Comparison of self-care behaviors of heart failure patients in 15 countries worldwide

Factors Related to Self-Care Behaviors' in Chronic Heart Failure Patients: A Cross-Sectional Study in Western Iran

PurposeSelf-care is recognized as an important element in the comprehensive management of patients with heart failure. The study aimed to explore the correlations of self-care behaviors in chronic heart failure patients in Kermanshah, West Iran.DesignDescriptive and analytical cross-sectional.SettingHospital.SampleThe research population included 597 (246 female and 351 male) patients with chronic heart failure visiting Imam Ali Cardiovascular Hospital in Kermanshah in 2022.MeasuresDemographic information, European Heart Failure Self-care Behavior Scale.AnalysisIndependent-sample t test, ANOVA, and Kruskal-Wallis in SPSS-24. The significance level was set at 5%.ResultsThe participants' age was 63.04 ± 14.1 years. The mean and standard deviation of the participants' self-care behaviors was 2.91 ± 31.00, and only 20.60% of the patients reported engaging in satisfactory self-care behaviors. Self-care behaviors were significantly related to Income level, ethnicity, family history of background disease, history of co-morbidity, history of addiction, access to medical centers, and not with any other variables.ConclusionBased on the study's results, most participants exhibited moderate self-care behaviors, suggesting that these patients may need preventive educational interventions to acquire the knowledge, skills, and attitudes necessary for effective self-care behaviors. Therefore, it is essential to design and implement a health promotion educational intervention aimed at convincing these patients to make lifestyle changes and adhere to their dietary and medication regimens to improve self-care behaviors.

Usefulness of the LAVITA Telemonitoring System in Patients With Heart Failure - A Feasibility Study

Background

Heart failure (HF) hospitalization is increasing in Japan's aging population. Current guidelines recommend daily biometric monitoring for patients with HF to facilitate early clinical intervention. However, promoting patient self-management remains insufficient. Therefore, we assessed the usefulness of the LAVITA telemonitoring system, which automatically obtains and stores the biometric data of patients with HF via wireless devices.

Methods and Results

This prospective, single-arm, multicenter cohort study enrolled patients with HF. Patients were introduced to the LAVITA telemonitoring system and trained to measure body weight, blood pressure, pulse rate, oxygen saturation (SpO2), physical activity with activity trackers (AT), and electronic patient-reported outcomes (ePRO). The primary outcome was the measurement rate of each cetology at 9-12 weeks post-discharge. The secondary outcomes included the subgroup analyses by age, sex, and left ventricular function. Thirty patients continued to use the system at home. The measurement rates of patient data were as follows: body weight 92.4% (interquartile range [IQR] 83.3-97.8%); blood pressure 95.6% (IQR 84.8-98.5%); pulse rate 96.5% (IQR 86.5-98.8%); SpO2 93.1% (IQR 76.6-97.9%); AT 88.4% (IQR 31.3-98.5%); and ePRO 76.9% (IQR 26.4-95.9%). The subgroup analysis did not significantly differ.

Conclusions

The LAVITA telemonitoring system had high measurement rates for the biometric data of patients with HF, including elderly patients. Hence, it can possibly improve patient self-management and facilitate early clinical intervention.

Influence of Sex and Gender on Adherence to Self-care Behaviors for Cardiovascular Disease Risk Management in the Global Context: A Systematic Review

BACKGROUND

Adherence to self-care behaviors can prevent or delay adverse outcomes associated with cardiovascular disease (CVD). Sex and socioculturally constructed gender might impact individuals' ability to adhere to healthy lifestyles.

OBJECTIVE

The aim of this study was to systematically identify, evaluate, and synthesize the literature on the influence of sex and gender on adherence to self-care behaviors for CVD risk management in the global context.

METHODS

We searched the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Global Health Databases for peer-reviewed original articles published between 2013 and 2023. We selected studies that investigated self-care behaviors, self-care maintenance, or self-care management as outcomes and reported sex- and gender-related factors (such as education level, employment status, and marital status). The data were synthesized in a narrative form.

RESULTS

The search identified 3540 studies, 52 of which met the inclusion criteria for full-text review. Global North countries accounted for 55% of all the studies. Self-reported questionnaire scores were used in most of the studies (n = 47). Better self-care was associated with being a woman (n = 17), attaining a higher education level (n = 15), and having higher perceived social support (n = 10). The associations between adherence to self-care behaviors and employment status, socioeconomic status, marital status, and household size were inconsistent.

CONCLUSIONS

Adherence to self-care behaviors for CVD risk management varied widely, based on gender-related factors. Further research is needed to use a consistent measure of self-care adherence behavior and integrate a wider range of gender-related factors.

Post-Discharge Self-Care Confidence and Performance Levels in Patients Hospitalized due to Heart Failure

BACKGROUND

Multidisciplinary self-care education plays a critical role in ensuring the high-quality transitional care of patients hospitalized due to heart failure (HF). However, whether confidence concerning self-care during their index hospitalizations would influence their post-discharge self-care performances and long-term outcomes remains uncertain.

METHODS

We conducted an assessment of 100 consecutive patients with HF who completed self-care questionnaires both during their hospitalizations and 1 year after discharge. Among these patients hospitalized due to HF, self-care confidence was assessed immediately after they completed their pre-discharge education program. One year after the index hospitalization, we evaluated self-care performance by using the European Heart Failure Self-care Behavior Scale. Logistic regression analysis was employed to identify determinants of poor self-care behavior 1 year after the hospitalization. Additionally, the Cox proportional hazards model with adjustment for the Seattle Heart Failure Model was applied to assess their association with 2-year mortality and readmission risk.

RESULTS

The enrolled patients predominantly had HF with reduced ejection fraction (43.0%), and approximately half of the patients had experienced a previous hospitalization due to HF (47.0%). The 3 worst-performing aspects of post-discharge self-care behavior (among the 12 items) were appropriate consultation for fatigue (40.0%), weight gain (52.0%) and application of regular exercise (57.0%). After adjustment, low self-care confidence during the index hospitalization was associated with poor post-discharge self-care performance (OR: 1.11, CI: 1.00-1.21). Poor post-discharge self-care behavior was not associated with worse prognoses over a 2-year follow-up (hazard ratio [HR]: 1.82, CI: 0.85-3.86); however, the association was significant in patients with reduced ejection fraction (HR: 4.04, CI: 1.17-13.89) and previous HF hospitalization (HR: 3.66, CI: 1.46-9.13).

CONCLUSIONS

Post-discharge self-care performance was associated with self-care confidence during the index HF hospitalization. Effective measures that improve pre-discharge confidence levels in self-care should be considered to enhance the quality of transitional care.

Knowledge and self-care behavior among heart failure patients in South India

BACKGROUND

Heart failure (HF) is a chronic condition with significant public health concerns. HF necessitates adequate knowledge and adherence to self-care for enhanced quality of life and decreased rehospitalization. This study aimed to explore knowledge and self-care behavior in patients with HF.

MATERIAL AND METHODS

The study was conducted in cardiology wards of a tertiary care hospital and the design was a randomized controlled trial. The baseline data (before the intervention) from 160 HF patients enrolled in a randomized controlled trial were analyzed. Knowledge and self-care behavior were measured using the Dutch HF Knowledge Questionnaire (score ranging from 0 to 15) and European HF Self-care Behavior Scale-9 (score ranging from 0 to 100). Higher scores indicated better self-care behavior and knowledge. Descriptive statistics such as frequency, percentage, mean, and standard deviation and inferential statistics such as independent sample t-test and ANOVA were performed.

RESULTS

The majority (75.0%) were men with a mean age of 56.1 ± 7.9 years. A significant proportion had hypertension (65%), diabetes (58.7%), or both comorbidities (40.6%). Most exhibited a left ventricular ejection fraction <30% (60.6%) and New York Heart Association class II (43.1%). The mean knowledge and self-care behavior scores were 7.1 ± 2.0 and 45.0 ± 12.4, respectively. Over half of the participants had inadequate self-care behavior (51.2%), and 88.3% lacked sufficient knowledge about HF. Medication adherence was high (87.0%) among the participants, while only 3.1% reported regular weight monitoring and 32.3% exercised regularly.

CONCLUSIONS

There was a lack of HF-related knowledge and inadequate self-care behavior for HF management. Effective interventions to improve disease-related knowledge may lead to better self-care behavior and improve clinical outcomes.

Transcultural adaptation and theoretical models validation of the Spanish version of the Self-Care of Diabetes Inventory

Background

For patients with diabetes mellitus, self-care is crucial because it prevents complications and helps preserve quality of life. Clinicians and researchers require effective tools for assessing self-care behaviors across various dimensions to identify individual needs and maximize resource allocation. The aim of this study was to evaluate the validity and reliability of the Spanish version of the Self-Care of Diabetes Inventory (SCODI).

Methods

Two hundred eighteen participants with DMT1 and DMT2 who were recruited through convenience sampling from a university hospital participated in our cross-sectional study. After translation and cultural adaptation, the enrolled patients answered the questions. We performed an exploratory factor analysis (EFA) on each of the SCODI scales and Confirmatory factor analysis (CFA) was performed using our models which appropriate fit indices.

Results

The original structure of the four-dimensions tool was confirmed. The overall consistency across the four scales was assessed by Cronbach's alpha: self-care maintenance (0.766), self-care monitoring (0.790), self-care management (0.771), and self-care confidence (0.936). The model fit yielded a chi-square index of 1.028 with 773 degrees of freedom. Confirmatory factor analysis showed a good fit, thereby affirming the reliability of the model.

Conclusion

The internal consistency and reliability of the SCODI Spanish version are deemed adequate. This tool is appropriate when it is desired to evaluate the self-care practices of Spanish persons suffering from diabetes due to its good psychometric qualities.

Leveraging digital health technologies in heart failure self-care interventions to improve health equity

For patients with heart failure, self-care is crucial, but recommendations for self-care are often not adhered to. Digital health interventions have the potential to help patients improve their self-care and, ultimately, their health outcomes, but without careful examination, digital interventions may generate further inequality. In this study, we use a digital health equity framework to examine challenges and opportunities related to digital health interventions across many domains of influence that may affect health equity. We draw from our own experience in conducting a decentralized clinical trial with multiple sensors and apps to help patients with heart failure improve adherence to key self-care behaviors. Finally, we provide recommendations for leveraging digital health interventions in research and practice to address health equity.

Generic and disease-specific self-care instruments in older patients affected by multiple chronic conditions: A descriptive study

AIMS

To describe and compare generic and disease-specific self-care measures in patients with multiple chronic conditions (MCCs) in the three dimensions of self-care maintenance, monitoring, and management.

DESIGN

Multicentre cross-sectional study.

METHODS

Patients aged 65 and over with MCCs. We used Self-Care of Chronic Illness Inventory to measure generic self-care, Self-care of Diabetes Inventory to measure self-care in diabetes mellitus, Self-Care of Heart Failure (HF) Index to measure self-care in HF, and Self-Care of Chronic Obstructive Pulmonary Disease Inventory to measure self-care in chronic lung diseases.

RESULTS

We recruited 896 patients. Multimorbid patients with diabetes had lower scores on the self-care maintenance scale, and diabetic patients in insulin treatment on the generic management scale than on the disease-specific instrument. Multimorbid patients with HF or chronic lung diseases scored higher on generic self-care maintenance and monitoring scales than disease-specific ones. There was a partial consistency between the generic and disease-specific self-care maintenance and management. Inadequate behaviours were recorded in disease-specific self-care monitoring rather than generic ones.

CONCLUSIONS

Older patients affected by MCCs scored differently in the generic and disease-specific instruments, showing inadequate self-care in some of the three self-care dimensions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The choice between generic and disease-specific instruments to use in clinical practice and research should be made considering the specific aims, settings, patients characteristics, and knowledge of the different performance of the instruments by users.

IMPACT

No study has described and compared generic and specific self-care measures in patients affected by MCCs. Knowing these differences can help nurses choose the most suitable measure for their aims, context, and patients and plan generic and disease-specific self-care educational interventions for those behaviours in which MCCs patients perform poorly.

PATIENT CONTRIBUTION

Patients were informed about the study, provided informed consent, and answered questionnaires through interviews.

Assessing the Health Education Needs of Heart Failure Patients in Saudi Arabia

Objectives This study aimed to assess the health education needs of heart failure patients at King Fahad Medical City in Riyadh. It also sought to identify the preferred methods of health education and the challenges these patients face during educational sessions. Methods A descriptive, cross-sectional survey study was conducted between January 2024 and June 2024. Data were collected using a self-administered questionnaire, designed based on previous studies and established frameworks. Statistical analysis was performed using SPSS version 21. Results The study found that health education is crucial and highly sought after by many Saudi patients. Different patients have varying requirements for health education, with one-on-one sessions led by physicians identified as the most preferred method. However, patients frequently encountered challenges, including unclear medical terminology, insufficient time for questions, and an overwhelming amount of information. Concerns were also raised about the educators' listening skills and the effectiveness of their educational approach. Conclusion To address these challenges, it is recommended that health education needs be integrated into clinic visits, involving all relevant healthcare professionals such as nurses, pharmacists, and physicians. This integration can ensure that patients receive comprehensive knowledge about their conditions, thereby improving their health behaviors and outcomes.

Development and content validity of educational videos on self-management of fluid restriction and thirst for individuals with heart failure

OBJECTIVE

To create and evaluate the content validity of educational videos on self-management of fluid restriction and thirst for individuals with heart failure (HF).

METHOD

A psychometric study was conducted in three stages: (1) an integrative literature review to identify strategies for self-management of fluid restriction and thirst by individuals with HF; (2) creation of animated videos about strategies for self-management of fluid restriction and thirst; and (3) analysis of the content validity of the educational videos by 11 experts. For each criterion, the content validity ratio (CVR) was calculated; it was considered adequate when <0.636. Suggestions were evaluated by the researchers, and the videos were modified.

RESULTS

Ten scripts and videos were created, averaging 30 s each. The videos' contents were based on 11 studies retrieved from the review and one specialized website. The videos were evaluated by experts, and adjustments were made when CVR < 0.636 and when allowed by the video production platform.

CONCLUSIONS

Educational videos were developed and have satisfactory content validity evidence according to expert opinions.

IMPLICATIONS FOR NURSING PRACTICE

These videos are expected to be used as educational strategies in clinical practice to prevent episodes of decompensation due to excessive fluid volume.

Contribution of informal caregivers to self-care in individuals with heart failure

OBJECTIVES

to evaluate the contribution of informal caregivers to the self-care of individuals with heart failure.

METHODS

a cross-sectional study was conducted with 87 caregivers from March to October 2022 in the city of João Pessoa/PB. The caregivers' contribution was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index instrument. Scores ≥ 70 points indicate adequate contribution. Data were analyzed using descriptive statistics and Spearman's correlation.

RESULTS

the sample consisted of 81.6% female caregivers. Median scores obtained for the self-care contribution scales were: 63.3 for maintenance; 55.5 for management; and 66.6 for confidence. Caregivers never or rarely recommended monitoring body weight, regular physical exercise, extra use of diuretics, and fluid restriction.

CONCLUSIONS

informal caregivers showed inadequate contribution in the areas of maintenance, management, and confidence in self-care of individuals with heart failure.

Achieving consensus on the key elements of a nurse-led multidisciplinary chronic heart failure service in Thailand: An e-Delphi study

AIMS

To describe the outcomes of an e(electronic)-Delphi survey used to achieve consensus on the essential elements that should be included in a multidisciplinary, nurse-led service for patients with chronic heart failure (CHF).

DESIGN

The study design was based on a three-round e-Delphi survey.

METHODS

A series of three survey rounds were used to gather expert opinions and achieve consensus on the key elements that should be included in a CHF disease management program from a sample of healthcare professionals and organizational leaders with expertise in existing CHF services. Consensus for each item was defined as at least 90% agreement.

RESULTS

There were 20 participants (18 healthcare professionals and 2 organizational leaders) in round-1, 22 (20 healthcare professionals and 2 organizational leaders) in round-2, and 17 (15 healthcare professionals and 2 organizational leaders) in round-3. Fifteen participants attended a final online meeting (13 healthcare professionals and 2 organizational leaders). Consensus was obtained on five essential components: (i) consumer education, (ii) treatment optimization using a multidisciplinary approach, (iii) discharge planning, (iv) provision of supportive community care and (v) mechanisms to respond to early symptoms of decompensated CHF.

CONCLUSION

Participants focused on mechanisms to improve treatment effectiveness, patient and family knowledge, communication between healthcare providers and supportive care in the community. The proposed model of care may be useful to other health service providers who are designing or adapting CHF models of care for the South-East Asian environment.

IMPACT

This research provides a solid basis for using a Delphi method to resolve the challenges and issues of transferring global model-based recommendations in CHF knowledge. The Delphi method proved successful as an important step in developing a culturally acceptable model of chronic care that meets the goals of local healthcare providers.

The Relationship Between Self-Efficacy and Functional Capacity Among Discharged Heart Failure Patients in Jordan

BACKGROUND

Self-efficacy is an important factor associated with healthy lifestyle changes in heart failure treatment. Functional capacity testing of heart failure patients (HFPs) can stratify prognosis. Reduced functional capacities in HFPs are linked to a poor heart failure prognosis. Limited research has examined the potential relationship between self-efficacy and functional capacity.

AIM

The aims of this study were to assess self-efficacy level and functional capacity among HFPs after hospitalization, and examine whether there is a relationship between them.

METHODS

A descriptive correlational design was used. A convenience sample of 220 HFPs was recruited from 2 hospitals in Jordan. The Arabic version of Cardiac Self-Efficacy Questionnaire was used to assess self-efficacy, the 6-Minute Walking Test (6-MWT) was used to assess functional capacity, and the Borg rating of perceived exertion scale (Borg Scale) was used to assess exertion during 6-MWT.

RESULT

The sample included 46.8% male (n = 103) and 53.2% female (n = 117). The mean age was 52.66 ± 8.91 years. Most of the HFPs were categorized based on New York Heart Association classification as class I, 35.9% (n = 79), and class II, 41.4% (n = 91). The mean ejection fraction was 41.46 ± 9.44. The global self-efficacy was moderate (32.98 ± 9.92), and the mean score for the 6-MWT was 494.35 ± 143.37. The Borg Scale mean was 10.94 ± 3.34. In addition, there was a positive relationship between self-efficacy and 6-MWT (r = 0.63, n = 220, P = .01).

CONCLUSION

This study provides baseline data for further research on treatment of HFPs, and the development of evidence-based tailored health interventions to maintain and improve self-efficacy and functional capacity among these service users. Moreover, replicated researches can test the study results considering different methodologies, such as using objective functional capacity tool and longer follow-up periods.

Psychometric properties of the Japanese version of the Self-Care of Heart Failure Index version 7.2

AIMS

It is more important for patients with heart failure (HF) to objectively identify their self-care status. The Self-Care of Heart Failure Index (SCHFI) version 7.2 is a reliable and valid instrument comprising three scales: self-care maintenance, symptom perception, and self-care management. We aimed to translate the SCHFI v.7.2 into Japanese and test its validity and reliability.

METHODS AND RESULTS

This was a cross-sectional study. Two translators performed forward and backward translations between English and Japanese. To assess structural validity, confirmatory factor analyses were performed using the structure of the original version. To assess convergent validity, the associations between each scale and self-care self-efficacy were evaluated. To assess internal consistency, model-based internal consistency coefficients were calculated. Participants were 314 Japanese outpatients with HF (mean age: 72.8 ± 12.8 years). Regarding structural validity, all scales showed adequate model fit indices, supporting a two-factor structure with items similar to those in the original version. However, to improve the model fit indices, it was necessary to add error correlations for the self-care maintenance and symptom perception scales. Regarding convergent validity, all scales showed significant associations with self-care self-efficacy. Regarding internal consistency, the model-based internal consistency coefficients were sufficient for all scales (0.739, 0.908, and 0.783 for the self-care maintenance, symptom perception, and self-care management scales, respectively).

CONCLUSION

The Japanese version of the SCHFI v.7.2 had adequate validity and reliability. This instrument is useful for assessing self-care in Japanese HF patients. However, factors influencing self-care should be considered when interpreting results.

Determining Contextual Factors for a Heart Failure Self-Care Intervention: A Consensus Delphi Study (ACHIEVE)

There is a rising recognition of the crucial role self-care plays in managing heart failure (HF). Yet patients often have difficulties implementing ongoing self-care recommendations into their daily lives. There is also recognition of the importance of theory for successful intervention design, and understanding of key factors for implementation so interventions fit a given context. Local key stakeholders can provide valuable insights to help understand relevant context-specific factors for intervention implementation. This study sought to engage stakeholders to explore and determine relevant contextual factors needed to design and facilitate successful implementation of an HF self-care intervention in the German health care system. A ranking-type Delphi approach was used to establish consensus from stakeholders (i.e., clinicians, patients, policymakers/potential funders) regarding eight factors (content, interventionist, target group, location, mode of delivery, intensity, duration, and format) to adequately define the components and implementation strategy of the intervention. Seventeen participants were invited to participate in the first Delphi round. A response rate of 94% (16/17) was achieved and maintained for all three Delphi rounds. Stakeholder consensus determined that nurses specializing in HF are the most appropriate interventionists, target groups should include patients and carers, and the intervention should occur in an outpatient HF clinic, be a mixture of group and individual training sessions, and last for 30 minutes. Sessions should take place more frequently in the beginning and less often over time. Local stakeholders can help determine contextual factors that must be taken into account for successful delivery of an intervention. This enables the intervention to be developed and applied based on these factors, to make it suitable for the target context and to enhance participation to achieve the desired outcomes.

Effects of nurse-led self-care interventions on health outcomes among people with heart failure: A systematic review and meta-analysis

AIM

To estimate the effects of nurse-led self-care interventions on people with heart failure (HF).

BACKGROUND

Research evidence of the effects of nurse-led HF self-care interventions on patient outcomes is scant.

DESIGN

A systematic review and meta-analysis of randomised controlled trials (RCTs).

DATA SOURCES

Six databases (MEDLINE, Embase, Web of Science, CENTRAL, CINAHL and PsycINFO) were searched from the inception to December 2022 to identify eligible studies.

METHODS

RCTs published in English that evaluated the impact of nurse-led HF self-care interventions on quality of life, anxiety, symptom burden, sleep quality, healthcare service utilisation and mortality were included. The risk of bias in included studies was assessed using RoB 2.0. We conducted data syntheses using the R software and graded the quality of the evidence using the GRADE approach. The systematic review was conducted in accordance with the PRISMA.

RESULTS

Twenty-five studies with 2746 subjects were included. Our findings demonstrated, that compared to the controls, nurse-led self-care interventions improved QOL (SMD: .83, 95% CI: .50-1.15, moderate evidence), anxiety (MD: 1.39, 95% CI: .49-2.29, high evidence) and symptom burden (SMD: .81, 95% CI: .24-1.38, low evidence) in people with HF. No significant effects were found in all-cause hospital readmission and all-cause emergency department visit. Research evidence on sleep quality, cardiac-related hospital readmission, cardiac-related emergency department visit and all-cause mortality remained unclear.

CONCLUSIONS

Our review suggests that nurse-led HF self-care interventions have favourable effects on the QOL, anxiety and symptom burden. Further, well-designed RCTs are warranted to address the gaps identified in this review.

RELEVANCE TO CLINICAL PRACTICE

The results indicated that nurse-led HF self-care interventions could improve QOL, anxiety and symptom burden in people with HF. Nurse-led self-care intervention could be integrated into current HF management practices.

Efficacy of a self-monitoring traffic light diary on outcomes of patients with heart failure: A randomized controlled trial

BACKGROUND AND OBJECTIVE

Patients with heart failure experience high hospitalization. However, patients cannot recognize symptoms according to current approaches, which needs to be improved by new self-monitoring instruments and strategies. Thus, we aimed to assess a self-monitoring traffic light diary on outcomes of patients with heart failure.

METHODS

This was a single-blind, two-arm parallel group randomized controlled trial at the heart failure clinic of Tehran Heart Center (Tehran, Iran). Adult patients with a definitive diagnosis of heart failure with reduced ejection fraction (i.e., ejection fraction of less than 40 %), and New York Heart Association functional classes II-IV were included. A block-balanced randomization method was used to assign eligible subjects to the intervention or control group. Baseline data were collected before random allocation. Participants in the intervention group received a comprehensive intervention consisting of (1) self-care education by an Australian Heart Foundation booklet on heart failure, (2) regular self-monitoring of weight and shortness of breath at home, and (3) scheduled call follow-ups for three months. Patients in the control group received usual care. The primary outcome was heart failure self-care; the secondary outcomes were heart failure quality of life, knowledge, and all-cause hospitalization.

RESULTS

From June to August 2017, 68 patients were included in the study. The overall age of participants was 55 (13.6) years old, and 71 % of patients were male. A significant association between the intervention and self-care maintenance (β 5.1; 95 % CI 2.50 to 7.70, P < 0.001), self-care management (β 10.6; 95 % CI 6.50 to 14.8, P < 0.001), self-care confidence (β 8.0; 95 % CI 5.0 to 11.0, P < 0.001) and heart failure knowledge (β 1.7; 95 % CI 1.30, 2.04; P < 0.001) was found. However, there was no association between the intervention and quality of life (β 2.5; 95 % CI -0.79, 5.88, P 0.135) and hospitalization-free survival of the two groups (Log-Rank P 0.540).

CONCLUSION

A self-monitoring traffic light diary can improve self-care behaviors and heart failure knowledge in patients with heart failure with reduced ejection fraction.

RCT APPROVAL ID

Iranian Registry of Clinical Trials IRCT2017021032476N1.

STUDY PROTOCOL

PMCID: PMC6262204.

The Importance of Cultural Awareness in the Management of Heart Failure: A Narrative Review

Heart failure is a commonly encountered clinical syndrome arising from a range of etiologic cardiovascular diseases and manifests in a phenotypic spectrum of varying degrees of systolic and diastolic ventricular dysfunction. Those affected by this life-limiting illness are subject to an array of burdensome symptoms, poor quality of life, prognostic uncertainty, and a relatively onerous and increasingly complex treatment regimen. This condition occurs in epidemic proportions worldwide, and given the demographic trend in societal ageing, the prevalence of heart failure is only likely to increase. The marked upturn in international migration has generated other demographic changes in recent years, and it is evident that we are living and working in ever more ethnically and culturally diverse communities. Professionals treating those with heart failure are now dealing with a much more culturally disparate clinical cohort. Given that the heart failure disease trajectory is unique to each individual, these clinicians need to ensure that their proposed treatment options and responses to the inevitable crises intrinsic to this condition are in keeping with the culturally determined values, preferences, and worldviews of these patients and their families. In this narrative review, we describe the importance of cultural awareness across a range of themes relevant to heart failure management and emphasize the centrality of cultural competence as the basis of appropriate care provision.

Six-Month Pilot Testing of a Digital Health Tool to Support Effective Self-Care in People With Heart Failure: Mixed Methods Study

BACKGROUND

Digital tools may support people to self-manage their heart failure (HF). Having previously outlined the human-centered design development of a digital tool to support self-care of HF, the next step was to pilot the tool over a period of time to establish people's acceptance of it in practice.

OBJECTIVE

This study aims to conduct an observational pilot study to examine the usability, adherence, and feasibility of a digital health tool for HF within the Irish health care system.

METHODS

A total of 19 participants with HF were provided with a digital tool comprising a mobile app and the Fitbit Charge 4 and Aria Air smart scales for a period of 6 months. Changes to their self-care were assessed before and after the study with the 9-item European HF Self-care Behavior Scale (EHFScBS) and the Minnesota Living with HF Questionnaire (MLwHFQ) using a Wilcoxon signed rank test. After the study, 3 usability questionnaires were implemented and descriptively analyzed: the System Usability Scale (SUS), Wearable Technology Motivation Scale (WTMS), and Comfort Rating Scale (CRS). Participants also undertook a semistructured interview regarding their experiences with the digital tool. Interviews were analyzed deductively using the Theoretical Domains Framework.

RESULTS

Participants wore their devices for an average of 86.2% of the days in the 6-month testing period ranging from 40.6% to 98%. Although improvements in the EHFScBS and MLwHFQ were seen, these changes were not significant (P=.10 and P=.70, respectively, where P>.03, after a Bonferroni correction). SUS results suggest that the usability of this system was not acceptable with a median score of 58.8 (IQR 55.0-60.0; range 45.0-67.5). Participants demonstrated a strong motivation to use the system according to the WTMS (median 6.0, IQR 5.0-7.0; range 1.0-7.0), whereas the Fitbit was considered very comfortable as demonstrated by the low CRS results (median 0.0, IQR 0.0-0.0; range 0.0-2.0). According to participant interviews, the digital tool supported self-management through increased knowledge, improved awareness, decision-making, and confidence in their own data, and improving their social support through a feeling of comfort in being watched.

CONCLUSIONS

The digital health tool demonstrated high levels of adherence and acceptance among participants. Although the SUS results suggest low usability, this may be explained by participants uncertainty that they were using it fully, rather than it being unusable, especially given the experiences documented in their interviews. The digital tool targeted key self-management behaviors and feelings of social support. However, a number of changes to the tool, and the health service, are required before it can be implemented at scale. A full-scale feasibility trial conducted at a wider level is required to fully determine its potential effectiveness and wider implementation needs.

Prevalence and predictors of poor self-care behaviors in patients with chronic heart failure

Despite the indispensable role of self-care behavior in managing heart failure, the practice of self-care behavior remains poor, especially in developing countries. There is a scarcity of research focusing on poor self-care behavior and its determinants within our specific context. Therefore, the objective of this study was to investigate the prevalence and predictors of poor self-care behavior among ambulatory heart failure patients. A facility-based cross-sectional study was conducted at a tertiary care hospital in Ethiopia, involving patients with heart failure. We utilized the European Heart Failure Self-Care Behavior Scale (EHFScBS-9) to evaluate adherence to self-care behaviors. Data were gathered through patient interviews and a review of medical records. A binary logistic regression analysis was performed to identify predictors of poor self-care behavior in heart failure patients. We included a total of 343 participants in the final analysis of this study. The findings revealed that a majority of the patients (73.8%) demonstrated poor overall self-care behavior. Specifically, the majority of patients did not engage in regular exercise (76.1%), failed to consult doctors in case of rapid weight gain (75.6%), did not monitor weight daily (71.5%), did not restrict fluid intake (69.9%), and did not contact doctors in case of experiencing fatigue (68.6%). Additionally, 32.4% of patients did not reach out to doctors when experiencing shortness of breath, 30% did not restrict salt intake, 29% did not adhere to prescribed medication, and only 7% did not consult doctors if edema occurred. Our findings indicated that rural residence (AOR: 5.76, 95% CI: 2.47-13.43), illiteracy (AOR: 2.64, 95% CI: 1.52-6.31), prior hospitalization (AOR: 2.09, 95% CI: 1.21-3.61), and taking five or more medications (AOR: 1.83, 1.01-3.33) were significant predictors of poor self-care behavior. In conclusion, a majority of the participants in our study demonstrated poor self-care behavior. Risk factors for this behavior included rural residence, illiteracy, prior hospitalization, and taking five or more medications. Therefore, it is crucial to prioritize these high-risk patients and implement interventional programs aimed at improving self-care behaviors and overall treatment outcomes in heart failure patients.

The ubiquity of 'self-care' in health: Why specificity matters

Despite increased interest in self-care for health, little consensus exists around its definition and scope. The World Health Organization has published several definitions of self-care, including in a 2019 Global Guideline rooted in sexual and reproductive health and rights (SRHR), later expanded to encompass health more generally. To establish a robust understanding of self-care, this exploratory study inventorises, consolidates, presents and analyses definitions of self-care beyond the SRHR field. A pragmatic review identified definitions and conceptualisations of self-care from peer-reviewed and grey literature published between 2009 and 2021. The search identified 91 definitions of self-care from 116 relevant publications. Data extraction informed analysis to identify recurring themes and approaches, revealing three key areas of variation: self-care being: (1) defined directly or descriptively; (2) situated within individual, interpersonal or structural contexts; (3) defined broadly or topic-specifically. A multilevel conceptualisation can guide a more broadly applicable understanding of self-care: first, as an aspect of healthcare; second, as a concept operating at individual, interpersonal and institutional levels; third, as a concept that impacts specific health fields and contexts differently. A comprehensive but adaptable framework works in service of improving health and wellbeing for all, acknowledging the linkages between self-care and health-related human rights.

What frail, older patients talk about when they talk about self-care-a qualitative study in heart failure care

BACKGROUND

Self-care plays a crucial role in the management of heart failure (HF) and is especially important for older patients who are frail. However, there is limited knowledge about how frail, older patients with HF perceive and experience self-care. Therefore, the aim of this study was to describe the experiences of self-care among frail, older patients with HF.

METHODS

A qualitative descriptive design with semi-structured interviews with frail, older patients diagnosed with HF (n = 19; median age 82 years). Thematic analysis, guided by Braun and Clarke, was used to analyse the data.

RESULTS

Two main themes emerged from the analysis: 1) "To maintain my health," encompassing various aspects such as hygiene practices, engaging in physical activity, medication adherence, following a healthy diet, and ensuring adequate rest; and 2) "To maintain my well-being and happiness," highlighting the importance of hobbies, maintaining independence, participating in social activities, and creating a supportive environment.

CONCLUSION

This study provides valuable insights into the perspectives of frail, older patients with HF regarding self-care. It was observed that older patients often associate self-care with general well-being, hygiene, and happiness. Clear communication between healthcare providers and patients is essential to align different perspectives on self-care and ensure that self-care plans are tailored to individual needs. Moreover, addressing the emotional well-being and happiness of patients should be prioritized, as these factors play a significant role in promoting self-care adherence.

Sense of Security Mediates the Relationship Between Self-care Behavior and Health Status of Patients With Heart Failure: A Cross-sectional Study

BACKGROUND

Promoting patients' sense of security is among the goals of nursing care within heart failure management.

OBJECTIVE

The aim of this study was to examine the role of sense of security in the relationship between self-care behavior and health status of patients with heart failure.

METHODS

Patients recruited from a heart failure clinic in Iceland answered a questionnaire about their self-care (European Heart Failure Self-care Behavior Scale; possible scores, 0-100), their sense of security (Sense of Security in Care-Patients' Evaluation; possible scores, 1-100), and their health status (Kansas City Cardiomyopathy Questionnaire, including symptoms, physical limitations, quality of life, social limitations, and self-efficacy domains; possible scores, 0-100). Clinical data were extracted from electronic patient records. Regression analysis was used to examine the mediation effect of sense of security on the relationship between self-care and health status.

RESULTS

The patients (N = 220; mean [SD] age, 73.6 [13.8] years; 70% male, 49% in New York Heart Association functional class III) reported a high sense of security (mean [SD], 83.2 [15.2]) and inadequate self-care (mean [SD], 57.2 [22.0]); their health status, as assessed by all domains of the Kansas City Cardiomyopathy Questionnaire, was fair to good except for self-efficacy, which was good to excellent. Self-care was associated with health status ( P < .01) and sense of security ( P < .001). Regression analysis confirmed the mediating effect of sense of security on the relationship between self-care and health status.

CONCLUSIONS

Sense of security in patients with heart failure is an important part of daily life and contributes to better health status. Heart failure management should not only support self-care but also aim to strengthen sense of security through positive care interaction (provider-patient communication) and the promotion of patients' self-efficacy, and by facilitating access to care.

Electrochemical-based approaches for the treatment of pharmaceuticals and personal care products in wastewater

In recent times, emerging contaminants (ECs) like pharmaceuticals and personal care products (PPCPs) in water and wastewater have become a major concern in the environment. Electrochemical treatment technologies proved to be more efficient to degrade or remove PPCPs present in the wastewater. Electrochemical treatment technologies have been the subject of intense research for the past few years. Attention has been given to electro-oxidation and electro-coagulation by industries and researchers, indicating their potential to remediate PPCPs and mineralization of organic and inorganic contaminants present in wastewater. However, difficulties arise in the successful operation of scaled-up systems. Hence, researchers have identified the need to integrate electrochemical technology with other treatment technologies, particularly advanced oxidation processes (AOPs). Integration of technologies addresses the limitation of indiviual technologies. The major drawbacks like formation of undesired or toxic intermediates, s, energy expenses, and process efficacy influenced by the type of wastewater etc., can be reduced in the combined processes. The review discusses the integration of electrochemical technology with various AOPs, like photo-Fenton, ozonation, UV/H2O2, O3/UV/H2O2, etc., as an efficient way to generate powerful radicals and augment the degradation of organic and inorganic pollutants. The processes are targeted for PPCPs such as ibuprofen, paracetamol, polyparaben and carbamezapine. The discussion concerns itself with the various advantages/disadvantages, reaction mechanisms, factors involved, and cost estimation of the individual and integrated technologies. The synergistic effect of the integrated technology is discussed in detail and remarks concerning the prospects subject to the investigation are also stated.

Feasibility, acceptability, and outcome responsiveness of the SYMPERHEART intervention to support symptom perception in persons with heart failure and their informal caregivers: a feasibility quasi-experimental study

BACKGROUND

Symptom perception is an important process of heart failure (HF) self-care that persons with HF need in order to master self-care management. It also leads to better patient outcomes. Symptom perception consists of body observation and analysis, which are both challenging. We aimed to test the feasibility, acceptability, and outcome responsiveness of a novel intervention (SYMPERHEART) delivered to persons with HF with their informal caregiver.

METHODS

We designed SYMPERHEART as a complex evidence-informed education and support intervention targeting body observation and analysis. We conducted a feasibility quasi-experimental study with a single group pre-post-test design. We included three subsamples: persons with HF receiving home-based care, their informal caregivers exposed to SYMPERHEART, and home-care nurses who delivered SYMPERHEART during 1 month. We assessed feasibility by recruitment time, time to deliver SYMPERHEART, eligibility rate, and intervention fidelity. We assessed acceptability by consent rate, retention rate, persons with HF engagement in body observation, and treatment acceptability. Outcome responsiveness was informed by patient-reported (PRO) and clinical outcomes: HF self-care and the informal caregivers' contribution to HF self-care, perception of HF symptom burden, health status, caregivers' burden, and HF events. We performed descriptive analyses for quantitative data and calculated Cohen's d for PROs. A power analysis estimated the sample size for a future full-scale effectiveness study.

RESULTS

We included 18 persons with HF, 7 informal caregivers, and 9 nurses. Recruitment time was 112.6 h. The median time to deliver SYMPERHEART for each participant was 177.5 min. Eligibility rate was 55% in persons with HF. Intervention fidelity revealed that 16 persons with HF were exposed to body observation and analysis. Consent and retention rates in persons with HF were 37.5% and 100%, respectively. Participants engaged actively in symptom and weight monitoring. Treatment acceptability scores were high. Symptom perception and informal caregivers' contribution to symptom perception were found to be responsive to SYMPERHEART. We estimate that a sample size of 50 persons with HF would be needed for a full-scale effectiveness study.

CONCLUSIONS

SYMPERHEART was found to be feasible and acceptable. This feasibility study provides information for a subsequent effectiveness study.

TRIAL REGISTRATION

ISRCTN. ISRCTN18151041 , retrospectively registered on 4 February 2021, ICTRP Search Portal.

The impact of informal caregivers' preparedness on short-term outcomes of heart failure patients with insufficient self-care

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.

Informing behaviour change intervention design using systematic review with Bayesian meta-analysis: physical activity in heart failure

Embracing the Bayesian approach, we aimed to synthesise evidence regarding barriers and enablers to physical activity in adults with heart failure (HF) to inform behaviour change intervention. This approach helps estimate and quantify the uncertainty in the evidence and facilitates the synthesis of qualitative and quantitative studies. Qualitative evidence was annotated using the Theoretical Domains Framework and represented as a prior distribution using an expert elicitation task. The maximum a posteriori probability (MAP) for the probability distribution for the log OR was used to estimate the relationship between physical activity and each determinant according to qualitative, quantitative, and qualitative and quantitative evidence combined. The probability distribution dispersion (SD) was used to evaluate uncertainty in the evidence. Three qualitative and 16 quantitative studies were included (N = 2739). High pro-b-type natriuretic peptide (MAP = -1.16; 95%CrI: [-1.21; -1.11]) and self-reported symptoms (MAP = - 0.48; 95%CrI: [ -0.40; -0.55]) were suggested as barriers to physical activity with low uncertainty (SD = 0.18 and 0.19, respectively). Modifiable barriers were symptom distress (MAP = -0.46; 95%CrI: [-0.68; -0.24], SD = 0.36), and negative attitude (MAP = -0.40; 95%CrI: [-0.49; -0.31], SD = 0.26). Modifiable enablers were social support (MAP = 0.56; 95%CrI: [0.48; 0.63], SD = 0.26), self-efficacy (MAP = 0.43; 95%CrI: [0.32; 0.54], SD = 0.37), positive physical activity attitude (MAP = 0.92; 95%CrI: [0.77; 1.06], SD = 0.36).

The CRAVE and ARGE scales for motivation states for physical activity and sedentarism: Brazilian Portuguese translation and single-item versions

Motivation states for physical activity and sedentarism potentially vary from moment to moment. The CRAVE scale (Cravings for Rest and Volitional Energy Expenditure) was developed to assess transient wants and desires to move. Three studies were conducted with the aims of: (1) translating and validating the scale in Brazilian Portuguese, (2) examining changes with exercise, and (3) determining the best single-item for Move and Rest subscales for English and Portuguese. In Study 1, six bilingual speakers translated the scale into Brazilian Portuguese [named Anseios por Repouso e Gastos com Energia (ARGE)]. The ARGE had good content validity coefficients across three dimensions (0.89-0.91), as determined by three independent, bilingual referees. 1,168 participants (mean age = 30.6, SD = 12.2) from across Brazil completed an online version of the ARGE. An Exploratory Factor Analysis found two clear, oblique, and inversely related factors (Move and Rest; GFI = 1.00, RMSR = 0.03). Reliability was good (Cronbach α's: 0.93 and 0.92). Two models of the scale (10 vs. 13 items) were compared with Confirmatory Factor Analysis. The previously validated version using 10 scored items (GFI = 1.00, RMSEA = 0.07, RMSR = 0.02) outperformed the version scored with 13 items. State anxiety and exercise behavior had small associations with Move and Rest (-0.20 to 0.26). In Study 2, ARGE Move scores had high correspondence post-session (ICC = 0.83) for 9 women performing short Sprint Interval Training (sSIT; 6 sessions). Large, but non-significant, effects were detected for changes in motivation states with sSIT. In Study 3, IRT analyses found that for the United States sample, "be physically active" and "be still" were the most representative items for Move and Rest, respectively, while for the Brazil sample they were "exert my muscles" and "be a couch potato." Overall, it was found that: (A) the ARGE scale demonstrated good psychometric properties, (B) the original scoring (with 10 items) resulted in the best model, (C) it had small associations with exercise behavior, and (D) the subscales were reduced to single items that varied by country, indicating potential cultural differences in the concept of motivation states for physical activity.

A Qualitative Study on the Self-Care Experiences of People with Heart Failure

We aimed to explore in-depth experiences and emotions of people with heart failure within the context of self-care. A qualitative descriptive study was conducted using semi-structured interviews. Ten patients were recruited from an outpatient clinic at a university-affiliated hospital in South Korea between September and November 2019. Data were analyzed using a thematic content analysis approach. Participants were 68-86 years old, and 80% were men. Five themes of the self-care experiences of persons with heart failure were identified: "Suddenly diagnosed with heart failure," "Unpredictable symptoms and unprepared for self-care," "Dependent on caring family on a heartbreaking uphill," "Self-care efforts with apprehension," and "Continued self-care efforts with expert help." Programs to support self-care for people with heart failure are needed and should be developed by incorporating patients' needs and reflecting their uncertainty and vulnerability.

Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post-hospital discharge period

BACKGROUND

People living with heart failure (HF) are particularly vulnerable after hospital discharge. An alliance between patient authors, clinicians, industry, and co-developers of HF programs can represent an effective way to address the unique concerns and obstacles people living with HF face during this period. The aim of this narrative review article is to discuss challenges and opportunities of this approach, with the goal of improving participation and clinical outcomes of people living with HF.

METHODS

This article was co-authored by people living with HF, heart transplant recipients, patient advocacy representatives, cardiologists with expertise in HF care, and industry representatives specializing in patient engagement and cardiovascular medicine, and reviews opportunities and challenges for people living with HF in the post-hospital discharge period to be more integrally involved in their care. A literature search was conducted, and the authors collaborated through two virtual roundtables and via email to develop the content for this review article.

RESULTS

Numerous transitional-care programs exist to ease the transition from the hospital to the home and to provide needed education and support for people living with HF, to avoid rehospitalizations and other adverse outcomes. However, many programs have limitations and do not integrally involve patients in the design and co-development of the intervention. There are thus opportunities for improvement. This can enable patients to better care for themselves with less of the worry and fear that typically accompany the transition from the hospital. We discuss the importance of including people living with HF in the development of such programs and offer suggestions for strategies that can help achieve these goals. An underlying theme of the literature reviewed is that education and engagement of people living with HF after hospitalization are critical. However, while clinical trial evidence on existing approaches to transitions in HF care indicates numerous benefits, such approaches also have limitations.

CONCLUSION

Numerous challenges continue to affect people living with HF in the post-hospital discharge period. Strategies that involve patients are needed, and should be encouraged, to optimally address these challenges.

Association Between Self-care and Resilience: A Cross-sectional Study in Heart Failure Patients

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.

Self-Care and Compliance with Medication and Their Relationship to the Quality of Life of Patients with Heart Failure

INTRODUCTION

Heart failure is a major health problem, often accompanied by limited physical activity and severe effects in various areas of patient quality of life. Self-care, as well as compliance with medication, can further contribute to clinical stability and improved patient outcomes.

PURPOSE

The purpose of this chapter is to assess the effect of self-care and compliance with medication, on the quality of life of patients with heart failure.

METHOD

The research sample consisted of 67 patients diagnosed with heart failure who visited the cardiology outpatient clinic of a general hospital in the capital of Greece. The assessment of self-care behavior was performed by the scale EHFScBS and SCHFI v.6, the Morsiky Green Levine Adherence Scale (MAQ) was used for the evaluation of adherence to medical treatment, while for the evaluation of the quality of life the questionnaire MLWHFQ was used.

RESULTS

The multifactorial linear regression analysis showed that age, compliance with medication and scoring in the dimension "Self-care confidence" relates independently to the overall quality-of-life scale rating. In particular, participants over 80 had a significantly higher score, that is, worse quality of life, compared to those under the age of 70 (p < 0.001), while participants with low compliance with treatment had a significantly worse quality of life compared to participants with high compliance (p < 0.001). It has been noticed that the better self-care they had and the higher compliance with their medication, their quality of life was better.

CONCLUSION

Self-care behavior and adherence to medical treatment of patients with heart failure are related to their quality of life. Age, educational level, and "Self-care confidence" are factors that influence self-care behavior, compliance with medication, and quality of life. In-depth patient information on the need for adherence to therapeutic guidelines may help to reduce pharmaceutical costs and maximize the therapeutic effect. For this reason, health professionals treating these patients should take into account all the factors that negatively affect their quality of life and treat them with the appropriate interventions.

Self-Care and Quality of Life Among Adult Patients With Heart Failure: Scoping Review

Introduction

Although self-care has a therapeutic effect on heart failure (HF), patients experience a marked reduction in physical and executive function, resulting in poor quality of life (QoL). A literature review revealed limited evidence regarding the possible relationship between self-care and QoL in HF patients. Therefore, this scoping review aimed to identify scientific evidence that examines the extent of self-care, QoL, and relationship between self-care and QoL in patients with HF.

Methods

Full-text research published from March 23, 2010, to March 23, 2020, written in English, that had content on both self-care and QoL among adult patients with HF was included. A literature search of electronic databases and web searches was conducted for published articles. Four databases were used: MEDLINE, Scopus, Web of Science, and the Cochrane Library. Studies collected from Google and Google Scholar web searches were also included.

Results

Of 1,537 papers identified by the search, 12 were included. The reviewed studies included 3,127 patients. Ten articles used a cross-sectional study design, whereas the remaining articles used a longitudinal and quasi-experimental design. This review found that the extent of self-care practices among patients with HF was inadequate, a significant proportion of patients enrolled in the reviewed studies had a moderate QoL, and higher self-care practices were associated with a better QoL. Self-care behavior and QoL were affected by social support, sex, age, educational level, place of residence, illness knowledge, presence of comorbidities, and functional classification of HF.

Conclusion

Self-care behavior was positively correlated with QoL in patients with HF. Self-care and QoL in these patients have been reported to be affected by several factors. Further research with a rigorous study design is recommended to investigate the influence of self-care practices on QoL in patients with HF.

The psychometric properties of the Iranian version of Social Communication Questionnaire (SCQ) in children with autism spectrum disorder

Purpose

This study aims to investigate the psychometric properties of the social communication questionnaire (SCQ) in Iran by identifying children with autism spectrum disorder (ASD) who had Persian-speaking parents.

Design/methodology/approach

A case–control study was performed from June to August 2021 in Hamadan, Iran. The case group consisted of children who were examined by clinicians who used a coding scheme based on the DSM-V criteria for ASD by a psychiatrist. The control group consisted of non-ASD children who were asked to participate in the study. This study conducted the reliability, content and face validity to evaluate the psychometric properties of the tool. In the first step, Kaiser–Meyer–Olkin and Bartlett’s test were used to determine sampling adequacy and appropriateness of correlation matrix. In the second step, the exploratory factor analysis approach was used. The method of extracting the factors is done by using the varimax rotation method and selecting the number of factors using an eigenvalue and scree plot. Statistical analysis was performed using Software Package for Social Sciences 21 with the statistical significance set at level less than 0.05.

Findings

The quantitative content validity analysis revealed that the mean of content validity ratio and content validity index were 0.92 and 0.91, respectively. Mean score ± standard deviation in the two groups of ASD and control were 14.23 ± 3.84 and 7.83 ± 4.80, respectively. With cut-off point >12.5, sensitivity, specificity and misclassification error values were 73.33%, 80.0% and 23%, respectively.

Research limitations/implications

The results showed that the internal consistency of the SCQ is desirable. Also, the internal consistency of its five subscales was obtained between 0.700 and 0.87. The findings showed that SCQ questionnaire is highly reliable in reciprocal social interaction (Factor 1) and the total score, while other factors were relatively reliable.

Originality/value

To the best of the authors’ knowledge, this is the first paper on psychometric properties of SCQ in ASD children in Iran.

A longitudinal assessment of chronic care pathways in real-life: self-care and outcomes of chronic heart failure patients in Tuscany

BACKGROUND

Worldwide healthcare systems face challenges in assessing and monitoring chronic care pathways and, even more, the value generated for patients. Patient-reported outcomes measures (PROMs) represent a valid Real-World Evidence (RWE) source to fully assess health systems' performance in managing chronic care pathways.

METHODS

The originality of the study consists in the chance of adopting PROMs, as a longitudinal assessment tool for continuous monitoring of patients' adherence to therapies and self-care behavior recommendations in clinical practice and as a chance to provide policy makers insights to improve chronic pathways adopting a patient perspective. The focus was on PROMs of patients with chronic heart failure (CHF) collected in the Gabriele Monasterio Tuscan Foundation (FTGM), a tertiary referral CHF centre in Pisa, Italy. During the hospital stay, CHF patients were enrolled and received a link (via SMS or email) to access to the first questionnaire. Follow-up questionnaires were sent 1, 7 and 12 months after the index hospitalisation. Professionals invited 200 patients to participate to PROMs surveys. 174 answers were digitally collected at baseline from 2018 to 2020 and analysed. Quantitative and qualitative analyses were conducted, using Chi2, t-tests and regression models together with narrative evidence from free text responses.

RESULTS

Both quantitative and qualitative results showed FTGM patients declared to strongly adhere to the pharmacological therapy across the entire pathway, while seemed less careful to adhere to self-care behavior recommendations (e.g., physical activity). CHF patients that performed adequate Self-Care Maintenance registered outcome improvements. Respondents declared to be supported by family members in managing their adherence.

CONCLUSIONS

The features of such PROMs collection model are relevant for researchers, policymakers and for managers to implement interventions aimed at improving pathway adherence dimensions. Among those, behavioral economics interventions could be implemented to increase physical activity among CHF patients since proven successful in Tuscany. Strategies to increase territorial care and support patients' caregivers in their daily support to patients' adherence should be further explored. Systematic PROMs collection would allow to monitor changes in the whole pathway organization. This study brings opportunities for extending such monitoring systems to other organizations to allow for reliable benchmarking opportunities.

Factors associated with poor self-management documented in home health care narrative notes for patients with heart failure

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.

Self-care and quality of life among men with chronic heart failure

Introduction

Chronic Heart Failure (CHF) involves a complex regimen of daily self-care behaviors: pharmacological therapy, symptom monitoring and lifestyle modifications. Patients with CHF may have a reduced health related quality of life (HRQoL) due to various physical and emotional symptoms. HRQoL may be improved through the use of self-care interventions.

Purpose

To assess the level of self-care and quality of life among men with chronic heart failure.

Methods

The study was conducted among 80 men diagnosed with CHF (mean age 58 years). The study was cross-sectional. A self-administered questionnaire and analysis of medical records were used to collect baseline sociodemographic and clinical data. Self-care was assessed using the standardized European Heart Failure Self-care Behavior Scale- EHFScBS-9 and quality of life was assessed using the World Health Organization Quality of Life Bref.

Results

The Patients in NYHA class II constituted the vast majority (71.25%), mean LVEF in the study group was 43.5%, and mean disease duration was 3 years. The most common comorbidities were ischemic heart disease (72.5%), hypertension (70%) and diabetes mellitus (60%). The most commonly reported non-pharmacological treatments for NS were fluid restriction (45%), moderate physical activity (42.50%) and daily weight control (41.25%). The EHFSc-9 questionnaire score averaged 50.31 points out of 100 possible (SD = 26.52). The mean score regarding perception of QoL was 2.78 points (SD = 0.91), and 40% of patients indicating poor perception of QoL. The mean score for self-rated Analysis of the results of the individual domains of the WHOQoL BREF questionnaire showed that patients rated their QoL best in the environmental domain (M = 13.28; SD = 3.11), then in the social domain (M = 12.81; SD = 2.71), and in the psychological domain (M = 12.8; SD = 3.2). In contrast, QoL in the physical domain was rated the lowest (M = 10.44; SD = 2.85). There was no significant correlation between quality of life and self-care (p > 0.05).

Conclusions

Men with CHF have unsatisfactory self-care outcomes and low quality of life scores and are dissatisfied with their health. Strategies to improve selfcare and quality of life in this group are indicated.

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.

Patient Self-Care and Caregiver Contribution to Patient Self-Care of Chronic Conditions: What Is Dyadic and What It Is Not

OBJECTIVES

Self-care of chronic conditions involves both patients and their informal caregivers and therefore might be considered as a dyadic phenomenon. Nevertheless, empirical evidence supporting a dyadic construct is unavailable. This study aimed to explore the existence of a dyadic construct in self-care maintenance, monitoring, and management in patients affected by chronic conditions and their informal caregivers.

METHODS

This study used a cross-sectional design. We used the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory, which measure patient self-care and informal caregivers' contribution to self-care maintenance, monitoring and management. Exploratory Structural Equation Modeling was performed to verify the existence of dyadic latent constructs in each scale in patients and informal caregivers.

RESULTS

A convenience sample of 493 patients and informal caregivers, with a mean age of 76.47 and 52.76 years, respectively, was studied. In the self-care maintenance scales, 2 correlated factors (r = 0.34, P < .001) were identified, indicating the presence of a dyadic second-order construct. In addition, 2 factors that were not correlated (r = 0.11, P = .064) were identified in the self-care monitoring scales, indicating the absence of a dyadic construct. Finally, we found a 3-factor model in the self-care management scales composed of both patient and caregiver items, indicating a dyadic first-order construct.

CONCLUSIONS

Knowing which care behaviors are dyadic in chronic conditions is important for tailoring interventions to improve self-care. Self-care maintenance and management would benefit from dyadic interventions, while self-care monitoring would not. The results of this study may illuminate future theoretical and scientific developments in dyadic care of chronic illness.

The Association Between Self-reported Sleep Quality and Self-care in Adults With Heart Failure

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.

Experiences of Disease Adaptationin Patients With Heart Failure: A Qualitative Study

This study aimed to explore the experiences of adaptation in heart failure (HF) patients according to the Roy adaptation model. A qualitative study was conducted between December 2020 and March 2021 in China. A total of 21 patients with HF were recruited at of two general hospitals. Semi structured face-to-face interviews were conducted with each participant. NVivo 11 was used to encode the transcription and thematic analysis was preformed to analyze the transcripts. Eleven minor themes emerged from the data, namely unbalanced nutrition, inappropriate activities, unrestricted liquid intake, excessive sodium intake, worrying about the future, negative emotions, poor spiritual aspect, unable to fulfill social roles, forced to stop work, interpersonal alienation, and less communication with friends or family. Most participants with HF experienced poor disease adaptation. The themes that emerged offer a new perspective on the experiences of disease adaptation in patients with HF.

A Motivational Interviewing Intervention Improves Physical Symptoms in Patients with Heart Failure: A Secondary Outcome Analysis of the Motivate-HF Randomized Controlled Trial

CONTEXT

Heart failure (HF) patients experience high burden of physical symptoms during their disease trajectory.

OBJECTIVE

To evaluate the effects of Motivational Interviewing (MI) on the burden of physical symptoms in HF patients.

METHODS

We performed a secondary analysis of data from the MOTIVATE-HF randomized controlled trial. A sample of 510 patients (median 74 years, 58% male) and their caregivers (median 55 years, 75.5% female) was randomly allocated to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard of care). The MI intervention consisted of one face-to-face session plus three telephone calls conducted within two months from enrollment. Symptoms' burden was assessed with the Heart Failure Somatic Perception Scale (HFSPS) with the dimensions of Chest Discomfort, Dyspnea, Early and subtle and Edema. Data were collected at baseline and at 3, 6, 9, and 12 months after enrollment.

RESULTS

At 12 months, Chest Discomfort improved in Arms 1 and 2 vs Arm 3 (Δ: -8.13, 95% CI: -14.61; -1.65). Dyspnea improved in Arms 1 and 2 vs Arm 3 both at 9 and 12 months (Δ: -7, 95% CI: -13.18; -0.82 and -6.78, 95% CI: -13.19; -0.38); HFSPS total score improved in Arm 1 and Arm 2 vs Arm 3 at 9 months (Δ: -4.55, 95% CI: -9.05; -0.05). Over 1 year, Chest Discomfort and HFSPS total score in Arm 2 improved compared to Arm 3 (β= -2.61, 95% CI: -4.21; -1.00, P = 0.0015 and β=-1.35, 95% CI: -2.50; -0.21, P = 0.02).

CONCLUSION

MI reduces the burden of physical HF symptoms, particularly when caregivers are involved in the intervention.

Self-care: A concept analysis

Objectives

There is extensive literature from various disciplines on self-care, an important aspect of nursing intervention via evaluation and education, but its meaning remains unprecise due to the difficulty integrating the diverse definitions developed over time across disciplines. Therefore, it is vital to clarify the meaning of self-care and formulate the defining attributes, antecedents, and consequences to self-care.

Methods

Walker and Avant’s concept analysis approach was used to analyze the concept of self-care. A search of the literature was completed using the databases CINAHL, PubMed, and EBSCOhost for years 1975–2020; literature search included peer-review articles, full-text publications, and available in English. A total of 31 articles were reviewed, and saturation was reached.

Results

An extensive review of the literature revealed salient characteristics that reflected the most frequently used terms associated with the concept. Guided by Walker and Avant’s method, three defining attributes emerged as common themes: awareness, self-control, and self-reliance.

Conclusions

A clarified definition was identified: the ability to care for oneself through awareness, self-control, and self-reliance in order to achieve, maintain, or promote optimal health and well-being.

Psychometric Characteristics of the Caregiver Contribution to Self-care of Heart Failure Index in a South American Population

BACKGROUND

Caregivers can contribute enormously to the self-care of patients with heart failure (HF). The Caregiver Contribution to Self-care of Heart Failure Index (CC-SCHFI) measures these contributions across 3 scales: self-care maintenance, which evaluates caregiver contributions to symptom monitoring and treatment adherence; self-care management, which evaluates caregiver contributions in dealing with symptoms; and caregiver confidence, which assesses caregiver self-efficacy in managing all contributions to self-care. Although the CC-SCHFI has been used in several investigations, only 1 study has evaluated its psychometric characteristics.

OBJECTIVE

The aim of this study was to evaluate the psychometric properties of the CC-SCHFI in Brazil.

METHODS

A cross-sectional design was used in this study. Confirmatory factor analysis was used to assess construct validity, and factor score determinacy coefficients were computed to evaluate internal consistency reliability.

RESULTS

The sample comprised 99 caregivers of patients with HF. Most were women (73%), with a mean age of 48 ± 14 years; 57% were patients' spouses. Confirmatory factor analysis confirmed the original factor structure of the instrument, with supportive fit indices for all 3 scales (comparative fit index, 0.95-1.00; root-mean-square error of approximation, 0.00-0.057). Reliability estimates were adequate for each CC-SCHFI scale (0.77-0.96).

CONCLUSIONS

The CC-SCHFI is a valid and reliable scale to measure caregiver contributions to self-care maintenance, caregiver contributions to self-care management, and caregiver confidence in HF.

Use of mobile applications in heart failure self-management: a qualitative study exploring the patient and primary care clinician perspective (Preprint)

Background

Mobile apps have the potential to support patients with heart failure and facilitate disease self-management, but this area of research is recent and rapidly evolving, with inconsistent results for efficacy. So far, most of the published studies evaluated the feasibility of a specific app or assessed the quality of apps available in app stores. Research is needed to explore patients’ and clinicians’ perspectives to guide app development, evaluation, and implementation into models of care.

Objective

This study aims to explore the patient and primary care clinician perspective on the facilitators and barriers to using mobile apps, as well as desired features, to support heart failure self-management.

Methods

This is a qualitative phenomenological study involving face-to-face semistructured interviews. Interviews were conducted in a general practice clinic in Sydney, Australia. Eligible participants were adult patients with heart failure and health care professionals who provided care to these patients at the clinic. Patients did not need to have previous experience using heart failure mobile apps to be eligible for this study. The interviews were audio-recorded, transcribed, and analyzed using inductive thematic data analysis in NVivo 12.

Results

A total of 12 participants were interviewed: 6 patients (mean age 69 [SD 7.9] years) and 6 clinicians. The interviews lasted from 25 to 45 minutes. The main facilitators to the use of apps to support heart failure self-management were communication ability, personalized feedback and education, and automated self-monitoring. Patients mentioned that chat-like features and ability to share audio-visual information can be helpful for getting support outside of clinical appointments. Clinicians considered helpful to send motivational messages to patients and ask them about signs and symptoms of heart failure decompensation. Overall, participants highlighted the importance of personalization, particularly in terms of feedback and educational content. Automated self-monitoring with wireless devices was seen to alleviate the burden of tracking measures such as weight and blood pressure. Other desired features included tools to monitor patient-reported outcomes and support patients’ mental health and well-being. The main barriers identified were the patients’ unwillingness to engage in a new strategy to manage their condition using an app, particularly in the case of low digital literacy. However, clinicians mentioned this barrier could potentially be overcome by introducing the app soon after an exacerbation, when patients might be more willing to improve their self-management and avoid rehospitalization.

Conclusions

The use of mobile apps to support heart failure self-management may be facilitated by features that increase the usefulness and utility of the app, such as communication ability in-between consultations and personalized feedback. Also important is facilitating ease of use by supporting automated self-monitoring through integration with wireless devices. Future research should consider these features in the co-design and testing of heart failure mobile apps with patients and clinicians.

The Level of Self-Care among Patients with Chronic Heart Failure

Introduction: In a long-term approach to the treatment of heart failure, importance is given to the process of self-care management and behaviors. The number of rehospitalizations and unscheduled medical visits can be reduced by actively engaging patients in the self-care process. Methods: The study included 403 patients with chronic heart failure (mean LVEF 40.53%), hospitalized in the Cardiology Department. Medical record analysis and a self-report questionnaire were used to obtain basic sociodemographic and clinical data. The European Heart Failure Self-care Behavior Scale, revised into a nine-item scale (EHFScBS-9), was used to evaluate self-care behavior. Results: Analysis of the EHFSc-9 self-care behavior scale showed that the mean score was 49.55 out of 100 possible points (SD = 22.07). Univariate analysis revealed that significant (p < 0.05) negative predictors of the EHFScB-9 self-care scale included: male sex (b = −5146), hospitalizations in the last year (b = −5488), NYHA class II (b = −11,797) and NYHA IV class (b = −15,196). The multivariate linear regression model showed that a significant (p ˂ 0.05) negative predictor of the EHFScB-9 self-care scale was male sex (b = −5.575). Conclusions: Patients with chronic HF achieve near optimal self-care behavior outcomes. A patient prepared to engage with self-care will have fewer rehospitalizations and a better quality of life.

Validity and Reliability of the Caregiver Contribution to Self-Care of Heart Failure Index Version 2

BACKGROUND

Lay caregivers are important in contributing to self-care of patients with heart failure (HF). The Caregiver Contributions to Self-Care of Heart Failure Index (CC-SCHFI) measures these contributions, but after developing the Situation-Specific Theory of Caregiver Contributions to Heart Failure Self-Care, the CC-SCHFI needed updating to reflect the theory.

OBJECTIVE

The aim of this study was to test the psychometric characteristics of the CC-SCHFI 2 that measures caregiver contributions (CC) to HF self-care with 3 scales: CC to self-care maintenance, CC to symptom perception, and CC to self-care management.

METHODS

This is a cross-sectional study. We tested the CC-SCHFI 2 with confirmatory factor analysis, internal consistency, item-total correlations, and test-retest reliability. With the CC-SCHFI 2, we also administered the Self-Care of Heart Failure Index v.7.2 to patients and the Caregiver Contribution to Heart Failure Self-Care Scale to caregivers to assess concurrent validity.

RESULTS

A sample of 277 caregivers was enrolled (mean [SD] age, 52.7 [14.9] years; 70.4% female). In confirmatory factor analysis, each CC-SCHFI 2 scale had supportive fit indices: comparative fit index ranged between 0.94 and 0.95, and root mean square error of approximation ranged between 0.05 and 0.07. Internal consistency of the 3 scales was evident with a Cronbach α between .81 and .83 and a global reliability index between 0.79 and 0.86. Item-total correlations were all greater than 0.30. In concurrent validity testing, there were significant correlations between the CC-SCHFI 2 and the Self-Care of Heart Failure Index v.7.2 and the Caregiver Contribution to Heart Failure Self-Care Scale. Test-retest reliability showed intraclass correlation coefficients between 0.72 and 0.91.

CONCLUSIONS

Testing of the CC-SCHFI 2 supported validity and reliability, indicating that the instrument can be used in clinical practice and research to evaluate CC to the self-care of patients with HF.

The Impact of Motivational Interviewing on Self-care and Health-Related Quality of Life in Patients With Chronic Heart Failure

BACKGROUND

Self-care is an integral component of successful chronic heart failure (HF) management. Structured educational programs have already been shown to be effective in improving self-care, but some patients show resistance and little motivation for change.

OBJECTIVE

The objective of this study was to compare efficacy in improving self-care and health-related quality of life (HRQoL) for an educational intervention based on motivational interviewing (MI) compared with a conventional educational intervention.

METHODS

This experimental pretest-posttest study with an equivalent historical control group included 93 patients in the intervention group and 93 matched patients in the control group. Participants attended a first visit after HF hospitalization discharge and 6 to 7 follow-up visits during 6 months. The European Heart Failure Self-care Behavior scale and the Minnesota Living with Heart Failure Questionnaire were used to assess self-care and HRQoL, respectively. Data on mortality and hospital readmissions were collected as adverse events.

RESULTS

Self-care improved significantly more in the MI-based intervention group than in the control group (P = .005). Although both self-care and HRQoL improved in both groups over time (P < .05), there was no significant between-group difference in terms of HRQoL improvement over time (P = .13).

CONCLUSIONS

Our findings suggest that MI delivered by MI-trained nurses is effective in significantly improving self-care by patients with HF. Nonetheless, further studies are required to evaluate the impact of MI on other outcomes, such as HRQoL and adverse clinical events.

Development and psychometric testing of the European Heart Failure Self-Care behaviour scale caregiver version (EHFScB-C)

BACKGROUND

The European Heart Failure Self-Care Behaviour Scale (EHFScBS) is used worldwide to measure heart failure (HF) patient self-care, but a caregiver version does not exist.

OBJECTIVE

To develop and test the European HF Self-Care Behaviour Scale for Caregivers (EHFScBS-C) in a population of informal caregivers of HF patients.

METHODS

The EHFScBS-C was derived from the EHFScBS to measure the extent to which caregivers contribute to HF patient self-care. The EHFScBS-C was developed in English and then translated into Italian, Spanish and Dutch, after which it was back-translated. EHFScBS-C data were collected from 193 HF caregivers enrolled in Italy, Spain and the Netherlands.

RESULTS

Exploratory factor analysis revealed two factors with supportive fit indices (CFI = 0.990; RMSEA = 0.048): caregivers' contributions to HF self-care related to medical issues, and caregivers' contributions related to lifestyle. Internal consistency reliability was supported as well (Cronbach's alpha 0.90 for the overall scale). Construct validity was demonstrated with significant correlations with the Caregiver Preparedness Scale.

CONCLUSION AND PRACTICE IMPLICATIONS

The EHFScBS-C has adequate validity and reliability for its use in clinical practice and research to measure the extent to which caregivers contribute to HF patient self-care. The EHFScBS-C can be used in combination with the EHFScBS to conduct dyadic studies.