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Whittal A, Ehringfeld I, Steinhoff P, Herber OR. Determining Contextual Factors for a Heart Failure Self-Care Intervention: A Consensus Delphi Study (ACHIEVE). HEALTH EDUCATION & BEHAVIOR 2024; 51:311-320. [PMID: 34605710 PMCID: PMC10981183 DOI: 10.1177/10901981211043116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a rising recognition of the crucial role self-care plays in managing heart failure (HF). Yet patients often have difficulties implementing ongoing self-care recommendations into their daily lives. There is also recognition of the importance of theory for successful intervention design, and understanding of key factors for implementation so interventions fit a given context. Local key stakeholders can provide valuable insights to help understand relevant context-specific factors for intervention implementation. This study sought to engage stakeholders to explore and determine relevant contextual factors needed to design and facilitate successful implementation of an HF self-care intervention in the German health care system. A ranking-type Delphi approach was used to establish consensus from stakeholders (i.e., clinicians, patients, policymakers/potential funders) regarding eight factors (content, interventionist, target group, location, mode of delivery, intensity, duration, and format) to adequately define the components and implementation strategy of the intervention. Seventeen participants were invited to participate in the first Delphi round. A response rate of 94% (16/17) was achieved and maintained for all three Delphi rounds. Stakeholder consensus determined that nurses specializing in HF are the most appropriate interventionists, target groups should include patients and carers, and the intervention should occur in an outpatient HF clinic, be a mixture of group and individual training sessions, and last for 30 minutes. Sessions should take place more frequently in the beginning and less often over time. Local stakeholders can help determine contextual factors that must be taken into account for successful delivery of an intervention. This enables the intervention to be developed and applied based on these factors, to make it suitable for the target context and to enhance participation to achieve the desired outcomes.
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Affiliation(s)
- Amanda Whittal
- Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Witten/Herdecke University, Witten, Germany
| | | | | | - Oliver Rudolf Herber
- Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Witten/Herdecke University, Witten, Germany
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de Araujo Kaji P, de Lucena Ferretti-Rebustini RE, Bosco Aprile DC, de Lima Lopes J, Batista Santos V, Takao Lopes C. Control Attitudes Scale-Revised-Brazilian Version. J Cardiovasc Nurs 2023:00005082-990000000-00123. [PMID: 37661304 DOI: 10.1097/jcn.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Heart failure demands self-care skills and behaviors that can be negatively impacted by a low level of perceived control (PC), a belief about having the necessary resources to deal with negative events. Having valid and reliable instruments to measure PC is important to support interventions that improve self-care and related outcomes. The Control Attitudes Scale-Revised (CAS-R) was developed in the United States to measure PC in cardiac conditions. In Brazil, there are no instruments available to measure this construct. OBJECTIVE The aims of this study were to translate and adapt the CAS-R to the Brazilian population and to assess the content validity of the adapted version. METHODS The CAS-R was translated, back-translated, and assessed by an expert committee for linguistic equivalences. An agreement > 80% was considered adequate. Content validity (clarity, theoretical relevance, and practical pertinence) was assessed by both an expert professional panel (n = 6-8) and a panel of patients with heart failure (n = 40). A content validity coefficient > 0.70 was considered acceptable. RESULTS The translations to Brazilian Portuguese were considered consistent with the original CAS-R. In the third round of linguistic equivalence assessment, all items achieved acceptable agreement, except for 2 items. After modifications to the instrument to achieve adequate equivalences, the adapted version had a final content validity coefficient of 0.93. Most patients were able to understand the instrument. CONCLUSIONS The CAS-R-Brazilian version is equivalent to the original CAS-R and has satisfactory evidence of content validity. Additional psychometric testing will be performed to allow for the assessment of PC in individuals with heart failure in Brazil.
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Wilson AMMM, Almeida GSMD, Santos BDCFD, Nakahara-Melo M, Conceição APD, Cruz DDALMD. Factors associated with caregivers' contribution to self-care in heart failure. Rev Lat Am Enfermagem 2022; 30:e3632. [PMID: 35976358 DOI: 10.1590/1518-8345.5838.3632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/26/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to analyze the caregiver's contribution to self-care in heart failure and the predictor variables of this contribution. METHOD a cross-sectional descriptive and analytical study, with the participation of 140 dyads (patients and caregivers). The contribution to self-care was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index. Caregivers and patients were interviewed separately to obtain the data. Multiple linear regressions were used to verify predictor variables of caregiver contribution. RESULTS the mean score for contribution to maintenance self-care was 62.7 (SD=7.1), for management, 62.9 (SD=20.4) and for confidence was 63.3 (SD=22.1). The variables number of patient's medications, caregiver being related to the patient, social perception of caregiver, health-related quality of life of the patient and caregiver's confidence in contributing to self-care were predictors of caregiver's contribution to maintenance or management self-care. CONCLUSION the caregiver's contribution was insufficient. The social support perceived by the caregiver, the type of relationship the caregiver to the patient, the number of medications used by the patient, as well as the caregiver's confidence in contributing to self-care are variables that should be considered to assess the risk of insufficient contribution of the caregiver.
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Affiliation(s)
| | - Glauber Silva Mendes de Almeida
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil.,Universitatsklinikum Duesseldorf, Kardiochirurgie, Duesseldorf, NRW, Alemanha
| | - Bruna de Cassia Ferreira Dos Santos
- Hospital Municipal Dr Moysés Deutsch, Pronto-Socorro, São Paulo, SP, Brasil.,Universidade Federal de Juiz de Fora, Departamento de Enfermagem Aplicada, Juiz de Fora, MG, Brasil
| | - Michele Nakahara-Melo
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Ana Paula da Conceição
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil.,Instituto Dante Pazzanese de Cardiologia, Unidade de Internação Adulto, São Paulo, SP, Brasil
| | - Diná de Almeida Lopes Monteiro da Cruz
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil.,Bolsista do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil
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Wilson AMMM, Almeida GSMD, Santos BDCFD, Nakahara-Melo M, Conceição APD, Cruz DDALMD. Factores asociados a la contribución de los cuidadores para el autocuidado de la insuficiencia cardiaca. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5838.3634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumen Objetivo: analizar la contribución del cuidador para el autocuidado en la insuficiencia cardiaca y las variables predictoras de esa contribución. Método: estudio transversal descriptivo y analítico, con la participación de 140 díadas (pacientes y cuidadores). La contribución para el autocuidado fue evaluada por medio del Caregiver Contribution to Self-Care of Heart Failure Index. Los cuidadores y pacientes fueron entrevistados separadamente para obtención de los datos. La regresión linear múltiple fue utilizada para verificar variables predictoras de la contribución del cuidador. Resultados: la puntuación media de contribución para el autocuidado de manutención fue 62,7 (DE=7,1), de administración fue 62,9 (DE=20,4) y de confianza fue 63,3 (DE=22,1). Las variables: número de medicamentos del paciente, cuidador tener parentesco con el paciente, percepción social del cuidador, calidad de vida relacionada a la salud del paciente y la confianza del cuidador en la contribución para el autocuidado, fueron predictoras de la contribución del cuidador para el autocuidado de manutención o de administración. Conclusión: la contribución del cuidador fue insuficiente. El apoyo social percibido por el cuidador, el cuidador tener o no parentesco con el paciente, el número de medicamentos utilizados por el paciente y la confianza del cuidador en contribuir para el autocuidado, son variables que deben ser consideradas para evaluar el riesgo de contribución insuficiente del cuidador.
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Affiliation(s)
| | | | | | - Michele Nakahara-Melo
- Universidade de São Paulo, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
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Wilson AMMM, Almeida GSMD, Santos BDCFD, Nakahara-Melo M, Conceição APD, Cruz DDALMD. Factors associated with caregivers’ contribution to self-care in heart failure. Rev Lat Am Enfermagem 2022. [PMID: 35976358 PMCID: PMC9364777 DOI: 10.1590/1518-8345.5838.3633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: to analyze the caregiver’s contribution to self-care in heart failure and the predictor variables of this contribution. Method: a cross-sectional descriptive and analytical study, with the participation of 140 dyads (patients and caregivers). The contribution to self-care was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index. Caregivers and patients were interviewed separately to obtain the data. Multiple linear regressions were used to verify predictor variables of caregiver contribution. Results: the mean score for contribution to maintenance self-care was 62.7 (SD=7.1), for management, 62.9 (SD=20.4) and for confidence was 63.3 (SD=22.1). The variables number of patient’s medications, caregiver being related to the patient, social perception of caregiver, health-related quality of life of the patient and caregiver’s confidence in contributing to self-care were predictors of caregiver’s contribution to maintenance or management self-care. Conclusion: the caregiver’s contribution was insufficient. The social support perceived by the caregiver, the type of relationship the caregiver to the patient, the number of medications used by the patient, as well as the caregiver’s confidence in contributing to self-care are variables that should be considered to assess the risk of insufficient contribution of the caregiver.
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Affiliation(s)
| | | | | | - Michele Nakahara-Melo
- Universidade de São Paulo, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
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Identifying relevant factors for successful implementation into routine practice: expert interviews to inform a heart failure self-care intervention (ACHIEVE study). BMC Health Serv Res 2021; 21:585. [PMID: 34140007 PMCID: PMC8211453 DOI: 10.1186/s12913-021-06596-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/31/2021] [Indexed: 11/11/2022] Open
Abstract
Background Adherence to heart failure (HF) self-care behaviours has been found to be effective for alleviating illness symptoms, increasing quality of life and reducing hospital re-admissions and mortality. However, many patients fail to implement on-going self-care into their daily lives. It is therefore crucial to improve the behaviour of HF patients to increase self-care adherence. The aim of this study is to identify relevant factors to successfully implement a complex, theory-based HF self-care intervention into routine practice. Methods We conducted semi-structured interviews to obtain key stakeholders’ opinions on previously developed behaviour change techniques for enhancing HF patients’ self-care behaviours, in order to optimise implementation of these techniques in an intervention. The interview topic guide was developed based on the Normalisation Process Theory (NPT), a tool that takes into account the feasibility of implementation and the acceptability to stakeholders. Interviews were analysed using thematic analysis and supported by MAXQDA 2020, a software for qualitative research. Results Interview participants included 18 key stakeholders consisting of three crucial groups: clinical experts (n = 7), patients (n = 3) and high calibre policy makers/potential funders (n = 8). The interviews revealed numerous factors to consider for successful implementation of an intervention into routine practice. The findings are presented according to two major categories: (1) themes within the NPT framework and (2) themes beyond the NPT framework. Themes within the NPT component ‘Coherence’ include three sub-themes: ‘understandability’, ‘value beyond existing interventions’ and ‘perceived benefits’. The NPT component ‘Cognitive participation’ revealed two sub-themes: ‘time resources’ and ‘financial sustainability’. Finally, the NPT component ‘Collective action’ uncovered three sub-themes: ‘need for training’, ‘compatibility with existing practice’ and ‘influence on roles’. A further two themes were identified beyond the NPT framework, namely: ‘structural challenges’ and (2) ‘role of carers’. Conclusions Factors identified previously by NPT were validated, but stakeholders further identified relevant aspects beyond NPT. Based on these findings, we suggest the existing NPT framework could be expanded to include a fifth component: questions considering specific environmental factors (contextual considerations). Sensitising researchers to these issues at an early stage when designing an intervention can facilitate its later success. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06596-w.
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Myers SL, Siegel EO, Hyson DA, Bidwell JT. A qualitative study exploring the perceptions and motivations of patients with heart failure who transitioned from non-adherence to adherence. Heart Lung 2020; 49:817-823. [PMID: 33011459 DOI: 10.1016/j.hrtlng.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/15/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Management of heart failure (HF) involves complex self-care recommendations. Many patients have difficulty adhering to these recommendations, and mechanisms that support behavior change are poorly understood. OBJECTIVE The objective of this study was to explore the perceptions and motivations of individuals with HF who became adherent to HF treatment recommendations after being non-adherent. METHODS This was a qualitative descriptive study. Participants were recruited from cardiology clinics and completed a semi-structured interview on their experiences and motivations for self-care behavior change. Data was analyzed using thematic analysis. The sample size (n = 8) was sufficient to achieve saturation. RESULTS Five themes were identified: experiencing mortality, optimism and hope, making connections between behavior and health, self-efficacy, and the role of the clinician. The temporal chronological sequence of these themes across participants varied. CONCLUSIONS This study adds to our current understanding of HF self-care by suggesting mechanisms that may enhance existing self-care interventions, and demonstrating the important role of the clinician.
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Affiliation(s)
- Sharon L Myers
- Heart and Vascular Center, University of California, Davis, 2335 Stockton Blvd, Sacramento, CA, 95817, United States.
| | - Elena O Siegel
- Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th St, Sacramento, CA, 95817, United States.
| | - Dianne A Hyson
- College of Social Sciences and Interdisciplinary Studies, California State University, Sacramento, 6000 J St, Sacramento, CA, 95819, United States.
| | - Julie T Bidwell
- Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th St, Sacramento, CA, 95817, United States.
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Cruz DDALMD, Wilson AMMM, Melo MN, Conceição APD, Diaz LJR. SCHFI 6.2 Self-Care Confidence Scale - Brazilian version: psychometric analysis using the Rasch model. Rev Lat Am Enfermagem 2020; 28:e3313. [PMID: 32876285 PMCID: PMC7458570 DOI: 10.1590/1518-8345.3378.3313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 03/31/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate the psychometric properties of the Self-Care Confidence Scale in heart failure in the Brazilian version of the Self Care Heart Failure Index, version 6.2, using the Rasch model criteria. METHOD secondary study, of psychometric analysis, using the Rasch model, of the six items of the scale. The sample consisted of 409 patients with heart failure undergoing outpatient treatment [mean age 57.9 (standard deviation = 11.6) years, 54.8% male]. RESULTS of the total of six items, one ("De maneira geral, você está confiante sobre estar livre dos sintomas de insuficiência cardíaca?") presented maladjustment to the model (Infit = 1.84 and Outfit = 1.99). After the exclusion of this item, the others showed a good fit, composed one dimension and explained 55% of the variance in the data; the categories of response to the items were adequate, the values of separation and reliability of person were 2.13 and 0.82, respectively, and Cronbach's alpha was 0.87. Items of extreme difficulty were identified and there is no differential functioning of the items in relation to sex. CONCLUSION with the exclusion of the first item, the Self-Care Confidence Scale showed good psychometric properties, with caution in interpreting the results of the six-item scale.
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Affiliation(s)
| | | | - Michele Nakahara Melo
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Cheng L, Sit JWH, Choi KC, Chair SY, Li X, Wu Y, Long J, Yang H. The effects of an empowerment-based self-management intervention on empowerment level, psychological distress, and quality of life in patients with poorly controlled type 2 diabetes: A randomized controlled trial. Int J Nurs Stud 2019; 116:103407. [PMID: 31679744 DOI: 10.1016/j.ijnurstu.2019.103407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is considerable interest in advocating empowerment in diabetes care. Health professionals, however, often fail to realize empowerment in clinical practice, especially in patients with poorly controlled type 2 diabetes. OBJECTIVES To evaluate the effectiveness of an empowerment-based intervention on empowerment level, psychological distress, and quality of life among patients with poorly controlled type 2 diabetes. DESIGN An analysis of secondary outcomes of a prospective multi-center, randomized, parallel, investigator-blinded controlled trial. METHODS A total of 242 adult patients with poorly controlled type 2 diabetes [Hemoglobin A1c (HbA1c)≥ 58 mmol/mol in the recent six months] were randomly allocated to either intervention (n = 121) or attentional control (n = 121) groups. The design of the intervention was based on the Empowerment Process Model. The intervention group received a 6-week empowerment-based transitional care program, with significant emphasis on establishing personally meaningful goals, facilitating collaborative partnership and shared decision-making, resolving life-disease conflicts via situational reflection. Participants in the attentional control group received two general health education classes and post-discharge social calls on top of routine care. Outcomes of interest include empowerment level, diabetes distress, and quality of life. Participants were invited to complete a set of questionnaires before randomization, one-week, and three-month post-intervention. Statistical analyses were performed using the generalized estimating equations based on the intention-to-treat principle. RESULTS Comparing with the attention control group, participants in the intervention group showed significant improvements on empowerment level [(β= 0.163; 95% confidence interval (CI): 0.011 to 0.316, p = 0.036) at one-week post-intervention and (β= 0.176; 95% CI: 0.020 to 0.331, p = 0.027) at three-month post-intervention, respectively]. This group of patients also displayed significant reduction in terms of emotional-distress (β= -0.424, 95% CI: -0.798 to -0.049, p = 0.027) and regimen-distress (β= -0.397, 95% CI: -0.702 to -0.091, p = 0.011) at three-month post-intervention and physician-related distress (β= -0.236, 95% CI: -0.466 to -0.006, p = 0.044) at one-week post-intervention. Significant improvement in quality of life (β= 4.151, 95% CI: 1.291, 7.012, p = 0.004) at three-month post-intervention was also observed in the intervention group. CONCLUSIONS Findings provide empirical evidence for the values of an empowerment-based intervention program for patients with poorly controlled type 2 diabetes in increasing the empowerment level and perceived quality of life and reducing diabetes distress. Long-term effects of the intervention and its underlying mechanisms need further investigation.
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Affiliation(s)
- Li Cheng
- School of Nursing, Sun Yat-Sen University, Guangzhou, China.
| | - Janet W H Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Kai-Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Sek-Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Xiaomei Li
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, China.
| | - Yuning Wu
- The Department of Endocrinology, The Ninth Affiliated Hospital of Xi'an Jiaotong University, China.
| | - Junhong Long
- The Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, China.
| | - Hui Yang
- The Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, China.
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