Self-care Behaviour Scale Research Articles

Effects of Continuous Nursing Intervention on Exercise Tolerance and Rehospitalization Rate in Patients with Chronic Heart Failure

To observe the effect of continuous nursing intervention on exercise tolerance and rehospitalization rate in patients with chronic heart failure. Methods 134 patients with chronic heart failure admitted to our hospital were divided into two groups, routine nursing intervention group (control group) and continuous nursing intervention group (observation group), with 67 cases in each group. The resting and peak heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the two groups were recorded. The change of 6min walking distance, modified European Heart Failure Self-Care Behavior Scale (EHFSCB-9) and quality of life (SF-36) of the two groups were compared before and after intervention, and moreover, rehospitalization rate of heart failure of two groups 6 months after discharge was compared between the two groups. Results : Before intervention, there was no significant difference between the two groups (P>0.05). After intervention, there was no significant difference in resting and peak HR, SBP and DBP between the two groups and those before intervention (P>0.05). Further comparison between the two groups showed that there was no significant difference in resting and peak HR, SBP and DBP between the observation group and the control group (P>0.05). After intervention, 6min walking distance and SF-36 scale scores (role physical, physiological function, physical pain, energy, health status, social function, mental health and emotional function) were increased in the two groups (P<0.05). Further comparison between the two groups showed that 6min walking distance and SF-36 scale scores (except somatic pain score and role physical score) in the observation group were higher than those in the control group (P<0.05), and the EHFSCB-9 scores in the two groups decreased gradually after intervention (P<0.05). Further comparison between the two groups showed that the EHFSCB-9 scores in the observation group (except low salt diet score and taking medicine based on doctor’s advice score) were lower than those in the control group (P<0.05). The rehospitalization rate of heart failure within 6 months after discharge was 11.91% in the observation group, significantly lower than 25.37% in the control group, and the difference was significant (P<0.05). Conclusion : Continuous nursing intervention can strengthen the self-care ability of patients with chronic heart failure, improve exercise tolerance and quality of life, and reduce the rehospitalization rate to heart failure within 6 months.

The Level of Self-Care among Patients with Chronic Heart Failure.

Introduction: In a long-term approach to the treatment of heart failure, importance is given to the process of self-care management and behaviors. The number of rehospitalizations and unscheduled medical visits can be reduced by actively engaging patients in the self-care process. Methods: The study included 403 patients with chronic heart failure (mean LVEF 40.53%), hospitalized in the Cardiology Department. Medical record analysis and a self-report questionnaire were used to obtain basic sociodemographic and clinical data. The European Heart Failure Self-care Behavior Scale, revised into a nine-item scale (EHFScBS-9), was used to evaluate self-care behavior. Results: Analysis of the EHFSc-9 self-care behavior scale showed that the mean score was 49.55 out of 100 possible points (SD = 22.07). Univariate analysis revealed that significant (p < 0.05) negative predictors of the EHFScB-9 self-care scale included: male sex (b = −5146), hospitalizations in the last year (b = −5488), NYHA class II (b = −11,797) and NYHA IV class (b = −15,196). The multivariate linear regression model showed that a significant (p ˂ 0.05) negative predictor of the EHFScB-9 self-care scale was male sex (b = −5.575). Conclusions: Patients with chronic HF achieve near optimal self-care behavior outcomes. A patient prepared to engage with self-care will have fewer rehospitalizations and a better quality of life.

The Impact of Motivational Interviewing on Self-care and Health-Related Quality of Life in Patients With Chronic Heart Failure.

Self-care is an integral component of successful chronic heart failure (HF) management. Structured educational programs have already been shown to be effective in improving self-care, but some patients show resistance and little motivation for change. The objective of this study was to compare efficacy in improving self-care and health-related quality of life (HRQoL) for an educational intervention based on motivational interviewing (MI) compared with a conventional educational intervention. This experimental pretest-posttest study with an equivalent historical control group included 93 patients in the intervention group and 93 matched patients in the control group. Participants attended a first visit after HF hospitalization discharge and 6 to 7 follow-up visits during 6 months. The European Heart Failure Self-care Behavior scale and the Minnesota Living with Heart Failure Questionnaire were used to assess self-care and HRQoL, respectively. Data on mortality and hospital readmissions were collected as adverse events. Self-care improved significantly more in the MI-based intervention group than in the control group ( P = .005). Although both self-care and HRQoL improved in both groups over time ( P < .05), there was no significant between-group difference in terms of HRQoL improvement over time ( P = .13). Our findings suggest that MI delivered by MI-trained nurses is effective in significantly improving self-care by patients with HF. Nonetheless, further studies are required to evaluate the impact of MI on other outcomes, such as HRQoL and adverse clinical events.

Effects of Continuous Nursing Intervention on Exercise Tolerance and Rehospitalization Rate in Patients with Chronic Heart Failure

Objective To observe the effect of continuous nursing intervention on exercise tolerance and rehospitalization rate in patients with chronic heart failure. Methods 134 patients with chronic heart failure admitted to our hospital were divided into two groups, routine nursing intervention group (control group) and continuous nursing intervention group (observation group), with 67 cases in each group. The resting and peak heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the two groups were recorded. The change of 6min walking distance, modified European Heart Failure Self-Care Behavior Scale (EHFSCB-9) and quality of life (SF-36) of the two groups were compared before and after intervention, and moreover, rehospitalization rate of heart failure of two groups 6 months after discharge was compared between the two groups. Results: Before intervention, there was no significant difference between the two groups (P&gt;0.05). After intervention, there was no significant difference in resting and peak HR, SBP and DBP between the two groups and those before intervention (P&gt;0.05). Further comparison between the two groups showed that there was no significant difference in resting and peak HR, SBP and DBP between the observation group and the control group (P&gt;0.05). After intervention, 6min walking distance and SF-36 scale scores (role physical, physiological function, physical pain, energy, health status, social function, mental health and emotional function) were increased in the two groups (P&lt;0.05). Further comparison between the two groups showed that 6min walking distance and SF-36 scale scores (except somatic pain score and role physical score) in the observation group were higher than those in the control group (P&lt;0.05), and the EHFSCB-9 scores in the two groups decreased gradually after intervention (P&lt;0.05). Further comparison between the two groups showed that the EHFSCB-9 scores in the observation group (except low salt diet score and taking medicine based on doctor's advice score) were lower than those in the control group (P&lt;0.05). The rehospitalization rate of heart failure within 6 months after discharge was 11.91% in the observation group, significantly lower than 25.37% in the control group, and the difference was significant (P&lt;0.05). Conclusion: Continuous nursing intervention can strengthen the self-care ability of patients with chronic heart failure, improve exercise tolerance and quality of life, and reduce the rehospitalization rate to heart failure within 6 months.

The types of comorbidities are associated with self-care of heart failure, but not the number of comorbidities

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): RO1HL083176 Improving Self-Care Behavior and Outcomes in Rural Patients with Heart Failure Background/Introduction: Patients with heart failure (HF) experience cardiac and non-cardiac related comorbid conditions. Such comorbidities create challenges to successful engagement in self-care of HF because patients are asked to simultaneously perform a variety of recommended self-care activities for HF and their comorbid conditions. It is possible that patients with a greater number of comorbid conditions experience more difficulty performing activities of HF self-care compared to those with a smaller number of comorbid conditions. However, it is also possible that types of comorbid conditions are more important factors influencing self-care of HF. Purpose To explore whether self-care of HF is associated with the number of comorbid conditions or types of comorbid conditions. Methods A total of 589 patients with HF (66 years, 41% female, 65% NYHA III/IV) were included in this study. The number of comorbid conditions was measured using the list of the conditions in the Charlson Comorbidity Index. Types of comorbidities were defined as follows: concordant conditions, sharing overall pathophysiologic risk profiles with HF, and discordant conditions, not being directly related to HF. Patients were categorized into 4 groups: HF patients without comorbidities; those with concordant conditions; those with discordant conditions; and those with both concordant and discordant conditions. Self-care was measured with the European HF self-care behavior scale. A multivariate linear regression was performed to explore the relationship of HF self-care with the number and types of comorbid conditions after adjusting for relevant covariates. Results The number of comorbid conditions was not associated with self-care of HF. However, the types of comorbid conditions were related to self-care of HF after controlling for covariates. Compared to HF patients without comorbidities, patients with both concordant and discordant conditions were more likely to have poorer self-care (β=0.155, 95% CI 0.29-4.09). However, levels of self-care in patients having either concordant or discordant conditions were not different from levels in patients having no comorbid conditions. Conclusion: Patients’ adherence to HF self-care was associated with the types of comorbidities, but not the simple count of comorbidities. Patients who had both concordant and discordant conditions were more likely to perform poor self-care of HF compared to those who had either concordant or discordant conditions or no comorbid conditions. It appears that HF patients with both concordant and discordant conditions experience difficulty integrating HF self-care in relation to a variety of conditions.

Exploring the Relationship of Health Beliefs and Self-Care Behaviors Related to Diabetic Foot Ulcers of Type II Diabetes Mellitus Patients: A Cross-Sectional Study.

Objective: Diabetic foot ulcers are an invasive complication of diabetes and are increasing. This study investigates the relationship between health beliefs and foot self-care behaviors, among people with type II diabetes. Methods: A cross-sectional design was adopted, and 98 patients were recruited from outpatient clinics of the endocrine department. The questionnaires of Demographic, Diabetes Foot Ulcer Health Belief Scale (Health Beliefs, DFUHBS), and Diabetes Foot Self-Care Behavior Scale (Self Care, DFSBS) were used to collect data. Results: Among the subjects living alone or who had diabetes less than ten years, the score of DFSBS was significantly lower than among those living with families or who had diabetes for ten years or more. The frequency of performing diabetes foot self-care behavior, among males was lower than among females significantly. Although there was no significant difference in the Health Belief total score, there were differences in the benefit subscale. Those who had junior high school level or less or had diabetes less than ten years, their score was significantly lower than those with senior high school level or more or had diabetes ten years or more. In a multivariable regression model, living with family, diabetes duration, and health beliefs explained 42.9% of the variance of diabetic-foot self-care behaviors. Conclusions: Living alone, shorter duration of diabetes, male gender, and lower health belief scores predict less adequate diabetic foot self-care behavior. Health care providers should assess these factors when designing individual care plans.

Optimization of Heart Failure Patients Discharge Plan in Rajaie Cardiovascular Medical and Research Center: An Action Research.

ABSTRACTBackground: Chronic heart failure can lead to frequent hospitalizations. Improving the discharge planning is an approach to reduce hospitalization. Since there has not been enough structured and effective discharge plan in Iranian hospitals, the present study was designed to optimize this program.Method: This is a participatory action research based on Hart and Bond’s framework, conducted in a cardiovascular center in Iran from June 2016 to April 2018 during two cycles. Based on the optimization strategies obtained through semi-structured interviews with 15 participants, three focus group discussions and six expert panels, the operational discharge plan, including three areas of patient empowerment, telephone follow-up and home visit, was designed, implemented for three months and evaluated for 23 patients. European Heart Failure Self-Care Behavior Scale and information registration form to record the number of hospitalization and length of hospital stay were used to collect the quantitative data. The non-parametric Wilcoxon test was used to analyze the data by SPSS 16. Qualitative participatory evaluation was performed during a group discussion and analyzed based on qualitative content analysis method with conventional approach P<0.05 was statistically significant.Results: Considering the solutions provided by the participants, the operational discharge plan was designed and implemented with the cooperation of relevant stakeholders. Evaluation showed significant effects of designed discharge plan on self-care behavior (P<0.001), number of hospitalizations (P<0.001), and length of hospital stay (P<0.001).Conclusion: Changes were made to improve the heart failure patients’ discharge plan using action research, which resulted in reduced re-hospitalization and improved self-care behavior.

Self-care Management Intervention in Heart Failure (SMART-HF): A Multicenter Randomized Controlled Trial

BackgroundSelf-care behavior is important in avoiding hospitalization for patients with heart failure (HF) and refers to those activities performed with the intention of improving or restoring health and well-being, as well as treating or preventing disease. The purpose was to study the effects of a home-based mobile device on self-care behavior and hospitalizations in a representative HF-population. Methods and ResultsSMART-HF is a randomized controlled multicenter clinical trial, where patients were randomized 1:1 to receive standard care (control group [CG]) or intervention with a home-based tool designed to enhance self-care behavior (intervention group [IG]) and followed for 240 days. The tool educates the patient about HF, monitors objective and subjective symptoms and adjusts loop diuretics. The primary outcome is self-care as measured by the European Heart Failure Self-care behavior scale and the secondary outcome is HF related in-hospital days.A total of 124 patients were recruited and 118 were included in the analyses (CG: n = 60, IG: n = 58). The mean age was 79 years, 39% were female, and 45% had an ejection fraction of less than 40%. Self-care was significantly improved in the IG compared to the CG (median (interquartile range) (21.5 [13.25; 28] vs 26 [18; 29.75], p = 0.014). Patients in the IG spent significantly less time in the hospital admitted for HF (2.2 days less, relative risk 0.48, 95% confidence interval 0.32–0.74, P = .001). ConclusionsThe device significantly improved self-care behavior and reduced in-hospital days in a relevant HF population.

Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre-Post Study.

BackgroundPatients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life.ObjectiveOur objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial.MethodsPatients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient’s condition. In our evaluation, the primary outcome was the combination of unscheduled emergency department revisits of discharged participants or death within 90 days. Secondary outcomes included 90-day hospital readmissions, patient quality of life (as measured by Veterans Rand 12-Item Health Survey and Kansas City Cardiomyopathy Scale), self-efficacy (as measured by European Heart Failure Self-Care Behaviour Scale 9), end-user experience, and health system cost-effectiveness including cost reduction and hospital bed capacity. In this feasibility study, we also tested the recruitment strategy, clinical protocols, evaluation framework, and data collection methods.ResultsSeventy participants were enrolled into this trial. Participant engagement to monitoring was measured at 94% (N=70; ie, data submitted 56/60 days on average). Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 79% reduction of emergency department revisits post monitoring, an 87% reduction in hospital readmissions, and a 60% reduction in the median hospital length of stay (n=36). Cost of hospitalization for participants decreased by 71%, and emergency department visit costs decreased by 58% (n=30). Overall health system costs for our participants showed a 56% reduction post monitoring (n=30). HF-specific quality of life (Kansas City Cardiomyopathy Scale) scores showed a significant increase of 101% (n=35) post monitoring (P<.001). General quality of life (Veterans Rand 12-Item Health Survey) improved by 19% (n=35) on the mental component score (P<.001) and 19% (n=35) on the physical component score (P=.02). Self-efficacy improved by 6% (n=35). Interviews with participants revealed that they were satisfied overall with the monitoring program and its usability, and participants reported being more engaged, educated, and involved in their self-management.ConclusionsResults from this small-sample feasibility study suggested that our HHM intervention can be beneficial in supporting patients post discharge. Additionally, key insights from the trial allowed us to refine our methods and procedures, such as shifting our recruitment methods to in-patient wards and increasing our scope of data collection. Although these findings are promising, a more rigorous trial design is required to test the true efficacy of the intervention. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across British Columbia.Trial RegistrationClinicalTrials.gov NCT03439384; https://clinicaltrials.gov/ct2/show/NCT03439384

Child ego state and self-care behavior change in heart failure patients

BackgroundThe psychological characteristics of ego functions interfere with self-care behavior in several diseases. However, the effect of ego functions on self-care behavior after education in heart failure (HF) remains unclear. MethodsSeventy-one HF patients were enrolled. Patients’ scores on the Japanese version of the European Heart Failure Self-care Behaviour Scale (EHFScBS) were measured before and after the HF intervention, and the rate of change was used as an indicator of educational effectiveness. The Tokyo University Egogram New Ver. II was used to assess five types of ego state functions: Critical parent, Nurturing parent, Adult, Free Child, and Adapted Child (AC). ResultsA comparison of the five ego states showed that AC scores were significantly lower than those of the other ego states (p < 0.01). Total EHFScBS scores significantly decreased from 33 (26–39) to 16 (14–20) (p < 0.01) after the HF education, and the median rates of change in EHFScBS was −46.2%. Patients with a lower rate of change in EHFScBS were more likely to have low AC scores, as characterized by a lack of compliance and coordination, and were less likely to receive higher education (all p < 0.05). Even after adjustment for covariates, low AC scores were independently associated with low rate of change in EHFScBS (p < 0.01). ConclusionsEducational behavior change for self-care is less effective in HF patients with an ego state with low AC.

Effect of Orem's Self-Care Behavior Model on Quality of Life of Elderly Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a global health concern. It is a leading cause of morbidity and mortality worldwide. By 2030 it is predicted to become the third leading cause of death and the sixth cause of disability worldwide. Aim: The study aimed to evaluate the effect of Orem's self-care behavior on quality of life of elderly patients with chronic obstructive pulmonary disease in Benha City. Methods: Quasi-experimental (pre/post-test) design was utilized in this study. The study was conducted at Outpatient Clinics of Chest Hospital in Benha City, Egypt on a purposive sample of 100 elderly patients with chronic obstructive pulmonary disease. A self-administered questionnaire, an observational checklist for elderly patients practicing regarding COPD, Quality of Life Scale (QOLS) and COPD Self-Care Behavior Scale (COPDSC) were used to collect the data. Results: 55% of the studied elderly patients had good total knowledge score post model implementation, 81% of the studied elderly patients were satisfactory practices post model implementation, 72% of the studied elderly patients had good total quality of life scores post model implementation, also there were improvement in self-care behavior post model implementation p < 0001. Conclusions: This study concluded the positive effects of Orem's self-care behavior on elderly patient's knowledge, practices and their quality of life regarding chronic obstructive pulmonary disease. The study recommended that continuous self -care behavior program for the elderly patients with chronic obstructive pulmonary disease to increase their knowledge and improve their behaviors and their practices.

Factors Associated with Heart Failure Knowledge and Adherence to Self-Care Behaviors in Hospitalized Patients with Acute Decompensated Heart Failure Based on Data from "the Weak Heart" Educational Program.

PurposeAs insufficient adherence to recommendations is a major cause of poor health outcomes in patients with heart failure (HF), it is important to identify the factors that improve disease knowledge and self-care behaviors. We aimed to identify factors associated with HF knowledge and self-care behaviors in patients hospitalized due to acute decompensated heart failure (ADHF) in Poland.Patients and MethodsThis was a secondary analysis of data from a multi-center, prospective, non-randomized educational program named “The Weak Heart”, which was conducted in 14 cardiology centers in Poland. The level of HF knowledge was assessed using a questionnaire developed by the research team, and self-care behaviors were evaluated using the European Heart Failure Self-care Behaviour Scale (9-EHFScBS) questionnaire.ResultsThe study included 259 patients admitted to the hospital with ADHF. The mean HF knowledge and 9-EHFScBS questionnaire scores were 8.25± 4.34 and 25.2±9.5, respectively. The patients’ level of education (P = 0.002), number of prior HF hospitalizations (P = 0.008), and previous disease education (P < 0.001) were independently associated with better HF knowledge. Age (P = 0.03) and disease education (P = 0.02) were independently associated with self-care behaviors.ConclusionThe adherence to self-care recommendations among patients with ADHF is insufficient. Disease education positively influenced both HF knowledge and self-care abilities. To improve patients’ adherence to HF recommendations, well-designed models of education based on HF management guidelines should be implemented.

The relationship between self-care, long-term mortality, and heart failure hospitalization: insights from a real-world cohort study.

The assumption that improved self-care in the setting of heart failure (HF) care necessarily translates into improvements in long-term mortality and/or hospitalization is not well established. We aimed to study the association between self-care and long-term mortality and other major adverse HF events (MAHFE). We conducted an observational, prospective, cohort study of 1123 consecutive patients with chronic HF. The primary endpoint was all-cause mortality. We used the European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure global self-care (overall score) and three specific dimensions of self-care including autonomy-based adherence, consulting behaviour and provider-based adherence. After a mean follow-up of 3.3 years, all-cause death occurred in 487 patients (43%). In adjusted analysis, higher EHFScBS-9 scores (better self-care) at baseline were associated with lower risk of all-cause death [hazard ratio (HR) 0.993, 95% confidence interval (CI) (0.988-0.997), P-value = 0.002], cardiovascular (CV) death [HR 0.989, 95% CI (0.981-0.996), P-value = 0.003], HF hospitalization [HR 0.993, 95% CI (0.988-0.998), P-value = 0.005], and the combination of MAHFE [HR 0.995, 95% CI (0.991-0.999), P-value = 0.018]. Similarly, impaired global self-care [HR 1.589, 95% CI (1.201-2.127), P-value = 0.001], impaired autonomy-based adherence [HR 1.464, 95% CI (1.114-1.923), P-value = 0.006], and impaired consulting behaviour dimensions [HR 1.510, 95% CI (1.140-1.923), P-value = 0.006] were all associated with higher risk of all-cause mortality. In this study, we have shown that worse self-care is an independent predictor of long-term mortality (both, all-cause and CV), HF hospitalization, and the combinations of these endpoints in patients with chronic HF. Important dimensions of self-care such as autonomy-based adherence and consulting behaviour also determine the risk of all these outcomes in the long term.

Effectiveness of telemonitoring on self-care behaviors among community-dwelling adults with heart failure: a quantitative systematic review.

ABSTRACTObjective:This review examined the effectiveness of telemonitoring versus usual care on self-care behaviors among community-dwelling adults with heart failure.Introduction:Heart failure is a global health crisis. There is a body of high-level evidence demonstrating that telemonitoring is an appropriate and effective therapy for many chronic conditions, including heart failure. The focus has been on traditional measures such as rehospitalizations, length of stay, cost analyses, patient satisfaction, quality of life, and death rates. What has not been systematically evaluated is the effectiveness of telemonitoring on self-care behaviors. Involving patients in self-care is an important heart failure management strategy.Inclusion criteria:This review included studies on adult participants (18 years and older), diagnosed with heart failure (New York Heart Association Class I – IV), who used telemonitoring in the ambulatory setting. Studies among pediatric patients with heart failure, adult patients with heart failure in acute care settings, or those residing in a care facility were excluded.Methods:Eight databases, including CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Epistemonikos, ProQuest Dissertations and Theses, PsycINFO, and Web of Science were systematically searched for English-language studies between 1997 and 2019. Studies selected for retrieval were assessed by two independent reviewers for methodological quality using critical appraisal checklists appropriate to the study design. Those meeting a priori quality standards of medium or high quality were included in the review.Results:Twelve publications were included in this review (N = 1923). Nine of the 12 studies were randomized controlled trials and three were quasi-experimental studies. Based on appropriate JBI critical appraisal tools, the quality of included studies was deemed moderate to high. In a majority of the studies, a potential source of bias was related to lack of blinding of treatment assignment. Telemonitoring programs ranged from telephone-based support, interactive websites, and mobile apps to remote monitoring systems and devices. Self-care outcomes were measured with the European Heart Failure Self-care Behaviour Scale in nine studies and with the Self-care of Heart Failure Index in three studies. Telemonitoring improved self-care behaviors across 10 of these studies, achieving statistical significance. Clinical significance was also observed in nine of the 12 studies. All studies utilized one of two validated instruments that specifically measure self-care behaviors among patients with heart failure. However, in some studies, variation in interpretation and reporting was observed in the use of one instrument.Conclusions:Overall, telemonitoring had a positive effect on self-care behavior among adult, community-dwelling patients with heart failure; however, there is insufficient and conflicting evidence to determine how long the effectiveness lasts. Longitudinal studies are needed to determine the sustained effect of telemonitoring on self-care behaviors. In addition, the limitations of the current studies (eg, inadequate sample size, study design, incomplete statistical reporting, self-report bias) should be taken into account when designing future studies. This review provides evidence for the use of telemonitoring, which is poised for dramatic expansion given the current clinical environment encouraging reduced face-to-face visits.Systematic review registration number:PROSPERO CRD42019131852

Methodological quality of studies assessing validity and reliability of the European Heart Failure Self-care Behaviour Scale: a systematic review using the COSMIN methodology

The European Heart Failure Self-care Behaviour Scale (EHFScBS) is frequently used to assess self-care behaviours in patients with heart failure. This scale has been translated into several languages. The COnsensus-based Standards for the selection of health status Measurement INstrument (COSMIN) Risk of Bias checklist for a systematic review has recently been published. The aim of the study was to assess the methodological quality of studies reporting on psychometric evaluations of the EHFScBS using the COSMIN methodology. To identify relevant studies, a systematic literature search was performed using PubMed and CINAHL databases in December 2019 and the search was updated in June 2020. The COSMIN Risk of Bias checklist was used to assess the methodological quality. In total, 21 relevant studies were rated. The overall methodological quality of content validity was rated as inadequate in 17 studies and a main reason of the inadequate rating was a lack of patient involvement. Structural validity was adequately addressed in 12 studies, internal consistency in seven, and eight of 11 studies reporting on construct validity and had good methodological quality. Although the use of the EHFScBS has grown rapidly and the validity and reliability are reported to be good, the methodological quality of studies reporting on psychometric properties of the scale is not optimal. Further studies are necessary to strengthen the evidence on validity and reliability of the EHFScBS.

A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study.

BackgroundHeart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)–based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease.ObjectiveThe objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study.MethodsThe development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure app [ThessHF app]) was evidence based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients’ quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients’ quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score and the hospitalization rate.ResultsA systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4% (SD 7.2%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6% [SD 15.6%], P=.06) scores. The hospitalization rate for the follow-up duration was 3%.ConclusionsThe need for telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF.

Self-care perception and behaviour in patients with heart failure: A qualitative and quantitative study.

Background and objectiveSelf‐care strategies in heart failure (HF) are effective for disease management, yet adherence in many patients is inadequate. Reasons are presumably multifactorial but remain insufficiently investigated; thus, we aimed to analyse self‐care adherence and associated factors in outpatients with HF.Methods and resultsTo measure self‐care levels and explore barriers and facilitators to self‐care adherence in patients with HF, quantitative study using the European Self‐Care Behaviour Scale (EHFScBS‐9) (n = 80; NYHA II–III, mean age 72 ± 10 years, 58% male) and qualitative study using semi‐structured interviews (n = 32; NYHA II–III, mean age 73 ± 11, 63% male) were conducted. We detected lowest adherence to regular exercise (39%) and contacts with healthcare provider in case of worsening symptoms (47%), whereas adherence was highest for regular medication taking (94%). Using the EHFScBS‐9 standardized cut‐off score ≤ 70, 51% of patients reported inadequate self‐care. Binary logistic regression analysis showed significant influence of education (OR = 0.314, 95% CI: 0.103–0.959) and perceived control (OR = 1.236, 95% CI: 1.043–1.465) on self‐care adequacy. According to the situation‐specific theory of HF self‐care, most commonly reported factors affecting the process of self‐care were knowledge about HF self‐care behaviours (84%), experience with healthcare professionals (84%), beliefs about their expertise (69%) and habits related to medication taking (72%). Among values, working responsibilities (53%) and maintenance of traditions (31%) appeared as the most prevalent socially based values affecting motivation for self‐care. Situational characteristics related to the person (self‐confidence, 53%; adaptive coping strategies, 88%), problem (burdensome breathing difficulties, 56%; co‐morbidities, 81%) and environment (practical support from family/caregivers, 59%; financial difficulties, 50%) were also commonly reported.ConclusionsVarious factors, including health‐related beliefs, habits and socially based values, need to be taken into account when planning self‐care interventions in patients with HF. A patient tailored approach should be based on adequate patient evaluation, taking into consideration the particular personal and social context.

Persistent effect of nurse-led education on self-care behavior and disease knowledge in heart failure patients

PurposeThe guidelines on the management of patients with heart failure support intensive patient education on self-care. The present study aimed to evaluate the short-term and long-term impacts of a structured education provided by a qualified heart failure nurse on patients’ self-care behavior and disease knowledge. MethodsOne hundred fifty patients (66 ± 12 years) hospitalized for heart failure participated in a structured one-hour educational session by a heart failure nurse. Patients completed a questionnaire comprising 15 questions (nine questions from the European Heart Failure Self-Care Behavior Scale [EHFScB-9] and six on the patients’ disease knowledge) one day before and one day and six months after the educational session. Possible responses for each question ranged from 1 (complete agreement) to 5 (complete disagreement). ResultsAfter the educational session, the total EHFScB-9 score improved from 24.31 ± 6.98 to 14.94 ± 6.22, and the disease knowledge score improved from 18.03 ± 5.44 to 10.74 ± 4.30 (both P < 0.001). Scores for individual questions ranged from 1.26 ± 0.81 (adherence to the medication protocol) to 3.66 ± 1.58 (everyday weighing habits) before the education. The greatest improvement after education was observed on response to weight gain (−2.00‬±1.57), daily weight control (−1.77 ± 1.64), and knowledge on the cause of patients’ heart failure (−1.53 ± 1.43). At 6-month follow-up, EHFScB-9 score was 17.33 ± 7.23 and knowledge score was 12.34 ± 5.30 (both P < 0.001 compared with baseline). No factor was predictive of an insufficient teaching effect. ConclusionsThe educational program led by a qualified nurse improves patients’ self-care behavior and disease knowledge with a persistent effect at 6-month follow-up. There are no patient characteristics which preclude the implementation of an educational session.

Self-care, symptom experience, needs, and past health-care utilization in individuals with heart failure: results of a cross-sectional study

Self-care in heart failure (HF) is generally sub-optimal and impacts morbidity and mortality. To describe self-care prevalence and explore its relationships with symptom experience, patient needs, and health-care utilization in a Swiss hospital providing regional secondary care. Cross-sectional study, convenience sample of individuals with HF from four campuses of one regional Swiss hospital. Self-care was assessed via the Self-Care of Heart Failure Index (SCHFI) and the European Heart Failure Self-care Behaviour Scale (EHFScBS), symptom experience via the M.D. Anderson Symptom Inventory-HF (MDASI-HF) and needs via the Heart Failure Needs Assessment Questionnaire (HFNAQ). Healthcare utilization reflected the preceding year's hospitalization incidence. A cut-off level of ≥70% indicated adequate self-care. We analysed SCHFI, EHFScBS, MDASI-HF and HFNAQ scores' relationships with hospitalizations using Spearman's rho correlation; no prior hypotheses were stated. Sample of 310 individuals with HF (37.4% female; mean age 76.8; 55% NYHA III). Adequate self-care maintenance, management, and confidence were reported by 24%, 10%, and 61%. respectively. The sample's mean number of experienced symptoms was 12.8 (SD 4.0) and 14.0 (SD 5.8) for needs. Over the previous year, 269 hospitalizations had occurred (median: 0, IQR 1). Hospitalizations positively correlated with self-care; symptom experience with needs. Neither symptom experience nor needs correlated with hospitalizations. The findings indicated low self-care levels and suggest a need for increased support to maintain physiological stability, manage symptoms and prevent hospitalizations. This study is the first of its kind in Switzerland and among few studies worldwide to report on self-care, symptom experience, needs, and health-care utilization. Interventional studies are warranted considering baseline self-care capabilities, symptoms, and needs of individuals with HF.

The relationships among self-efficacy, social support, and self-care behavior in the elderly patients with chronic pain (a STROBE-compliant article).

The relationships among the self-efficacy, social support and self-care behavior in the elderly patients with chronic pain has not been reported. Therefore, we explored the relationships among self-efficacy, social support and self-care behavior in the elderly patients with chronic pain.General data questionnaire, self-efficacy scale, social support scale and self-care behavior scale were performed in 1032 elderly patients with chronic pain from Shenyang city between February and December 2017. The relationships among self-efficacy, social support and self-care behavior, and self-efficacy as a mediator between the social support and self-care behavior were analyzed by Pearson correlation analysis and Bootstrap method.In these elderly patients with chronic pain, the total scores of the self-efficacy, social support and self-care behavior were 35.59 ± 12.38, 65.64 ± 19.68 and 50.52 ± 15.26, respectively. The self-efficacy was positively correlated with the self-care behavior (r = 0.414, P < .001), the self-efficacy was positively correlated with the social support (r = 0.293, P < .001) and the social support was positively correlated with the self-care behavior (r = 0.322, P < .001). The mediating effect of self-efficacy was 0.121 which accounted for 27.31% of the total effects.The self-efficacy plays a mediating effect between social support and self-care behavior in the elderly patients with chronic pain.