Heart Failure Self-care Behaviour Research Articles

Evaluation of self care behaviours, medication and dietary compliance of patients with heart failure

In this study, it was aimed to evaluate the self-care behaviors, dietary and medication compliance of patients with heart failure.The study was conducted as a cross-sectional sampling study between April and August 2016. After identifying the clinical diagnosis and treatment, 120 patients who were diagnosed with HF were included in the study. Data were obtained by using personal information form, Turkish versions of the European Heart Failure Self-care Behavior Scale (EHFScBS), Beliefs about Medication Compliance Scale and Beliefs about Dietary Compliance Scale for patients with HF. The mean score on EHFSc BS was found to be 31.20± 8.05. Benefit and barrier subscale mean scores were found to be 26.11 ± 4.23 and 13.09 ± 3.5 for dietary compliance and 20.44 ± 2.7 and 22.36 ± 3.8 for medication compliance, respectively. According to the results of the study ıt was found that there was a moderate relationship between self-care behaviors and dietary compliance (r=0,538,p<0,05) benefits and medication compliance (r=0,420, p<0,05 ) benefits. Keywords: The European Heart Failure self care scale; medication compliance; dietary compliance; heart failure.

Relationship between self-care and comprehensive understanding of heart failure and its signs and symptoms

Although incomplete understanding of heart failure and its signs and symptoms appears to be a barrier to successful self-care, there are few studies examining the relationship between self-care and levels of comprehensive understanding of heart failure and its signs and symptoms. To determine whether incomplete understanding of heart failure and its signs and symptoms is associated with self-care in heart failure patients who were recently discharged from the hospital due to heart failure exacerbation. Patients completed the nine-item European Heart Failure Self-care Behavior scale and questionnaire to assess knowledge of heart failure and its signs and symptoms. Three groups were formed by their different levels of understanding of heart failure and its signs and symptoms. Multivariable linear regression was used to determine whether these three levels of understanding groups predicted self-care after controlling for demographic and clinical variables. Of 571 patients 22.1%, 40.1% and 37.8% had poor, moderate, and complete understanding, respectively. Compared with patients in the poor understanding group, patients in complete and moderate understanding groups were more likely to have better adherence to self-care activities (standardized β = -0.14, 95% confidence interval -3.41, -0.47; standardized β = -0.19, 95% confidence interval -4.26, -1.23, respectively). Fewer than half of the patients had a comprehensive understanding of heart failure and its signs and symptoms, which was associated with poor self-care. Our study suggests that patient education should include contents to promote comprehensive understanding of heart failure and its symptoms, as well as the importance of self-care behaviors.

Alfabetización en salud y resultados de salud en pacientes muy ancianos con insuficiencia cardiaca

Introduction and objectivesHealth literacy (HL) has been associated with lower mortality in heart failure (HF). However, the results of previous studies may not be generalizable because the research was conducted in relatively young and highly-educated patients in United States settings. This study assessed the association of HL with disease knowledge, self-care, and all-cause mortality among very old patients, with a very low educational level. MethodsThis prospective study was performed in 556 patients (mean age, 85 years), with high comorbidity, admitted for HF to the geriatric acute-care unit of 6 hospitals in Spain. About 74% of patients had less than primary education and 71% had preserved systolic function. Health literacy was assessed with the Short Assessment of Health Literacy for Spanish-speaking Adults questionnaire, knowledge of HF with the DeWalt questionnaire, and HF self-care with the European Heart Failure Self-Care Behaviour Scale. ResultsDisease knowledge progressively increased with HL; compared with being in the lowest (worse) tertile of HL, the multivariable beta coefficient (95%CI) of the HF knowledge score was 0.60 (0.01-1.19) in the second tertile and 0.87 (0.24-1.50) in the highest tertile, P-trend = .008. However, no association was found between HL and HF self-care. During the 12 months of follow-up, there were 189 deaths. Compared with being in the lowest tertile of HL, the multivariable HR (95%CI) of mortality was 0.84 (0.56-1.27) in the second tertile and 0.99 (0.65-1.51) in the highest tertile, P-trend = .969. ConclusionsNo association was found between HL and 12-month mortality. This could be partly due to the lack of a link between HL and self-care.Full English text available from: www.revespcardiol.org/en

Effectiveness of a PRECEDE-based education intervention on quality of life in elderly patients with chronic heart failure

BackgroundOne of the most important challenges in public health is to improve the quality of life in patients with chronic heart failure (CHF). Depression, self-care capacity, and quality of life interact each other in these patients. It’s difficult to treat with general education programs and conventional therapy. PRECEDE model is a comprehensive and exclusive theory-based education programs. Its effectiveness for reducing depression and increasing quality of life has been demonstrated in patients with coronary artery bypass grafting, type 2 diabetes, and the elderly. It has not been used in elderly patients with CHF. Thus, this study aims to investigate the effects of this model on self-care behaviors, depression, and quality of life in these patients.MethodsPatients who met the inclusion criteria were randomly assigned to the intervention or control group. All the patients received conventional medical care. The patients in the intervention group also received 9 sessions of education intervention based on the PRECEDE model and then followed up for 3 months after the intervention. Data were collected before and 3 months after the intervention using 4 questionnaires, namely a PRECEDE-based questionnaire to evaluate predisposing, reinforcing, and enabling factors; the 9-item European Heart Failure Self-care Behavior Scale (EHFScBS-9); the 9-item Personal Health Questionnaire (PHQ-9); and the Minnesota Living with Heart Failure Questionnaire (MLHFQ).ResultsNo significant differences were found in the mean scores for the predisposing, enabling, and reinforcing factors, and the mean total scores in EHFScBS-9, PHQ-9, and MLHFQ before the intervention between the intervention and control groups. After the intervention, the scores for the predisposing, reinforcing, and enabling factors increased significantly, and the mean total scores in EHFScBS-9, PHQ-9, and MLHFQ decreased significantly in the intervention group. In addition, these scores significantly differed from those of the control group. Furthermore, the MLHFQ score significantly correlated with the EHFScBS-9 and PHQ-9 scores.ConclusionThis study demonstrates a trend that PRECEDE model of health education promotion is effective in relieving depression symptoms, enhancing self-monitoring, and improving the quality of life of elderly patients with CHF.Trial registrationTrial registration number: ChiCTR-IOR-17012779; Trial registry: Chinese Clinical Trial Registry; Date registered: 22 Sep 2017; Retrospectively registered.

Adherence to guidelines in patients with chronic heart failure in primary health care

Objective: To describe adherence to international guidelines for chronic heart failure (CHF) management concerning diagnostics, pharmacological treatment and self-care behaviour in primary health care.Design: A cross-sectional descriptive study of patients with CHF, using data obtained from medical records and a postal questionnaire.Setting: Three primary health care centres in Sweden.Subjects: Patients with a CHF diagnosis registered in their medical record.Main outcome measures: Adherence to recommended diagnostic tests and pharmacological treatment by the European Society of Cardiology guidelines and self-care behaviour, using the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). Results. The 155 participating patients had a mean age of 79 (SD9) years and 89 (57%) were male. An ECG was performed in all participants, 135 (87%) had their NT-proBNP measured, and 127 (82%) had transthoracic echocardiography performed. An inhibitor of the renin angiotensin system (RAS) was prescribed in 120 (78%) patients, however only 45 (29%) in target dose. More men than women were prescribed RAS-inhibition. Beta blockers (BBs) were prescribed in 117 (76%) patients, with 28 (18%) at target dose. Mineralocorticoidreceptor antagonists were prescribed in 54 (35%) patients and daily diuretics in 96 (62%). The recommended combination of RAS-inhibitors and BBs was prescribed to 92 (59%), but only 14 (9%) at target dose. The mean score on the EHFScBS-9 was 29 (SD 6) with the lowest adherence to daily weighing and consulting behaviour.Conclusion: Adherence to guidelines has improved since prior studies but is still suboptimal particularly with regards to medication dosage. There is also room for improvement in patient education and self-care behaviour.

Interpretability of the European Heart Failure Self-care Behaviour scale.

ObjectiveThe European Heart Failure Self-care Behaviour scale (EHFScBs) is a valid patient-reported questionnaire to measure self-care behavior of heart failure (HF) patients. We assessed the interpretability of the EHFScBs.MethodsWe used data of 1,023 HF patients. Interpretability refers to the clinical meaning of the score and its changes over time. We operationalized interpretability by evaluating distributions of EHFScBs scores across relevant HF subgroups by eyeballing, by testing the risk on hospitalizations and mortality of a plausible threshold, and by determining a clinically relevant minimal important change (MIC). The scale score ranged from 0 to 100, with a higher score meaning better self-care. A threshold of ≥70 was defined as adequate and <70 as inadequate self-care.ResultsThe EHFScBs scores were similarly normally distributed among the subgroups with a mean between 57.8 (SD 19.4) and 72.0 (SD 18.0). The 464 HF patients with adequate self-care had significantly less all-cause hospitalizations than the 559 patients with inadequate self-care.ConclusionThe degree of self-care showed to be independent of relevant HF subgroups. A single threshold of 70 accurately discriminated between patients with adequate and inadequate self-care.Practice implicationsThe threshold of 70 can be used in designing studies and informing health policy makers.

Cognitive deficits and self-care behaviors in elderly adults with heart failure.

IntroductionElderly adults with heart failure (HF) may have problems with self-care behaviors because of cognitive deficits. Self-care deficits have been found to be significantly associated with negative health care outcomes among HF patients. The aim of this paper was to assess cognitive deficits and the level of self-care ability in elderly patients with HF, and to determine if a relationship exists between cognitive deficits and self-care.Materials and methodsThe study included 270 elderly patients (mean age: 72.5 years) with HF. We used the Mini Mental State Examination Scale (MMSE) to evaluate cognitive functioning, and the European Heart Failure Self-care Behavior Scale, revised into a nine-item scale (EHFScBS-9), to evaluate self-care behaviors. Associations between the variables were examined using multiple regression analysis.ResultsLower scores in both MMSE and EHFScBS-9 questionnaires were correlated with older age, living alone, lower education, longer duration of illness, higher number of rehospitalizations, as well as lower left ventricular ejection fraction and higher New York Heart Association (NYHA) class. The multiple regression analysis was used for evaluation of the impact of the following predictors: MMSE score, age, duration of illness, ejection fraction, number of hospitalizations, sex, residence, education, relationship status, and NYHA class on EHFScBS-9 score.ConclusionsElderly patients with HF may have worse self-care behaviors because of their cognitive deficits. Age was the strongest predictor of worse MMSE scores. Multidisciplinary health teams should pay attention to the special needs of elderly patients who live with their illness for many years and have no social support because of living alone.

Improving kNowledge Transfer to Efficaciously RAise the level of Contemporary Treatment in Heart Failure (INTERACT-in-HF): Study protocol of a mixed methods study.

Heart failure is a complex disease with poor outcome. This complexity may prevent care providers from covering all aspects of care. This could not only be relevant for individual patient care, but also for care organisation. Disease management programmes applying a multidisciplinary approach are recommended to improve heart failure care. However, there is a scarcity of research considering how disease management programme perform, in what form they should be offered, and what care and support patients and care providers would benefit most. Therefore, the Improving kNowledge Transfer to Efficaciously Raise the level of Contemporary Treatment in Heart Failure (INTERACT-in-HF) study aims to explore the current processes of heart failure care and to identify factors that may facilitate and factors that may hamper heart failure care and guideline adherence. Within a cross-sectional mixed method design in three regions of the North-West part of Europe, patients (n = 88) and their care providers (n = 59) were interviewed. Prior to the in-depth interviews, patients were asked to complete three questionnaires: The Dutch Heart Failure Knowledge scale, The European Heart Failure Self-care Behaviour Scale and The global health status and social economic status. In parallel, retrospective data based on records from these (n = 88) and additional patients (n = 82) are reviewed. All interviews were audiotaped and transcribed verbatim for analysis.

Anxiety and self-care behaviour in patients with chronic systolic heart failure: A multivariate model.

While comprehensive evidence exists regarding negative effects of depression on self-care behaviours in patients with chronic heart failure (CHF), the relation between anxiety and self-care behaviours in patients with CHF is not clear. The aim of this study was to analyse the interactions between anxiety, depression and self-care behaviours in patients with CHF. The self-care behaviour of CHF outpatients was measured using the European Heart Failure Self-care Behaviour Scale (EHFScBS). The Patient Health Questionnaire (PHQ) was used to assess anxiety, the PHQ-9 was used to measure depression severity. Differences between patients with and without anxiety were assessed with the respective tests. Associations between anxiety, self-care and other predictors were analysed using linear regressions. Of the 308 participating patients, 35 (11.4%) fulfilled the PHQ criteria for an anxiety disorder. These patients took antidepressants more frequently (11.8% versus 2.3%, p = .02), had had more contacts with their general practitioner within the last year (11.8 ± 16.1 versus 6.7 ± 8.6, p = .02), and had a higher PHQ-9 depression score (12.9 ± 5.7 versus 6.5 ± 4.7, p < .01) than patients without anxiety disorder. Anxiety and self-care were negatively associated (ß = -0.144, r2 = 0.021, p = 0.015). The explanation of variance was augmented in a multivariate regression with the predictors age, sex, education, living with a partner, and New York Heart Association (NYHA) class ( r2 = 0.098) when anxiety was added ( r2 = 0.112). Depression further increased the explanation of variance (ß = -0.161, r2 = 0.131, p = 0.019). Anxiety is negatively associated with self-care behaviour in patients with CHF. However, this effect disappears behind the stronger influence of depression on self-care. The consideration of mental comorbidities in patients with CHF is important.

Health Literacy and Health Outcomes in Very Old Patients With Heart Failure

Introduction and objectivesHealth literacy (HL) has been associated with lower mortality in heart failure (HF). However, the results of previous studies may not be generalizable because the research was conducted in relatively young and highly-educated patients in United States settings. This study assessed the association of HL with disease knowledge, self-care, and all-cause mortality among very old patients, with a very low educational level. MethodsThis prospective study was performed in 556 patients (mean age, 85 years), with high comorbidity, admitted for HF to the geriatric acute-care unit of 6 hospitals in Spain. About 74% of patients had less than primary education and 71% had preserved systolic function. Health literacy was assessed with the Short Assessment of Health Literacy for Spanish-speaking Adults questionnaire, knowledge of HF with the DeWalt questionnaire, and HF self-care with the European Heart Failure Self-Care Behaviour Scale. ResultsDisease knowledge progressively increased with HL; compared with being in the lowest (worse) tertile of HL, the multivariable beta coefficient (95%CI) of the HF knowledge score was 0.60 (0.01-1.19) in the second tertile and 0.87 (0.24-1.50) in the highest tertile, P-trend = .008. However, no association was found between HL and HF self-care. During the 12 months of follow-up, there were 189 deaths. Compared with being in the lowest tertile of HL, the multivariable HR (95%CI) of mortality was 0.84 (0.56-1.27) in the second tertile and 0.99 (0.65-1.51) in the highest tertile, P-trend = .969. ConclusionsNo association was found between HL and 12-month mortality. This could be partly due to the lack of a link between HL and self-care.

Self-care and its predictors among patients with heart failure in Karachi, Pakistan

Background: Self-care in heart failure (HF) is essential to improve Quality of Life (QoL) and reduce hospital readmissions. It is a well-researched phenomenon in western countries but still unexplored in developing countries like Pakistan. Aim: The aim of this study was to explore the level of self-care behaviour (SCB) and its associated factors among patients with HF in Karachi Pakistan. Methods: In a cross-sectional survey, SCB was measured from 230 patients with HF, using the European Heart Failure Self-Care Behavior scale (EHFSCBs_9). Its associated factors were assessed via a self-developed checklist prepared by the researcher (lead author). Results: The overall mean of SCB was 29.73+/-7.03. As a result of multi-variable regression analysis, out of the six variables, only three variables were significantly associated with SCB, explaining the 23.4% variance. These variables were education; income; and chronicity of HF diagnosis. Conclusion: The findings of the study suggest that public health initiatives in the form of supportive-educative interventions are a dire need to enhance self-care among patients with HF.

Insuficiencia cardiaca en atención primaria: actitudes, conocimientos y autocuidado

ObjectiveTo determine the attitudes, knowledge, and self-care practices in patients with heart failure (HF) in Primary Care, as well as to identify factors associated with better self-care. DesignCross-sectional and multicentre study. SettingPrimary Care. ParticipantsSubjects over 18 years old with HF diagnosis, attended in 10 Primary Health Care Centres in the Metropolitan Area of Barcelona. Main measurementsSelf-care was measured using the European Heart Failure Self-Care Behaviour Scale. Sociodemographic and clinical characteristics, tests on attitudes (Self-efficacy Managing Chronic Disease Scale), knowledge (Patient Knowledge Questionnaire), level of autonomy (Barthel), and anxiety and depression screening (Goldberg Test), were also gathered in an interview. A multivariate mixed model stratified by centre was used to analyse the adjusted association of covariates with self-care. ResultsA total of 295 subjects (77.6%) agreed to participate, with a mean age of 75.6 years (SD: 11), 56.6% women, and 62% with no primary education. The mean self-care score was 28.65 (SD: 8.22), with 25% of patients scoring lower than 21 points. In the final stratified multivariate model (n=282; R2 conditional=0.3382), better self-care was associated with higher knowledge (coefficient, 95% confidence interval: −1.37; −1.85 to −0.90), and coronary heart disease diagnosis (−2.41; −4.36: −0.46). ConclusionSelf-care was moderate. The correlation of better self-care with higher knowledge highlights the opportunity to implement strategies to improve self-care, which should consider the characteristics of heart failure patients attended in Primary Care.

Self-care and health-related quality of life in chronic heart failure: A longitudinal analysis.

Background:Self-care is assumed to benefit health outcomes in patients with chronic heart failure (HF), but the evidence is conflicting for health-related quality of life (HRQOL). The aim of this study was to examine the association of (changes in) self-care with HRQOL while adjusting for psychological distress.Methods:In total, 459 patients (mean age = 66.1 ± 10.5 years, 73% male) with chronic HF completed questionnaires at baseline and at 6, 12 and 18 months of follow-up. Self-care and HF-specific HRQOL were quantified with the European Heart Failure Self-care Behaviour scale and the Minnesota Living with Heart Failure Questionnaire.Results:Using general linear models, multivariable between-subject (estimate = –0.14, p = 0.005) and no within-subject effects of self-care were found for better HRQOL over time. Associations between self-care and HRQOL were fully explained by depression (estimate = 1.77, p < 0.001). Anxiety (estimate = 4.49, p < 0.001) and Type D personality (estimate = 13.3, p < 0.001) were associated with poor HRQOL, but only partially accounted for the relationship between self-care and emotional HRQOL.Conclusions:Self-care was prospectively associated with better disease-specific HRQOL in patients with HF, which was fully accounted for by depression, and partially accounted for by anxiety and Type D personality. Changes in self-care within a person did not affect HRQOL. Psychological distress should be considered in future efforts to address self-care and HRQOL.

Patterns, relevance and predictors of heart failure dyadic symptom appraisal.

Caregivers are thought to play a major role in helping patients first appraise and then respond to heart failure (HF) symptoms. The aims of this study were to: (a) characterise distinct patterns of HF patient-caregiver dyads with respect to symptom appraisal; and (b) link dyadic symptom appraisal to contributions to self-care and caregiver strain. A cross-sectional dyadic descriptive design was used to capture patient and caregiver appraisal of patient HF symptoms (i.e. dyspnoea, fatigue, pain and anxiety). Contributions to self-care were measured using patient and caregiver versions of the Self-Care of Heart Failure Index and the European Heart Failure Self-care Behaviour Scale. Caregiver strain was measured using the Multidimensional Caregiver Strain Index. Multilevel and latent class mixture modelling (LCMM) were used to examine distinct patterns of symptom appraisal. Two patterns of dyadic symptom appraisal were identified: one pattern ( n = 24; 38.7%) wherein caregivers appraised patients' symptoms as being significantly worse than did the patient (labelled as 'Caregiver > Patient'); and a second pattern ( n = 38; 61.3%) wherein patients appraised their symptoms similar to or worse than that as perceived by their caregiver (labelled as 'Patient ⩾ Caregiver'). Dyads in the Caregiver > Patient pattern of symptom appraisal reported much better contributions to self-care (symptom response behaviours only), but also greater caregiver strain, compared with dyads in the Patient ⩾ Caregiver pattern. Greater patient depression and older caregiver age were significant determinants of fitting the Patient ⩾ Caregiver pattern. Differences in how HF patients and caregivers appraise symptoms together must be taken into consideration when examining contributions to HF care and caregiver outcomes.

Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies.

Self-care is an important element in the comprehensive management of patients with heart failure. The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed and tested to measure behaviours performed by the heart failure patients to maintain life, healthy functioning, and wellbeing. The purpose of this review was to evaluate the importance of factors associated with heart failure self-care behaviours as measured by the EHFScBS. Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect). Obtained associating factors of heart failure self-care were qualitatively synthesised and the association levels of most commonly addressed factors were further explored. We identified 30 studies that were included in the review; a diverse range of personal and environmental factors associated with self-care behaviours in heart failure patients were identified. Age, health-related quality of life, gender, education, New York Heart Association class, depressive symptoms and left ventricular ejection fraction were most often correlated with the EHFScBS score. Consistent evidence for the relationship between self-care behaviours and depression was found, while their association with New York Heart Association class and health-related quality of life was non-significant in most of the studies. Associations with other factors were shown to be inconsistent or need to be further investigated as they were only addressed in single studies. A sufficient body of evidence is available only for a few factors related to heart failure self-care measured by the EHFScBS and indicates their limited impact on patient heart failure self-care. The study highlights the need for further exploration of relationships that would offer a more comprehensive understanding of associating factors.

Patterns of Self-care in Adults With Heart Failure and Their Associations With Sociodemographic and Clinical Characteristics, Quality of Life, and Hospitalizations: A Cluster Analysis.

Self-care is important in heart failure (HF) treatment, but patients may have difficulties and be inconsistent in its performance. Inconsistencies in self-care behaviors may mirror patterns of self-care in HF patients that are worth identifying to provide interventions tailored to patients. The aims of this study are to identify clusters of HF patients in relation to self-care behaviors and to examine and compare the profile of each HF patient cluster considering the patient's sociodemographics, clinical variables, quality of life, and hospitalizations. This was a secondary analysis of data from a cross-sectional study in which we enrolled 1192 HF patients across Italy. A cluster analysis was used to identify clusters of patients based on the European Heart Failure Self-care Behaviour Scale factor scores. Analysis of variance and χ test were used to examine the characteristics of each cluster. Patients were 72.4 years old on average, and 58% were men. Four clusters of patients were identified: (1) high consistent adherence with high consulting behaviors, characterized by younger patients, with higher formal education and higher income, less clinically compromised, with the best physical and mental quality of life (QOL) and lowest hospitalization rates; (2) low consistent adherence with low consulting behaviors, characterized mainly by male patients, with lower formal education and lowest income, more clinically compromised, and worse mental QOL; (3) inconsistent adherence with low consulting behaviors, characterized by patients who were less likely to have a caregiver, with the longest illness duration, the highest number of prescribed medications, and the best mental QOL; (4) and inconsistent adherence with high consulting behaviors, characterized by patients who were mostly female, with lower formal education, worst cognitive impairment, worst physical and mental QOL, and higher hospitalization rates. The 4 clusters identified in this study and their associated characteristics could be used to tailor interventions aimed at improving self-care behaviors in HF patients.

The use of platform for remote monitoring on the base of mobile app for improving self-care in patients with chronic heart failure

To determine a possibility for improving the capability of patients with chronic heart failure (CHF) for self-care and self-control using a remote monitoring platform on a basis of mobile application. The study included 142 patients with CHF of different etiology. During the stay in hospital, patients attended structured classes on different aspects of self-control and self-care in CHF. The group of active management consisted of 47 patients who subsequently used a version of mobile application. The control group consisted of 95 patients with CHF. The remote monitoring platform was based on a translated to Russian version of the European Heart Failure Self-Care Behavior Scale (EHFScBS_9), which included 9 items addressing different issues of selfcontrol. Responses were presented as a scale ranging from "completely agree" (1) to "completely disagree (5). The total score was calculated by adding scores for each item. The lower the score the better was the capability of CHF patients for self-care. The followup duration was 6 months. On admission, the mean EHFScBS_9 score decreased to 15±2.3 in the mobile application group whereas in the control group, the mean score was 23.95±3.02, which indicated a significantly better capability for self-care in the mobile application group (p.

Abstract 12114: Effects of an Educational Intervention on Disease Knowledge and Self-care Behaviors of Patients With Heart Failure: A Randomized Controlled Trial

Introduction: In this randomized clinical trial, we tested the effects of an educational intervention designed to improve disease knowledge and self-care behaviors of patients with heart failure (HF). Methods: Patients with HF (n=602; 41% female, age 66.1 ± 12.9 years) were randomized into control (usual care) or 1 of 2 intervention groups: Fluid Watchers LITE (LITE) or Fluid Watchers PLUS (PLUS). Patients in both intervention groups received face-to-face education on HF self-care led by a nurse, and then received either 2 follow-up phone calls (LITE group) or biweekly calls until they demonstrated content competency (PLUS group). The levels of HF knowledge and self-care behaviors were measured with self-report questionnaires at baseline and 3, 12, and 24 months. Data were analyzed using linear mixed-models. Results: The 3 groups were not significantly different in their HF knowledge and self-care at baseline. Significant group-by-time interactions were found in models for knowledge and self-care (Figure). Both intervention groups showed improvement in HF knowledge at 3 months, but the improvement lasted only in the PLUS group throughout 24 months. Both intervention groups exhibited significantly better self-care behaviors at 3 and 12 months compared with the control group. The intervention effects on self-care remained stable in both groups, but were not significant at 24 months. Results were similar when covariates (i.e., socioeconomic characteristics and baseline psychological status) were controlled in the models. Conclusions: The face-to-face educational intervention was effective in improving disease knowledge and self-care behaviors among patients with HF. Both intervention groups showed improvement in knowledge and self-care at 3 months, and their effects on self-care remained significant until 12 months. In addition, the intervention with more follow-up calls resulted in greater and more sustained improvement in knowledge about HF.

Abstract 11886: The Impact of Poor Understanding of Heart Failure and Its Symptoms on Self-care

Introduction: A comprehensive understanding of heart failure (HF) and its symptoms is one of the goals of patient education. Patients cannot be expected to adequately perform self-care and respond to symptoms appropriately with incomplete understanding of HF and its symptoms. Purpose: To examine whether levels of understanding of HF and its symptoms predicts self-care in HF patients who had a recent hospitalization for HF symptoms. Methods: Patients with HF (N=577, mean 66 years, 41% female, 35% NYHA III/IV) completed the 9-item European HF Self-care Behavior scale to assess self-care. The HF Knowledge Questionnaire was used to assess knowledge of HF and its symptoms. Three groups were formed by their different levels of understanding of HF and its symptoms: poor, moderate, and complete. Linear regression was used to determine whether levels of understanding of HF and its symptoms predicted self-care after controlling for age, gender, education, marital status, comorbidity, NYHA functional class, and depressive symptoms. Results: Of 577 patients, 16% and 32% of the patients had poor and moderate understanding of HF and its symptoms, respectively. Levels of understanding of HF and its symptoms independently predicted self-care. Compared with patients with complete understanding, those with poor and moderate understanding were more likely to inadequately perform self-care (standardized β=0.24 and 95% CI 3.39-6.48; standardized β=0.12 95% CI 0.53-2.93, respectively). Conclusions: A large minority of patients with HF had poor or moderate understanding of HF and its symptoms. Levels of understanding of HF and its symptoms predicted poor self-care behaviors in these patients. Thus, patient education must be designed to help patients achieve a thorough understanding of the disease and its symptoms to ensure successful self-care among HF patients.

The Impact of a Hospital-Based Educational Program Based on the Health Belief Model on Self-Care Behaviors of Heart Failure Patients

Background: The empowerment of heart failure (HF) patients to improve self-care behaviors through appropriate training programs is necessary. Evidence has indicated a lack of theory-based trials in hospitals and healthcare centers, both of which represent important health promotion settings. Objectives: This study aimed to examine the effect of a hospital-based educational program based on the constructs of the health belief model (HBM) on self-care behaviors of patients with HF. Methods: This controlled quasi-experimental study consisted of 84 patients with HF (42 patients in an intervention group and 42 in a control group) who were admitted to two large, specialized, referral hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from April to August 2015. The patients were selected using purposive sampling. Data on self-care according to the constructs of the HBM were collected using a European HF self-care behavior questionnaire and a researcher-made questionnaire. Results: Before the intervention, the mean score for self-care behaviors was 30.69 ± 5.13 in the intervention group and 31.23 ± 5.48 in the control group. In the first and second post-tests of the intervention group, the mean scores for self-care behaviors were 39.47 ± 3.40 and 40.09 ± 2.91, respectively (P < 0.001). There was a significant increase in the determinants of self-care behaviors based on the HBM after the intervention. The results also pointed to a significant difference in the constructs of the HBM (knowledge, perceived susceptibility, severity, benefits, barriers, cues to action and self-efficacy) in the intervention group during different stages of measurement. Conclusions: This study showed that implementation of the HBM-based educational intervention positively influenced the self-care behaviors of patients with HF. Thus, implementing long-term educational interventions, including continuous follow-ups, in inpatient treatment centers may result in improved and sustained self-care behaviors. We strongly suggest that novel trials of educational interventions that use other health behavior theories and training strategies are needed to expand training knowledge in hospitals.