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

Generic and disease-specific caregiver contribution to self-care in a population with multiple chronic conditions: A comparative study

AIM

Describe and compare generic and disease-specific caregiver contribution (CC) to self-care behaviours in the dimensions of self-care maintenance, self-care monitoring and self-care management in multiple chronic conditions (MCCs).

DESIGN

Multicentre cross-sectional study.

METHODS

We enrolled caregivers of patients with MCC, from April 2017 to November 2022, if they were (a) 18 years of age or older and (b) identified by the patient as the principal unpaid informal caregiver. The Caregiver Contribution to Self-Care of Chronic Illness Inventory, Caregiver Contribution to Self-Care of Heart Failure Index, Caregiver Contribution to Self-Care of COPD Inventory and Caregiver Contribution to Self-care of Diabetes Inventory were used to measure generic and disease-specific contribution to patient self-care. Descriptive statistics, Student's t-tests and Pearson's correlation coefficients were used.

RESULTS

We found adequate generic CC for self-care monitoring but inadequate CC in self-care maintenance and management. All CC to disease-specific self-care maintenance, monitoring and management scales' scores were inadequate, except for caregivers of diabetic patients in which we observed an adequate score in the CC to self-care maintenance and self-care management scales in those practice insulin therapy.

CONCLUSION

Caregivers experience difficulties in performing behaviours of contribution to their patients affected by chronic conditions. Caregivers of patients with MCCs contribute more to self-care in aspects related to provider prescriptions and less to lifestyle changes.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Healthcare professionals have to know in which behaviours caregivers show gaps and reflect on the reasons for poor CC to self-care to develop interventions to enhance these behaviours.

IMPACT

This study underlines the importance of choosing the most appropriate instrument for measuring CC to self-care, considering the caregiver's characteristics.

REPORTING METHOD

We adhered to STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Caregivers of patients affected by MCCs were enrolled.

Psychometric properties of the caregiver contribution to self-care of oral anticancer agents index: Longitudinal study

BACKGROUND

The use of oral anticancer agents (OAAs) has increased in recent decades. Despite the advantages of OAAs, people with cancer face challenges such as adherence, prevention, recognition, and management of OAA side effects. Informal caregivers can help their patients who take OAAs by facing the above challenges with the implementation of behaviours to maintain stability (Caregiver contribution to self-care maintenance), monitoring (Caregiver contribution to self-care monitoring) and managing (Caregiver contribution to self-care management) the conditions of their patients.

OBJECTIVE

To develop and test the psychometric properties of the Caregiver Contribution to self-care in the Oral Anticancer Agents Index (CC-SCOAAI).

METHODS

A longitudinal study was conducted. Factorial validity was tested using Confirmatory Factor Analysis (CFA). Furthermore, we also tested the internal consistency and validity of the CC-SCOAAI construct. The Mann-Whitney U test was used to demonstrate associations between CC-SCOAAI scores and patient's re-hospitalizations, emergency-room attendances, and mortality.

RESULTS

We enrolled 318 caregivers, mostly female (63.52 %), with an age of <44 (39.94 %) and spouse of the patient (54.66 %). The CFA demonstrated the factorial validity of the CC-SCOAAI. Caregivers of patients with more re-hospitalizations had a lower contribution to self-care maintenance (U = 2933.500; p = .04), while caregivers of patients with more emergency room admissions (U = 1392.500; p < .001) and re-hospitalizations (U = 2385.500; p < .001) had a lower contribution to self-care management. Caregivers of patients with emergency-room admissions (U = 1392.500; p = .005), re-hospitalisations (U = 2322.500; p < .001) and mortality (U = 515.500; p = .001) had lower contribution to self-care monitoring.

CONCLUSIONS

CC-SCOAAI is a valid and reliable tool. Given that caregivers are crucial in supporting these patients, the CC-SCOAAI may help clinicians improve caregiver efficacy and researchers using CC-SCOAAI to determine better self-care outcomes in patients with OAA.

Arabic Version of the Caregiver Contribution to Self-Care of Heart Failure Index v2: A Psychometric Evaluation

BACKGROUND

Accurate assessment of caregivers' roles in self-care for heart failure (HF) is essential for effectively managing the condition. This evaluation helps identify areas needing additional support, allowing healthcare providers to create tailored and effective patient care strategies.

OBJECTIVE

The objective of this study is to test the validity and reliability of the Arabic version of The Caregiver Contribution to Self-Care of Heart Failure Index Version 2 (CC-SCHFI v2) among the caregivers of patients with HF in Jordan.

METHODS

A cross-sectional design was used to test the validity and reliability of the Arabic version of CC-SCHFI v2. A translation process and psychometric evaluation were performed. Three hundred caregivers and 300 patients with HF were statistically analyzed.

RESULTS

Caregivers had a mean age of 42 years (females were dominant), whereas patients had a mean age of 66 years. Statistical analysis showed significant results: content validity showed high content validity index (0.92), construct validity showed that Bartlett test (P < .001) confirmed factorability, and the Kaiser-Meyer-Olkin index was 0.74. Confirmatory factor analysis indicated a good fit (χ2 = 150.23, df = 90, P < .001; comparative fit index = 0.95, TLI = 0.94, root mean square error of approximation = 0.045), revealing a 3-factor solution that accounted for 75% of the total variance, 50% for self-care maintenance, 15% for symptom perception, and 10% for self-care management. Concurrent validity showed a strong correlation (r = 0.68, P < .001) between the CC-SCHFI v2 and SCHFI scales. Reliability was good internal consistency, with Cronbach α between 0.78 and 0.84, and the test-retest showed intraclass correlation coefficients from 0.85 to 0.90.

CONCLUSION

This study provides valuable evidence supporting the reliability and validity of the Arabic version of the CC-SCHFI v2 among the caregivers of patients with HF in Jordan.

Assessment instruments of caregiver contributions to self-care of chronic illness: A systematic review

OBJECTIVE

This study aimed to identify and assess the psychometric properties of assessment instruments of caregiver contributions to self-care of chronic illness.

METHODS

Ten databases and relevant websites were used to retrieve relevant literature. Methodological quality was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias Checklist. Each instrument's psychometric properties were assessed using COSMIN criteria. The recommendation level was assessed using a modified Grading, Recommendations, Assessment, Development, and Evaluation system.

RESULTS

Twenty-three studies reported 11 different instrument versions. None of the instruments exhibited an A-level recommendation. The Caregiver Contribution to Heart Failure Self-care (CACHS) scale can be temporarily recommended. Significant issues exist with the standardization of result reporting, instrument development, content validity, and criterion validity.

CONCLUSION

According to this study's findings, the CACHS scale can be provisionally recommended. Further research on reporting standards, instrument development, content validity, and criterion validity is required.

The Effects of Teach-Back and Blended Training on Self-Care and Care Burden Among Caregivers of Patients with Heart Failure Caregivers

A quasi-experimental study aimed to investigate the effects of both teach-back and blended training methods on the contribution to self-care and perceived care burden among family caregivers of patients with heart failure. Seventy family caregivers of patients with heart failure were randomly allocated to two groups: one receiving the teach-back method and the other receiving the blended training method. Data were collected before, 1 month, and 3 months after the intervention. Data collection included demographic data and two tools: the Caregiver Contribution to Self-Care of Heart Failure Index and the Caregiver Burden Questionnaire for Heart Failure. Both teach-back and blended training methods were effective in educating family caregivers of patients with heart failure requiring home care. However, the teach-back method demonstrated better outcomes for the two concepts examined in this study.

Psychometric testing of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory version 2

AIM

To assess the psychometric properties of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory version 2 (CC-SC-CII-v2) among primary caregivers of individuals with any single or multiple chronic illnesses.

BACKGROUND

The instrument encompasses three scales that evaluate Caregiver Contribution to Self-Care (CC-SC) Maintenance, Monitoring and Management.

METHODS

The English version CC-SC-CII-v2 was translated and adapted for Thai context, and a cross-sectional multicenter study involved 430 caregivers from 16 primary care centres in Thailand. Structural validity, internal consistency reliability and test-retest reliability were examined.

RESULTS

The original two-factor CC-SC Maintenance scale required a re-specified model for good fit, while the CC-SC Monitoring and CC-SC Management scales fit well. The simultaneous model of three scales demonstrated satisfactory fit. The CC-SC Maintenance and CC-SC Management scales both had a composite reliability index of 0.85, with omega coefficients of 0.86 and 0.83, respectively. CC-SC Monitoring had an alpha coefficient of 0.89. The intraclass correlation coefficients ranging from 0.84 to 0.91, indicating good test-retest reliability.

CONCLUSION

The Thai CC-SC-CII-v2 is a valid and reliable instrument that can provide clinicians and investigators with an evaluation of the contributions of caregivers to the self-care of patients with chronic illnesses.

Evaluating dyadic factors associated with self-care in patients with heart failure and their family caregivers: Using an Actor-Partner Interdependence Model

Dyadic conditions of patients with heart failure and their caregivers may affect both patient self-care and caregiver contribution to patient self-care (CCPS). The purpose of this study was to examine the relationships of patient-caregiver physical function and depressive symptoms to the patient self-care (maintenance and management) and CCPS. Data from 55 were analyzed using an Actor-Partner Interdependence Model to address the aim through AMOS. Patient self-care was very poor. Better patient physical function was related to better patient self-care management (actor effect) and poorer CCPS maintenance (partner effect). Better caregiver physical function was related to CCPS management (actor effect). Severer patient depressive symptoms were related to poorer patient self-care maintenance (actor effect) and poorer CCPS management (partner effect). Physical function and depressive symptoms in patient-caregiver dyads were related to patient self-care and CCPS. To improve patient self-care and CCPS, dyadic support for physical function and depressive symptoms is needed.

Leveraging home health aides to improve outcomes in heart failure: A pilot study protocol

Heart failure (HF) affects six million people in the U.S., is associated with high morbidity, mortality, and healthcare utilization.(1, 2) Despite a decade of innovation, the majority of interventions aimed at reducing hospitalization and readmissions in HF have not been successful.(3-7) One reason may be that most have overlooked the role of home health aides and attendants (HHAs), who are often highly involved in HF care.(8-13) Despite their contributions, studies have found that HHAs lack specific HF training and have difficulty reaching their nursing supervisors when they need urgent help with their patients. Here we describe the protocol for a pilot randomized control trial (pRCT) assessing a novel stakeholder-engaged intervention that provides HHAs with a) HF training (enhanced usual care arm) and b) HF training plus a mobile health application that allows them to chat with a nurse in real-time (intervention arm). In collaboration with the VNS Health of New York, NY, we will conduct a single-site parallel arm pRCT with 104 participants (HHAs) to evaluate the feasibility, acceptability, and effectiveness (primary outcomes: HF knowledge; HF caregiving self-efficacy) of the intervention among HHAs caring for HF patients. We hypothesize that educating and better integrating HHAs into the care team can improve their ability to provide support for patients and outcomes for HF patients as well (exploratory outcomes include hospitalization, emergency department visits, and readmission). This study offers a novel and potentially scalable way to leverage the HHA workforce and improve the outcomes of the patients for whom they care. Clinical trial.gov registration: NCT04239911.

Psychometric testing of the caregiver contribution to self-care of coronary heart disease inventory

BACKGROUND

Caregivers are important contributors to the self-care of patients with coronary heart disease (CHD).

AIMS

The aims of this study are to describe the development and psychometric properties of the caregiver contribution to self-care of coronary heart disease inventory (CC-SC-CHDI).

METHODS

The CC-SC-CHDI was developed from the patient version of the scale, the Self-care of Coronary Heart Disease Inventory (SC-CHDI) and translated into Italian using forward and backward translation. Baseline data from the HEARTS-IN-DYADS study were used. Confirmatory factor analysis (CFA) was conducted to assess factorial validity; Cronbach's alpha and the model-based internal consistency index were used to test internal consistency reliability, and Pearson's correlation coefficient was used to test convergent validity, by investigating the association between the CC-SC-CHDI and the SC-CHDI scores.

RESULTS

We included 131 caregivers (mean age 55 years, 81.2% females, 74% married) of patients affected by CHD (mean age 66 years, 80.2% males, 74% married). The CFA confirmed two factors in the caregiver contribution to self-care maintenance scale ("consulting behaviors" and "autonomous behaviors"), one factor for the CC to self-care monitoring scale, and two factors in the CC to self-care management scale ("consulting behaviors and problem-solving behaviors"). Reliability estimates were adequate for each scale (Cronbach's alpha and model-based internal consistency indexes ranging from 0.73 to 0.90). Significant and positive correlations were observed between CC-SC-CHDI and SC-CHDI scales.

CONCLUSION

The CC-SC-CHDI has satisfactory validity and reliability and can be used confidently in clinical settings and research to assess caregiver contributions to CHD self-care.

Effects of the family customised online FOCUS programme on patients with heart failure and their informal caregivers: a multicentre, single-blind, randomised clinical trial

Background

Living with heart failure can severely affect the physical and mental health of patients with heart failure and their caregivers. Available dyadic self-care interventions for heart failure are scarce, especially in China. We aimed to develop and test the family FOCUS programme.

Methods

This single-blind, randomised, controlled study was conducted at four hospitals in Tianjin, China. Patients with heart failure (aged at least 18 years) and their caregiver (dyads) were randomly assigned to either the intervention (n = 71) or control (n = 71) group in a 1:1 ratio. The primary outcomes of this study were patient self-care, with three specific dimensions (self-care maintenance, symptom perception, and self-care management), and caregiver contribution to self-care, mirroring these three dimensions. The outcomes were assessed at baseline (T0) and 4 (T1), 12 (T2), and 24 (T3) weeks post-discharge, respectively. This work is registered on ChiCTR, ChiCTR2100053168.

Findings

Between May 20, 2022, and September 30, 2022, 142 dyads with heart failure were enrolled. The intervention group exhibited dropout rates of 6%, 8.5%, and 18.3% at 4, 12, and 24 weeks after discharge, while the control group showed 9.9%, 12.3%, and 25.4%. Compared with the control group, patients in the intervention group reported improved self-care maintenance (β: 8.5, 95% CI: 0.7, 16.4) and management (β: 7.2, 95% CI: 0.1, 14.3) at T1, as well as improved symptom perception at both T1 (β: 9.7, 95% CI: 1.5, 17.9) and T2 (β: 9.6, 95% CI: 0.6, 18.6). Furthermore, caregiver contributions to self-care maintenance, self-care management, and symptom perception (excluding T3) exhibited significant improvements at all timepoints.

Interpretation

Although the significant improvements in patients' self-care were not long-lasting, this study suggested that the family FOCUS programme consistently enhanced caregivers' contributions to self-care. Future work could explore the effect of the family FOCUS programme on families with multiple chronic conditions.

Funding

The National Natural Science Foundation of China.

Self-care nursing assessment: cross-cultural adaptation and validation of the Spanish version of the Self-care of chronic illness inventory

BACKGROUND

Self-care is the primary means of caring for a chronic condition. Therefore, it is necessary to assess it by using a good validity and reliability instrument. The Self-Care of Chronic Illness Inventory (SC-CII) is a generic instrument developed to measure self-care processes behaviors using three separate scales in patients with chronic illness. The original cross-cultural assessment concluded the need for future studies sampling patients from different sites to increase the generalizability of the psychometric evaluation results. It was unclear whether this tool had sound psychometrics properties in the context of Spanish culture. The purpose of this study was to cross-culturally adapt the SC-CII, test its psychometric properties and validate its use among Spanish people with chronic diseases.

METHODS

A cross-cultural translation of the SC-CII was performed from English to Spanish. The psychometric evaluation was conducted in a sample of 350 patients with chronic conditions through a multicenter cross-sectional study based on the STROBE guideline. Data were collected from face-to-face interviews during 2022. Internal validity was assessed with Confirmatory Factor Analysis, internal consistency reliability with Cronbach alpha for unidimensional scales and McDonald's Omega reliability coefficient for multidimensional scales.

RESULTS

Most (63.4%) participants were older adults aged 65 years or older with a mean age of 65.45 ± 14.97. The average number of chronic conditions reported was 2.81%; the most common conditions were hypertension (52.3%), musculoskeletal disorders (46.3%) and diabetes (38.9%). Patients reported adequate self-care behaviors in all three scales of the SC-CII. The Self-Care Maintenance and Management scales were multidimensional, and the Self-Care Monitoring scale was unidimensional. In Confirmatory Factor Analysis, the Self-Care Maintenance and Monitoring scales had satisfactory fit indices. The Self-care Management scale had acceptable fit indices. The Omega reliability coefficient for multidimensional scales was 0.75 (Self-Care Maintenance) and 0.72 (Self-Care Management). The Cronbach alpha coefficient of the Self-Care Monitoring scale was 0.85. Item-total correlations were all significant except one. Test-retest reliability showed an intraclass correlation coefficient of 0.92.

CONCLUSIONS

The SC-CII has appropriate psychometrics characteristics and is a culturally suitable and reliable instrument for assessing to the self-care behaviors of patients with chronic disease in Spain. The scale provides a simple and rapid solution to assess the self-care process.

A Nurse-Led Model of Care with Telemonitoring to Manage Patients with Heart Failure in Primary Health Care: A Mixed-Method Feasibility Study

Purpose

To determine whether a nurse-led care model with telemonitoring in primary care for patients with stable heart failure and their caregivers is feasible and acceptable.

Patients and Methods

A mixed-methods feasibility study was conducted. Patients with stable heart failure and their caregivers were consecutively enrolled from March 2021 to April 2022. Participants were managed by nurses in a community health center through education and monitoring with a mobile app. The outcomes were feasibility outcomes, self-care outcomes, and qualitative acceptability and satisfaction. Quantitative and qualitative outcomes were linked to understanding how the model of care might benefit patients.

Results

Twenty-six patients and nine of their caregivers were enrolled. Ten participants used the mobile app. Nineteen patients and eight caregivers were interviewed. Participants who improved their self-care appreciated the help in finding coping strategies, being close to the clinic, and feeling cared for. Participants with fewer improvements in self-care perceived the model of care as useless and were far from the centre. Participants decided to use the app mainly for usefulness prevision, and most of them were satisfied.

Conclusion

The model of care was not successful in recruiting patients, and adjustments are needed to improve the recruitment strategy and to engage people who perceive the model of care as not useful or unable to use the app.

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.

A psychometrics evaluation of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory Version 2 in stroke caregivers

Objectives

To evaluate the psychometric characteristics of the Thai version of Caregiver Contribution to Self-Care (CC-SC) of Chronic Illness Inventory version 2 (CC-SC-CII-v2) in stroke caregivers.

Methods

We conducted a multicenter, cross-sectional study following the COSMIN guidelines, evaluating validity and reliability of three separate scales, CC-SC Maintenance, CC-SC Monitoring, and CC-SC Management, as well as overall CC-SC-CII-v2. From September to December 2022, we enrolled 422 stroke caregivers from primary care centers in southern Thailand. Structural validity was assessed through confirmatory factor analysis (CFA), while concurrent validity was evaluated using Pearson's correlation r coefficients between CC-SC-CII-v2 and the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC). Internal coherence reliability was assessed using Cronbach's α coefficient, the composite reliability index, and the McDonald's ω coefficient. Additionally, test-retest reliability was assessed with intraclass correlation coefficients (ICCs).

Results

The study included mostly middle-aged women who cared for their parent. CFA supported the two-factor structure of the CC-SC Maintenance and Management scales and the one-factor structure of the CC-SC Monitoring scale. A simultaneous CFA on the combined set of items supported the more general model. The concurrent validity of CC-SC-CII-v2 with CSE-CSC was established (r ranging 0.47-0.65, all P < 0.001). Reliability estimates supported adequate Cronbach's α coefficient (ranging 0.83-0.89), composite reliability (ranging 0.84-0.85), McDonald's ω coefficients (ranging 0.83-0.85), and ICCs (ranging 0.86-0.90) across the three scales.

Conclusions

The Thai CC-SC-CII-v2 demonstrated strong psychometric properties among stroke caregivers. It can be a valuable instrument to investigate the role of caregivers in contributing to stroke patients' self-care in diverse cultural contexts like Thailand.

Validity and Reliability of Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease Inventory and Caregiver Self-Efficacy in Contributing to Self-Care Scale

The study tested the construct validity and reliability of the Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease (COPD) Inventory and the Caregiver Self-Efficacy in Contributing to Self-Care of COPD Scale. The two instruments were developed by modifying the Self-Care of COPD Inventory and Self-Care Self-Efficacy Scale in COPD into caregiver versions. The psychometric properties were tested in a convenience sample of 261 informal caregivers of COPD patients recruited in Italy in two cross-sectional studies. Structural validity was tested by confirmatory factor analysis, construct validity by posing several hypotheses, and internal consistency through factor score determinacy and global reliability index for multidimensional scales. In confirmatory factor analysis, the caregiver contribution to self-care maintenance, monitoring and management scales, composing the Caregiver Contribution to Self-Care of COPD Inventory, presented good fit indices. Global reliability indices ranged 0.75-0.88. The caregiver self-efficacy scale presented a comparative fit index of 0.96 and a global reliability index of 0.82. The caregiver contribution to self-care and the caregiver self-efficacy scales correlated moderately among themselves and with the patient versions of the scales, and scores were higher with caregiver-oriented dyadic care types and female caregivers. Our study provides evidence of the two instruments' construct validity and internal consistency.

Optimising quality of life for people living with heart failure in care homes: Protocol for the co-design and feasibility testing of a digital intervention

BACKGROUND

Heart failure (HF) affects up to 64.3 million people globally. Advancements in pharmaceutical, device or surgical therapies, have led to patients living longer with HF. Heart failure affects 20% of care home residents, with these individuals presenting as older, frailer, and with more complex needs compared to those living at home. Thus, improving care home staff (e.g., registered nurse and care assistant) knowledge of HF has the potential to benefit patient care and reduce acute care utilization. Our aim is to co-design, and feasibility test, a digital intervention to improve care home staff knowledge of HF and optimise quality of life for those living with the condition in long-term residential care.

METHODS

Using a logic model, three workstreams have been identified. Workstream 1 (WS1), comprised of three steps, will inform the 'inputs' of the model. First, qualitative interviews (n = 20) will be conducted with care home staff to identify facilitators and barriers in the provision of care to people with HF. Concurrently, a scoping review will be undertaken to synthesise current evidence of HF interventions within care homes. The last step will involve a Delphi study with 50-70 key stakeholders (for example care home staff, people with HF and their family and friends) to determine key education priorities related to HF. Using data from WS1, a digital intervention to improve care home staff knowledge and self-efficacy of HF will be co-designed in workstream 2 (WS2) alongside those living with HF or their carers, HF professionals, and care home staff. Lastly, workstream 3 (WS3) will involve mixed-methods feasibility testing of the digital intervention. Outcomes include staff knowledge on HF and self-efficacy in caring for HF residents, intervention usability, perceived benefits of the digital intervention on quality of life for care home residents, and care staff experience of implementing the intervention.

DISCUSSION

As HF affects many care home residents, it is vital that care home staff are equipped to support people living with HF in these settings. With limited interventional research in this area, it is envisaged that the resulting digital intervention will have relevance for HF resident care both nationally and internationally.

Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial

In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely.

Better Preparation and Training Determine Home Care Workers' Self-Efficacy in Contributing to Heart Failure Self-Care

OBJECTIVE

Identify determinants of home care workers' (HCW) self-efficacy in contributing to heart failure (HF) self-care.

METHODS

Secondary analysis of a survey (n = 328) examining characteristics of HCWs caring for adults with HF in New York. Self-efficacy assessed using Caregiver Self-Efficacy in Contributing to Self-Care Scale. Standardized scores range 0-100; ≥ 70 points indicate adequate self-efficacy. Characteristics determined by self-efficacy (low vs. adequate). Prevalence ratios with 95% confidence intervals (PR [95% CI]) were estimated using multivariable Poisson regression with robust standard errors.

RESULTS

Home care workers with adequate self-efficacy had at least some prior HF training (55% vs. 17%, p < .001) and greater job satisfaction (90% vs. 77%, p = .003). Significant determinants for adequate self-efficacy were employment length (1.02 [1.00-1.03], p = .027), preparation for caregiving (3.10 [2.42-3.96], p < .001), and HF training (1.48 [1.20-1.84], p < .001).

CONCLUSION

Home care agencies and policy-makers can target caregiving preparation and HF training to improve HCWs' confidence in caring for adult HF patients.

Examining how congruence in and satisfaction with dyadic care type appraisal contribute to quality of life in heart failure care dyads

AIMS

Given the complexity of heart failure (HF) management, persons with HF and their informal caregivers often engage in dyadic illness management. It is unknown how congruent appraisal of dyadic HF care type is associated with dyadic health. Our aim was to examine how congruence in and satisfaction with appraisal of dyadic HF care type contribute to quality of life (QOL) for dyads.

METHODS AND RESULTS

This is a secondary analysis of cross-sectional data on 275 HF care dyads (patients 45.1% female, caregivers 70.5% female). Congruent appraisal and satisfaction were assessed using the Dyadic Symptom Management Type instrument. Quality of life was measured using the Short Form-12. Multilevel dyadic models were estimated to examine the contribution of congruence and satisfaction with dyadic care type to physical and mental QOL. Congruent appraisal of dyadic care type was positively associated with caregivers' mental QOL (B = 2.69, P = 0.026). Satisfaction with dyadic care type was positively associated with physical and mental QOL for persons with HF (B = 1.58, P = 0.011 and B = 2.09, P = 0.002, respectively) and informal caregivers (B = 1.70, P = 0.004 and B = 2.90, P < 0.001, respectively), while controlling for age, New York Heart Association class, daily hours spent together, relationship type, and congruence with dyadic care type.

CONCLUSION

Satisfaction with dyadic care type appraisal was a stronger contributor to QOL for HF care dyads, compared with congruent appraisals. It is important to understand reasons for dissatisfaction within the dyad to assist dyad members in reaching shared appraisals while managing HF.

Factors Related to Patients' Self-care and Self-care Confidence in Korean Patients With Heart Failure and Their Caregivers: A Cross-sectional, Correlational Study

BACKGROUND

The relationships of patient factors and caregiver contribution to patients' self-care to different types of self-care have been rarely examined in Korean patients with heart failure.

OBJECTIVE

The aim of this study was to examine patient (ie, age, depressive symptoms, and self-care confidence) and caregiver (ie, caregiver contribution to self-care maintenance and self-care management, and caregiver confidence in contributing to self-care) factors related to different types of self-care (ie, self-care maintenance, symptom perception, and self-care management) and self-care confidence in Korean patients with heart failure.

METHODS

In this cross-sectional, correlational study, data from 41 pairs of patients (mean age, 68.0 years) and caregivers (mean age, 54.1 years) were collected and analyzed using multiple regression.

RESULTS

Higher levels of self-care confidence in patients were related to higher levels of self-care maintenance in patients. Higher levels of self-care confidence in patients were related to higher levels of symptom perception. Higher levels of self-care confidence in patients and caregiver contribution to self-care maintenance were related to higher levels of self-care management. Less severe depressive symptoms in patients and higher levels of caregiver confidence in contributing to self-care were related to higher levels of self-care confidence.

CONCLUSION

Different patient and caregiver factors were related to different types of self-care and self-care confidence in Korean patients, but patients' self-care confidence was related to all types of self-care. Clinicians and researchers need to develop and deliver effective interventions to both patients and their caregivers to improve patients' self-care confidence and, in turn, self-care, considering different factors associated with each type of self-care.

The Influence of Informal Caregivers' Preparedness on Psychological Symptoms and Quality of Life Among Patients With Heart Failure And Insufficient Self-care

BACKGROUND

Most patients with heart failure find self-care difficult to perform and rely on family caregivers for support. Informal caregivers, however, often face insufficient psychological preparation and challenges in providing long-term care. Insufficient caregiver preparedness not only results in psychological burden for the informal caregivers but may also lead to a decline in caregiver contributions to patient self-care that affects patient outcomes.

OBJECTIVE

Our objective was to test (1) the association of baseline informal caregivers' preparedness with psychological symptoms (anxiety and depression) and quality of life 3 months after baseline among patients with insufficient self-care and (2) the mediating effects of caregivers' contributions to self-care of heart failure (CC-SCHF) on the relationship of caregivers' preparedness with patients' outcomes at 3 months.

METHODS

A longitudinal design was used to collect data between September 2020 and January 2022 in China. Data analyses were conducted using descriptive statistics, correlations, and linear mixed models. We used model 4 of the PROCESS program in SPSS with bootstrap testing to evaluate the mediating effect of CC-SCHF of informal caregivers' preparedness at baseline with psychological symptoms or quality of life among patients with HF 3 months later.

RESULTS

Caregiver preparedness was positively associated with CC-SCHF maintenance (r = 0.685, P < .01), CC-SCHF management (r = 0.403, P < .01), and CC-SCHF confidence (r = 0.600, P < .01). Good caregiver preparedness directly predicted lower psychological symptoms (anxiety and depression) and higher quality of life for patients with insufficient self-care. The associations of caregiver preparedness with short-term quality of life and depression of patients with HF with insufficient self-care were mediated by CC-SCHF management.

CONCLUSIONS

Enhancing the preparedness of informal caregivers may improve psychological symptoms and quality of life of heart failure patients with insufficient self-care.

Effectiveness of Motivational Interviewing on contribution to self-care, self-efficacy, and preparedness in caregivers of patients with heart failure: a secondary outcome analysis of the MOTIVATE-HF randomized controlled trial

AIMS

Caregiver characteristics and behaviours are associated with patients' and caregivers' outcomes. However, there is scarce evidence on interventions aimed at improving caregiver contribution (CC) to patient self-care, caregiver self-efficacy, and caregiver preparedness in heart failure (HF). This study aims to evaluate the effect of Motivational Interviewing (MI) on CC to patient self-care, caregiver self-efficacy, and caregiver preparedness in HF.

METHODS AND RESULTS

This is a secondary outcome analysis of MOTIVATE-HF randomized controlled trial. Caregivers of patients with HF were randomized into three arms: Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard care). The intervention consisted of one MI session plus three telephone contacts. Data were collected at baseline and after 3, 6, 9, and 12 months. A total of 510 patient and caregiver (median age 54 years, 76% females) dyads were enrolled, 235 caregivers and 238 patients completed the study until 12 months. Caregiver contribution to self-care maintenance and management and caregiver preparedness significantly improved over time, but without significant differences among the three arms. At 9 months, caregiver self-efficacy improved more in Arm 2 than Arm 3 [difference: 8.36, 95% confidence interval (CI) (3.13; 13.59), P = 0.001]. This improvement remained significant also at linear mixed model [β^ = 1.39, 95% CI (0.02; 2.75), P = 0.046].

CONCLUSION

Motivational Interviewing did not improve CC to patient self-care and caregiver preparedness. However, it increased caregiver self-efficacy, which is known to be a powerful mediator of CC to self-care.

REGISTRATION

Clinicaltrials.gov: NCT02894502.

The adaptation to Turkish of the caregiver contributions to selfcare of heart failure index: a validity and reliability study

Objective: Although heart failure is a chronic and progressive disease, it is also a disease that requires the patient and caregivers who are not healthcare professionals to spend many years together in the process of follow-up, treatment, and care. Correct evaluation of the patient and caregiver in this process is one of the most important points that will guide the process. The aim of this study was to conduct a validity and reliability study of the Turkish version of the Caregiver Contributions to Self-Care of Heart Failure Index v.2- (CC-SCHFI) and to determine the contributions of caregivers of patients with heart failure. Material and Method: The study sample was formed of the caregivers of patients who presented at a training and research hospital with a diagnosis of heart failure, who voluntarily agreed to participate in the research. Data were collected using a Personal Information Form and the CC-SCHFI. For the reliability study of the language adaptation of the CC-SCHFI, the internal consistency coefficient and the item-total points reliability coefficient were used, and to determine structure validity, Explanatory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were applied. Results: The cultural adaptation to Turkish of the CC-SCHFI was found to be high. In the validity and reliability study, the structure validity and internal consistency were high and it was concluded that the scale could be used under the sub-dimension headings of “Recommendations for Protection”, “The Role of the Caregiver in Treatment Compliance”, and “Caregiver Practices”.

Factors associated with caregivers' contribution to self-care in heart failure

OBJECTIVE

to analyze the caregiver's contribution to self-care in heart failure and the predictor variables of this contribution.

METHOD

a cross-sectional descriptive and analytical study, with the participation of 140 dyads (patients and caregivers). The contribution to self-care was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index. Caregivers and patients were interviewed separately to obtain the data. Multiple linear regressions were used to verify predictor variables of caregiver contribution.

RESULTS

the mean score for contribution to maintenance self-care was 62.7 (SD=7.1), for management, 62.9 (SD=20.4) and for confidence was 63.3 (SD=22.1). The variables number of patient's medications, caregiver being related to the patient, social perception of caregiver, health-related quality of life of the patient and caregiver's confidence in contributing to self-care were predictors of caregiver's contribution to maintenance or management self-care.

CONCLUSION

the caregiver's contribution was insufficient. The social support perceived by the caregiver, the type of relationship the caregiver to the patient, the number of medications used by the patient, as well as the caregiver's confidence in contributing to self-care are variables that should be considered to assess the risk of insufficient contribution of the caregiver.

Effectiveness of a family customised online FOCUS programme aimed on building resiliency in dyad relationship to support dyadic illness management in persons with heart failure and their informal caregiver: a randomised clinical trial protocol

INTRODUCTION

Living with heart failure (HF), is a shared journey and arduous work for patients and their informal family caregivers. Given the key role and limited evidence of dyad illness management in improving dyad health in the context of HF, we developed a customisable, relationship focused, family online dynamic disease management programme-FOCUS programme-to improve dyad health for HF patients and their informal caregivers in China.

METHODS AND ANALYSIS

Based on the Theory of Dyadic Illness Management and the Systemic Transactional Model of Stress and Coping, the family customised online FOCUS programme has five modules: (1) family participatory; (2) open communication; (3) coping effectiveness; (4) uncertainty reduction and 5) shared dyad life stories. HF family dyads will be recruited in the cardiology wards of four university-affiliated hospitals in China. The dyads (N=142) will be randomly allocated to the intervention group that will receive the family customised online FOCUS programme, and the attention control group that will not receive elements of the FOCUS programme. Dyadic coping, HF somatic perception, self-care, anxiety and depression for patients and family caregivers and all-cause mortality and hospital admission for patients will be measured at baseline, 4 weeks (after the discharge, T1), 12 weeks (after the discharge, T2) and 24 weeks (after the discharge, T3). Statistical analysis will be performed using SPSS V. 22.0 software.

ETHICS AND DISSEMINATION

The study protocol was approved by the ethics committees of Tianjin Medical University (Reference number TMUHEC2019002) that covers all the centres enrolled in this study. The findings of this study will be published in scientific journals and will be presented at scientific conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2100053168.

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.

Symptom Recognition as a Mediator in the Self-Care of Chronic Illness

Background

The recognition of a symptom is needed to initiate a decision to engage in a behavior to ameliorate the symptom. Yet, a surprising number of individuals fail to detect symptoms and delay in addressing early warnings of a health problem.

Purpose

The aim of this study was to test the hypothesis that symptom recognition mediates the relationship between monitoring for and management of symptoms of a chronic illness.

Methods

A secondary analysis of existing cross-sectional data. A sample of 1,629 patients diagnosed with one or more chronic conditions was enrolled in the United States (US) (n = 407), Italy (n = 784) and Sweden (n = 438) between March 2015 and May 2019. Data on self-care monitoring, symptom recognition, and self-care management was assessed using the Self-Care of Chronic Illness Inventory. After confirming metric invariance in cultural assessment, we used structural equation modeling to test a mediation model where symptom recognition was conceptualized as the mediator linking self-care monitoring and self-care management with autonomous (e.g., Change your activity level) and consulting behaviors (e.g., Call your healthcare provider for guidance).

Results

Symptom recognition mediated the relation between self-care monitoring and autonomous self-care management behaviors (β = 0.098, β = 0.122, β = 0.081, p < 0.001 for US, Italy, and Sweden, respectively). No mediation effect was found for consulting self-care management behaviors.

Conclusion

Our findings suggests that symptom recognition promotes autonomous self-care behaviors in people with a chronic condition. Self-care monitoring directly affects consulting self-care management behaviors but not through symptom recognition. Further research is needed to fully understand the role of symptom recognition in the self-care process.

Heart failure readmission reductions during the COVID-19 pandemic

Behaviors, treatments, and self-management strategies used by patients and caregivers at home.

Factores asociados a la contribución de los cuidadores para el autocuidado de la insuficiencia cardiaca

Resumen Objetivo: analizar la contribución del cuidador para el autocuidado en la insuficiencia cardiaca y las variables predictoras de esa contribución. Método: estudio transversal descriptivo y analítico, con la participación de 140 díadas (pacientes y cuidadores). La contribución para el autocuidado fue evaluada por medio del Caregiver Contribution to Self-Care of Heart Failure Index. Los cuidadores y pacientes fueron entrevistados separadamente para obtención de los datos. La regresión linear múltiple fue utilizada para verificar variables predictoras de la contribución del cuidador. Resultados: la puntuación media de contribución para el autocuidado de manutención fue 62,7 (DE=7,1), de administración fue 62,9 (DE=20,4) y de confianza fue 63,3 (DE=22,1). Las variables: número de medicamentos del paciente, cuidador tener parentesco con el paciente, percepción social del cuidador, calidad de vida relacionada a la salud del paciente y la confianza del cuidador en la contribución para el autocuidado, fueron predictoras de la contribución del cuidador para el autocuidado de manutención o de administración. Conclusión: la contribución del cuidador fue insuficiente. El apoyo social percibido por el cuidador, el cuidador tener o no parentesco con el paciente, el número de medicamentos utilizados por el paciente y la confianza del cuidador en contribuir para el autocuidado, son variables que deben ser consideradas para evaluar el riesgo de contribución insuficiente del cuidador.

Factors associated with caregivers’ contribution to self-care in heart failure

Objective:

to analyze the caregiver’s contribution to self-care in heart failure and the predictor variables of this contribution.

Method:

a cross-sectional descriptive and analytical study, with the participation of 140 dyads (patients and caregivers). The contribution to self-care was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index. Caregivers and patients were interviewed separately to obtain the data. Multiple linear regressions were used to verify predictor variables of caregiver contribution.

Results:

the mean score for contribution to maintenance self-care was 62.7 (SD=7.1), for management, 62.9 (SD=20.4) and for confidence was 63.3 (SD=22.1). The variables number of patient’s medications, caregiver being related to the patient, social perception of caregiver, health-related quality of life of the patient and caregiver’s confidence in contributing to self-care were predictors of caregiver’s contribution to maintenance or management self-care.

Conclusion:

the caregiver’s contribution was insufficient. The social support perceived by the caregiver, the type of relationship the caregiver to the patient, the number of medications used by the patient, as well as the caregiver’s confidence in contributing to self-care are variables that should be considered to assess the risk of insufficient contribution of the caregiver.

Cross-cultural adaptation and validation of the caregiver contribution to self-care of chronic illness inventory in China: a cross-sectional study

OBJECTIVE

Caregiver contribution (CC) is important for the self-care behaviors of chronic disease individuals, as it could enhance patient outcomes. Therefore, it is necessary to assess this CC by using a good validity and reliability instrument. The Caregiver Contribution to Self-Care Chronic Illness Inventory (CC-SC-CII) was designed to assess CC to self-care behaviors of patients with chronic illness in Italy. However, it was unclear whether this tool had sound psychometrics properties in the context of Chinese culture. Therefore, we performed the cross-cultural adaption of the CC-SC-CII and we tested its psychometric properties among Chinese caregivers of patients with chronic disease.

DESIGN

A cross-sectional observational design.

SETTINGS

Participants were recruited from communities and institutions in Pingdingshan, Henan Province, China.

PARTICIPANTS

301 caregivers of care recipients with chronic disease completed the Chinese version of the CC-SC-CII (C-CC-SC-CII).

PRIMARY AND SECONDARY OUTCOME MEASURES

The content validity index of items (I-CVI), the scale content validity index-average (S-CVI/Ave), exploratory factor analysis, confirmatory factor analysis (CFA), internal consistency and item analysis were tested.

RESULTS

The range of I-CVI was between 0.833 and 1.00, and the score of S-CVI was 0.991. In CFA, the C-CC to self-care monitoring scale had satisfactory fit indices. However, the C-CC to self-care maintenance and management scales had unsupported fit indices. The reliability coefficients of C-CC-SC-CII were 0.792, 0.880 and 0.870 for its three scales. Item-total correlations were all over 0.590. Test-retest reliability showed that the range of intraclass correlation coefficients was from 0.728 to 0.783.

CONCLUSION

The C-CC-SC-CII has sound psychometrics characteristics and is a culturally appropriate and reliable instrument for assessing CC to the self-care behaviours of patients with chronic disease in China.

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.

SYMPERHEART: an intervention to support symptom perception in persons with heart failure and their informal caregiver: a feasibility quasi-experimental study protocol

INTRODUCTION

Symptom perception in heart failure (HF) has been identified as crucial for effective self-care, and is related to patient and health system outcomes. There is uncertainty regarding the feasibility and acceptability of symptom perception support and doubts regarding how to include informal caregivers. This study aims to test the feasibility, acceptability and outcome responsiveness of an intervention supporting symptom perception in persons with HF and their informal caregiver.

METHODS AND ANALYSIS

A feasibility study with a quasi-experimental pretest and post-test single group design is conducted. The convenience sample consists of 30 persons with HF, their informal caregivers and six nurses. SYMPERHEART is an evidence-informed intervention that targets symptom perception by educational and support components. Feasibility is measured by time-to-recruit; time-to-deliver; eligibility rate; intervention delivery fidelity rate. Acceptability is measured by rate of consent, retention rate, treatment acceptability and the engagement in the intervention components. Outcome responsiveness includes: HF self-care (via the Self-care of Heart Failure Index V.7.2); perception of HF symptom burden (via the Heart Failure Somatic Perception Scale V.3); health status (via the Kansas City Cardiomyopathy Questionnaire-12); caregivers' contribution to HF self-care (via the Caregiver Contribution to Self-Care of Heart Failure Index 2); caregivers' burden (via the Zarit Burden Interview). Clinical outcomes include HF events, hospitalisation reason and length of hospital stay. Descriptive statistics will be used to report feasibility, acceptability, patient-reported outcomes (PRO) and clinical outcomes. PRO and caregiver-reported outcome responsiveness will be reported with mean absolute change and effect sizes.

ETHICS AND DISSEMINATION

The study is conducted according to the Declaration of Helsinki. The Human Research Ethics Committee of the Canton of Vaud, Switzerland, has approved the study. Written informed consent from persons with HF and informal caregivers are obtained. Results will be published via peer reviewed and professional journals, and further disseminated via congresses.

TRIAL REGISTRATION NUMBER

ISRCTN18151041.

A psychometric evaluation of the Caregiver Contribution to Self-Care of Heart Failure Index in a Thai population

BACKGROUND

Caregivers are major contributor to the self-care of patients with heart failure. The Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI) measures these contributions across three scales: self-care maintenance (symptom monitoring and treatment adherence); self-care management (dealing with symptoms); and confidence in contributing to the self-care (self-efficacy in managing self-care) of patients with heart failure. Informal caregivers play a vital role in supporting family members with heart failure in Thailand, yet no validated tool exists to measure their contribution. We examined the psychometric properties of the CC-SCHFI in a Thai population.

METHODS

The CC-SCHFI was translated into Thai using a standard forward and backward translation procedure. A cross-sectional design was used to examine the psychometric properties of the Thai version of the CC-SCHFI in 100 family caregivers of heart failure patients in Southern Thailand. Confirmatory factor analysis was used to assess construct validity, and factor score determinacy coefficients were computed to evaluate internal consistency reliability.

RESULTS

The Thai version of the CC-SCHFI demonstrated acceptable internal consistency (composite reliability of each scale ranged from 0.76 to 0.99). Reliability estimates were adequate for each scale (McDonald's omega ranged from 0.75 to 0.96). Confirmatory factor analysis supported the original factor structure of the instrument, with good fit indices for all three scales (comparative fit index = 0.98-1.00; root-mean-square error of approximation = 0.00-0.07).

CONCLUSIONS

The Thai version of the CC-SCHFI appears to be a valid and reliable instrument for measuring caregiver contributions to self-care maintenance and self-care management as well as contributing to caregiver confidence in the self-care of Thai heart failure patients.

The influence of dyadic congruence and satisfaction with dyadic type on patient self-care in heart failure

BACKGROUND

Chronic illness management is increasingly carried out at home by individuals and their informal caregivers (dyads). Although synergistic in concept, the nuances of dyadic congruence in caring for patients with heart failure are largely unexamined.

AIMS

The purpose of this study was to examine the role of dyadic-type congruence on patient self-care (maintenance, symptom perception, and management) while controlling for actor and partner effects.

METHODS

This secondary data analysis of 277 dyads consisted of a series of multilevel models to examine the impact of dyadic congruence on a patient's self-care maintenance, symptom perception, and self-care management. Patient-level and caregiver-level data were input into each model simultaneously to account differential appraisals of factors related to the dyad.

RESULTS

Bivariate analyses yielded dyad congruence which was associated with better patient self-care maintenance, symptom perception and management. However, after multilevel models were constructed, dyad congruence was found to be a significant predictor of patient's symptom perception scores, but not self-care maintenance or management scores. Caregiver's satisfaction with the dyad was differentially and significantly associated with self-care - it was inversely associated with patient self-care maintenance and positively associated with patient self-care management.

CONCLUSION

This is the first study, to our knowledge, reporting that congruence in heart failure dyads is associated with better patient symptom perception and this advances our prior hypothesis that dyad typologies could be used to predict patient self-care performance. Since symptom perception is the key to preventing heart failure exacerbation, screening heart failure patient and caregiver dyads for congruence is important in clinical settings.

Using an Electronic App to Promote Home-Based Self-Care in Older Patients With Heart Failure: Qualitative Study on Patient and Informal Caregiver Challenges

Background

Heart failure (HF) affects many older individuals in North America, with recurrent hospitalizations despite postdischarge strategies to prevent readmission. Proper HF self-care can potentially lead to better clinical outcomes, yet many older patients find self-care challenging. Mobile health (mHealth) apps can provide support to patients with respect to HF self-care. However, many mHealth apps are not designed to consider potential patient barriers, such as literacy, numeracy, and cognitive impairment, leading to challenges for older patients. We previously demonstrated that a paper-based standardized diuretic decision support tool (SDDST) with daily weights and adjustment of diuretic dose led to improved self-care.

Objective

The aim of this study is to better understand the self-care challenges that older patients with HF and their informal care providers (CPs) face on a daily basis, leading to the conversion of the SDDST into a user-centered mHealth app.

Methods

We recruited 14 patients (male: 8/14, 57%) with a confirmed diagnosis of HF, aged ≥60 years, and 7 CPs from the HF clinic and the cardiology ward at the Hamilton General Hospital. Patients were categorized into 3 groups based on the self-care heart failure index: patients with adequate self-care, patients with inadequate self-care without a CP, or patients with inadequate self-care with a CP. We conducted semistructured interviews with patients and their CPs using persona-scenarios. Interviews were transcribed verbatim and analyzed for emerging themes using an inductive approach.

Results

Six themes were identified: usability of technology, communication, app customization, complexity of self-care, usefulness of HF-related information, and long-term use and cost. Many of the challenges patients and CPs reported involved their unfamiliarity with technology and the lack of incentive for its use. However, participants were supportive and more likely to actively use the HF app when informed of the intervention’s inclusion of volunteer and nurse assistance.

Conclusions

Patients with varying self-care adequacy levels were willing to use an mHealth app if it was simple in its functionality and user interface. To promote the adoption and usability of these tools, patients confirmed the need for researchers to engage with end users before developing an app. Findings from this study can be used to help inform the design of an mHealth app to ensure that it is adapted for the needs of older individuals with HF.

The Self-Care of Heart Failure Index version 7.2: Further psychometric testing

Clinicians and researchers need valid and reliable instruments to evaluate heart failure (HF) self-care. The Self-Care of Heart Failure Index (SCHFI) is a theoretically driven instrument developed for this purpose. The SCHFI measures self-care with three scales: self-care maintenance, measuring behaviors to maintain HF stability; symptom perception, measuring monitoring behaviors; and self-care management, assessing the response to symptoms. After the theory underpinning the SCHFI was updated, the instrument was updated to version 7.2 but it was only tested in the United States. In this study we tested the psychometric characteristics (structural and construct validity, internal consistency, and test-retest reliability) of the SCHFI v.7.2 in an Italian population of HF patients. We used a cross-sectional design to study 280 HF patients with additional data collected after 2 weeks for test-retest reliability. Adults with HF (mean age 75.6 (±10.8); 70.8% in New York Heart Association [NYHA] classes II and III) were enrolled from six centers across Italy. Confirmatory factor analysis showed supportive structural validity in the three SCHFI v.7.2 scales (CFI from 0.94 to 0.95; RMSEA from 0.05 to 0.07). Internal consistency reliability estimated with Cronbach's α and composite reliability ranged between .73 and .88; test-retest reliability ranged between 0.73 and 0.92. Construct validity was supported with significant correlations between the SCHFI v.7.2 scale scores and quality of life, brain natriuretic peptide levels and NYHA class. This study further supports the psychometric characteristics of the SCHFI v.7.2, illustrating that it can be used in clinical practice and research also in an Italian population.

Psychometric characteristics of the caregiver contribution to self-care of chronic illness inventory

AIM

The purpose of the this study was to test the factorial structure, internal consistency reliability and concurrent validity of the Caregiver Contribution to Self-Care Chronic Illness Inventory.

BACKGROUND

Existing measures of caregiver contribution to self-care are disease-specific or behaviour-specific; no generic measures exist.

DESIGN

A cross-sectional study.

METHOD

Between April 2017 - December 2018, we enrolled a convenience sample of 358 patients with chronic illnesses and their caregivers. Patients completed the Self-Care of Chronic Illness Inventory while caregivers completed the Caregiver Contribution to Self-Care of Chronic Illness Inventory, a modification of the Self-Care of Chronic Illness Inventory, which includes three scales as follows: the Caregiver Contribution to Self-Care Maintenance, the Caregiver Contribution to Self-Care Monitoring and the Caregiver Contribution to Self-Care Management. Of each scale, we tested the factorial structure with confirmatory factor analysis and reliability with the factor score determinacy coefficient, the global reliability index for multidimensional scale and Cronbach's alpha. Also, we used Pearson's correlations for concurrent validity purposes.

RESULTS

Confirmatory factor analysis supported the two-factor structure of the Caregiver Contribution to Self-Care Maintenance and Management scales and the one-factor structure of the Caregiver Contribution to Self-Care Monitoring scale. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model (Comparative Fit Index = 0.933). Reliability estimates ranged between 0.701 and 0.961 across the three scales. Concurrent validity of Caregiver Contribution to Self-Care of Chronic Illness Inventory with the Self-Care of Chronic Illness Inventory was not sufficiently supported since weak correlations were found.

CONCLUSION

The Caregiver Contribution to Self-Care of Chronic Illness Inventory is valid and reliable and can be used in clinical practice and research.

IMPACT

The Caregiver Contribution to Self-Care of Chronic Illness Inventory is an useful instrument to evaluate the extent to which caregivers contribute to patient self-care in chronic illnesses.