A single educational intervention on heart failure self-care: Extended follow-up from a multisite randomized controlled trial (original) (raw)
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International Journal of Nursing Studies, 2017
Background: The prevalence of heart failure is increasing in Lebanon but to date there is no systematic evaluation of a disease management intervention. Objective: The aim of this study was to evaluate the effect of involving family caregivers in the self-care of patients with heart failure on the risk of hospital readmission. Design: A multi-site, block randomised controlled trial. Settings: The study was conducted over a 13-month period in three tertiary medical centres in Beirut and Mount Lebanon, Lebanon. Participants: Adult patients presenting for an exacerbation of heart failure to one of the study centres were included. Patients with limited life expectancy or physical functionality, planned cardiac bypass or valve replacement surgery, living alone or in nursing homes, or aged less than 18 years were excluded. Methods: Patients allocated to the intervention group and their family caregivers were provided with a comprehensive, culturally appropriate, educational session on self-care maintenance and symptom management along with self-care resources. The usual care group received the self-care resources only. Follow-up phone calls were conducted 30 days following discharge by a research assistant blinded to treatment assignment. The primary outcome was hospital readmission and the secondary outcomes were self-care, quality of life, major vascular events and healthcare utilization. Results: The final sample included 256 patients hospitalized for heart failure randomised into control (130 patients) and intervention (126 patients) groups. The mean age was 67 (SD = 8) years, and the majority (55%) were male. Readmission at 30 days was significantly lower in the intervention group compared to the control group (n = 10, 9% vs. n = 20, 19% respectively, OR = 0.40, 95% CI = 0.02, 0.10, p = 0.02). Self-care scores improved in both groups at 30 days, with a significantly larger improvement in the intervention group than the control group in the maintenance and confidence sub-scales, but not in the self-care management sub-scale. No differences were seen in quality of life scores or emergency department presentations between the groups. More patients in the control group than in the intervention group visited health care facilities (n = 24, 23% vs. n = 12, 11% respectively, OR = 0.39, 95% CI = 0.18, 0.83, p = 0.01). Conclusion: The trial results confirmed the potential of the family-centred self-care educational intervention under evaluation to reduce the risk of readmission in Lebanese patients suffering from exacerbated heart failure.
Journal of advanced nursing, 2015
A discussion of the conceptual elements of an intervention tailored to the needs of Lebanese families. The role of informal caregiving is strongly recommended for individuals with chronic conditions including heart failure. Although this importance is recognized, conceptual and theoretical underpinnings are not well elucidated nor are methods of intervention implementation. Discussion paper on the conceptual underpinning of the FAMILY model. This intervention was undertaken using linked methods: (1) Appraisal of theoretical model; (2) review of systematic reviews on educational interventions promoting self-management in chronic conditions in four databases with no year limit; (3) socio-cultural context identification from selected papers; (4) expert consultation using consensus methods; and (5) model development. Theories on self-care and behavioural change, eighteen systematic reviews on educational interventions and selected papers identifying sociocultural elements along with exp...
Global Journal of Health Science, 2016
Background: Congestive heart failure is a common cause of hospitalization. If patients can adhere to self-care behaviors, the progression of the disease can be prevented. The aim of this study is to evaluate the effect of education on self-care in chronic heart failure patients admitted to Shahid Mostafa Khomeini Hospital of Ilam in 2016. Methods: This study is of intervention typeand 40 patient's sufferingfrom heart failure were selected. Research tools include a standard indicator questionnaire for measuring self-care by patients. The questionnaire contains 22 questions about their certainty ofself-care. Four point Likert scale was used for scoring and SPSS V.19 was used for data analysis. Results: The sample consisted of 16 men (40%) and 24 women (60%) most of which were married (75%). The statistical correlation between the total score of self-care behavior before and after education was significant (P VALUE = 0.003), which shows that the education conducted on the patients was effective and caused more scores in all areas. Conclusion: Self-care behavior can be attained and spread through education. It is recommended that the patients suffering are given enough information about their diet and activities after their discharge from hospital.
Trial of a family-based education program for heart failure patients in rural Thailand
BMC cardiovascular disorders, 2014
Background: Heart failure (HF) significantly impacts on the daily lives of patients and their carers. In Western society HF education programs have increased patient and carer knowledge and improved health-related quality of life. However, there is a paucity of such evidence in Asia. For example, to date no studies have been conducted in Thailand to investigate the potential benefits of a family-based education program on the health outcomes of HF patients and carers.
2016
Introduction: Heart failure is a major public health problem, affecting over 26 million people worldwide. It is associated with a high rate of mortality, symptom burden and diminished quality of life. Best practice guidelines for the management of chronic heart failure recommend that patients and carers/family members are educated about heart failure self-care. Effective heart failure self-care has the potential to improve health outcomes. Studies conducted in Thailand addressing heart failure self-care are limited and none have investigated the potential benefits of education programs on the health outcomes of both parties within the dyad: the patient with heart failure and their carer. Aims: The primary aim of this research was to examine the effectiveness of a family-based education program for patients with heart failure and their carers in rural Thailand. The research comprises a series of studies, each with specific aims: i) to investigate current heart failure family-based ed...
Family Influences on Heart Failure Self-care and Outcomes
The Journal of Cardiovascular Nursing, 2008
Many patient education guidelines for teaching heart failure patients recommend inclusion of the family; however, family-focused interventions to promote self-care in heart failure are few. This article reviews the state of the science regarding family influences on heart failure self-care and outcomes. The literature and current studies suggest that family functioning, family support, problem solving, communication, self-efficacy, and caregiver burden are important areas to target for future research. In addition, heart failure patients without family and those who live alone and are socially isolated are highly vulnerable for poor self-care and should receive focused attention. Specific research questions based on existing science and gaps that need to be filled to support clinical practice are posed.
Self-care and Its Predictors in Patients With Chronic Heart Failure in Western Iran
Background: Chronic heart failure (CHF) is an increasing and costly health problem worldwide. Effective self-care behaviors reduce the cost and improve CHF outcomes. Interventions targeting improvement of self-care need to identify the baseline status of patients and factors associated with self-care to tailor the programs to patients' needs. Aim: The aim of this study was to describe self-care and its predictors in patients with CHF in western Iran. Methods: In a cross-sectional study, 255 patients with CHF in Kermanshah were recruited and 231 (mean [SD] age, 66 [13] years; 51.5% women) completed the interviews. Self-care maintenance, self-care management, and self-care confidence were evaluated using a Persian heart failure self-care index. Each of these 3 measures had a total possible score of 100, with 22 indicators. Results: The mean (SD) self-care scores were low: maintenance, 33.8 (10.7); management, 32.2 (12.0); and confidence, 43.6 (15.6). Self-care maintenance was significantly and positively associated with education, disease duration, and living conditions. Self-care management was significantly and positively associated with education and number of hospital admissions. However, the parameter estimates in all those relationships were small. Conclusion: Self-care in patients with CHF in Iran needs major improvement, and many determinants of self-care identified by other studies were not consistently associated with poor self-care scores in Iran. Further research considering a wide range of factors associated with self-care (eg, socioeconomic and health systemYrelated factors) and application of culturally relevant interventional strategies is recommended.
Azerbaijan Medical Journal, 2023
Heart failure is a prolonged and progressive syndrome that leads to low quality of life and hospital readmissions. Avoiding or early recognizing health problems in heart failure is associated with proper self-care and recovering overall health-related quality of life. To describe the self-care behaviors and association of sociodemographic and clinical factors that affect patients' quality of life. The quantitative, cross-sectional convenience sample technique was used to collect 200 patients diagnosed with heart failure admitted to Sulaimani Cardiac Hospital, Iraq, from January to May 2022. The data were collected through direct interviews, a validated questionnaire, and the Self-Care of Heart Failure Index. About 50% of the participants were aged 62-77 years, 65.5% were males, 66% were illiterate, and 65.5% had a low economic state. According to the classification of the New York Heart Association, 48% of them were class III heart failure. The mean scores of 1.67, 1.56, and 1.80 were observed on self-care confidence, poor self-care management, and poor self-care maintenance using the Self-Care of Heart Failure Index without significant difference (p≤0.05). The outcomes of this study demonstrated that most patients had inappropriate scores in selfcare maintenance, management, and confidence subscales. The study also found that higher scores were associated with certain factors, such as age group, residence, number of recent hospital admissions for heart failure, and severity of heart failure.