Heart Disease Self-management Research Articles

Intensive nurse-led follow-up in primary care to improve self-management and compliance behaviour after myocardial infarction.

To assess the effects of intensive follow-up by primary care nurses on cardiovascular disease self-management and compliance behaviours after myocardial infarction. Although cardiovascular disease prevention and cardiac rehabilitation take place in hospital settings, a nurse-led approach is necessary in primary care during the first few months after a myocardial infarction. Therefore, it is important to assess self-management of cardiovascular disease and levels of compliance with the prescribed diet, physical activity, and medication. The study used a multicentre, quasi-experimental, pre-post design without a control group. Patients with acute coronary syndrome from 40 healthcare facilities were included in the study. A total of 212 patients participated in a programme including 11 interventions during the first 12-18 months after myocardial infarction. The following Nursing Outcomes Classification (NOC) outcomes were assessed at baseline and at the end of the intervention: Self-management: Cardiac Disease (1617) and Compliance Behaviour: Prescribed Diet (1622), Compliance Behaviour: Prescribed Activity (1632), and Compliance Behaviour: Prescribed Medication (1623). Marjory Gordon's functional health patterns and a self-care notebook were used in each intervention. Pre-post intervention means were compared using Student's t-tests for related samples. The results of the study are reported in compliance with the TREND Statement. A total of 132 patients completed the intervention. The indicators for each NOC outcome and the variations in scores before and after the intensive follow-up showed a statistically significant improvement (p-value = 0.000). Compliance Behaviour: Prescribed Diet (pre = 3.7; post = 4.1); Compliance Behaviour: Prescribed Activity (pre = 3.9; post = 4.3); Compliance Behaviour: Prescribed Medication (pre = 3.9; post = 4.7). Intensive, immediate follow-up after myocardial infarction improves compliance behaviours and self-management of heart disease. A combined self-care and family care approach should be encouraged to empower post-myocardial infarction patients. To facilitate patients' self-efficacy, the use of health education tools such as a cardiovascular self-care notebook can also be helpful. This study highlights the benefits of intensive, protocolised, comprehensive patient follow-up in primary care during the first few months after an acute myocardial infarction (AMI). Primary care nurses train patients in cardiovascular self-care. Patients were not involved in either the design or the carrying out of the study. However, at the end of the study, they participated in an evaluation process about the utility of the research study and their satisfaction with it. This process was carried out using an ad hoc survey consisting of 10 questions assessing the nursing care and follow-up inputs that were received.

Effect of Nurse-Led Individualised Self-Care Model on Myocardial Infarction Patients with Diabetes: A Randomised Controlled Pilot Trial

Background: To assess the effectiveness of the nurse-led individualised self-care model on myocardial infarction (MI) patients with diabetes. Methods: A total of 120 MI patients were enrolled from May 2020 to December 2021. The intervention group received the nurse-led individualised self-care model (n = 60), whereas the control group only received routine health education (n = 60). The Myocardial Infarction Dimensional Assessment Scale (MIDAS), Coronary Heart Disease Self-Management Behavior Scale (CSMS), Self-Rated Abilities for Health Practices (SRAHP) scale, General Self-Efficacy Scale (GSES), Hospital Anxiety and Depression Scale (HADS), blood glucose and nursing satisfaction in both groups were observed and recorded. Results: The six MIDAS subscales except for insecurity, and all dimensions of the CSMS, SRAHP, GSES and HADS scores, of the intervention group were significantly improved compared to those of the control group (p < 0.05). Compared with the control group (5.69 ± 1.43 mmol/L), the intervention group showed a decrease in the serum levels of fasting blood glucose (4.83 ± 1.57 mmol/L; p < 0.01). Conclusions: Our pilot study provides preliminary evidence supporting the feasibility of implementing nurse-led individualised self-care, suggesting its preliminary effects in improving health-related quality of life, self-care ability, health behaviours, self-efficacy, social support and nursing satisfaction among MI patients with diabetes. However, considering the unblinded and pilot nature of this study, these positive results should be interpreted with caution. Clinical Trial Registration: OSF Registration number: DOI 10.17605/OSF.IO/DVW95 (https://archive.org/details/osf-registrations-dvw95-v1).

Effect of long-term nursing intervention on quality of life and social support of patients with coronary heart disease after percutaneous coronary intervention.

To assess the effect of long-term nursing intervention on the quality of life and social support of patients after percutaneous coronary intervention (PCI). A randomised controlled trial was designed. A total of 60 patients with coronary heart disease treated with PCI were randomly divided into the control group and the intervention group. The patients in the control group received routine nursing care, while the patients in the intervention group received long-term nursing intervention. The Simplified Quality of Life Scale-Quality of Life Scale, the Coronary Heart Disease Self-Management Scale, and the Social Support Rating Scale were used to collect and analyse the data. After the intervention, the scores for quality of life, social support and self-management in the intervention group were higher than those in the control group, and the differences were statistically significant (p < 0.05). Long-term nursing intervention can improve the quality of life and sense of social support of patients with coronary heart disease after PCI.

E-health - Potentialities and challenges for health professionals and patients: Integrative Literature Review

Introduction: E-health is based on information and communication technologies in health and has been implemented and developed all over the world. Objective: to identify the scientific and available evidence on the use of the e-health policy, evaluating the potential and the challenges that it poses to health professionals and patients. Method: Integrative literature review, through research in PubMed, b-on and CINAHL databases. We considered for inclusion in the study, randomized controlled trials, controlled clinical trials and observational studies, written in English and Portuguese, published within the last 10 years and available in full text. Results: 356 studies were found, 8 studies were included in this review in which health professionals and patients recognize the importance and benefits of e-health, in various aspects. The self-management of heart disease has great potential in e-health, being one of the most studied areas in this context. The Covid-19 pandemic has further demonstrated the benefits of e-health. Conclusions: It was identified that the potential of e-health is evident in various contexts, whether in terms of diagnosis, disease monitoring and consultation environment. There is still a way to go in promoting self-care in patients with acute and/or chronic illness through the long-term e-health strategy, recognizing its benefits in maintaining the disease by the user.

Heart Disease Self-management for African American Older Adults: Outcomes of an Adapted Evidence-Based Intervention.

Background and ObjectivesTo assess the impact of an evidence-based self-management intervention adapted through a community-engaged process for African American midlife and older adults with heart disease and/or cardiovascular risk factors.Research Design and MethodsAdults 50 years and over, living in or near Detroit, MI, with diagnosed heart disease or greater or equal to two major risk factors for heart disease, were randomized to a 7-week group-format program called Take Heart, or a usual-care control group. Take Heart included education about heart disease and support for behavioral lifestyle change, using a goal-setting process based on self-regulation theory. Outcome data were collected via telephone surveys at baseline and 1 year from baseline. Primary outcomes were self-reported emergency department visits and hospitalizations in the last year. Secondary outcomes were health-related quality of life (PROMIS-29 Adult Profile) and cardiac symptom burden.ResultsA total of 453 participants enrolled (74% female, 84% African American, mean age 65.4 years; 55% with diagnosed heart disease and 45% with risk factors only); 362 provided baseline and follow-up data. Using generalized linear and binomial regression models, at 12-month follow-up, there were no significant differences between intervention and control groups in ED visits or hospitalizations. Intervention versus control participants had greater improvements in PROMIS fatigue (p = .003) and sleep (p = .04) subscales as well as cardiac symptom burden (p = .04).Discussion and ImplicationsThe Take Heart intervention was associated with modest improvements in sleep, fatigue, and cardiac symptom burden. Take Heart was well received and has potential for dissemination by agencies serving older adults.Clinical Trial Registration Number: https://www.clinicaltrials.gov/ct2/show/NCT02950818

Comparison of Recruitment Strategies for Engaging Older Minority Adults: Results From Take Heart

Few studies report best practices for recruiting older adults from minority, low SES communities for behavioral interventions. In this presentation, we describe recruitment processes and numbers for Take Heart, a randomized controlled trial testing the effectiveness of an adapted heart disease self-management program for primarily African American, low SES adults 50 years or older in Detroit. Community-based (CB), electronic medical record (EMR), and in-person hospital clinic (HC) recruitment methods were implemented. Within 22 months, 453 participants were enrolled, with an overall recruitment yield of 37%. The CB method had the highest yield (49%), followed by HC (36%) and EMR (16%). The average cost of recruiting and enrolling one participant was $142. Face-to-face interactions and employing a community health worker were particularly useful in engaging this population. Further research is needed to confirm these findings in other minority and low SES populations and share lessons learned about recruitment challenges and successes.

Study on the Correlation among Sleep Quality, Cognitive Function, and Self-Management Ability in Hospitalized Elderly Patients with Coronary Heart Disease

Background. Coronary heart disease (CHD) is the leading cause of death worldwide. The incidence of cardiovascular disease is especially common in low-level and middle-income countries. With the increase in the number of patients with CHD and the complexity of treatment on patients with CHD, many hospitals are devoted to developing new models of care and management for patients with CHD. Understanding the unique characteristics of the patient’s condition, including factors related to self-management, cognitive function, and sleep quality, will lead to a substantial reduction in cardiovascular disease and related mortality. Objective. To investigate the correlation among sleep quality, cognitive function, and self-management ability in hospitalized elderly patients with coronary heart disease (CHD). Methods. 120 hospitalized elderly patients with coronary heart disease (CHD) were investigated by using a self-designed general data questionnaire, Pittsburgh Sleep Quality Index (PSQI), Montreal Cognitive Function Assessment (MoCA) scale, and Coronary Heart Disease Self-management Behavior Scale (CSMS). Results. The Spearman analysis showed that sleep quality was positively correlated with cognitive function in hospitalized elderly CHD patients ( P &lt; 0.05 ). Sleep quality was positively correlated with self-management ability in CHD patients ( P &lt; 0.05 ). Conclusion. Improving the cognitive function and self-management ability of elderly patients with coronary heart disease can improve their sleep quality.

Application of self-management plan based on information-motivation-behavioral skill (IMB) model for percutaneous coronary intervention patients

Objective To explore the application effect of self-management plan based on information-motivation-behavior skill (IMB) model in patients with percutaneous coronary intervention (PCI) . Methods Using Convenience sampling method, patients undergoing PCI in the Department of Cardiology, Fuwai Central China cardiovascular Hospital, He'nan Provincial People's Hospital from November to December 2018 were selected as the research objects and randomly divided into the control group (n=30) and experimental group (n=29) . The control group received routine nursing care, on the basis of that, the experimental group was implemented self-management plan based on IMB model. The intervention effects were compared by using the Coronary Heart Disease Self-management Behavior Scale (CSMS) , General Self-efficacy Scale (GSES) , Seattle Angina Questionnaire (SAQ) . Results There were statistically significant differences in the total scores of CSMS between the two groups after intervention (P<0.05) . There were statistically significant differences in GSES scores between the two groups after intervention (P<0.05) ; there were statistically significant differences in SAQ scores between the two groups after intervention (P<0.05) . Conclusions The self-management plan based on IMB model can effectively improve the PCI patients' self-efficacy, and improve their self-management behaviors and quality of life. Key words: Quality of life; IMB model; PCI; Self-management

Sharing the Patient Experience: A "Talk Story" Intervention for Heart Failure Management in Native Hawaiians.

Background:Native Hawaiians (NHs) suffer disproportionately from cardiovascular disease morbidity and mortality.Objective:To test a narrative intervention of patient stories to support heart disease self-management in NHs.Method:Six NH storyteller videos were developed with community feedback following established methods. The NH participants with heart failure (N = 35) were recruited from a major medical center in Hawai‘i. Participants completed demographic questionnaires, watched videos via iPad, and described experiences. Follow-up was 4 weeks later.Results:Mean participant age was 57.0 years (standard deviation [SD]:13.0) and 31% (11) were female. On a scale of 1 (worst) to 4 (best), respondents rated the videos 3.7 (SD: 0.5) in relevance for helping them manage their heart disease and 3.6 (SD: 0.5) in their experience using these videos. When asked what they liked best, the most common response was that they are “like me” (from 14 respondents, ranging from a 43-year-old woman to an 84-year-old man). Of those completing follow-up (n = 15), 87% said videos helped them.Conclusion:Our narrative “talk story” intervention showed promise as a culturally relevant method to share patient experiences and reduce health disparities.

Application effect of timing theory on self-management and medication adherence in patients with percutaneous coronary intervention

Objective To investigate the effect of intervention theory based on timing theory on self-management behavior and medication compliance of patients with percutaneous coronary intervention (PCI) . Methods A total of 126 patients who underwent PCI in People's Hospital of He'nan Province in 2018 were enrolled, including 67 who had PCI from April to June in 2018 in the experimental group and 59 who had PCI from January to March in 2018 in the control group. Patients in the control group received routine nursing intervention. The patients in the experimental group were treated with an intervention program based on timing theory. The Coronary Heart Disease Self-Management Scale and the Morisky Medication Adherence Questionnaire were used to compare the effects of the intervention. Results After intervention, the scores of daily life management (17.11±3.62) , bad habit management (16.33±4.36) , disease knowledge management (17.11±3.68) , symptom management (14.25±4.15) , first aid management (13.55±4.27) , treatment compliance management (11.13±3.62) and emotional cognitive management (15.69±4.25) in the experimental group were higher than the control group with (14.57±3.69) , (14.17±3.88) , (14.36±3.56) , (12.34±4.46) , (10.41±3.89) , (7.69±4.14) , (13.23±4.32) respectively, and the differences were statistically significant (t=3.895, 2.921, 4.250, 2.489, 4.293, 4.976, 3.217; P<0.05) . After the intervention, the scores of the medication adherence questionnaire in the experimental group was (6.35±1.12) , and the control group was (5.92±1.17) . The difference between the two groups was statistically significant (t=2.106, P=0.037) . Conclusions Timing theory can improve the self-management behavior and medication compliance of PCI patients, and can be applied in clinical practice. Key words: Medication adherence; Percutaneous coronary intervention; Timing theory; Self-management

Status quo and influencing factors of self-management in readmitted patients with myocardial infarction

Objective To investigate the correlation between self-efficacy, discharge readiness and self-management in readmitted patients with myocardial infarction, to explore the influencing factors to self-management and to provide a basis for intervention strategies in clinical practice. Methods Totally 198 readmitted patients with myocardial infarction from First Hospital of Shanxi Medical University were selected using convenient sampling from December 2017 to May 2018 and investigated with the general informational questionnaire, Coronary Heart Disease Self-Efficacy Questionnaire (CHDSEQ) , Discharge Readiness Scale (DRS) , and Coronary Heart Disease Self-Management Scale (CHDSMS) . Pearson correlation analysis and multivariate linear multilayer regression analysis were used to explore the influencing factors to self-management behavior. Results The CHDSMS score of the 198 patients was (75.21±9.31) , with a 63.12% scoring metrics; the CHDSEQ score was (50.91±10.43) ; the DRS score was (161.53±26.76) . Correlation analysis showed that self-efficacy was positively correlated with self-management (r=0.537, P<0.01) , and that discharge readiness was positively correlated with self-management (r=0.416, P<0.01) . Multilayer correlation analysis revealed that the two factors could account for 14.1% of the variance of self-management. Conclusions Medical and nursing workers should evaluate the discharge readiness of readmitted patients with myocardial infarction accurately, improve patients' self-efficacy, and provide effective discharge guidance for different groups according to relevant influencing factors, thus improving patients' self-management. Key words: Myocardial infarction; Self-efficacy; Discharge readiness; Self-management; Influencing factors

A Novel Cardiac Auscultation Monitoring System Based on Wireless Sensing for Healthcare.

Heart sounds deliver vital physiological and pathological evidence about health. Wireless cardiac auscultation offers continuous cardiac monitoring of an individual without 24*7 manual healthcare care services. In this paper, a novel wireless sensing system to monitor and analyze cardiac condition is proposed, which sends the information to the caregiver as well as a medical practitioner with an application of the Internet of Things (IoT). An integrated system for heart sound acquisition, storage, and asynchronous analysis has been developed, from scratch to information uploading through IoT and signal analysis. Cardiac auscultation sensing unit has been designed to monitor cardiovascular health of an individual. Bluetooth protocol is used to offer power efficiency and moderate data transmission rate. The Hilbert–Huang transform is used to eliminate interference signals and to help to extract the heart sound signal features. Subsequence segmentation algorithm based on double-threshold has been developed to extract physiological parameters. Preprocessing, segmentation, and clustering technique were performed for significant health information interpretation. The cardiac auscultation monitoring system may provide a way for heart disease self-management.

Text Message and Internet Support for Coronary Heart Disease Self-Management: Results From the Text4Heart Randomized Controlled Trial.

BackgroundMobile technology has the potential to deliver behavior change interventions (mHealth) to reduce coronary heart disease (CHD) at modest cost. Previous studies have focused on single behaviors; however, cardiac rehabilitation (CR), a component of CHD self-management, needs to address multiple risk factors.ObjectiveThe aim was to investigate the effectiveness of a mHealth-delivered comprehensive CR program (Text4Heart) to improve adherence to recommended lifestyle behaviors (smoking cessation, physical activity, healthy diet, and nonharmful alcohol use) in addition to usual care (traditional CR).MethodsA 2-arm, parallel, randomized controlled trial was conducted in New Zealand adults diagnosed with CHD. Participants were recruited in-hospital and were encouraged to attend center-based CR (usual care control). In addition, the intervention group received a personalized 24-week mHealth program, framed in social cognitive theory, sent by fully automated daily short message service (SMS) text messages and a supporting website. The primary outcome was adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score (≥3) at 3 and 6 months. Secondary outcomes included clinical outcomes, medication adherence score, self-efficacy, illness perceptions, and anxiety and/or depression at 6 months. Baseline and 6-month follow-up assessments (unblinded) were conducted in person.ResultsEligible patients (N=123) recruited from 2 large metropolitan hospitals were randomized to the intervention (n=61) or the control (n=62) group. Participants were predominantly male (100/123, 81.3%), New Zealand European (73/123, 59.3%), with a mean age of 59.5 (SD 11.1) years. A significant treatment effect in favor of the intervention was observed for the primary outcome at 3 months (AOR 2.55, 95% CI 1.12-5.84; P=.03), but not at 6 months (AOR 1.93, 95% CI 0.83-4.53; P=.13). The intervention group reported significantly greater medication adherence score (mean difference: 0.58, 95% CI 0.19-0.97; P=.004). The majority of intervention participants reported reading all their text messages (52/61, 85%). The number of visits to the website per person ranged from zero to 100 (median 3) over the 6-month intervention period.ConclusionsA mHealth CR intervention plus usual care showed a positive effect on adherence to multiple lifestyle behavior changes at 3 months in New Zealand adults with CHD compared to usual care alone. The effect was not sustained to the end of the 6-month intervention. A larger study is needed to determine the size of the effect in the longer term and whether the change in behavior reduces adverse cardiovascular events.Trial RegistrationACTRN 12613000901707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364758&isReview=true (Archived by WebCite at http://www.webcitation.org/6c4qhcHKt)

Self-Management of Heart Disease in Older Adults

The American Heart Association estimates that 81% of people who die of coronary heart disease are 65 years old or older. The leading risk health behaviors include physical inactivity, poor diet, smoking, and binge drinking. Using the 2011–2012 California Health Interview Survey (CHIS), this study looked at how self-management, which includes a plan developed by a medical professional and the confidence to manage one’s disease, may decrease negative risk behaviors in older adults. The presence of a plan and increased self-efficacy decreased engagement in negative dietary behaviors and low physical activity. Implications for strategies that address heart disease and self-management are discussed.

Improving coronary heart disease self-management using mobile technologies (Text4Heart): a randomised controlled trial protocol

BackgroundCardiac rehabilitation (CR) is a secondary prevention program that offers education and support to assist patients with coronary heart disease (CHD) make lifestyle changes. Despite the benefits of CR, attendance at centre-based sessions remains low. Mobile technology (mHealth) has potential to reach more patients by delivering CR directly to mobile phones, thus providing an alternative to centre-based CR. The aim of this trial is to evaluate if a mHealth comprehensive CR program can improve adherence to healthy lifestyle behaviours (for example, physically active, fruit and vegetable intake, not smoking, low alcohol consumption) over and above usual CR services in New Zealand adults diagnosed with CHD.Methods/designA two-arm, parallel, randomised controlled trial will be conducted at two Auckland hospitals in New Zealand. One hundred twenty participants will be randomised to receive a 24-week evidence- and theory-based personalised text message program and access to a supporting website in addition to usual CR care or usual CR care alone (control). The primary outcome is the proportion of participants adhering to healthy behaviours at 6 months, measured using a composite health behaviour score. Secondary outcomes include overall cardiovascular disease risk, body composition, illness perceptions, self-efficacy, hospital anxiety/depression and medication adherence.DiscussionThis study is one of the first to examine an mHealth-delivered comprehensive CR program. Strengths of the trial include quality research design and in-depth description of the intervention to aid replication. If effective, the trial has potential to augment standard CR practices and to be used as a model for other disease prevention or self-management programs.Trial registryAustralian New Zealand Clinical Trials Registry: ACTRN12613000901707

Results of a Community Translation of the “Women Take PRIDE” Heart Disease Self-Management Program

This article reports the results of a community demonstration of an evidence-based heart disease self-management program for older women. Women Take PRIDE (WTP) is a group-based education and behavior modification program, based on social cognitive theory, designed to enhance heart disease self-management among older women. We implemented the program in community settings with 129 participants. Evaluation data was collected at baseline and at 4- and 12-month follow-ups. Outcomes included general health status, functional health status, and knowledge. Results showed significant improvements in self-rated health, energy, social functioning, knowledge of community resources, and number, frequency, and bother of cardiac symptoms. These results demonstrate that an evidence-based heart disease self-management program can be effective at improving health and quality of life among older women with heart disease when implemented in community settings.

The potential of Web-based interventions for heart disease self-management: a mixed methods investigation.

BackgroundExisting initiatives to support patient self-management of heart disease do not appear to be reaching patients most in need. Providing self-management programs over the Internet (web-based interventions) might help reduce health disparities by reaching a greater number of patients. However, it is unclear whether they can achieve this goal and whether their effectiveness might be limited by the digital divide.ObjectiveTo explore the effectiveness of a web-based intervention in decreasing inequalities in access to self-management support in patients with coronary heart disease (CHD).MethodsQuantitative and qualitative methods were used to explore use made of a web-based intervention over a period of 9 months. Patients with CHD, with or without home Internet access or previous experience using the Internet, were recruited from primary care centers in diverse socioeconomic and ethnic areas of North London, UK. Patients without home Internet were supported in using the intervention at public Internet services.ResultsOnly 10.6% of eligible patients chose to participate (N=168). Participants were predominantly Caucasian well-educated men, with greater proportions of male and younger CHD patients among participants than were registered at participating primary care practices. Most had been diagnosed with CHD a number of years prior to the study. Relatively few had been newly diagnosed or had experienced a cardiac event in the previous 5 years. Most had home Internet access and prior experience using the Internet. A greater use of the intervention was observed in older participants (for each 5-year age increase, OR 1.25 for no, low or high intervention use, 95% CI, 1.06-1.47) and in those that had home Internet access and prior Internet experience (OR 3.74, 95% CI, 1.52-9.22). Less use was observed in participants that had not recently experienced a cardiac event or diagnosis (≥ 5 years since cardiac event or diagnosis; OR 0.69, 95% CI, 0.50-0.95). Gender and level of education were not statistically related to level of use of the intervention. Data suggest that a recent cardiac event or diagnosis increased the need for information and advice in participants. However, participants that had been diagnosed several years ago showed little need for information and support. The inconvenience of public Internet access was a barrier for participants without home Internet access. The use of the intervention by participants with little or no Internet experience was limited by a lack of confidence with computers and discomfort with asking for assistance. It was also influenced by the level of participant need for information and by their perception of the intervention.ConclusionsThe availability of a web-based intervention, with support for use at home or through public Internet services, did not result in a large number or all types of patients with CHD using the intervention for self-management support. The effectiveness of web-based interventions for patients with chronic diseases remains a significant challenge.

Self-Management of Heart Disease by Older Adults

A randomized, controlled trial involving 636 older individuals was conducted to evaluate an intervention to enhance self-management of heart disease. Program participants experienced less impact of illness on their psychosocial functioning (p &lt;.05), especially their emotional behavior (p &lt; .05) and alertness (p &lt; .01). Compared to controls, male program participants experienced improvements in their physical functioning, specifically their ability to ambulate (p &lt; .05) and the frequency and severity of their symptoms. Female program participants did not experience gains in physical functioning. Most group differences emerged by 12 months and decayed by the 18-month final evaluation. To accurately assess the pattern of change associated with a program of this type, evaluation over at least 18 months following program completion may be needed. Separate interventions for older men and women with heart disease appear warranted, as do follow-up activities at strategic points in time to sustain program effects.

Resource Reviews: Living a Healthy Life with Chronic Conditions: Self Management of Heart Disease, Arthritis, Stroke, Diabetes, Emphysema &amp; others, Zapp! Empowerment in Health Care: How to Improve Patient Care, Increase Job Satisfaction and Lower Health Costs

Resource Reviews: Living a Healthy Life with Chronic Conditions: Self Management of Heart Disease, Arthritis, Stroke, Diabetes, Emphysema &amp; others, Zapp! Empowerment in Health Care: How to Improve Patient Care, Increase Job Satisfaction and Lower Health Costs

Nonparticipation of Older Adults in a Heart Disease Self-Management Project

Nonparticipation is an important issue in gerontological research. However, literature describing factors influencing participation of older adults in disease management programs is limited. This article contributes to the understanding of nonparticipation in older adults by reviewing the relevant literature and delineating a strategy for assessing the impact of nonparticipation on the generalizability of findings. Involvement in a study of an educational intervention for teaching self-management skills was investigated. Four hundred elderly cardiac patients were divided into three groups: participants in the self-management program evaluation; nonparticipants who declined involvement in the study, but agreed to provide a limited amount of information via telephone interview; and those who refused involvement of any kind. Participants were most likely to be male, with more formal education, who were more worried about their heart conditions, and less likely to perceive that help was available to them. Nonparticipants mentioned "time constraints," "transportation," and "physical limitations" as primary barriers to involvement.