Home care workers in heart failure: a systematic review

Historical Gaps in the Integration of Patient-Centric Self-Management Components in HFrEF Interventions: An Umbrella Narrative Review

Background: Chronic disease self-management (CDSM) interventions have shown promise in improving patient outcomes in heart failure (HF), particularly for those with reduced ejection fraction (HFrEF). Patient-centric self-management programs often incorporate key components such as education, self-monitoring, and goal setting. However, the extent to which these components are consistently reported and integrated into studies remains unclear. This umbrella narrative review aims to analyze systematic reviews to assess the consistency of reporting on patient-centric self-management components implemented in trials and studies. Methods: This umbrella narrative review synthesized findings from systematic reviews and meta-analyses published between 2000 and 2023 for CDSM tools in HF. Eligible studies were assessed for the presence and consistency of reporting on education, self-monitoring, and goal setting in self-management interventions for HFrEF. Data extraction focused on the frequency of reporting these components and the gaps in reporting long-term patient outcomes. Results: Among the included systematic reviews, education was the most consistently reported component (100%), while self-monitoring and goal setting were each reported in around 50% of studies. Reporting of long-term outcomes, such as mortality and quality of life, was highly variable and often absent. These inconsistencies highlight significant gaps in the evidence base for CDSM interventions. Conclusions: This review identifies gaps in the consistent reporting of key CDSM components in systematic reviews of HFrEF interventions. The inconsistent inclusion of all three components together and limited reporting of long-term outcomes may hinder the development of a robust evidence base for the adoption of these tools in HF guidelines. Future studies should prioritize comprehensive reporting to strengthen the foundation for patient-centric self-management strategies in HF care. PROSPERO registration number CRD42023431539.

Homecare workers needs and experiences in end of life care: rapid review

BACKGROUND

Social homecare workers provide essential care to those living at home at the end of life. In the context of a service experiencing difficulties in attracting and retaining staff, we have limited knowledge about the training, support needs and experiences of this group.

AIM

To gain a timely understanding from the international literature of the experience, training and support needs of homecare workers providing end-of-life care.

METHODS

We conducted a rapid review and narrative synthesis using the recommendations of the Cochrane Rapid Reviews Methods Group. Building on a previous review, social homecare worker and end-of-life search terms were used to identify studies. Quality appraisal was conducted using a multimethods tool.

DATA SOURCES

CINAHL and Medline databases (2011-2023; English language).

RESULTS

19 papers were included representing 2510 participants (91% women) providing new and deeper insights. Four themes were generated: (1) emotional support; homecare workers need to manage complex and distressing situations, navigating their own, their clients' and clients' family, emotions; (2) interaction with other social and healthcare workers; homecare workers are isolated from, and undervalued and poorly understood by the wider healthcare team; (3) training and support; recognising the deteriorating client, symptom management, practicalities around death, communications skills and supervision; (4) recognising good practice; examples of good practice exist but data regarding effectiveness or implementation of interventions are scant.

CONCLUSIONS

Social homecare workers are essential for end-of-life care at home but are inadequately trained, often isolated and underappreciated. Our findings are important for policy-makers addressing this crucial challenge, and service providers in social and healthcare.

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.

The impact of home care on individuals with chronic heart failure: A comprehensive review

BACKGROUND

Heart failure is a widespread condition linked to elevated mortality rates, readmission incidents, and healthcare expenditures. Home care has emerged as a promising strategy for managing patients with heart failure. This study seeks to comprehensively review the impact of home care on individuals diagnosed with heart failure.

METHODS

A comprehensive review was conducted by searching for relevant articles in Persian and English using keywords such as 'Nursing,' 'Home care,' 'Home care services,' Health Care Costs,' 'Heart diseases,' and 'Heart failure' across various databases including SID, Magiran, Ovid, Scopus, Web of Science, CINAHL, ProQuest, Embase and Medline. The search was limited to articles published between 2000 and 2023, focusing on those suitable for the study's purpose.

RESULTS

A total of 1,260 articles were initially identified. After eliminating duplicate and irrelevant articles, evaluating the availability of full texts, and applying entry and exit criteria, as well as utilizing the CONSORT, STROBE checklist, and JBI Checklist for qualitative assessment of the studies, a total of 13 English articles were deemed suitable for inclusion in the final review. These studies utilized various study designs to investigate the effects of home care on patients with heart failure.

CONCLUSION

The findings of this study suggest that home care has a positive impact on the quality of life, knowledge, and self-care of patients with heart failure. Additionally, it has been shown to reduce healthcare costs, readmission rates, and mortality. Therefore, it is recommended to prioritize home care for patients with chronic heart failure following discharge.

An evidence map of systematic reviews on models of outpatient care for patients with chronic heart diseases

BACKGROUND

Chronic heart disease affects millions of people worldwide and the prevalence is increasing. By now, there is an extensive literature on outpatient care of people with chronic heart disease. We aimed to systematically identify and map models of outpatient care for people with chronic heart disease in terms of the interventions included and the outcomes measured and reported to determine areas in need of further research.

METHODS

We created an evidence map of published systematic reviews. PubMed, Cochrane Library (Wiley), Web of Science, and Scopus were searched to identify all relevant articles from January 2000 to June 2021 published in English or German language. From each included systematic review, we abstracted search dates, number and type of included studies, objectives, populations, interventions, and outcomes. Models of care were categorised into six approaches: cardiac rehabilitation, chronic disease management, home-based care, outpatient clinic, telemedicine, and transitional care. Intervention categories were developed inductively. Outcomes were mapped onto the taxonomy developed by the COMET initiative.

RESULTS

The systematic literature search identified 8043 potentially relevant publications on models of outpatient care for patients with chronic heart diseases. Finally, 47 systematic reviews met the inclusion criteria, covering 1206 primary studies (including double counting). We identified six different models of care and described which interventions were used and what outcomes were included to measure their effectiveness. Education-related and telemedicine interventions were described in more than 50% of the models of outpatient care. The most frequently used outcome domains were death and life impact.

CONCLUSION

Evidence on outpatient care for people with chronic heart diseases is broad. However, comparability is limited due to differences in interventions and outcome measures. Outpatient care for people with coronary heart disease and atrial fibrillation is a less well-studied area compared to heart failure. Our evidence mapping demonstrates the need for a core outcome set and further studies to examine the effects of models of outpatient care or different interventions with adjusted outcome parameters.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42020166330).

A systematic review on clinical guidelines of home health care in heart failure patients

BACKGROUND

"Guidelines for the care of heart failure patients at home support safe and effective evidence-based practice. The aims of the present study were: [1] to identify guidelines addressing the care at home for adults with heart failure and [2] evaluate the quality of the guidelines and the extent to which they address eight components of home-based HF disease management."

METHODS

A systematic review was conducted of articles published between 1st of January 2000 to 17th of May 2021 using the databases of PubMed, Web of Science, Scopus, Embase, Cochrane, and nine specific websites for guideline development organisations. Clinical guidelines for HF patients with recommendations relevant to care provision at home were included. The results were reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA-2020) criteria. The quality of included guidelines was evaluated using the Appraisal of Guidelines for Research and Evaluation-II (AGREE-II) by two authors independently. Guidelines were evaluated for their coverage of eight components of HF care at home, consisting of integration, multi-disciplinary care, continuity of care, optimized treatment, patient education, patient and partner participation, care plans with clear goals of care, self-care management and palliative care.

RESULTS

Ten HF guidelines, including two nursing-focused guidelines and eight general guidelines were extracted from 280 studies. After evaluation of quality by AGREE-II, two guidelines obtained the highest score: "NICE" and the "Adapting HF guideline for nursing care in home health care settings. Five guidelines addressed all eight components of care at home while the others had six or seven.

CONCLUSIONS

This systematic review identified ten guidelines addressing care at home for patients with HF. The highest quality guidelines most relevant to the care at home of patients with HF are the "NICE" and "Adapting HF guideline for nursing care in home health care settings" and would be most appropriate for use by home healthcare nurses.

Understanding the Technological Landscape of Home Health Aides: Scoping Literature Review and a Landscape Analysis of Existing mHealth Apps

BACKGROUND

Home health aides (HHAs) provide necessary hands-on care to older adults and those with chronic conditions in their homes. Despite their integral role, HHAs experience numerous challenges in their work, including their ability to communicate with other health care professionals about patient care while caring for patients and access to educational resources. Although technological interventions have the potential to address these challenges, little is known about the technological landscape and existing technology-based interventions designed for and used by this workforce.

OBJECTIVE

We conducted a scoping review of the scientific literature to identify existing studies that have described, designed, deployed, or tested technology-based tools and apps intended for use by HHAs to care for patients at home. To complement our literature review, we conducted a landscape analysis of existing mobile apps intended for HHAs providing in-home care.

METHODS

We searched the following databases from their inception to October 2020: Ovid MEDLINE, Ovid Embase, Cochrane Library, and CINAHL (EBSCO). A total of 3 researchers screened the yield using prespecified inclusion and exclusion criteria. In addition, 4 researchers independently reviewed these articles, and a fifth researcher arbitrated when needed. Among studies that met the inclusion criteria, data were extracted and summarized narratively. An analysis of mobile health apps designed for HHAs was performed using a predefined set of terms to search Google Play and Apple App stores. Overall, 2 researchers independently screened the resulting apps, and those that met the inclusion criteria were categorized according to their intended purpose and functionality.

RESULTS

Of the 8643 studies retrieved, 182 (2.11%) underwent full-text review, and 4.9% (9/182) met our inclusion criteria. Approximately half (4/9, 44%) of the studies were descriptive in nature, proposing technology-based systems (eg, web portals and dashboards) or prototypes without a technical or user-based evaluation of the technology. In most (7/9, 78%) papers, HHAs were just one of several users and not the sole or primary intended users of the technology. Our review of mobile apps yielded 166 Android and iOS apps, of which 48 (29%) met the inclusion criteria. These apps provided HHAs with one or more of the following functions: electronic visit verification (29/48, 60%), clocking in and out (23/48, 48%), documentation (22/48, 46%), task checklist (19/48, 40%), communication between HHA and agency (14/48, 29%), patient information (6/48, 13%), resources (5/48, 10%), and communication between HHA and patients (4/48, 8%). Of the 48 apps, 25 (52%) performed monitoring functions, 4 (8%) performed supporting functions, and 19 (40%) performed both.

CONCLUSIONS

A limited number of studies and mobile apps have been designed to support HHAs in their work. Further research and rigorous evaluation of technology-based tools are needed to assess their impact on the work HHAs provide in patient's homes.

Development and Piloting of a Community-Partnered Heart Failure Training Course for Home Health Care Workers

BACKGROUND

Despite their unique contributions to heart failure (HF) care, home healthcare workers (HHWs) have unmet educational needs and many lack HF caregiving self-efficacy. To address this, we used a community-partnered approach to develop and pilot a HF training course for HHWs.

METHODS

We partnered with the Training and Employment Fund, a benefit fund of the largest healthcare union in the United States, to develop a 2-hour virtual HF training course that met HHWs' job-specific needs. English and Spanish-speaking HHWs interested in HF training, with access to Zoom, were eligible. We used a mixed methods design with pre/postsurveys and semi-structured interviews to evaluate the course: (a) feasibility, (b) acceptability, and (c) effectiveness (change in knowledge [Dutch Heart Failure Knowledge Scale range 0-15] and caregiving self-efficacy [HF Caregiver Self-efficacy Scale range 0-100]).

RESULTS

Of the 210 HHWs approached, 100 were eligible and agreed, and 70 enrolled. Of them, 53 (employed by 15 different home care agencies) participated. Posttraining data showed significant improvements (pretraining mean [SD] versus posttraining mean [SD]; P value) in HF knowledge (11.21 [1.90] versus 12.21 [1.85]; P=0.0000) and HF caregiving self-efficacy (75.21 [16.57] versus 82.29 [16.49]; P=0.0017); the greatest gains occurred among those with the lowest pre-training scores. Participants found the course engaging, technically feasible, and highly relevant to their scope of care.

CONCLUSIONS

We developed and piloted the first HF training course for HHWs, which was feasible, acceptable, and improved their HF knowledge and caregiving self-efficacy. Our findings warrant scalability to the workforce at large with a train-the-trainer model.

Eliciting the educational priorities of home care workers caring for adults with heart failure

BACKGROUND

Although home care workers (HCWs) are increasingly caring for adults with heart failure (HF), many feel unprepared and lack HF training. To serve as the foundation for a future educational intervention, we aimed to elicit HCWs' HF educational needs.

METHODS

We partnered with the largest healthcare union in the US to recruit 41 HCWs employed by 17 home care agencies. Using the nominal group technique, we asked HCWs to respond to three questions: When caring for an HF patient: (1) What information do you want? (2) What symptoms worry you? (3) What situations do you struggle with? Participants ranked their responses by priority. Data were consolidated by question.

RESULTS

For question 1, participants ranked HF signs and symptoms most highly, followed by HF treatment and medications. For question 2, chest pain was most worrisome, followed by neurologic changes and shortness of breath. For question 3, participants struggled with encouraging patients to follow a heart-specific diet.

CONCLUSIONS

HCWs expressed a need to learn more about signs and symptoms of HF and ways to assist patients with HF self-care. These findings can inform the development of an HF training program for HCWs that specifically addresses their expressed needs.

The Influence of Preparedness, Mutuality, and Self-efficacy on Home Care Workers' Contribution to Self-care in Heart Failure: A Structural Equation Modeling Analysis

BACKGROUND

Home care workers (HCWs) are increasingly caring for patients with heart failure (HF). Previous studies have shown that they contribute to HF patients' care, but how their preparedness and their relationship with patients (mutuality) influence caregiving is unknown, as well as the role of HCWs' self-efficacy.

OBJECTIVE

Guided by the Situation-Specific Theory of Caregiver Contribution to HF Self-Care, we investigated the influence of HCWs' preparedness and mutuality on HCWs' contribution to HF self-care and the mediating effect of HCWs' self-efficacy in the process.

METHODS

We conducted a cross-sectional survey of HCWs who cared for patients with HF. The survey included the Caregiver Preparedness Scale, Mutuality Scale, Caregiver Contribution to Self-Care of HF Index, and Caregiver Self-Efficacy in Contributing to Self-Care Scale. We performed structural equation modeling and a mediation analysis.

RESULTS

A total of 317 HCWs employed by 22 unique home care agencies across New York, NY, completed the survey. They had a median age of 50 years, 94% were women, and 44% were non-Hispanic Black. Results demonstrated that mutuality had a direct influence on HCW contribution to self-care and preparedness influenced their contribution to self-care, but only through the mediation of self-efficacy.

CONCLUSION

Home care workers' preparedness, mutuality, and self-efficacy have important roles in influencing their contribution to HF self-care. As a workforce increasingly involved in the care of patients with HF, knowing the mechanisms underpinning HCWs' contribution to self-care may illuminate future interventions aimed at improving their contributions and HF patient outcomes.

Effectiveness of an educational intervention to reduce the burden on home care workers and facilitating factors: A pre-post study

AIMS

To determine if a training program, aimed at home care workers, for caring for the elderly and for providing their own self-care is effective for reducing workers burden in the short and long terms and to identify the associated variables that can influence burden across 12 months.

BACKGROUND

An increasing number of older adults rely on home care workers as a complement to the care received from family caregivers. However, these workers do not usually have any formal training in nursing care and occasionally suffer burden.

DESIGN

A pre- and post-intervention study with a follow-up at 12 months including 86 participants.

METHODS

An 85-hour training course, which included a practical module lasting 35 h, was offered on five separate occasions between 2014 and 2017 in Barcelona (Spain). The care burden was measured according the Zarit Burden Interview and care knowledge and perceived difficulty performing care tasks were assessed. We also gathered data on the physical and psychological status of the care recipients.

RESULTS

The educational intervention was effective after training (-7.45% p = .020) and although the initial burden on caregivers did not worsen significantly despite spending 12 months caring for people with moderate physical and psychological dependence, the decrease in the burden was not maintained over time. Associated variables that can influence the burden over 6 months were the caregivers' baseline perception of lacking knowledge and/or having no difficulty with care tasks. The variable that could influence overburden in caregivers at 12 months was becoming ill before the intervention.

CONCLUSIONS

For the first time, the effectiveness of home workers-specific training has been demonstrated: a reduction in the perceived burden was observed immediately following training completion, but this reduction was not sustained at 6/12 months. The practical interpretation is that a remedial/follow-up training course may be needed. Whether difficulty in providing care or having sufficient knowledge and having an illness influence self-care maintenance requires further verification.

Eliciting the educational needs and priorities of home care workers on end-of-life care for patients with heart failure using nominal group technique

BACKGROUND

Home care workers, as paid caregivers, assist with many aspects of home-based heart failure care. However, most home care workers do not receive systematic training on end-of-life care for heart failure patients.

AIM

To elicit the educational needs and priorities of home care workers caring for community- dwelling adults with heart failure at the end-of-life.

DESIGN

Nominal group technique involving a semi-quantitative structured group process and point rating system was used to designate the importance of priorities elicited from home care workers. Individual responses to the question, "If you have ever cared for a heart failure patient who was dying (or receiving end-of-life care on hospice), what are some of the challenges you faced?", were aggregated into categories using directed content analysis methods.

SETTING/PARTICIPANTS

Forty-one home care workers were recruited from a non-profit training and education organization in New York City.

RESULTS

Individual responses to the question were aggregated into five categories: (1) how to cope and grieve; (2) assisting patients with behavior changes, (3) supporting patients to improve their quality of life, (4) assisting patients with physical symptom management, and (5) symptom recognition and assessment.

CONCLUSIONS

Our findings confirm the need for the formal development and evaluation of an educational program for home care workers to improve the care of heart failure patients at the end-of-life. There is also a need for research on integrating home care workers into the interprofessional healthcare team to support optimal health outcomes for patients with heart failure.

Heart Failure Training and Job Satisfaction: A Survey of Home Care Workers Caring for Adults with Heart Failure in New York City

Background

Home care workers (HCWs), who include home health aides and personal care attendants, frequently care for adults with heart failure (HF). Despite substantial involvement in HF care, prior qualitative studies have found that HCWs lack training and confidence, which creates challenges for this workforce and potentially for patient care. Herein, we quantified the prevalence of HF training among HCWs and determined its association with job satisfaction.

Methods

We conducted a cross-sectional survey of agency-employed HCWs caring for HF patients across New York, NY from 2018-2019. HF training was assessed with, "Have you received prior HF training?" Job satisfaction was assessed with, "How satisfied are you with your job?" The association between HF training and job satisfaction was determined with robust poisson regression.

Results

323 HCWs from 23 agencies participated; their median age was 50 years (IQR: 37,58), 94% were women, 44% were non-Hispanic Black, 23% were Hispanic, 78% completed ≥ high school education, and 72% were foreign-born. They had been caregiving for a median of 8.5 years (IQR: 4,15) and 73% had cared for 1-5 HF patients. Two-thirds received none/a little HF training and 82% felt satisfied with their job. In a fully adjusted model, HCWs with some/a lot of HF training had 14% higher job satisfaction than those with none/a little HF training (aPR 1.14; 95% CI 1.03-1.27).

Conclusions

The majority of HCWs have not received HF training. HF training was associated with higher job satisfaction, suggesting that HF training programs may improve HCWs' experience caring for this patient population.

Home Health Care Use and Post-Discharge Outcomes After Heart Failure Hospitalizations

OBJECTIVES

This study compared the characteristics of Medicare beneficiaries who were hospitalized for heart failure (HF) and then discharged home who received home health care (HHC) to the characteristics of those who did not, and examined associations among HHC and readmission and mortality rates.

BACKGROUND

After hospitalization for HF, some patients receive HHC. However, the use of HHC over time, the factors associated with its use, and the post-discharge outcomes after receiving it are not well studied.

METHODS

This study used Get With The Guidelines-HF data, merged with Medicare fee-for-service claims. Propensity score matching and Cox proportional hazards models were used to evaluate the associations between HHC and post-discharge outcomes.

RESULTS

From 2005 to 2015, 95,531 patients were admitted for HF, and 32,697 (34.2%) received HHC after discharge. The rate of HHC increased over time from 31.4% to 36.1% (p < 0.001). HHC recipients were older, more likely to be female, and had more comorbidities. HHC was associated with a higher risk of all-cause 30-day readmission (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.20 to 1.30), HF-specific 30-day readmission (HR: 1.20; 95% CI: 1.13 to 1.28), all-cause 90-day readmission (HR: 1.23; 95% CI: 1.19 to 1.26), HF-specific 90-day readmission (HR: 1.16; 95% CI: 1.11 to 1.22), and all-cause 30-and 90-day mortality, respectively (HR: 1.70; 95% CI: 1.56 to 1.86) and HR: 1.49; 95% CI: 1.41 to 1.57) compared to those who did not receive HHC.

CONCLUSIONS

Use of HHC after HF hospitalization increased among Medicare beneficiaries. HHC recipients were older and sicker than non-HHC recipients. Although HHC was associated with a higher risk of readmissions and mortality, this finding should be interpreted cautiously, given the presence of unmeasured variables that could affect receipt of HHC. Research is needed to determine whether the results reflect appropriate health care use.

Understanding the Workflow of Home Health Care for Patients with Heart Failure: Challenges and Opportunities

BACKGROUND

Readmission rates are high among heart failure (HF) patients who require home health care (HHC) after hospitalization. Although HF patients who require HHC are often sicker than those who do not, HHC delivery itself may also be suboptimal.

OBJECTIVE

We aimed to describe the workflow of HHC among adults discharged home after a HF hospitalization, including the roles of various stakeholders, and to determine where along these workflow challenges and opportunities for improvement exist.

DESIGN AND PARTICIPANTS

In this qualitative study, we used purposeful sampling to approach and recruit a variety of key stakeholders including home health aides, nurses, HF patients, family caregivers, physicians, social workers, home care agency leaders, and policy experts. The study took place in New York, NY, from March to October 2018.

APPROACH

Using a semi-structured topic guide, we elicited participants' experiences with HHC in HF through a combination of one-on-one interviews and focus groups. Data were recorded, transcribed, and analyzed thematically. We also asked selected participants to depict in a drawing their understanding of HHC workflow after hospitalization for HF patients. We synthesized the drawings into a final image.

KEY RESULTS

Study participants (N = 80) described HHC for HF patients occurring in 6 steps, with home health aides playing a main role: (1) transitioning from hospital to home; (2) recognizing clinical changes; (3) making decisions; (4) managing symptoms; (5) asking for help; and (6) calling 911. Participants identified challenges and opportunities for improvement for each step.

CONCLUSIONS

Our findings suggest that HHC for HF patients occurs in discrete steps, each with different challenges. Rather than a one-size-fits-all approach, various interventions may be required to optimize HHC delivery for HF patients in the post-discharge period.

Mobile and Web-Based Apps That Support Self-Management and Transition in Young People With Chronic Illness: Systematic Review

BACKGROUND

More adolescents with chronic physical illness are living into adulthood, and they require the development of proficient self-management skills to maintain optimal physical health as they transition into adult care services. It is often during this vulnerable transition period that deterioration in illness control is seen as a result of inadequate self-management skills and understanding of their chronic illness. Mobile technology has been proposed as an innovative opportunity to assist in improving the management of chronic conditions as young people transition to adult care services. Over the past 5 years, there has been a significant increase in research into the use of health-related apps.

OBJECTIVE

This study aimed to evaluate the utility and effectiveness of mobile and Web-based health apps that support self-management and transition in young people with chronic physical health illnesses.

METHODS

We conducted a comprehensive review of the literature in 5 bibliographic databases, using key search terms, considering only articles published from 2013, as we were extending the data from 2 previous systematic reviews. Abstracts were screened for possible inclusion by 2 reviewers. Data extraction and quality assessment tools were used for the evaluation of included studies.

RESULTS

A total of 1737 records were identified from the combined electronic searches, and 854 records were removed as duplicates. A total of 68 full articles were further assessed for eligibility, and 6 articles met our review criteria: 3 pilot studies, 2 randomized controlled trials, and 1 prospective cohort study. Publication years ranged from 2015 to 2018. The apps reported were targeted at type 1 diabetes mellitus, epilepsy, asthma, beta thalassemia major, and sickle cell disease, with a combined sample size of 336. A total of 4 studies included in this review reported being effective in increasing knowledge of the targeted condition and increasing therapy adherence, including increased medication adherence. A total of 2 manuscripts only mentioned the word transition. Participant's satisfaction was reported for all studies. Heterogeneity of the studies prevented meta-analysis.

CONCLUSIONS

There remain limited data on the effectiveness and use of mobile and Web-based apps, which might facilitate the transition of adolescents with chronic illnesses from pediatric to adult health care services. This systematic review provides an updated overview of available apps for adolescents with chronic illnesses. This systematic review has been unable to provide evidence for effectiveness of this approach, but it does provide insights into future study design, with reference to the development, evaluation, and efficacy of apps tailored for adolescents with chronic illnesses, including the involvement of adolescents in such designs.

TRIAL REGISTRATION

PROSPERO CRD42018104611; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=104611.

"It's Like They Forget That the Word 'Health' Is in 'Home Health Aide'": Understanding the Perspectives of Home Care Workers Who Care for Adults With Heart Failure

Background

Home care workers (HCWs) increasingly provide long‐term and posthospitalization care for community‐dwelling adults with heart failure (HF). They observe, assist, and advise these patients, yet few studies have examined their role in HF. As the foundation for future interventions, we sought to understand the perspectives of HCWs caring for adults with HF.

Methods and Results

We conducted 8 focus groups in partnership with the Home Care Industry Education Fund, a benefit fund of the 1199 Service Employees International Union United Healthcare Workers East, the largest healthcare union in the United States. English‐ and Spanish‐speaking HCWs with HF clients were eligible to participate. Data were analyzed thematically. Forty‐six HCWs employed by 21 unique home care agencies participated. General and HF‐specific themes emerged. Generally, HCWs (1) feel overworked and undervalued; (2) find communication and care to be fragmented; (3) are dedicated to clients and families but are caught in the middle; and, despite this, (4) love their job. With respect to HF, HCWs (1) find it frightening and unpredictable; (2) are involved in HF self‐care without any HF training; and (3) find the care plan problematic.

Conclusions

Although frequently involved in HF self‐care, most HCWs have not received HF training. In addition, many felt poorly supported by other healthcare providers and the care plan, especially when their clients’ symptoms worsened. Interventions that provide HF‐specific training and aim to improve communication between members of the home health care team may enhance HCWs’ ability to care for adults with HF and potentially lead to better patient outcomes.