The effect of education through motivational interviewing compared with conventional education on self-care behaviors in heart failure patients with depression

The effect of social network based motivational interviewing on health behaviors among infertile women with polycystic ovary syndrome: A randomized controlled trial

Polycystic ovary syndrome is one of the commonest and complex endocrine disorders in females of reproductive age. Attention to self-care behaviors such as health-promoting behaviors can improve physiological and psychological conditions in women with PCOS. This study aimed to determine the efficacy of Social Network-Based Motivational Interviewing on health-promoting behaviors and quality of life of infertile women with polycystic ovary syndrome. In this randomized controlled trial, 60 infertile women with polycystic ovary syndrome were randomly selected and assigned to the interventio (n = 30) or a control group (n = 30). Participants in the control group received routine care. Those in the intervention group received five motivational group sessions in WhatsApp, which were conducted in five groups of six participants each. The data related to health-promoting behaviors and quality of life were collected through an online questionnaire. Both groups were followed up immediately and 2 months after the intervention. Data collected in the two stages were analyzed using the paired-samples t-test, Chi-square, and repeated measures analysis. No significant difference was observed between the two groups before the intervention means health-promoting behaviors and quality of life scores (p>0.05). Immediately and two months after the intervention, the mean scores of health-promoting behaviors and their domains increased in the intervention group. This increase is statistically compared to the first test, and the scores obtained by the control group in the second (p< 0.001, ES = 1.5) and the third test (p< 0.001, ES= 1.3) were significant. The score of the quality of life variable increase was not statistically significant compared to the first test and also to the scores obtained by the control group. However According to the Generalized estimating equations (GEE) test, the changes in quality of life score between the two groups in the three stages of measurement are statistically significant. WhatsApp support increases the health-promoting self-care behaviors rate and has favorable effects on follow-up.Trial registration: Iranian Registry for Clinical Trial (the link to trial: https://www.irct.ir/trial/48089 ). Registered August 11 2020.

Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation

BACKGROUND

Depression and anxiety occur frequently (with reported prevalence rates of around 40%) in individuals with coronary heart disease (CHD), heart failure (HF) or atrial fibrillation (AF) and are associated with a poor prognosis, such as decreased health-related quality of life (HRQoL), and increased morbidity and mortality. Psychological interventions are developed and delivered by psychologists or specifically trained healthcare workers and commonly include cognitive behavioural therapies and mindfulness-based stress reduction. They have been shown to reduce depression and anxiety in the general population, though the exact mechanism of action is not well understood. Further, their effects on psychological and clinical outcomes in patients with CHD, HF or AF are unclear.

OBJECTIVES

To assess the effects of psychological interventions (alone, or with cardiac rehabilitation or pharmacotherapy, or both) in adults who have a diagnosis of CHD, HF or AF, compared to no psychological intervention, on psychological and clinical outcomes.

SEARCH METHODS

We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2009 to July 2022. We also searched three clinical trials registers in September 2020, and checked the reference lists of included studies. No language restrictions were applied.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing psychological interventions with no psychological intervention for a minimum of six months follow-up in adults aged over 18 years with a clinical diagnosis of CHD, HF or AF, with or without depression or anxiety. Studies had to report on either depression or anxiety or both.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were depression and anxiety, and our secondary outcomes of interest were HRQoL mental and physical components, all-cause mortality and major adverse cardiovascular events (MACE). We used GRADE to assess the certainty of evidence for each outcome.

MAIN RESULTS

Twenty-one studies (2591 participants) met our inclusion criteria. Sixteen studies included people with CHD, five with HF and none with AF. Study sample sizes ranged from 29 to 430. Twenty and 17 studies reported the primary outcomes of depression and anxiety, respectively. Despite the high heterogeneity and variation, we decided to pool the studies using a random-effects model, recognising that the model does not eliminate heterogeneity and findings should be interpreted cautiously. We found that psychological interventions probably have a moderate effect on reducing depression (standardised mean difference (SMD) -0.36, 95% confidence interval (CI) -0.65 to -0.06; 20 studies, 2531 participants; moderate-certainty evidence) and anxiety (SMD -0.57, 95% CI -0.96 to -0.18; 17 studies, 2235 participants; moderate-certainty evidence), compared to no psychological intervention. Psychological interventions may have little to no effect on HRQoL physical component summary scores (PCS) (SMD 0.48, 95% CI -0.02 to 0.98; 12 studies, 1454 participants; low-certainty evidence), but may have a moderate effect on improving HRQoL mental component summary scores (MCS) (SMD 0.63, 95% CI 0.01 to 1.26; 12 studies, 1454 participants; low-certainty evidence), compared to no psychological intervention. Psychological interventions probably have little to no effect on all-cause mortality (risk ratio (RR) 0.81, 95% CI 0.39 to 1.69; 3 studies, 615 participants; moderate-certainty evidence) and may have little to no effect on MACE (RR 1.22, 95% CI 0.77 to 1.92; 4 studies, 450 participants; low-certainty evidence), compared to no psychological intervention.

AUTHORS' CONCLUSIONS

Current evidence suggests that psychological interventions for depression and anxiety probably result in a moderate reduction in depression and anxiety and may result in a moderate improvement in HRQoL MCS, compared to no intervention. However, they may have little to no effect on HRQoL PCS and MACE, and probably do not reduce mortality (all-cause) in adults who have a diagnosis of CHD or HF, compared with no psychological intervention. There was moderate to substantial heterogeneity identified across studies. Thus, evidence of treatment effects on these outcomes warrants careful interpretation. As there were no studies of psychological interventions for patients with AF included in our review, this is a gap that needs to be addressed in future studies, particularly in view of the rapid growth of research on management of AF. Studies investigating cost-effectiveness, return to work and cardiovascular morbidity (revascularisation) are also needed to better understand the benefits of psychological interventions in populations with heart disease.

The role of illness perceptions in delayed care-seeking in heart failure: A mixed-methods study

BACKGROUND

Unclear illness perceptions are common in heart failure. The self-regulation model of illness behaviour highlights factors that may impact how people with chronic illness choose to cope with or manage their condition and has been used to study pre-hospital delay for stroke and acute myocardial infarction. The principles of self-regulation can be applied in heart failure to help illuminate the link between unclear illness perceptions and sub-optimal symptom self-management.

OBJECTIVE

Informed by the self-regulation model of illness behaviour, this study examines the role of illness perceptions in coping responses that lead to delayed care-seeking for heart failure symptoms.

DESIGN

Mixed-methods phenomenological study.

SETTING(S)

Quaternary referral hospital - centre of excellence for cardiovascular care and heart transplantation.

PARTICIPANTS

Seventy-two symptomatic patients with heart failure participated in a survey assessing illness perceptions. A subset of fifteen individuals was invited to participate in semi-structured interviews.

METHODS

Illness perceptions were assessed using the Brief Illness Perception Questionnaire. In-depth semi-structured interviews were conducted to elicit previous care-seeking experiences and decision-making that led to a passive, or active coping response to worsening symptoms. Descriptive statistics were used to report questionnaire findings, and open-ended responses were grouped into descriptive categories. Interpretative phenomenological analysis was undertaken on interview transcripts.

RESULTS

Participants perceived little personal control over their condition and mostly attributed heart failure to lifestyle factors such as diet and lack of activity. Cognitive dissonance between perceived self-identity and heart failure-identity led to a highly emotional response which drove coping towards avoidance strategies and denial.

CONCLUSIONS

This study demonstrates the use of the principles of self-regulation in heart failure and offers a framework to understand how patient representations and emotional responses can inform behaviour in illness. Findings highlight the value of empowering patients to take control of their health and the need to help align values (e.g. independence) with behaviours (e.g. actively addressing problems) to facilitate optimal symptom self-management.

The ubiquity of 'self-care' in health: Why specificity matters

Despite increased interest in self-care for health, little consensus exists around its definition and scope. The World Health Organization has published several definitions of self-care, including in a 2019 Global Guideline rooted in sexual and reproductive health and rights (SRHR), later expanded to encompass health more generally. To establish a robust understanding of self-care, this exploratory study inventorises, consolidates, presents and analyses definitions of self-care beyond the SRHR field. A pragmatic review identified definitions and conceptualisations of self-care from peer-reviewed and grey literature published between 2009 and 2021. The search identified 91 definitions of self-care from 116 relevant publications. Data extraction informed analysis to identify recurring themes and approaches, revealing three key areas of variation: self-care being: (1) defined directly or descriptively; (2) situated within individual, interpersonal or structural contexts; (3) defined broadly or topic-specifically. A multilevel conceptualisation can guide a more broadly applicable understanding of self-care: first, as an aspect of healthcare; second, as a concept operating at individual, interpersonal and institutional levels; third, as a concept that impacts specific health fields and contexts differently. A comprehensive but adaptable framework works in service of improving health and wellbeing for all, acknowledging the linkages between self-care and health-related human rights.

Effect of motivational interviewing on treatment adherence and self-efficacy of adolescents with asthma: A randomized controlled trial

AIMS

This study examined the short-term effect of motivational interviewing on treatment adherence and self-efficacy of adolescents with asthma.

DESIGN

The randomized controlled trial.

METHOD

In this study, 72 adolescents with asthma were recruited and assigned to experimental and control groups randomly. In the experimental group, the motivational interviewing was performed for five weekly sessions lasting 80-90 min. The treatment adherence and self-efficacy questionnaires were completed before the intervention, 2 weeks and 3 months after the intervention in both groups. Data were analysed by Chi-Square test, independent samples T-test, repeated measures of Wilcoxon and generalized estimating equation.

RESULTS

The treatment adherence was found to be significantly higher 2 weeks (p = 0.006) and 3 months after the intervention (p = 0.04) in the experimental group than the control group. In addition, the degree of self-efficacy was significantly more in the experimental group 2 weeks (p < 0.001) and 3 months later (p < 0.001) than the control group. The result of generalized estimating equation showed that the intervention group had an average of 14.44 more self-efficacy points than the control group (p < 0.001). Also, treatment adherence in the intervention group was significantly higher than the control group (β = 6.14, p = 0.05(.

CONCLUSION

This study adds to the evidence for the effectiveness of motivational interviewing in treatment of adolescents with asthma.

What kind of patient education and self-care support do patients with heart failure receive, and by whom? Implementation of the ESC guidelines for heart failure in three European regions

BACKGROUND

In order to manage Heart Failure (HF) properly, both pharmacological and non-pharmacological interventions including patient education and self-care (SC) support are important. Appropriate health care (HC) professional support is necessary to improve patient SC-skills. However, little is known which HC-professionals deliver specific education and support in daily HF-care.

OBJECTIVES

To describe patient-education and SC-support as perceived by different HC-professionals in three neighboring North-West European regions: Maastricht(the Netherlands), Noorder-Kempen(Belgium), Aachen (Germany).

METHODS

Semi-structured interviews with cardiologists, HF-nurses and general practitioners (GPs) were performed, followed by qualitative content analysis with a five-step approach: 1) familiarization with data, 2) initial coding with an a-priori code manual, 3) structuring of data in main themes, 4) revision and recoding of initial codes and 5) synthesizing codes in main themes.

RESULTS

The sample consisted of 15 cardiologists, 35 GPs and 8 HF-nurses. All interviewed HC-professionals provide HF patient-education, yet, the extent differs between them. Whereas HF-nurses identify patient-education and SC-support as one of their main tasks, physicians report that they provide little education. Moreover, little patient education takes place in primary care; with almost none of the GPs reporting to educate patients about SC. GPs in region 2 refer HF-patients to their practice nurse for education and SC-support. None of the HC-professionals reported to provide patients with all key-topics for patient education and SC-support as defined by the ESC.

CONCLUSION

HF nurses consider patient-education and SC-support as one of their main tasks, whereas physicians pay limited attention to education. In none of the three regions, all recommended topics are addressed.

Implementing Evidence-Based Motivational Interviewing Strategies in the Care of Patients with Heart Failure

Motivational interviewing (MI) has positive effects on heart failure patient outcomes related to self-care. MI can be effectively used by the interprofessional team in the hospital and clinic settings, and it can be effective even in brief patient interactions. The spirit of MI uses collaboration, evocation, and honoring the patient's autonomy. Open-ended questions, affirmations, reflective listening, and summarization are skills used to build empathy and elicit change talk with the MI framework. Clinicians can consider obtaining feedback to improve their practice of MI techniques for enhanced efficacy in helping heart failure patients improve self-care behaviors.

Self-management of depression among Chinese community individuals: A cross-sectional study using the transtheoretical model

PURPOSE

To investigate the self-management of depression among members of a Chinese community.

DESIGN AND METHODS

A cross-sectional survey was conducted in Wuhan. The Depression Prevention and Management Survey was used to identify 429 participants' stage of change, perceived benefits, process of change and self-efficacy, based on the transtheoretical model perspective.

FINDINGS

A majority of participants (69.0%) were at the inactive stage of depression self-management. The mean score of the process of change was 87.62 (SD = 24.83). ANOVA analysis showed gender, education, and family function were significant influencing factors in the process of change.

PRACTICE IMPLICATIONS

Mental health nurses need to target their approach to the level of the individual based on the transtheoretical model to assist them to enhance their awareness and motivation. More consideration should be given to gender, education, and family function in the context of depression self-management.

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

BACKGROUND

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.

OBJECTIVE

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Motivational Interviewing and Self-care Practices in Adult Patients With Heart Failure: A Systematic Review and Narrative Synthesis

BACKGROUND

Heart failure contributes to frequent hospitalizations, large healthcare costs, and high mortality. Heart failure management includes patient adherence to strict self-care practices (ie, symptom recognition, limiting sodium and fluids, monitoring weight, maintaining an active lifestyle, and medication adherence as well as monitoring other medical conditions). These practices can be difficult to enact and maintain. Motivational interviewing, although not studied extensively in patients with heart failure, may enhance patients' abilities to enact and maintain self-care practices.

OBJECTIVE

The aim of this study was to examine the effectiveness of motivational interviewing on self-care practices in the adult population with heart failure.

METHODS

We conducted a narrative systematic review of peer-reviewed research literature focused on motivational interviewing in adult patients with heart failure. The following databases were searched from database inception to March 2019: MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, ERIC, Educational Resource Complete, and Scopus. Of 1158 citations retrieved, 7 studies met the inclusion criteria.

RESULTS

Outcomes were focused on self-care adherence (ie, maintenance, management, confidence), physical activity/exercise, and knowledge of self-care. Motivational interviewing has been effectively used either alone or in combination with other therapies and has been used in-home, over the telephone, and in hospital/clinic settings, although face-to-face interventions seem to be more effective. A number of limitations were noted in the included studies.

CONCLUSION

Motivational interviewing is a potentially effective adjunct to enhance self-care practices in patients with heart failure. Further high-quality research is needed to support changes in clinical practice.

Effectiveness of health education in the self-care and adherence of patients with heart failure: a meta-analysis

Objective:

to evaluate in the literature the effectiveness of the health education interventions in self-care and adherence to treatment of patients with Chronic Heart Failure.

Method:

a systematic review with meta-analysis. Studies were selected that compared health education interventions with the usual care to assess the outcomes of adherence and self-care. The quality of the methodological evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation system.

Results:

the educational interventions were more effective in relation to the usual care in the outcome of adherence (fixed effect=0-3841; p-value <0.001). There was no statistical difference in the outcome of self-care (fixed effect=0.0063; p-value=0.898).

Conclusion:

the educational interventions improved the outcome of adherence, though not self-care in the patient with Heart Failure.

Efficacy of motivational interviewing on enhancing self-care behaviors among patients with chronic heart failure: a systematic review and meta-analysis of randomized controlled trials

Although motivational interviewing (MI) seems to be promising for enhancing self-care behaviors (i.e., daily disease management and responses to symptoms) in patients with heart failure (HF), no quantitative pooling of effect sizes has been described to summarize and test its efficacy on self-care. Given that self-care behaviors of patients with HF are essential to enhance pharmacological adherence and disease management and optimize clinical outcomes, we sought to perform a systematic review of randomized control trials (RCTs) regarding MI's efficacy on enhancing self-care behaviors among patients with HF, synthesizing MI effects on self-care through meta-analyses. Nine randomized controlled trials were included. MI showed moderate effects on enhancing self-care confidence (Hedge's g = 0.768; 95%CI = 0.326-1.210; P = 0.001) and self-care management (i.e., responses to symptoms) (Hedge's g = 0.744; 95%CI = 0.256-1.232; P = 0.003) and large effects on improving self-care maintenance (i.e., adherence to treatment and symptom monitoring) (Hedge's g = 0.873; 95%CI  = 0.430-1.317; P < 0.001). No significant effects were found for enhancing the self-reported physical functioning (Hedge's g = -0.385; 95%CI = -1.063-0.294; P = 0.267) or the directly assessed physical functioning using the 6-min walking test (Hedge's g = -0.131; 95%CI = -0.981-0.720; P = 0.072). Although future research is still required to identify situation-specific indications regarding how MI should be implemented in relation to specific clinical conditions, this study showed that MI is an effective strategy to improve self-care in patients with HF.

Effectiveness of motivational interviewing on anxiety, depression, sleep quality and quality of life in heart failure patients: secondary analysis of the MOTIVATE-HF randomized controlled trial

Purpose

Anxiety, depression, poor sleep quality and lower quality of life (QOL) are associated with worse outcomes in heart failure (HF) patients. Motivational interview (MI) has been effective in different patient populations to promote self-care. However, its effect on anxiety, depression, sleep quality and QOL in HF patients is unknown. The aim of this study was to evaluate the effect of MI on anxiety, depression, sleep quality and QOL over 12 months from the intervention.

Methods

This was a planned, secondary outcome analysis of the MOTIVATE-HF study, a three-arm randomized controlled trial (1:1:1) evaluating the effect of MI in improving self-care in HF patients. In Arm 1, the patient received MI, while in Arm 2, the patient and the caregiver received MI. Arm 3, the control group, received standard treatment. Endpoints were evaluated with the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), the 12-Item Short-Form Health Survey (SF-12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) every three months for one year.

Results

We enrolled and randomized 510 HF patient and caregiver dyads (155 dyads in Arm 1, 177 dyads in Arm 2, and 178 dyads in Arm 3). A total of 238 HF patients and 235 caregivers completed the 12-month trial. No significant changes were seen in anxiety, depression and sleep quality over time among the three study arms, but disease-specific QOL improved in the intervention groups, especially in Arm 2.

Conclusion

Clinicians may want to include both patients and caregivers when providing MI interventions. Further research is needed to investigate the required intensity of MI to be effective on sleep quality, anxiety and depression (ClinicalTrials.gov Identifier: NCT02894502).

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02788-3).

Motivational Interviewing as a Strategy to Impact Outcomes in Heart Failure Patients: A Systematic Review

BACKGROUND

Heart failure (HF) hospitalization is an expensive healthcare utilization event. Motivational interviewing (MI) has been studied for effects on HF self-management behaviors.

OBJECTIVE

The objective of this systematic review was to conduct an exploration and report of evidence and gaps in the literature regarding the impact of MI on HF outcomes.

DATA SOURCES

A modified Cochrane systematic review was conducted via a literature search in the MEDLINE, CINAHL, Cochrane Collaborative Systematic Reviews, PsycINFO, Health Source: Nursing/Academic Edition, and Google Scholar databases.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS

Randomized controlled trials (RCTs) or controlled experimental studies published in English from January 1990 to February 2019 that included adults (18 years and older) diagnosed with HF New York Heart Association (NYHA) class I, II, II, or IV were eligible for inclusion. Interventions evaluated were an MI-based face-to-face communication or telephone-based conversation provided by any healthcare provider type.

STUDY APPRAISAL AND SYNTHESIS METHODS

The Cochrane method for assessing risk of bias was used to analyze the methodological quality of retained studies.

RESULTS

Of 167 initial articles, nine were retained, describing eight unique studies (758 total patients, range 30-241; age range 58-79 years; attrition range 13-36%). The impact of MI was examined for general self-care behaviors (SCBs) (physical activity specifically), quality of life (QoL), and/or hospital readmission prevention. Eight of nine articles reported a positive impact of MI over advice-giving, seven being statistically significant. MI interventions used an initial face-to-face encounter with three to five follow-up telephone encounters.

LIMITATIONS

This systematic review had the following limitations: most retained studies included intervention activities conducted in hospital/clinic settings, which limits generalizability of the intervention in other care settings; intervention fidelity, blinding, selection, interventionist training, and random assignment were not clear in all studies; retained studies did not include potential covariates such as health literacy, patient age, and perception of disease/health risks; and some retained studies relied on patient self-report of outcomes, which may introduce recall or social desirability bias.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

MI demonstrated a positive effect on the SCB hospital readmission prevention factor and on QoL. MI delivered with greater frequency and over a longer duration may improve the immediate risk of hospital readmission as well as long-term outcomes through better medication adherence and SCBs. However, heterogeneity in the methods, design, intervention type, and structure challenged comparisons across studies and further research is warranted.

The Effect of Cognitive-Behavioral Training Versus Conventional Training on Self-care and Depression Severity in Heart Failure Patients with Depression: A Randomized Clinical Trial

Introduction: Psychological factors including depression and anxiety are the most critical risk factors in the treatment and prognosis of heart failure which should be addressed in treatment and care programs. The purpose of this study was to examine the effect of cognitive-behavioral training (CBT) on depression severity and self-care ability of patients with heart failure.

Methods: This study was a randomized clinical trial that carried out on 80 patients with heart failure who had been hospitalized in 2018. The participants were divided into the CBT group (n= 40) and the conventional training (CT) group (n= 40), randomly. Data were collected using Beck Depression Inventory (BDI) and the Self-Care of Heart Failure Index (SCHFI) version 6.2 before and 8 weeks after the educational interventions. Data were analyzed in SPSS 21 using paired t-test, independent t-test, chi-square test, and covariance analysis.

Results: The mean score of self-care in the CBT group turned out to be significantly higher than the CT group after receiving the intervention. Also, the mean depression score of the CBT group 26.95 (5.53) after intervention was significantly lower than the CT group 36.04 (8.45).

Conclusion: Cognitive-behavioral intervention, compared with conventional training, had a greater positive impact on improving self-care and alleviating the severity of depression symptoms. Therefore, it is recommended that the principles of cognitive-behavioral therapy be integrated into routine educational programs.

Gender Differences in Hispanic Patients of Mexican Origin Hospitalized with Heart Failure

BACKGROUND

More than 3 million women in the United States die of heart failure (HF) annually. Women are significantly underrepresented in studies that inform practice guidelines, especially women hospitalized for HF despite the associated negative outcomes. HF is common in Hispanic people, the largest ethnic minority group in the United States, who are mostly of Mexican origin. There are no studies of gender differences in Mexican-Hispanic persons hospitalized for HF. We sought to describe gender differences in demographic and clinical characteristics, clinical presentation, treatment, in-hospital outcomes, and discharge status in Mexican-Hispanic patients hospitalized for HF.

METHODS

We conducted a secondary analysis of data collected for a study examining readmission in patients hospitalized with HF in a 107-bed community; hospital near the U.S.-Mexico border.

RESULTS

Of 155 self-identified Hispanic patients, 43.2% (n = 67) were women. Compared with men, women were equally affected by obesity, on average 6 years older (p < .01), and more likely to be widowed (31% vs 6%; p < .001). Women had significantly higher ejection fractions, more total comorbid conditions, more hyperlipidemia, more arthritis, more anxiety, and were less likely to be treated with digoxin and more likely to be treated with calcium channel blockers. At discharge, women were significantly less likely to receive an angiotensin-converting enzyme inhibitor or an aldosterone receptor blocker and had a higher systolic blood pressure.

CONCLUSIONS

Key gender differences in chronic illness burden, treatment, and discharge status were found, highlighting the heterogeneity of women with HF and the need for further gender-specific research to develop care strategies specific to women of all races and ethnicities.

Motivational interviewing to improve self-care in heart failure patients (MOTIVATE-HF): a randomized controlled trial

AIMS

Self-care, an essential component of heart failure (HF) treatment, is inadequate in most patients. We evaluated if motivational interviewing (MI) (i) improves patient self-care maintenance (primary endpoint; e.g. taking medications), self-care management (e.g. responding to symptoms) and self-care confidence (or self-efficacy) 3 months after enrolment; (ii) changes self-care over 1 year, and (iii) augments patient self-care if informal caregivers are involved.

METHODS AND RESULTS

Parallel randomized controlled trial (1:1:1). A sample of 510 patients (median 74 years, 58% male) and caregivers (median 55 years, 75% female) was randomized to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (usual care). The intervention in Arms 1 and 2 consisted of one face-to-face MI session with three telephone contacts. Self-care was evaluated with the Self-Care of HF Index measuring self-care maintenance, management, and confidence. Scores on each scale range from 0 to 100 with higher scores indicating better self-care; ≥70 is considered adequate. At 3 months, self-care maintenance improved 6.99, 7.42 and 2.58 points in Arms 1, 2, and 3, respectively (P = 0.028). Self-care maintenance was adequate in 18.4%, 19.4%, and 9.2% of patients in Arms 1, 2 and 3, respectively (P = 0.016). Over 1 year, self-care maintenance, management, and confidence scores in Arms 1 and 2 were significantly higher than in Arm 3 in several follow-ups. Over 1 year, Arm 2 had the best scores in self-care management.

CONCLUSIONS

MI significantly improved self-care in HF patients. Including caregivers may potentiate the effect, especially in self-care management. ClinicalTrial.gov, identifier: NCT02894502.

Relationship Between Praying and Self-Care in Elderly with Heart Failure: A Cross-Sectional Study in West of Iran

Given the prevalence of Heart Failure (HF), the current study was conducted, aiming to determine the relationship between praying and self-care in the patients with HF in Iran in 2018. The type of the study is descriptive-analytical, which has been conducted in patient group of more than 65, suffering HF. The population of study has consisted of HF patients, referring to Shahid Mostafa Khomeini Hospital of Ilam province. Therefore, the patients, referring to this hospital for medical treatments, were included in this study. The study data were analyzed using software SPSS16. The findings showed there was a significant relationship between the severity of prayer and the demographic variables, such as gender (p < 0.004), education (p < 0.03), and duration of the disease (p < 0.001). The findings also showed that there was a relationship between self-care and gender (p < 0.001), education (p < 0.004), and duration of disease (p < 0.001). Also, the findings showed that there is a relationship between self-care and prayer (r = 727), so that increasing the amount of prayer will increase self-care. The mean (SD) of total prayer is 167.33 (10.49) and total self-care is 35.86 (10.60). With the increase in the rate of praying, their self-care increased. Based upon this, religious interventions are recommended to be held for this group of patients, focusing on praying.

The Effect of an Education Program Based on Illness Perception on the Lifestyle of Patients with Metabolic Syndrome: A Randomized Controlled Clinical Trial

Background:

This study aimed to examine the effects of an education program based on illness perceptions on the lifestyle of patients with metabolic syndrome.

Methods:

This is a randomized controlled clinical trial on 80 patients with metabolic syndrome referred to diabetic clinic affiliated to Shiraz University of Medical Sciences from August to November 2016. The patients were assigned to two control and intervention groups using a simple randomization method. The intervention group received education based on illness perceptions, using face-to-face and telephone follow up sessions in five weeks. The lifestyle questionnaire, brief illness perception questionnaire and demographic information questionnaire were used for data collection. The patients’ lifestyle was examined before and at the end of the eighth week from the beginning of the intervention. Descriptive and inferential statistics were used for data analysis.

Results:

After the intervention, the total lifestyle score in the intervention group significantly increased, as compared to the control group (14.60±6.85 vs 6.15±5.80) (P<0.001). Of all the lifestyle dimensions, only stress management after the intervention showed no significant changes (P>0.001).

Conclusion:

Education based on illness perceptions affected the lifestyle of patients with metabolic syndrome. Therefore, nurses and healthcare providers can use this program for improving the lifestyle of patients with metabolic syndrome.

Trial Registration Number: IRCT2016020826437N1

The content comparison of health-related quality of life measures in heart failure based on the international classification of functioning, disability, and health: a systematic review

Introduction: Due to the necessity of assessing the health-related quality of life (HRQOL) in heart failure (HF) and the increased use of the International Classification of Functioning, Disability, and Health (ICF) for making a content comparison of measurement instruments, the present study aimed to evaluate the relationship between the instruments and ICF. To this aim, the disease-specific HRQOL instruments in HF were identified, and then psychometric properties and content comparison of included instruments were conducted by linking to ICF. Methods: Disease-specific HRQOL instruments in HF were identified through a comprehensive and systematic search strategy. Then, the psychometric properties of included instruments were determined, and their contents were analyzed and compared based on the ICF coding system. In addition, each instrument was independently linked to ICF by two researchers based on standardized linking rules, and finally their degree of agreement was assessed by the Cohen's kappa coefficient. Results: Ten instruments including a total of 247 items and 417 concepts were linked to 124 different ICF categories. Further, 39 (31.5%), 65 (52.5%), 13 (10.4%), and 7 (5.6%) categories were linked to body function, activity and participation, environmental factors, and body structure, respectively. According to the content analysis approach and psychometric properties, the appropriate measurement instruments were Kansas City Cardiomyopathy and Minnesota living with HF questionnaires, respectively. Conclusion: Content comparison provides researchers with valuable information on the instrument heterogeneity and overlapping, which results in selecting the most appropriate measurement instrument based on a specific clinical context.

"Doubtful accepting": A grounded theory study of living with cardiac resynchronization therapy

Heart failure is associated with low quality of life and a high mortality rate. There is limited information about patients' experiences of living with cardiac resynchronization therapy (CRT). In the present study, we sought to explore the process of living with CRT defibrillator. This qualitative study was completed from December 2014 to April 2016 using a grounded theory approach. Twenty semistructured interviews were held with 17 patients with heart failure. Data analysis was done via a previously-published approach. The core category of the process of living with the device is "doubtful accepting". This process includes three sequential phases: losing integrity, attempting to cope with the device, and coexisting. The process takes place in a context of barriers and facilitators, and results in a wide spectrum of outcomes, from frustration to empowerment. Nurses' awareness of this process can help them provide higher quality care, strengthen facilitators and reduce barriers to the process, and enable patients to effectively use coping strategies.