCU© couples will receive seven sessions over 2 months via Zoom; SUPPORT© couples will receive three sessions over 2 months via Zoom. All participants will complete self-report measures at baseline (T1), post-treatment (T2), and 3 months post-treatment (T3). Acceptability and feasibility of the intervention will be examined using both closed-ended and open-ended questions as well as enrollment, retention, completion, and satisfaction metrics. Preliminary exploration of change in outcomes of TCU© on dyadic health, dyadic appraisal, and collaborative management will also be conducted. DISCUSSION Theoretically driven, evidence-based dyadic interventions are needed to optimize the health of both members of the couple living with heart failure. Results from this study will provide important information about recruitment and retention and benefits and drawbacks of the TCU© program to directly inform any needed refinements of the program and decision to move to a main trial. TRIAL REGISTRATION ClinicalTrials.gov (NCT04737759) registered on 27 January 2021.
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Pettersson S, Jaarsma T, Hedgärd K, Klompstra L. Self-care in migrants with type 2 diabetes, during the COVID-19 pandemic. J Nurs Scholarsh 2023; 55:167-177. [PMID: 36353793 PMCID: PMC10098933 DOI: 10.1111/jnu.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Type 2 diabetes is increasing globally and particularly affects vulnerable groups in society, such as migrants. Research shows that type 2 diabetes is a risk factor for severe illness when infected with COVID-19. Diabetes-related complications can be prevented with good glycaemic control. In addition, good glycaemic control has been shown to be an important cornerstone for preventing severe illness in individuals infected with COVID-19. In order to maintain good glycaemic control, self-care is needed. The purpose of this article is to describe self-care maintenance and possible changes in self-care maintenance and to explore factors related to unchanged self-care maintenance in migrant patients with type 2 diabetes during the COVID-19 pandemic. The second aim is to describe well-being, social support, and the need for support from healthcare services during the COVID-19 pandemic in migrant patients with type 2 diabetes. DESIGN/METHOD A triangulation design with cross-sectional data collection was used. Both quantitative and qualitative data were collected and interpreted together in a triangulation design. Patients were selected by a diabetes nurse from a computer system at a health center in south-eastern Sweden and invited to participate in the study. A questionnaire was translated into the languages most commonly used at the clinic and sent out to 332 migrant patients who had been diagnosed with type 2 diabetes and treated in primary care. This questionnaire assessed self-care maintenance for diabetes (questions inspired by the Self-Care of Diabetes Inventory), with questions added to every item to assess changes during the pandemic. When changes occurred, we asked the participants to elaborate. Open-ended questions asked the participants how they would like to receive information when there are changes in their healthcare. Descriptive statistical analyses were used for the quantitative data and qualitative data was analyzed using a directed approach to content analysis. RESULTS In total, 79 participants answered the questionnaire (mean age 69 ± 11, 51% male, 47% born in the Middle East). Of these, 76% stated a change in self-care. More than half (58%) stated changes in maintaining an active lifestyle, 40% had changed their physical exercise, and 38% had changed their behavior to avoid getting sick. Participants said that this change was due to staying at home or canceling social activities because they feared meeting people during the pandemic. Others were more physically active than before on a regular basis during the pandemic due to taking walks to get fit, as a precaution related to COVID-19, and having greater awareness about how to avoid getting sick. Approximately one-quarter of the participants experienced a change in contact with healthcare due to poorer access to care, with fewer doctors' appointments and care being postponed during the pandemic. More than half (58%) would like to receive information about healthcare changes by a letter in the regular mail. Social support had changed for 35% of the participants, with less support from family and friends due to the risk of being infected with COVID-19. CONCLUSION The COVID-19 pandemic led to societal restrictions that changed the way of life for many individuals. Migrant patients with type 2 diabetes, who are already a vulnerable group regarding self-care, had difficulties in maintaining good living habits during the pandemic. During crises such as COVID-19, support with self-care, such as closer contact with healthcare providers, is vital. CLINICAL RELEVANCE Knowledge about how the COVID-19 pandemic has affected migrants with type 2 diabetes can be used to support healthcare providers in identifying individuals who are at high risk of suffering from the consequences of their diabetes associated with the pandemic.
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Affiliation(s)
- Sara Pettersson
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Klara Hedgärd
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
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72
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Stawnychy MA, Vellone E, Zeffiro V, Teitelman AM, Maria MD, Riegel B. Dyad Gender and Relationship Quality Influence Heart Failure Self-Care. Clin Nurs Res 2023; 32:29-39. [PMID: 36168717 DOI: 10.1177/10547738221119338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Caregivers promote heart failure self-care, yet little is known about how relationship quality and dyad gender influences self-care. The purpose of this study was to evauluate the contribution of dyad gender and relationship quality on heart failure self-care. The study was a secondary analysis from a heart failure self-care intervention. Dyad gender was categorized by patient-caregiver gender as Male-Male (M + M), Female-Female (F + F), Female-Male (Fp + Mc), and Male-Female (Mp + Fc). The Self-Care of Heart Failure Index v.6.2 measured self-care. The Mutuality Scale assessed relationship quality. Univariate linear regression identified determinants of patient self-care maintenance and self-efficacy. The sample (n = 503) was 48% Mp + Fc, 27% F + F, 15% Fp + Mc, and 10% M + M. Better caregiver mutuality in M + M dyads was associated with lower self-care maintenance (b = -7.45, 95% CI [-13.80, -1.11]) and self-efficacy (b = -18.07, 95% CI [-29.11, -7.04]). Better patient mutuality was associated with higher self-efficacy for M + M dyads (b = 12.63, 95% CI [2.18, 23.09]). Mutuality and dyad gender appear important for self-care. Consider the role of gender in the dyad in behavioral interventions.
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Affiliation(s)
| | | | | | | | | | - Barbara Riegel
- University of Pennsylvania, Philadelphia, USA.,Australian Catholic University, Melbourne, VIC, Australia
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73
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Psychometric Evaluation of the Korean Version of Control Attitudes Scale-Revised. J Cardiovasc Nurs 2023; 38:101-108. [PMID: 34166297 DOI: 10.1097/jcn.0000000000000833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heart failure (HF) is a chronic heart condition that requires patients to adapt to the disease and maintain a high degree of self-management. Patients with HF commonly feel loss of control, which has a negative effect on their compliance to self-care, health-related quality of life, and health outcomes. To promote self-care behavior and to develop healthy coping mechanisms, it is important to understand individual HF patients' perceived control, a self-generated belief that one has the ability to bring forth desired outcomes. Currently, there is no valid and reliable Korean instrument available in measuring perceived control among patients with HF. OBJECTIVE The objective of this study was to cross-culturally translate, adapt, and evaluate psychometric properties of the Korean version of Control Attitudes Scale-Revised (KCAS-R) in Korean patients with HF. METHODS The KCAS-R was developed using a translation/back-translation process and an examination of semantic and conceptual equivalence. Reliability was assessed using Cronbach α to determine internal consistency, and item-total and interitem correlations were assessed to test item homogeneity. The construct validity was examined using exploratory factor analysis, confirmatory factor analysis, and testing hypotheses for known associations with self-efficacy, self-care confidence, and self-care. RESULTS A convenience sample of 138 patients with HF were included for the psychometric testing of an 8-item KCAS-R. The Cronbach α for internal consistency was 0.835, and the item-total correlation was acceptable. The construct validity revealed a 2-factor structure accounting for 63.23% of the total variance. The KCAS-R was associated with higher levels of self-efficacy, self-care confidence, and self-care. In addition, patients with higher perceived control had less depression and anxiety compared with those with lower levels of perceived control. CONCLUSION This study provided support for the satisfactory reliability and validity of the 8-item KCAS-R in measuring perceived control in Korean patients with HF.
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74
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Kim J, Hwang SY, Kim SH, Shim JL. Structural Relationships Between Cognitive Function, Depressive Symptoms, Self-Care Confidence, and Maintenance in Patients With Heart Failure. SAGE Open Nurs 2023; 9:23779608231196665. [PMID: 37691722 PMCID: PMC10483967 DOI: 10.1177/23779608231196665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction In order to promote self-care maintenance behavior in patients with heart failure (HF), it is necessary to identify the direct and indirect effects of major latent variables. Objective This study aimed to identify structural relationships between different domains of cognitive function, depression and self-care confidence, and self-care maintenance. Methods This descriptive study involved a secondary analysis using data of 201 patients with HF from two observational studies in three hospitals in Korea. The structural equation model using AMOS version 24.0 was constructed to assess the relationships among the variables. The Seoul Neuropsychological Screening Battery was used to assess global cognition, immediate/delayed memory, and executive function, and the Self-Care of HF Index v.6.2. was used for self-care confidence and maintenance. Results Self-care maintenance was affected by memory function with a significant direct effect (β=.43, p = .006), as well as self-care confidence (β=.70, p < .001). Memory function and global function indirectly affected self-care maintenance through self-care confidence (β = -.37, p = .002; β = .14, p = .030). Depressive symptoms also had an indirect effect through self-care confidence on self-care maintenance (β = -.21, p = .005). Conclusion This study confirmed that it is important to increase self-care confidence through supportive care and to maintain memory function for maintaining self-care in the chronic course of HF patients. In particular, this study suggests that it is necessary to perform periodic memory check-ups for chronic HF patients on an outpatient basis, and counseling and education are needed to improve memory and increase confidence in self-care.
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Affiliation(s)
- JinShil Kim
- College of Nursing, Gachon University, Incheon, South Korea
| | - Seon Young Hwang
- College of Nursing, Gachon University, Incheon, South Korea
- College of Nursing, Hanyang University, Seoul, South Korea
| | - Sun Hwa Kim
- Department of Nursing, Hanyang University Medical Center, Seoul, South Korea
| | - Jae Lan Shim
- Department of Nursing, Dongguk University, Gyeongju, South Korea
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75
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Ryder M, Guerin S, Forde R, Lowe G, Jaarsma T, O'Neill M, Halley C, Connolly M. The perceived effects of COVID-19 while living with a chronic illness. J Nurs Scholarsh 2023; 55:154-162. [PMID: 36281970 PMCID: PMC9874398 DOI: 10.1111/jnu.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A diagnosis of chronic illness posed a serious threat to people during the recent COVID-19 pandemic. People with chronic illnesses were faced with increased mortality and reduced access to healthcare. Self-care is the process of maintaining health and managing a chronic illness. Nurses working in specialist services provide healthcare education to people with chronic illnesses. Access to these nurses was decreased during periods of the COVID-19 virus escalation due to the reconfiguration of services and redeployment of nurses. The purpose of the research was to learn from the experiences of people with a chronic illnesses in self-care behaviors and accessing altered healthcare services to inform future practices. DESIGN A population survey design. METHODS A mixed methods survey was designed, combining validated questionnaires and scales with open-ended questions. A convenience sample was utilized via using social media platforms. Data analysis included descriptive and inferential statistics. Content analysis was used to analyze open-ended responses. RESULTS There were 147 responses, with approximately half reporting no changes in face-to-face healthcare contact, 41% reporting decreased contacts and 12% increased contacts. Non-face-to-face contacts were reduced by almost 9%, did not change by almost 60%, while 33% indicated an increase. Participants reported mixed perceptions in contact with healthcare providers during restrictions. In the Patient Assessment of Chronic Illness Care and the Self-Care of Chronic Illness scales, participants scored statistically lower scores than in previous studies. Participants indicated that public health restrictions negatively impacted their confidence, created challenges with re-engaging and that access to care was more difficult. CONCLUSION This research highlights the importance of providing continued support to people with chronic illness irrespective of other challenges to healthcare services. A structured approach to virtual self-care education is required. CLINICAL RELEVANCE This research concluded that the experience of access to one healthcare professional as opposed to diverse multidisciplinary input was similar for a number of chronic illnesses groups of people during the COVID-19 pandemic. There was an altered dynamic of virtual contacts with healthcare providers and a lack of confidence interpreting what monitoring was required by people with a chronic illnesses due to a lack of preparedness for virtual healthcare delivery.
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Affiliation(s)
- Mary Ryder
- School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
| | - Suzanne Guerin
- School of PsychologyUniversity College DublinDublinIreland
| | - Rita Forde
- Nursing, Midwifery and Palliative CareKings College LondonLondonUK
| | - Grainne Lowe
- Institute of Health and WellbeingFederation University AustraliaMelbourneAustralia
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- Julius CenterUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Madeline O'Neill
- School of Nursing, Midwifery & Health Systems, University College DublinRegistered Advanced Nurse PractitionerOur Lady's Hospice and Care Services, Harold's CrossDublin 8Ireland
| | | | - Michael Connolly
- School of Nursing, Midwifery & Health Systems University College Dublin and Our Lady's Hospice & Care ServicesDublinIreland
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76
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Clements L, Frazier SK, Lennie TA, Chung ML, Moser DK. Improvement in Heart Failure Self-Care and Patient Readmissions with Caregiver Education: A Randomized Controlled Trial. West J Nurs Res 2022; 45:402-415. [PMID: 36482693 DOI: 10.1177/01939459221141296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Caregivers support heart failure (HF) self-care with little HF education. The purpose of this study was to evaluate the effectiveness of a caregiver-only educational intervention aimed at improving caregiver self-efficacy, perceived control, and HF knowledge, as well as patient self-care and 30-day cardiac readmission. In total, 37 patients and their caregivers were randomly assigned to a control condition or a caregiver-only educational intervention with telephone follow-up. Outcomes included patient 30-day cardiac readmission, patient self-care, caregiver self-efficacy, caregiver perceived control, and caregiver HF knowledge. Linear mixed model, Kaplan–Meier, and Cox regression analyses were used to determine the effects of the intervention on outcomes. Self-care maintenance ( p = 0.002), self-care management ( p = 0.005), 30-day cardiac readmission ( p = 0.003), and caregiver perceived control ( p < 0.001) were significantly better in the intervention group. The results suggest that interventions targeting caregiver HF education could be effective in improving HF patients’ 30-day cardiac readmissions, patient self-care, and caregiver perceived control.
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Affiliation(s)
- Linda Clements
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | | | - Terry A. Lennie
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Misook L. Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, KY, USA
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77
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Karimi P, Mohammadi M, Mozaffari N. The relationship between caregiver contributions to self-care and quality of life in heart failure patients in Ardabil hospitals in Ardebil-Iran. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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78
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Clinical Perspectives on the Development of a Gamified Heart Failure Patient Education Web Site. COMPUTERS, INFORMATICS, NURSING : CIN 2022:00024665-990000000-00075. [PMID: 36730077 DOI: 10.1097/cin.0000000000000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Heart failure is a complex, chronic disease that requires self-care to manage, and patients need support and education to perform adequate self-care. Although electronic health interventions to support behavior change and self-care in cardiovascular disease are gaining traction, there is little engaging online education specifically designed for heart failure patients. This paper describes the design and development of a heart failure self-care patient education Web site that integrated gamification, meaning the use of game design elements in a non-game context. We sought feedback on the Web site from a group of heart failure clinicians in a focus group using a semi-structured interview guide, and data were analyzed thematically. Clinician input during the design phase touched on themes such as patients' decision-making in heart failure and older adults' adoption of technology. Clinicians recommended that a narrative gamification technique should reflect real-life dilemmas patients encounter in their self-care. Clinicians also discussed the need to carefully plan reward-based gamification techniques to avoid unintended effects. Overall, a gamified Web site has the potential to support heart failure self-care, but efforts are needed to address the disparity of those with limited computer literacy or access.
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79
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Al-Hammouri MM, Rababah JA. Examining the underlying processes of different dimensions of self-care behavior among persons with heart failure. BMC Cardiovasc Disord 2022; 22:437. [PMID: 36203162 PMCID: PMC9541077 DOI: 10.1186/s12872-022-02876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/30/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose This study was conducted to compare how potential predictors differentially contribute to the different dimensions of self-care in persons with heart failure.
Methods A cross-sectional design was used in this study. Purposive sampling was used to recruit a sample (N = 252) in this study. The data were collected from three major referral hospitals in Jordan. Data analysis was performed using multiple linear regression. Results The results showed that around 89% of our sample had insufficiency in at least one dimension of self-care. The initial regression models showed that different combinations of predictors were significantly associated with different dimensions of self-care. These models were also different in terms of the variance explained and the coefficients of the significant predictors. After the follow-up analysis of the best fit models for these dimensions, these differences were maintained. Conclusion Despite the similarities in the proposed variables predicting different self-care dimensions, their differences may suggest variations in the underlying processes controlling different self-care dimensions. The current study showed that seven out of the nine proposed variables predicted different dimensions of self-care either in the initial or best-fit models.
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Affiliation(s)
- Mohammed Munther Al-Hammouri
- Department of Community and Mental, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
| | - Jehad A Rababah
- Department of Community and Mental, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
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80
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Chae S, Song J, Ojo M, Bowles KH, McDonald MV, Barrón Y, Hobensack M, Kennedy E, Sridharan S, Evans L, Topaz M. Factors associated with poor self-management documented in home health care narrative notes for patients with heart failure. Heart Lung 2022; 55:148-154. [PMID: 35597164 PMCID: PMC11021173 DOI: 10.1016/j.hrtlng.2022.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with heart failure (HF) who actively engage in their own self-management have better outcomes. Extracting data through natural language processing (NLP) holds great promise for identifying patients with or at risk of poor self-management. OBJECTIVE To identify home health care (HHC) patients with HF who have poor self-management using NLP of narrative notes, and to examine patient factors associated with poor self-management. METHODS An NLP algorithm was applied to extract poor self-management documentation using 353,718 HHC narrative notes of 9,710 patients with HF. Sociodemographic and structured clinical data were incorporated into multivariate logistic regression models to identify factors associated with poor self-management. RESULTS There were 758 (7.8%) patients in this sample identified as having notes with language describing poor HF self-management. Younger age (OR 0.982, 95% CI 0.976-0.987, p < .001), longer length of stay in HHC (OR 1.036, 95% CI 1.029- 1.043, p < .001), diagnosis of diabetes (OR 1.47, 95% CI 1.3-1.67, p < .001) and depression (OR 1.36, 95% CI 1.09-1.68, p < .01), impaired decision-making (OR 1.64, 95% CI 1.37-1.95, p < .001), smoking (OR 1.7, 95% CI 1.4-2.04, p < .001), and shortness of breath with exertion (OR 1.25, 95% CI 1.1-1.42, p < .01) were associated with poor self-management. CONCLUSIONS Patients with HF who have poor self-management can be identified from the narrative notes in HHC using novel NLP methods. Meaningful information about the self-management of patients with HF can support HHC clinicians in developing individualized care plans to improve self-management and clinical outcomes.
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Affiliation(s)
- Sena Chae
- College of Nursing, University of Iowa, 50 Newton Rd, Iowa City, IA 52242, United States.
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, United States
| | - Marietta Ojo
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Kathryn H Bowles
- Department of Biobehavioral Health Sciences Philadelphia PA, Center for Home Care Policy & Research, University of Pennsylvania School of Nursing, Visiting Nurse Service of New York, New York, NY, United States
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Yolanda Barrón
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Mollie Hobensack
- Columbia University School of Nursing, New York, NY, United States
| | - Erin Kennedy
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, United States
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Lauren Evans
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Maxim Topaz
- Center for Home Care Policy & Research, Columbia University School of Nursing, Data Science Institute, Columbia University, Visiting Nurse Service of New York, New York, NY, United States
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81
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Wilson AMMM, Almeida GSMD, Santos BDCFD, Nakahara-Melo M, Conceição APD, Cruz DDALMD. Factors associated with caregivers' contribution to self-care in heart failure. Rev Lat Am Enfermagem 2022; 30:e3632. [PMID: 35976358 DOI: 10.1590/1518-8345.5838.3632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/26/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to analyze the caregiver's contribution to self-care in heart failure and the predictor variables of this contribution. METHOD a cross-sectional descriptive and analytical study, with the participation of 140 dyads (patients and caregivers). The contribution to self-care was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index. Caregivers and patients were interviewed separately to obtain the data. Multiple linear regressions were used to verify predictor variables of caregiver contribution. RESULTS the mean score for contribution to maintenance self-care was 62.7 (SD=7.1), for management, 62.9 (SD=20.4) and for confidence was 63.3 (SD=22.1). The variables number of patient's medications, caregiver being related to the patient, social perception of caregiver, health-related quality of life of the patient and caregiver's confidence in contributing to self-care were predictors of caregiver's contribution to maintenance or management self-care. CONCLUSION the caregiver's contribution was insufficient. The social support perceived by the caregiver, the type of relationship the caregiver to the patient, the number of medications used by the patient, as well as the caregiver's confidence in contributing to self-care are variables that should be considered to assess the risk of insufficient contribution of the caregiver.
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Affiliation(s)
| | - Glauber Silva Mendes de Almeida
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil.,Universitatsklinikum Duesseldorf, Kardiochirurgie, Duesseldorf, NRW, Alemanha
| | - Bruna de Cassia Ferreira Dos Santos
- Hospital Municipal Dr Moysés Deutsch, Pronto-Socorro, São Paulo, SP, Brasil.,Universidade Federal de Juiz de Fora, Departamento de Enfermagem Aplicada, Juiz de Fora, MG, Brasil
| | - Michele Nakahara-Melo
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Ana Paula da Conceição
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil.,Instituto Dante Pazzanese de Cardiologia, Unidade de Internação Adulto, São Paulo, SP, Brasil
| | - Diná de Almeida Lopes Monteiro da Cruz
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil.,Bolsista do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil
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82
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Relação entre apoio social percebido e autocuidado de pacientes com insuficiência cardíaca. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao012966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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83
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Freedland KE, Skala JA, Carney RM, Steinmeyer BC, Rubin EH, Rich MW. Sequential Interventions for Major Depression and Heart Failure Self-Care: A Randomized Clinical Trial. Circ Heart Fail 2022; 15:e009422. [PMID: 35973032 PMCID: PMC9389592 DOI: 10.1161/circheartfailure.121.009422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Major depression and inadequate self-care are common in patients with heart failure (HF). Little is known about how to intervene when both problems are present. This study examined the efficacy of a sequential approach to treating these problems. METHODS Stepped Care for Depression in HF was a single-site, single-blind, randomized controlled trial of cognitive behavior therapy (CBT) versus usual care (UC) for major depression in patients with HF. The intensive phase of the CBT intervention lasted between 8 and 16 weeks, depending upon the rate of improvement in depression. All participants received a tailored HF self-care intervention that began 8 weeks after randomization. The intensive phase of the self-care intervention ended at 16 weeks post-randomization. The coprimary outcome measures were the Beck Depression Inventory (version 2) and the Maintenance scale of the Self-Care of HF Index (v6.2) at week 16. RESULTS One hundred thirty-nine patients with HF and major depression were enrolled; 70 were randomized to UC and 69 to CBT. At week 16, the patients in the CBT arm scored 4.0 points ([95% CI, -7.3 to -0.8]; P=0.02) lower on the Beck Depression Inventory, version 2 than those in the usual care arm. Mean scores on the Self-Care of HF Index Maintenance scale were not significantly different between the groups ([95% CI, -6.5 to 1.5]; P=0.22). CONCLUSIONS CBT is more effective than usual care for major depression in patients with HF. However, initiating CBT before starting a tailored HF self-care intervention does not increase the benefit of the self-care intervention. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02997865.
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Affiliation(s)
- Kenneth E. Freedland
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Judith A. Skala
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Robert M. Carney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Brian C. Steinmeyer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Eugene H. Rubin
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Michael W. Rich
- Cardiovascular Division of the Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
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84
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Cousin L, Bugajski A, Buck H, Lennie T, Chung ML, Moser DK. Race Moderates the Relationship Between Perceived Social Support and Self-care Confidence in Patients With Heart Failure. J Cardiovasc Nurs 2022; 37:E73-E80. [PMID: 37707974 DOI: 10.1097/jcn.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND African Americans are at the highest risk of developing heart failure (HF) compared with other races and are hospitalized at 7 to 8 times the rate of Whites. Poor overall self-care, low self-care confidence, and lower levels of perceived social support are factors related to increased risk for hospitalizations in HF. Yet, limited evidence is available regarding the factors that may differentially impact self-care confidence by race in patients with HF. OBJECTIVE The aim of this study was to examine to what extent race moderates the relationship between perceived social support and self-care confidence. METHOD This is a secondary analysis of cross-sectional data from African American and White patients with HF in North America (n = 429). Patients completed the Multidimensional Scale of Perceived Social Support and the Self-Care Confidence Scale of the Self-Care of Heart Failure Index. A moderation analysis was conducted using hierarchal linear regression. RESULTS Sample mean age was 60.8 ± 11.5 years, 22.4% were African American, and 54.7% were in New York Heart Association class I or II. Moderation analyses yielded a significant interaction of perceived social support and race, showing White patients, not African Americans, have significantly different self-care confidence scores depending on level of social support: White, b = 0.224, 95% confidence interval [0.046-0.094], t = 5.65, and P < .001; African American, b = -0.776, 95% confidence interval [-0.049 to 0.060], t = 0.212, and P = .832. CONCLUSIONS Our findings show a variable effect of perceived social support on self-care confidence as a function of race, suggesting the need for further research to develop and test interventions tailored to race and levels of social support in HF.
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Kim J, Kim KH, Lim YH, Heo S, Moon K, Oh MS, An M. Validity and Reliability of the Korean Version of the Revised Self-Care of Heart Failure Index v7.2. Clin Nurs Res 2022; 31:1296-1307. [PMID: 35726492 DOI: 10.1177/10547738221106590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The psychometric properties of the Korean version of the revised Self-Care of Heart Failure Index (SCHFI) remain undetermined; therefore, we aimed to evaluate the construct and convergent validity and reliability of the Korean version of the SCHFI in Korean patients with heart failure (HF). Using a cross-sectional design, 207 patients with HF provided data on self-care and self-efficacy in self-care for this psychometric testing. The confirmatory factor analysis supported the construct validity of the Korean version with a three-factor structure: Self-Care Maintenance, Symptom Perception, and Self-Care Management. Convergent validity was supported by the significant relationships between self-efficacy and each scale of the Korean version of the SCHFI (r = .425-.549, p < .001). The reliability estimates were marginally adequate, with a Cronbach's alpha of .655 to .776, McDonald's omega of .710 to .836, and composite reliability coefficients of .704 to .834. The SCHFI was supported as a valid and reliable measure of self-care for Koreans with HF. However, the marginal levels of the Cronbach's alpha coefficients still require validation in a larger sample.
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Affiliation(s)
| | - Kye Hun Kim
- Chonnam National University, Gwangju, South Korea
| | | | | | - Keumyi Moon
- Chonnam National University Hospital, Gwangju, South Korea
| | - Mi Sook Oh
- Chonnam National University Hospital, Gwangju, South Korea
| | - Minjeong An
- Chonnam National University, Gwangju, South Korea
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Nourse R, Cartledge S, Tegegne T, Gurrin C, Maddison R. Now you see it! Using wearable cameras to gain insights into the lived experience of cardiovascular conditions. Eur J Cardiovasc Nurs 2022; 21:750-755. [PMID: 35714119 DOI: 10.1093/eurjcn/zvac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022]
Abstract
Wearable cameras offer an innovative way to discover new insights into the lived experience of people with cardiovascular conditions. Wearable cameras can be used alone or supplement more traditional research methods, such as interviews and participant observations. This paper provides an overview of the benefits of using wearable cameras for data collection and outlines some key considerations for researchers and clinicians interested in this method. We provide a case study describing a study design using wearable cameras and how the data were used.
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Affiliation(s)
- Rebecca Nourse
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Susie Cartledge
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Teketo Tegegne
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Cathal Gurrin
- School of Computing, Dublin City University, Dublin, Ireland
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
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87
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Riegel B, De Maria M, Barbaranelli C, Matarese M, Ausili D, Stromberg A, Vellone E, Jaarsma T. Symptom Recognition as a Mediator in the Self-Care of Chronic Illness. Front Public Health 2022; 10:883299. [PMID: 35655456 PMCID: PMC9152258 DOI: 10.3389/fpubh.2022.883299] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background The recognition of a symptom is needed to initiate a decision to engage in a behavior to ameliorate the symptom. Yet, a surprising number of individuals fail to detect symptoms and delay in addressing early warnings of a health problem. Purpose The aim of this study was to test the hypothesis that symptom recognition mediates the relationship between monitoring for and management of symptoms of a chronic illness. Methods A secondary analysis of existing cross-sectional data. A sample of 1,629 patients diagnosed with one or more chronic conditions was enrolled in the United States (US) (n = 407), Italy (n = 784) and Sweden (n = 438) between March 2015 and May 2019. Data on self-care monitoring, symptom recognition, and self-care management was assessed using the Self-Care of Chronic Illness Inventory. After confirming metric invariance in cultural assessment, we used structural equation modeling to test a mediation model where symptom recognition was conceptualized as the mediator linking self-care monitoring and self-care management with autonomous (e.g., Change your activity level) and consulting behaviors (e.g., Call your healthcare provider for guidance). Results Symptom recognition mediated the relation between self-care monitoring and autonomous self-care management behaviors (β = 0.098, β = 0.122, β = 0.081, p < 0.001 for US, Italy, and Sweden, respectively). No mediation effect was found for consulting self-care management behaviors. Conclusion Our findings suggests that symptom recognition promotes autonomous self-care behaviors in people with a chronic condition. Self-care monitoring directly affects consulting self-care management behaviors but not through symptom recognition. Further research is needed to fully understand the role of symptom recognition in the self-care process.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Barbaranelli
- Department of Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Matarese
- Research Unit of Nursing Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, Department of Cardiology, Linkoping University, Linköping, Sweden
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden
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88
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The Association Between Self-reported Sleep Quality and Self-care in Adults With Heart Failure. J Cardiovasc Nurs 2022; 38:E98-E109. [PMID: 37027137 DOI: 10.1097/jcn.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sleep disturbance is one of the most common symptoms among patients with heart failure (HF), and it may affect the ability of patients to perform self-care. There is a lack of evidence on the association between sleep quality and its components and self-care in adults with HF. OBJECTIVE The aim of this study was to evaluate the association between sleep quality and its components and self-care in adults with HF. METHODS This study is a secondary analysis of baseline data from the MOTIVATE-HF study, a randomized controlled trial on patients with HF and their caregivers. Only patients' data were analyzed in this study (n = 498). Sleep quality and self-care were evaluated with the Pittsburgh Sleep Quality Index and the Self-Care of Heart Failure Index v6.2, respectively. RESULTS A habitual sleep efficiency of 75% to 84% was associated with lower self-care maintenance compared with a habitual sleep efficiency of 85% or greater ( P = .031), as was taking sleep medications once or twice a week compared with less than once a week ( P = .001). A frequency of daytime dysfunction less than once a week was associated with lower self-care management compared with a frequency of daytime dysfunction of 3 or more times a week ( P = .025). Taking sleep medications less than once a week was associated with lower self-care confidence compared with taking sleep medications 3 or more times a week ( P = .018). CONCLUSION Poor sleep quality is frequently reported by patients with HF. Sleep efficiency, sleep medications, and daytime dysfunction may influence self-care more than the other sleep quality components.
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89
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Self-Care of Chronic Illness Inventory: An Initial Psychometric Evaluation in People Living With HIV in Italy. J Assoc Nurses AIDS Care 2022; 33:459-467. [PMID: 35608896 DOI: 10.1097/jnc.0000000000000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Self-care is essential to achieve positive clinical outcomes in patients with chronic diseases; however, self-care behaviors of people living with HIV (PLWH) have not been extensively studied due to the lack of validated measurements. We performed preliminary psychometric analyses of the structural validity and internal consistency of the Self-Care of Chronic Illness Inventory among 108 PLWH living in Italy and assessed self-care levels. Our findings largely replicate the instrument's original factor structure and indicated high internal consistency and reliability. Additionally, we found that PLWH performed self-care behaviors at suboptimal levels. Recommendations for clinical care and future investigations are advanced.
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90
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Page SD, Lee C, Aryal S, Freedland K, Stromberg A, Vellone E, Westland H, Wiebe DJ, Jaarsma T, Riegel B. Development and testing of an instrument to measure contextual factors influencing self-care decisions among adults with chronic illness. Health Qual Life Outcomes 2022; 20:83. [PMID: 35606792 PMCID: PMC9125861 DOI: 10.1186/s12955-022-01990-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 05/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Decisions about how to manage bothersome symptoms of chronic illness are complex and influenced by factors related to the patient, their illness, and their environment. Naturalistic decision-making describes decision-making when conditions are dynamically evolving, and the decision maker may be uncertain because the situation is ambiguous and missing information. Contextual factors, including time stress, the perception of high stakes, and input from others may facilitate or complicate decisions about the self-care of symptoms. There is no valid instrument to measure these contextual factors. The purpose of this study was to develop and test a self-report instrument measuring the contextual factors that influence self-care decisions about symptoms. Methods Items were drafted from the literature and refined with patient input. Content validity of the instrument was evaluated using a Delphi survey of expert clinicians and researchers, and cognitive interviews with adults with chronic illness. Psychometric testing included exploratory factor analysis to test dimensionality, item response theory-based approaches for item recalibration, confirmatory factor analysis to generate factor determinacy scores, and evaluation of construct validity. Results Ten contextual factors influencing decision-making were identified and multiple items per factor were generated. Items were refined based on cognitive interviews with five adults with chronic illness. After a two round Delphi survey of expert clinicians (n = 12) all items had a content validity index of > 0.78. Five additional adults with chronic illness endorsed the relevance, comprehensiveness, and comprehensibility of the inventory during cognitive interviews. Initial psychometric testing (n = 431) revealed a 6-factor multidimensional structure that was further refined for precision, and high multidimensional reliability (0.864). In construct validity testing, there were modest associations with some scales of the Melbourne Decision Making Questionnaire and the Self-Care of Chronic Illness Inventory.
Conclusion The Self-Care Decisions Inventory is a 27-item self-report instrument that measures the extent to which contextual factors influence decisions about symptoms of chronic illness. The six scales (external, urgency, uncertainty, cognitive/affective, waiting/cue competition, and concealment) reflect naturalistic decision making, have excellent content validity, and demonstrate high multidimensional reliability. Additional testing of the instrument is needed to evaluate clinical utility. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01990-2.
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Affiliation(s)
| | - Christopher Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, US.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Subhash Aryal
- University of Pennsylvania School of Nursing, Philadelphia, PA, US
| | | | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | | | | | - Douglas J Wiebe
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, US
| | - Tiny Jaarsma
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,University Medical Center Utrecht, Utrecht, the Netherlands
| | - Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, PA, US.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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91
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Shara N, Bjarnadottir MV, Falah N, Chou J, Alqutri HS, Asch FM, Anderson KM, Bennett SS, Kuhn A, Montalvo B, Sanchez O, Loveland A, Mohammed SF. Voice activated remote monitoring technology for heart failure patients: Study design, feasibility and observations from a pilot randomized control trial. PLoS One 2022; 17:e0267794. [PMID: 35522660 PMCID: PMC9075666 DOI: 10.1371/journal.pone.0267794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 04/12/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a serious health condition, associated with high health care costs, and poor outcomes. Patient empowerment and self-care are a key component of successful HF management. The emergence of telehealth may enable providers to remotely monitor patients' statuses, support adherence to medical guidelines, improve patient wellbeing, and promote daily awareness of overall patients' health. OBJECTIVE To assess the feasibility of a voice activated technology for monitoring of HF patients, and its impact on HF clinical outcomes and health care utilization. METHODS We conducted a randomized clinical trial; ambulatory HF patients were randomized to voice activated technology or standard of care (SOC) for 90 days. The system developed for this study monitored patient symptoms using a daily survey and alerted healthcare providers of pre-determined reported symptoms of worsening HF. We used summary statistics and descriptive visualizations to study the alerts generated by the technology and to healthcare utilization outcomes. RESULTS The average age of patients was 54 years, the majority were Black and 45% were women. Almost all participants had an annual income below $50,000. Baseline characteristics were not statistically significantly different between the two arms. The technical infrastructure was successfully set up and two thirds of the invited study participants interacted with the technology. Patients reported favorable perception and high comfort level with the use of voice activated technology. The responses from the participants varied widely and higher perceived symptom burden was not associated with hospitalization on qualitative assessment of the data visualization plot. Among patients randomized to the voice activated technology arm, there was one HF emergency department (ED) visit and 2 HF hospitalizations; there were no events in the SOC arm. CONCLUSIONS This study demonstrates the feasibility of remote symptom monitoring of HF patients using voice activated technology. The varying HF severity and the wide range of patient responses to the technology indicate that personalized technological approaches are needed to capture the full benefit of the technology. The differences in health care utilization between the two arms call for further study into the impact of remote monitoring on health care utilization and patients' wellbeing.
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Affiliation(s)
- Nawar Shara
- MedStar Health Research Institute, Hyattsville, MD, United States of America
- Georgetown University, Washington, DC, United States of America
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, United States of America
- * E-mail:
| | - Margret V. Bjarnadottir
- Center for Health Information and Decision Systems, University of Maryland, College Park, MD, United States of America
| | - Noor Falah
- MedStar Health Research Institute, Hyattsville, MD, United States of America
- Georgetown University, Washington, DC, United States of America
| | - Jiling Chou
- MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Hasan S. Alqutri
- MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Federico M. Asch
- MedStar Health Research Institute, Hyattsville, MD, United States of America
| | | | - Sonita S. Bennett
- MedStar Health Research Institute, Hyattsville, MD, United States of America
- MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Alexander Kuhn
- MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Becky Montalvo
- MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Osirelis Sanchez
- MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Amy Loveland
- MedStar Health Research Institute, Hyattsville, MD, United States of America
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92
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Seid SS, Amendoeira J, Ferreira MR. Self-Care and Health-Related Quality of Life Among Heart Failure Patients in Tagus Valley Regional Hospital, Portugal: A Pilot Study. NURSING: RESEARCH AND REVIEWS 2022. [DOI: 10.2147/nrr.s358666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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93
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Pettersson S, Holstein J, Jirwe M, Jaarsma T, Klompstra L. Cultural competence in healthcare professionals, specialised in diabetes, working in primary healthcare-A descriptive study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e717-e726. [PMID: 34145649 DOI: 10.1111/hsc.13442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
Self-care is the most important cornerstone of diabetes treatment. As self-care is affected by cultural beliefs, it is important for healthcare professionals to be able to adapt their educational approach and to be culturally competent. The aim of this study was to describe the cultural competence in Swedish healthcare professionals, specialised in diabetes care and to examine related factors for cultural competence. The healthcare professionals' perceived level of cultural competence was measured across three domains-Openness and awareness, Workplace support and Interaction skills-in 279 Swedish healthcare professionals from all 21 regions of Sweden, using the Cultural Competence Assessment Instrument (Swedish version-CCAI-S). Descriptive statistics were used to describe cultural competence in healthcare professionals, and linear regression was conducted to examine factors related to cultural competence. Of the healthcare professionals studied, 58% perceived that they had a high level of Openness and awareness, 35% perceived that they had a high level of Interaction skills and 6% perceived that they had a high level of Workplace support. Two factors were found to be related to cultural competence, namely, high percentage of migrant clients at the healthcare clinic and whether the healthcare professionals previously had developed cultural competence through practical experience, education and/or by themselves. In conclusion, most healthcare professionals perceived that they had cultural openness and awareness but need more support from their workplace to improve their interaction skills. Cultural competence-related education could support the healthcare professionals to develop interaction skills.
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Affiliation(s)
- Sara Pettersson
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Jane Holstein
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Maria Jirwe
- Department of Health Sciences, Red Cross University College, Huddinge, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
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94
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Abstract
BACKGROUND Self-care is important for improving the health outcomes of individuals with chronic heart failure (CHF). However, predictors of self-care behaviors remain unclear in Chinese society. OBJECTIVE The aims of this study were to explore predictors of self-care in Chinese patients with CHF and clarify the complex relationships between predictors and self-care behaviors guided by the Situation-Specific Theory of Heart Failure Self-Care. METHODS A cross-sectional study was conducted among individuals hospitalized with CHF in China. Person, problem, and environmental factors pertaining to self-care were collected by a questionnaire survey. Self-care was assessed by the Self-Care of Heart Failure Index version 6. Direct and indirect relationships between factors and self-care behaviors and the mediating role of self-care confidence were analyzed by the structural equation model. RESULTS In total, 204 participants were involved in this study. The Situation-Specific Theory of Heart Failure Self-Care model demonstrated a good fit (root mean square error of approximation, 0.046; goodness of fit index, 0.966; normed fit index, 0.914; comparative fit index, 0.971). Inadequate self-care capabilities were common among Chinese patients with CHF. Person-related factors (female gender, higher monthly income and educational level), problem-related factors (severe New York Heart Association function class and better instrumental activities of daily living), and environmental factors (better social support and living in more developed areas) were significant predictors of better self-care behaviors ( P < .05). These associations were partly or fully mediated by self-care confidence. CONCLUSION The Situation-Specific Theory of Heart Failure Self-Care can be used to guide research and practice in patients with CHF. Interventions and policies on promoting self-care in Chinese population living with CHF are encouraged, particularly for underserved populations.
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95
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Antonio-Oriola R, Vellone E, Durante A, De Maria M, Di Nitto M, Gea-Caballero V, Santolalla-Arnedo I, Czapla M, Benavent-Cervera JV, Sánchez-González JL, Juárez-Vela R. Spanish Version of the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI): A Psychometric Evaluation. J Pers Med 2022; 12:625. [PMID: 35455741 PMCID: PMC9028340 DOI: 10.3390/jpm12040625] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Caregiver Contribution to Self-Care of Heart Failure (CC-SCHFI) is a theoretically driven instrument to measure the extent to which caregivers support heart failure (HF) patients to perform self-care. The CC-SCHFI measures caregivers' contribution to self-care maintenance and self-care management and caregiver confidence in contributing to heart failure patients' self-care. To date, the CC-SCHFI has never been tested in Spanish-speaking populations. PURPOSE To translate the CC-SCHFI from English into Spanish and to test its psychometric characteristics. METHOD CC-SCHFI translation and back-translation were performed according to the Beaton et al. methodology. Data from a cross-sectional study conducted in an outpatient clinic in Spain were used for the analysis. Psychometric analysis was performed with exploratory factor analysis (EFA) with oblique rotation. RESULTS Caregivers had a mean age of 60.5 years (SD 14,9) and the majority were female (85%). Data from 220 caregivers were analyzed. From EFA, using the principal axis factoring method, we extracted two factors in the self-care maintenance subscale ("treatment adherence behaviors" and "symptom control and maintenance behaviors"), two in the self-care monitoring subscale ("illness behaviors" and "prevention behaviors") and one factor for the self-efficacy subscale. The Pearson's rank correlation coefficients between SCHFI and CCSCHFI showed significant correlation in each subdimension.
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Affiliation(s)
- Rosa Antonio-Oriola
- Doctorate Program in Clinical and Community Nursing, University of Valencia, 46001 Valencia, Spain;
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Roma Tor Vergata, 00133 Rome, Italy; (E.V.); (M.D.M.)
| | - Angela Durante
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Roma Tor Vergata, 00133 Rome, Italy; (E.V.); (M.D.M.)
| | - Marco Di Nitto
- Centro per l’Eccellenza Clinica, la Qualità e la Sicurezza Delle Cure (CNEC), Istituto Superiore di Sanità, 00162 Rome, Italy;
| | - Vicente Gea-Caballero
- Faculty of Health Sciences, Valencia International University, 46002 Valencia, Spain; (V.G.-C.); (J.V.B.-C.)
| | - Iván Santolalla-Arnedo
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
| | - Michał Czapla
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
| | | | | | - Raúl Juárez-Vela
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
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96
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Yu DSF, Li PWC, Li SX, Smith RD, Yue SCS, Yan BPY. Effectiveness and Cost-effectiveness of an Empowerment-Based Self-care Education Program on Health Outcomes Among Patients With Heart Failure: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e225982. [PMID: 35380643 PMCID: PMC8984788 DOI: 10.1001/jamanetworkopen.2022.5982] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/14/2022] [Indexed: 01/08/2023] Open
Abstract
Importance Strategies that enhance self-care of patients with heart failure reduce mortality and health care use. Objective To examine whether an empowerment-based self-care education program was more effective and cost-effective to improve self-care, health status, and hospital service use than a didactic education program in patients with heart failure. Design, Setting, and Participants In this double-blind randomized clinical trial, a consecutive sample of 988 patients with heart failure from the cardiac clinics of 2 regional hospitals underwent eligibility screening from February 1, 2017, to May 31, 2019, using the criteria of age of 55 years or older, heart failure diagnosed 6 months before screening, and New York Heart Association class II to IV. A total of 236 participants were randomized to the empowerment (n = 118) or education (n = 118) group. Interventions The 12-week, group-based, empowerment-based education program included self-care assessment, goal-orientated actions in symptom recognition and response, fluid and dietary modification, and lifestyle management. Didactic education covered the same topics without empowerment strategies. Main Outcomes and Measures The primary outcome was self-care measured by the Self-care Heart Failure Index (SCHFI) maintenance, management, and symptom perception subscales at posttest and 3-month end points. Secondary outcomes included measures of knowledge, confidence, health-related quality of life, and health service use. Direct, indirect, and social costs of the 2 programs were collected for cost-effectiveness analysis. Results A total of 236 Chinese patients (mean [SD] age, 70 [8.0] years; 149 [63.1%] men) were included in the study. The empowerment group reported significantly greater improvement in SCHFI management scores (mean difference, 13.76; 95% CI, 5.89-21.62; Cohen d = 0.46 at posttest and Cohen d = 0.35 at 3 months) and symptom perception scores (mean difference, 20.36; 95% CI, 13.98-26.75; Cohen d = 0.84 at posttest and Cohen d = 0.61 at 3 months). The empowerment group had lower risks of emergency department attendance (incidence rate ratio, 0.55; 95% CI, 0.31-0.95; P = .03) and hospital admission (incidence rate ratio, 0.38; 95% CI, 0.21-0.68; P = .001) and better improved self-care knowledge (change in score [empowerment minus education], 1.29; 95% CI, 0.48-2.09) and confidence (change in score [empowerment minus education], 7.98; 95% CI, 1.91-14.05). Empowerment was cost-saving and cost-effective at T2 compared with the education group for quality-adjusted life-years, with an incremental cost-effectiveness ratio of -114 485. Conclusion and Relevance In this randomized clinical trial, an empowerment approach led to clinically relevant improvement in symptom perception and self-care management among patients with heart failure. Its cost-effectiveness in improving these prognostic factors also benefits the patient-reported outcome. Trial Registration Chinese Clinical Trial Registry: ChiCTR-IOR-16008254.
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Affiliation(s)
- Doris Sau-fung Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Polly Wai-chi Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Shirley Xue Li
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Robert D. Smith
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Sunny Chiu-Sun Yue
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong
| | - Bryan P. Y. Yan
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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97
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Luciani M, De Maria M, Page SD, Barbaranelli C, Ausili D, Riegel B. Measuring self-care in the general adult population: development and psychometric testing of the Self-Care Inventory. BMC Public Health 2022; 22:598. [PMID: 35346104 PMCID: PMC8960109 DOI: 10.1186/s12889-022-12913-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Self-care is important at all stages of life and health status to promote well-being, prevent disease, and improve health outcomes. Currently, there is a need to better conceptualize self-care in the general adult population and provide an instrument to measure self-care in this group. Therefore, the aim of this study was to develop and evaluate the Self-Care Inventory (SCI), a theory-based instrument to measure self-care in the general adult population. Methods Based on the Middle Range Theory of Self-Care, the 20-item SCI was developed with three scales: Self-Care Maintenance (8 items), Self-Care Monitoring (6 items), and Self-Care Management (6 items). A cross sectional study with a US-based sample (n = 294) was conducted to test the SCI. Internal validity was assessed with Confirmatory Factor Analysis. Internal consistency reliability was assessed with Cronbach alpha for unidimensional scales or composite reliability and the global reliability index for multidimensional scales. Construct validity was investigated with Pearson correlation to test the relationship between general self-efficacy, positivity, stress, and self-care scores. Results The Self-Care Maintenance and Management scales were multidimensional and the Self-Care Monitoring scale was unidimensional. The global reliability index for multidimensional scales was 0.85 (self-care maintenance) and 0.88 (self-care management). Cronbach alpha coefficient of the self-care monitoring scale was 0.88. Test-retest reliability was 0.81 (self-care maintenance), 0.91 (self-care monitoring), and 0.76 (self-care management). The General Self-Efficacy Scale was positively related to all three self-care scale scores: self-care maintenance r = 0.46, p < 0. 001, self-care monitoring r = 0.31, p < 0. 001, and self-care management r = 0.32, p < 0. 001. The positivity score was positively related to self-care maintenance (r = 0.42, p < 0. 001), self-care monitoring (r = 0.29, p < 0. 001), and self-care management (r = 0.34, p < 0. 001) scores. The perceived stress was positively related to the self-care management (r = 0.20, p < 0. 001) score. Conclusions The SCI is a theoretically based instrument designed to measure self-care in the general adult population. Preliminary evidence of validity and reliability supports its use in the general adult population.
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Weerahandi H, Chaussee EL, Dodson JA, Dolansky M, Boxer RS. Disease Management in Skilled Nursing Facilities Improves Outcomes for Patients With a Primary Diagnosis of Heart Failure. J Am Med Dir Assoc 2022; 23:367-372. [PMID: 34478693 PMCID: PMC8885787 DOI: 10.1016/j.jamda.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Skilled nursing facilities (SNFs) are common destinations after hospitalization for patients with heart failure (HF). Our objective was to determine if patients in SNFs with a primary hospital discharge diagnosis of HF benefit from an HF disease management program (HF-DMP). DESIGN This is a subgroup analysis of multisite, physician and practice blocked, cluster-randomized controlled trial of HF-DMP vs usual care for patients in SNF with an HF diagnosis. The HF-DMP standardized SNF HF care using HF practice guidelines and performance measures and was delivered by an HF nurse advocate. SETTING AND PARTICIPANTS Patients with a primary hospital discharge diagnosis of HF discharged to SNF. METHODS Composite outcome of all-cause hospitalization, emergency department visits, and mortality were evaluated at 30 and 60 days post SNF admission. Linear mixed models accounted for patient clustering at the physician level. RESULTS Of 671 individuals enrolled in the main study, 125 had a primary hospital discharge diagnosis of HF (50 HF-DMP; 75 usual care). Mean age was 79 ± 10 years, 53% women, and mean ejection fraction 46% ± 15%. At 60 days post SNF admission, the rate of the composite outcome was lower in the HF-DMP group (30%) compared with usual care (52%) (P = .02). The rate of the composite outcome at 30 days for the HF-DMP group was 18% vs 31% in the usual care group (P = .11). CONCLUSIONS AND IMPLICATIONS Patients with a primary hospital discharge diagnosis of HF who received HF-DMP while cared for in an SNF had lower rates of the composite outcome at 60 days. Standardized HF management during SNF stays may be important for patients with a primary discharge diagnosis of HF.
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Affiliation(s)
- Himali Weerahandi
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA; Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA.
| | | | - John A. Dodson
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY,Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY
| | - Mary Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Rebecca S. Boxer
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO,Division of Geriatric Medicine, University of Colorado, Aurora, CO
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Boxer RS, Dolansky MA, Chaussee EL, Campbell JD, Daddato AE, Page RL, Fairclough DL, Gravenstein S. A Randomized Controlled Trial of Heart Failure Disease Management in Skilled Nursing Facilities. J Am Med Dir Assoc 2022; 23:359-366. [PMID: 34146521 PMCID: PMC11903054 DOI: 10.1016/j.jamda.2021.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Patients discharged from the hospital to a skilled nursing facility (SNF) are not typically part of a heart failure disease management program (HF-DMP). The objective of this study is to determine if an HF-DMP in SNF improves outcomes for patients with HF. DESIGN Cluster-randomized controlled trial. PARTICIPANTS The trial was conducted in 47 SNFs, and 671 patients were enrolled (329 HF-DMP; 342 to usual care). METHODS The HF-DMP included documentation of ejection fraction, symptoms, weights, diet, medication optimization, education, and 7-day visit post SNF discharge. The composite outcome was all-cause hospitalization, emergency department visits, or mortality at 60 days. Secondary outcomes included the composite endpoint at 30 days, change in the Kansas City Cardiomyopathy Questionnaire and the Self-care of HF Index at 60 days. Rehospitalization and mortality rates were calculated as an exploratory outcome. RESULTS Mean age of the patients was 79 ± 10 years, 58% were women, and the mean ejection fraction was 51% ± 16%. At 30 and 60 days post SNF admission, the composite endpoint was not significant between DMP (29%) and usual care (32%) at 30 days and 60 days (43% vs 47%, respectively). The Kansas City Cardiomyopathy Questionnaire significantly improved in the HF-DMP vs usual care for the Physical Limitation (11.3 ± 2.9 vs 20.8 ± 3.6; P = .039) and Social Limitation subscales (6.0 ± 3.1 vs 17.9 ± 3.8; P = .016). Self-care of HF Index was not significant. The total number of events (composite endpoint) totaled 517 (231 in HF-DMP and 286 in usual care). Differences in the 60-day hospitalization rate [mean HF-DMP rate 0.43 (SE 0.03) vs usual care 0.54 (SE 0.05), P = .04] and mortality rate (HF-DMP 5.2% vs usual care 10.8%, P < .001) were significant. CONCLUSIONS AND IMPLICATIONS The composite endpoint was high for patients with HF in SNF regardless of group. Rehospitalization and mortality rates were reduced by the HF-DMP. HF-DMPs in SNFs may be beneficial to the outcomes of patients with HF. SNFs should consider structured HF-DMPs for their patients.
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Affiliation(s)
- Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente, Aurora, CO, USA; Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Erin L Chaussee
- Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA; Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jon D Campbell
- Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Andrea E Daddato
- Institute for Health Research, Kaiser Permanente, Aurora, CO, USA; Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert L Page
- Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Diane L Fairclough
- Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA; Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stefan Gravenstein
- Alpert Medical School of Brown University, Providence, RI, USA; Brown School of Public Health, Providence, RI, USA; Providence Veterans Administration Medical Center, Providence, RI, USA
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Patrick M, Miller B, Will B, Bena JF, Morrison SL, Siegmund LA. Anxiety and depression moderate the relationship between quality of life and self-care in patients with heart failure. Geriatr Nurs 2022; 44:54-59. [DOI: 10.1016/j.gerinurse.2021.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/04/2022]
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