Family Partnership Intervention Research Articles

Preliminary Study of the Cause of Persistent High Coronary Risk Status and Effect of Applying Family Partnership Intervention Program in Asymptomatic Air Force Officers

OBJECTIVE: Over the past three years, cardiovascular disease (CVD) hasbecome the leading cause of death among Thai military officers. Recent 10-yrcohort study in asymptomatic Air Force (AF) officers suggested that preventionof CVD was feasible by identifying high risk candidates (10-yr risk by themodified Coronary Risk Chart > 20%) for early treatment. At the same time, afailure in risk reduction could lead to catastrophic events. Most of the CVDcases, both acute coronary syndrome (ACS) and stroke, became persistent highrisk candidates for three consecutive years. This study intended to explore thecause of risk reduction failure and to reduce the risk by having family memberparticipation through the Family Partnership Intervention Program (FPIP). MATERAIL AND METHODS: Inclusion criteria were asymptomatic maleofficers, age ranged from 35-60 years, who had persistent high coronary risk score(> 20% over 10 years) for two consecutive years despite receiving medication,had no CVD and had family members available for the FPIP. Exclusion criteriawere officers of age < 35 and > 60 years, had serious illness (such as ACS, stroke,cancer, psychological disease) and had no family members available forparticipation. A personal interview to assess pre-existing risk factors and life stylerecommendations was conducted before and after the eight weeks period of FPIP. RESULTS: Ten AF officers (average age of 55.2 ± 5.3 years) took partvoluntarily. Most of them (70%) had a sedentary job and took prescribedmedication. The common major coronary risk factors were hypercholesterolemia(80%), hypertension (60%), diabetes mellitus (40%), and impaired fasting glucose(40%). Insufficient knowledge was the major cause of persistent high CVD riskstatus. It led to several unhealthy habits including having an atherogenic diet (highanimal fat, low fiber and sweet) 100%, exercise less than twice a week 90%,cigarette smoking 30%, self-reported mental stress 30% and poor medicalcompliance 14.2%. After 8-weeks of FPIP, 60% of candidates were able to reducetheir high risk status to the intermediate group (predicted ris 10-20%) in fivecases and to low risk group (predicted risk 5-10%) in one case. Although, serumtriglyceride and HDL cholesterol were not significantly different, totalcholesterol reduced from 224 ± 26.1 to 191 ± 30.7 mg/dl, p = 0.005, and bloodglucose decreased from 118 ± 22.0 to 103 ± 15.4, p = 0.016. CONCLUSION: Ineffective group education and insufficient preventive knowledgeled to unhealthy life style decisions and caused persisting high CVD risk status.Individual approach by setting common goals and having family memberparticipation could reduce the predicted CVD risk in 60% of cases. The majorlimitation of the study was the small number of cases and the short term study ofonly AF officers. These results may not be applied to general population and maynot guarantee the long term outcome beyond eight weeks. However, this studywas the first one to identify the cause of persistent high CVD risk status of AFofficers and offer a better way of effective risk reduction.

Family Caregiver Strain and Likelihood of Heart Failure Patient Clinical Events: A Replication Study

Introduction Higher caregiver strain was identified as a predictor of lower patient clinical event-risk in a previous analysis of Italian heart failure (HF) patient-caregiver dyads. The purpose of this analysis was to determine whether this trade-off in patient and caregiver outcomes was culturally bound, or replicable in a North American sample. Hypothesis We hypothesized that, similar to the Italian study, higher strain in North American caregivers would predict lower patient event-risk. Methods This was a secondary analysis of data from a 3-arm (usual care, patient-family education, and family partnership intervention) randomized controlled trial to improve HF self-care. Data collection occurred pre-intervention and 4 and 8 months post-intervention. Caregiver strain was measured pre-intervention using the 15-item Bakas Caregiving Outcomes Survey (BCOS: range 15-105, higher scores indicate more positive outcomes related to caregiving), and tertiles were used to divide caregivers into low, moderate, or high strain for analysis. Generalized linear regression was used to examine caregiver strain as a predictor of the likelihood of having any event (HF hospitalization, HF emergency room visit, or all-cause mortality) over time, controlling for intervention group and recent HF hospitalization (previous 4 months). Results All patients (n=92) were NYHA Class II or III, with the majority being Class II (n=68, 73.9%). Patients and caregivers were in their mid-fifties on average (56.3±10.1 and 53.4±12.4 years, respectively) and racially diverse (n=58, 63.0% and n=59, 64.8% African American, respectively), with most patients being male (n=57, 62.0%) and most caregivers being female (n=75, 84.2%). The most common dyad type was spousal (n=40, 44.0%). Over the 8 months, 28 patients were hospitalized, 6 had an emergency room visit and 6 died. The average BCOS scores for the low, moderate, and high strain groups were 82.9±12.5 (range 66-105), 61.1±1.6 (range 60-65), and 52.1±7.4 (range 31-59), respectively. There was no difference in events by intervention group. High caregiver strain (as compared to low strain) was associated with 91.9% lower likelihood of the patient having an event over 8 months follow-up (OR=0.081, 95%CI=0.008-0.850, p=0.036). There was no significant difference in event-risk by moderate caregiver strain. Conclusions Similar to previous findings in an Italian cohort, higher caregiver strain predicted lower HF patient clinical event-risk in this North American sample. Patient event-risk reductions may come with a cost for the family caregiver - a cost that has known sequelae (morbidity, mortality) and must be assessed and addressed.

Family partnership and education interventions to reduce dietary sodium by patients with heart failure differ by family functioning

ObjectivesDetermine if family functioning influences response to family-focused interventions aimed at reducing dietary sodium by heart failure (HF) patients. BackgroundLowering dietary sodium by HF patients often occurs within the home and family context. MethodsSecondary analysis of 117 dyads randomized to patient and family education (PFE), family partnership intervention (FPI) or usual care (UC). Dietary sodium measures were obtained from 3-day food record and 24-h urine samples. ResultsIn the poor family functioning groups, FPI and PFE had lower mean urine sodium than UC (p < .05) at 4 months, and FPI remained lower than UC at 8 months (p < .05). For good family functioning groups, FPI and PFE had lower mean sodium levels by 3-day food record at 4 and 8 months compared to the UC group. ConclusionOptimizing family-focused interventions into HF clinical care maybe indicated.

Family partner intervention influences self-care confidence and treatment self-regulation in patients with heart failure.

Heart failure self-care requires confidence in one's ability and motivation to perform a recommended behavior. Most self-care occurs within a family context, yet little is known about the influence of family on heart failure self-care or motivating factors. To examine the association of family functioning and the self-care antecedents of confidence and motivation among heart failure participants and determine if a family partnership intervention would promote higher levels of perceived confidence and treatment self-regulation (motivation) at four and eight months compared to patient-family education or usual care groups. Heart failure patients (N=117) and a family member were randomized to a family partnership intervention, patient-family education or usual care groups. Measures of patient's perceived family functioning, confidence, motivation for medications and following a low-sodium diet were analyzed. Data were collected at baseline, four and eight months. Family functioning was related to self-care confidence for diet (p=0.02) and autonomous motivation for adhering to their medications (p=0.05) and diet (p=0.2). The family partnership intervention group significantly improved confidence (p=0.05) and motivation (medications (p=0.004; diet p=0.012) at four months, whereas patient-family education group and usual care did not change. Perceived confidence and motivation for self-care was enhanced by family partnership intervention, regardless of family functioning. Poor family functioning at baseline contributed to lower confidence. Family functioning should be assessed to guide tailored family-patient interventions for better outcomes.

Family context influences psychological outcomes of depressive symptoms and emotional quality of life in patients with heart failure.

Although family influences in heart failure (HF) care are considered important, little evidence is available regarding relationships between the family context and specific outcomes for patients with HF. The aim of this study was to examine the relationships of patient perceptions of family functioning, autonomy support, and perceived criticism, as well as their family member's (FM) HF knowledge, with patient outcomes of depressive symptoms and HF quality of life (QOL). Participants (n = 117) with HF were enrolled in a family partnership intervention study. Self-report questionnaires measuring the HF patient's perceptions of family context and the FM's knowledge were analyzed relative to the HF patient's outcomes using correlations and sequential multivariate regression analyses. Only preintervention, baseline data are reported here. Age, ethnicity, Charlson comorbidity index, global family functioning, and FM's HF knowledge accounted for 37.8% (P < .001) of the variance in the patient's depressive symptoms. An additional moderating effect of ethnicity on the association between global family functioning and patient's depressive symptoms was significant (change R2 = 0.06, P = .001), resulting in a final model that accounted for 43.3% of depressive symptom variance. Age, ethnicity, global family functioning, and autonomy support accounted for 24.9% (P < .001) of the variance in emotional HF QOL. An additional moderating effect of ethnicity on the association between global family functioning and patient's emotional HF QOL was significant (change R2 = 0.05, P = .009), resulting in a final model that accounted for 28.9% of emotional QOL variance. This study underscores the importance of the patient's perspective on family functioning and autonomy support, along with FM's HF knowledge, on HF patient outcomes moderated by ethnicity. Future interventions could target the modifiable patient-family context relationships for improving depressive symptoms and QOL in HF patients. These findings point to the need for greater family assessment to identify those at risk for worse outcomes and to guide family focused interventions.

The effect of education of self care behaviors based on family-centered empowerment model in type II diabetes

The effect of education of self care behaviors based on family-centered empowerment model in type II diabetes

A nurse–family partnership intervention to increase the self‐efficacy of family caregivers and reduce catheter‐associated urinary tract infection in catheterized patients

The purpose of this study was to evaluate the effects of a nurse-family partnership model on the self-efficacy of family caregivers (FCs) and the incidence of catheter-associated urinary tract infection (CAUTI) among patients. A randomized controlled study was conducted. We recruited 61 patients and their FCs, who were randomly divided into an experimental group (n = 30) and a control group (n = 31). In the experimental group, the main caregivers comprised a nurse-family partnership, whereas the control participants received routine care. The findings were as follows: (i) the incidence of CAUTI was lower in the experimental group than in the control group (20% vs. 38.8%), but the difference was not statistically significant; and (ii) no significant difference emerged for reported Caregiver Self-Efficacy Score between the two groups. The nursing team and FCs must become partners in cooperative caregiving to enhance the quality of patient care.

A Trial of Family Partnership and Education Interventions in Heart Failure

BackgroundLowering dietary sodium and adhering to medication regimens are difficult for persons with heart failure (HF). Because these behaviors often occur within the family context, this study evaluated the effects of family education and partnership interventions on dietary sodium (Na) intake and medication adherence (MA). Methods and ResultsHF patient and family member (FM) dyads (n = 117) were randomized to: usual care (UC), patient-FM education (PFE), or family partnership intervention (FPI). Dietary Na (3-day food record), urinary Na (24-hour urine), and MA (Medication Events Monitoring System) were measured at baseline (BL) before randomization, and at 4 and 8 months. FPI and PFE reduced urinary Na at 4 months, and FPI differed from UC at 8 months (P = .016). Dietary Na decreased from BL to 4 months, with both PFE (P = .04) and FPI (P = .018) lower than UC. The proportion of subjects adherent to Na intake (≤2,500 mg/d) was higher at 8 months in PFE and FPI than in UC (χ2(2) = 7.076; P = .029). MA did not differ among groups across time. Both FPI and PFE groups increased HF knowledge immediately after intervention. ConclusionsDietary Na intake, but not MA, was improved by PFE and FPI compared with UC. The UC group was less likely to be adherent with dietary Na. Greater efforts to study and incorporate family-focused education and support interventions into HF care are warranted.

Quality and adequacy of dietary intake in a southern urban heart failure population.

Few studies have examined the quality and adequacy of dietary intake in patients attempting to limit sodium. The aim of this study was to provide a comprehensive analysis of the dietary intake of persons with heart failure (HF) in the Southern United States who have been advised to limit their sodium intake. Three-day food diaries were completed by 114 New York Heart Association class II and III persons with HF enrolled in a family partnership intervention study, which were reviewed by a dietitian and analyzed using validated nutritional software. The Harris-Benedict equation for sedentary adults was used to determine macronutrient intake adequacy. Demographic information and clinical data were obtained through patient report and medical record review. Dietary sodium ingestion ranged from 522 to 9251 mg/d (mean [SD], 2671 [1432] mg/d), with 38 (33.3%) individuals consuming the recommended 2000 mg/d or less in this sample (age, 28-78 years; 64.0% men; 57.0% African American). Mean (SD) caloric intake for the total sample was 1674 (636) kcal/d, with participants eating 99% of the recommended daily allowance (RDA) of protein, 63% of the RDA of carbohydrates, and 89% of the RDA of fat. Participants eating 2000 mg or less of sodium consumed significantly less calories (P < .001), protein (P < .001), carbohydrates (P = .008), and fat (P < .001), but not fiber (P = .103), compared with those consuming more than 2000 mg of sodium after adjusting for body mass index. When analyzed by amount of sodium consumption, persons ingesting 2000 mg or less of sodium per day ate significantly less grains (P = .001) and meat and beans (P = .004) and had less intake of the micronutrients calcium (P < .001), zinc (P = .002), and thiamine (P = .05). Only one-third of participants with HF who have been instructed on a low-sodium diet reported consuming the RDA of 2000 mg or less, indicating the need for further dietary instruction with a particular focus on modifying the Southern US diet.

Differential ratings of and maternal impact on anxiety and depression among African American children in special education

Abstract African American children are overrepresented in special education based on diagnoses of internalizing behaviors, such as anxiety and depression. Differential ratings of depression and anxiety between self-report and children's mothers and teachers have caused skepticism around the accuracy of teachers' ratings of signs and symptoms of anxiety and depression among African American children. If African American children are truly suffering from disproportionate rates of anxiety and depression, prevention and intervention efforts should be targeted to improve their mental health. According to the ecological systems theory and the social cognitive theory, children's mental health development is impacted by their environments and efficacy beliefs. This study aimed to see if teachers, mothers, and African American children in special education rate internalizing behaviors of children differently and to understand what factors impact these behaviors among African American children in special education. A secondary data analysis of a sample of 126 African American children in special education found that children's self-report of internalizing behaviors was significantly higher than mothers' and teachers' ratings of African American children's internalizing behaviors. Higher reports of mothers' mastery were associated with fewer internalizing behaviors of African American children in special education. In addition, African American girls were more likely to experience anxiety and depression than boys. There was not a statistically significant relationship between children's environment, receipt of the Nurse–Family Partnership intervention, and their internalizing behaviors.

Maternal Jail Time, Conviction, and Arrest as Predictors of Children's 15-year Antisocial Outcomes in the Context of a Nurse Home Visiting Program

Data from the Nurse–Family Partnership intervention program were analyzed to compare the “selection” versus “unique” effects of maternal jail time on adolescent antisocial and health risk outcomes. Data from 320 women and their firstborn children were available from the prenatal, birth, and 15-year assessments. Consistent with a selection perspective, prenatal and demographic risks directly and indirectly related to many adolescent antisocial outcomes. Maternal conviction and arrest were also associated with adolescent contact with the criminal justice system and health risk behaviors. Maternal jail time predicted whether or not children had ever been stopped by police, sent to youth corrections, or run away from home. However, these associations were not significant after controlling for prenatal risk factors and maternal conviction and arrest. The results highlight the importance of maternal criminality and other risk factors in children's environments, including prenatal variables.

Comparison of family partnership intervention care vs. conventional care in adult patients with poorly controlled type 2 diabetes in a community hospital: A randomized controlled trial

Background Although there is a significant correlation between the degree of family support and clinical outcome, little research has focused on the effectiveness of family partnership intervention care (FPIC) for patients with poorly controlled type 2 diabetes. Objectives This study aimed to compare FPIC with conventional care (CC) across a number of outcome measures in patients with poorly controlled type 2 diabetes. Design The study was performed using a randomized controlled trial design. Participants Patients with poorly controlled type 2 diabetes who were solely treated with oral antidiabetic agents and had at least two out of three hemoglobin A1C readings equal to or above 7% in the previous 12 months, were randomly assigned to the FPIC group ( n = 28) and to the CC group ( n = 28). Methods Baseline and 6-month follow-up scores were compared using the following outcome measures: (1) hemoglobin A1C, (2) BMI, (3) lipid profile, (4) family supportive behaviours, (5), knowledge of and attitudes toward diabetes, and (6) diabetes self-care behaviours. Descriptive and non-parametric statistics were employed to compare differences in outcome measures between the groups. Results There were no significant differences in the reduction of hemoglobin A1C levels ( p = 0.46), lipid profile values ( p > 0.05), and improvement of diabetes self-care behaviours ( p = 0.61) between the groups at 6 months post-intervention. However, there were significant differences in the scores of family supportive behaviours ( p = 0.031) and patients’ knowledge of and attitudes toward diabetes between the groups ( p < 0.05). Conclusion These findings support the use of FPIC to enhance family supportive behaviours, and to improve patients’ knowledge of and attitudes toward diabetes. Thus, the study is of value in helping policy decision-makers to develop more effective diabetes control intervention programmes.

Family Education and Support Interventions in Heart Failure

Self-management of dietary sodium restriction by persons with heart failure (HF) is difficult and usually occurs within the home setting and within a family context. To compare a patient and family education (EDUC) intervention with a combined education and family partnership intervention (EDUC + FPI) for effects on improving dietary sodium self-management in persons with HF. Patients with HF and a family member (FM) were randomized to EDUC (n = 29 dyads) or EDUC + FPI (n = 32 dyads). Participants with HF were primarily White males with a mean age of 61 years (+/-12). The FMs were primarily women and spouses and had a mean age of 54 years (+/-17). Self-reported dietary sodium (Diet NA) intake and 24-hr urinary sodium (Urine NA) were measured at baseline (BL) and 3 months (3M) after intervention. Data were analyzed with descriptive statistics, generalized least squares regression, paired t test, and chi-square test. Groups did not differ by age, gender, or clinical variables; however, family functioning (Family APGAR) scores were slightly higher in the EDUC + FPI group at BL. Both groups decreased Diet NA and Urine NA from BL to 3M; the EDUC + FPI group showed greater decrease in Urine NA and had a greater percentage of those who decreased Urine NA by at least 15% (p = .04). Regression analysis to predict Urine NA revealed a significant Group x Time interaction (p = .03) when accounting for time-varying measures of body mass index (p = .001). A family-focused intervention may be useful in reducing dietary sodium intake in persons with HF. The Urine NA results support the importance of incorporating family-focused education and support interventions into HF care.

Family partnership intervention: a guide for a family approach to care of patients with heart failure.

While family focused care is recommended in standards of care for heart failure (HF), little data exist to guide the structure, content, and delivery of family care. The purpose of this article is to describe what is known about the impact of HF, and to examine a family based approach to improve self-management and adherence in HF. A scientific and theoretical background was used to formulate a family based approach to HF care, the Family Partnership Intervention (FPI), and to determine the feasibility and acceptability of the intervention to family members and HF patients. The components of the intervention are described as well as examples of how it was used. Lessons learned in implementing the intervention during a pilot study are addressed.

The effect of a family-focused intervention on self management of diet, medication-taking, and activity after six months

Persons with heart failure (HF) are expected to perform selected self care behaviors related to dietary sodium reduction, medication-taking, and physical activity, and most of these occur within a family context. This study evaluated the effect of two family-based education and support interventions on these self care behaviors. HF patients and a participating family member (FM) were randomized to receive either an indepth patient-FM education session (EDUC: n=29 dyads) or in-depth patient-FM education plus a family partnership intervention (EDUC+FPI; n=34 dyads).