Self-care behaviour and associated factors among chronic heart failure clients on follow up at selected hospitals of Wollega zones, Ethiopia

Adherence to self-care practices and associated factors among heart failure patients in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Heart failure is the leading cause of hospital stays, medical expenses, and fatalities, and it is a severe problem for worldwide public health. Successful heart failure therapy requires a high level of self-care as well as devotion to different elements of the treatment plan. Despite the positive effects of heart failure self-care on health outcomes, many heart failure patients engage in insufficient self-care behaviors. Additionally, conflicting information has been found regarding the prevalence and predictors of self-care behaviors in Ethiopia. As a result, this review's objective is to provide an overview of the most recent studies on Ethiopian heart failure patients' self-care practices.

METHODS

We have used four databases such as PubMed, Science Direct, Scopus and Google Scholar. Eventually, the final systematic review and meta-analysis contained eleven papers that matched the eligibility requirements. A systematic data extraction check list was used to extract the data, and STATA version 14 was used for the analysis. Heterogeneity was evaluated using the I2 tests and the Cochrane Q test statistic. To examine publication bias, a funnel plot, Egger's weighted regression, and Begg's test were utilized.

RESULT

The pooled magnitude of adherence to self-care was 35.25% (95%CI: 27.36-43.14). The predictors of good adherence to self-care behavior includes heart failure knowledge (odds ratio = 5.26; 95% CI, 3.20-8.65), absence of depressive symptoms (odds ratio = 3.20;95% CI,1.18-8.70), higher level of education (AOR = 3.09;95%CI,1.45-6.61), advanced New York Heart Association (NYHA) class (odds ratio = 2.66; 95% CI, 1.39-5.07), absence of comorbidity(odds ratio = 2.92; 95% CI,1.69-5.06) and duration of heart failure symptoms(odds ratio = 0.37; 95% CI, 0.24-0.58).

CONCLUSION

The extent of self-care behavior adherence is shown to be low among heart failure patients. This study showed a positive relationship between self-care behavior and factors such as proper understanding of heart failure, the absence of co-morbidity, depression, higher levels of education, a longer duration of heart failure symptoms, and advanced classes of heart failure disease. Therefore, a continuous health education should be given for patients to enhance their understanding of heart failure. Besides, special attention should be given for patients having co-morbidity and depressive symptom.

The Effectiveness of Self-Management Strategies in Patients With Heart Failure: A Narrative Review

Heart failure (HF) is a common condition with high morbidity and mortality. Self-management strategies for heart failure can be effective in improving patients' quality of life and reducing mortality and hospitalization for heart failure. These self-management strategies are also cost-effective. A complex interplay between various factors related to patients, therapy, healthcare, and socioeconomic factors influences the effectiveness of self-management strategies. The primary aim of this study is to determine the effectiveness of self-management strategies in patients with heart failure in reducing mortality, hospitalization for heart failure, and healthcare cost savings at six months and one year. The secondary aim is to determine adherence to self-management strategies in patients with HF. The current study is a narrative review of studies evaluating the effectiveness of self-management strategies in heart failure. A literature search was done in PubMed, Embase, Google Scholar, ScienceDirect, and the Cochrane Library for studies published in the English language between 2012 and 2022. Descriptive statistics were used to summarize the characteristics of studies and interventions. We calculated odds ratios, risk ratios, or mean differences to calculate the effect of self-management strategies on mortality, hospitalization for HF, and healthcare costs between patient groups. We included a total of 30 studies in our narrative review: eight cross-sectional studies and 22 randomized controlled trials. These studies showed a significant effect of self-management strategies on mortality at six- and 12-month follow-ups. Studies on the effectiveness of self-management strategies on hospitalization for heart failure showed benefits at six and 12 months. Self-management strategies are cost-effective and feasible with improved disability-adjusted life years (DALY). One study showed higher costs associated with self-management strategies and only a slight decrease in DALY. Overall, adherence to self-management strategies was inadequate in these studies. Novel and innovative self-management interventions improve therapy adherence. There was a lack of uniformity in using tools to assess self-management across studies. There was a lack of ethnic diversity in the individual studies, limiting the generalization of these studies' findings. Our review showed that self-management strategies are beneficial for heart failure-related hospitalization, reduce mortality and hospitalization for heart failure, and are cost-effective. The use of innovative approaches like smartphone applications improves adherence.

Patient’s knowledge, gender, and physical activity level as the predictors of self-care in heart failure patients

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.

Self-care behavior and associated factors among patients with heart failure in public hospitals of Southeast Ethiopia

Objective

This study was performed to assess self-care behavior and associated factors among patients with heart failure attending public hospitals in Southeast Ethiopia in 2021.

Methods

An institutional-based cross-sectional study was conducted among 420 patients with heart failure from 15 May to 30 June 2021 using a simple random sampling technique. A multivariable binary logistic model was used to identify factors associated with self-care behavior. Statistical significance was declared at p < 0.05.

Results

The magnitude of good self-care behavior among patients with heart failure was 53.6% [95% confidence interval (CI), 48.9–58.3]. Factors associated with self-care behavior were treatment with a beta blocker [adjusted odds ratio (AOR), 0.49; 95% CI, 0.27–0.89], treatment with digitalis (AOR, 0.11; 95% CI, 0.05–0.24), the level of social support (AOR, 0.07; 95% CI, 0.03–0.15), and the presence of depressive symptoms (AOR, 0.21; 95% CI, 2.70–8.33).

Conclusion

Slightly more than half of the respondents had good self-care behavior. Attention should be given to enhancing good self-care practice through integration of health education as routine care.

Adherence to Self-Care Behaviors and Associated Factors among Adult Heart Failure Patients Attending Chronic Follow-Up Care at Jimma University Medical Center, Southwest Ethiopia

Background:

Optimal outcomes and quality of life in patients with heart failure (HF) depend on effective self-care activities. However, patients may experience difficulties, and their performance may be inconsistent.

Aim:

To determine the level of adherence to self-care behaviors and associated factors among adult HF patients attending chronic follow-up care at Jimma University Medical Center (JUMC).

Methods:

A cross-sectional study was conducted between August and September 2021. Data were collected through face-to-face interviews and by reviewing patients’ medical records. The collected data were analyzed using SPSS version 25 and the findings were presented in frequency, percentage, mean (SD), and median (IQR). Multivariate logistic regression was performed to determine factors associated with adherence to self-care behaviors. Odds ratios with 95% confidence intervals and p-values were used to report the findings.

Results:

Out of 266 HF patients, 50.0% had good adherence towards self-care behavior recommendations. The highest following recommendation was taking medication as prescribed (75.5%), followed by a dietary recommendation of a low-salt diet (45.2%). Participants who could not read and write (adjusted odds ratio (AOR) = 0.30 (95% confidence interval (CI) 0.13, 0.71), P = 0.006), had an illness duration greater than or equal to ten years (AOR = 0.31 (95% CI 0.12, 0.82), P = 0.02), in the NYHA class II HF (AOR = 0.33 (95% CI 0.15, 0.73), P = 0.007) were negatively associated with good adherence to self-care behavior recommendations.

Conclusion:

In this study, only half of the respondents had good adherence to self-care behaviors. Lower educational level, longer illness duration, and NYHA class II HF were predictors of poor adherence to self-care. Therefore, nurses should devise strategies to counsel or educate the HF patients on self-care practice recommendations, particularly patients with a lower education level and who lived longer with HF.