Randomized control trial of the Health Empowerment Intervention: feasibility and impact

The effect of health literacy and health empowerment on quality of life in the elderly

BACKGROUND

This study was conducted to determine the effect of health literacy and health promotion on quality of life in the elderly.

METHOD

This descriptive and cross-sectional study was conducted with 981 elderly individuals aged 65 years and older in Turkey. 'Introductory Information Form', 'Health Literacy Scale', 'Elderly Health Empowerment Scale' and 'Quality of Life Scale for the Elderly' were used to collect data. The research data were analyzed by Structural Equation Modelling using SPSS 22.0, AMOS V 24.0, G*Power 3.1 statistical package programs.

RESULTS

Health literacy level increased health empowerment level (t = 5.929 R²  = 0.035, P < 0.05). Health literacy level increased quality of life level (t = 13.439 R²  = 0.156, P < 0.05). Health empowerment level was found to affect quality of life level (t = 17.746 R²  = 0.243, P < 0.05). Health empowerment was found to have a mediating role in the effect of health literacy on quality of life (β = 0.502, 95% confidence interval (lower bound-upper bound) = 0.013-1.038). It was determined that the model created in line with the hypotheses was compatible and the model fit indices x² /SD = 4.919, root mean square error of approximation = 0.06, comparative fit index = 0.91, fit index = 0.95, adjusted fit index = 0.93, incremental fit index = 0.91 were within the desired limits.

CONCLUSIONS

As the level of health literacy increases, so does the level of health empowerment and quality of life. As the level of health empowerment increases, so does the level of quality of life. It is recommended to design policies that will help to increase the health literacy and health empowerment levels of the elderly. Longitudinal studies on quality of life in the elderly are recommended.

The Impact of a Health Empowerment Program on Self-Care Enablement and Mental Health among Low-Income Families: Evidence from a 5 Year Cohort Study in Hong Kong

Health empowerment can be an effective way to reduce health inequities. This prospective cohort study evaluated the 5 year impact of a health empowerment program (HEP) on health outcomes among adults from low-income families. The Patient Enablement Instrument version 2 (PEI-2), Depression, Anxiety and Stress Scale 21 (DASS-21), and 12 item Short-Form Health Survey version 2 (SF-12v2) were administered at baseline and follow-up for both intervention and comparison groups. A total of 289 participants (n = 162 for intervention group, n = 127 for comparison group) were included in the analysis. Most of the participants were female (72.32%), and aged from 26 to 66 years old (M = 41.63, SD = 6.91). Linear regressions weighted by inverse probability weighting using the propensity score showed that, after follow-up of 5 years, the intervention group demonstrated significantly greater increases in all items and total scores for the PEI-2 (all B > 0.59, p < 0.001), greater decreases in the DASS depression score (B = -1.98 p = 0.001), and greater increases in the Mental Component Summary score of the SF-12v2 (B = 2.99, p = 0.027) than the comparison group. The HEP may be an effective intervention enabling adults from low-income families to manage their health-related issues and improve their mental health, as evidenced by our study.

Interventions to enhance eudaemonic psychological well-being: A meta-analytic review with Ryff's Scales of Psychological Well-being

This meta-analysis enhances our insight into the effectiveness of interventions aimed at improving eudaemonic well-being. The focal outcome of these interventions is Ryff's Scales of Psychological Well-being. We summarized experimental studies and concluded whether a specific intervention approach improves individual positive functioning by assessing the six dimensions of psychological well-being and the composite score of well-being. Our study confirmed that eudaemonic well-being can be improved. The strongest influence is seen in integral programs that link directly to Ryff's conceptual model. Breaking down to dimensional scores, existing interventions had the strongest influence on Environmental Mastery, Personal Growth, and Self-Acceptance. The weakest influence was on Autonomy and Positive Relations with Others. Overall, our result is an important contribution to the well-being literature in that it shows, more convincing than previous meta-analyses due to its exclusive and comprehensive focus on Ryff's model, that psychological eudaemonic well-being can be enhanced by targeted intervention programs.

Goal attainment scaling as an outcome measure for randomised controlled trials: a scoping review

OBJECTIVES

(1) Identify the healthcare settings in which goal attainment scaling (GAS) has been used as an outcome measure in randomised controlled trials. (2) Describe how GAS has been implemented by researchers in those trials.

DESIGN

Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews approach.

DATA SOURCES

PubMed, CENTRAL, EMBASE and PsycINFO were searched through 28 February 2022.

ELIGIBILITY CRITERIA

English-language publications reporting on research where adults in healthcare settings were recruited to a randomised controlled trial where GAS was an outcome measure.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers completed data extraction. Data collected underwent descriptive statistics.

RESULTS

Of 1,838 articles screened, 38 studies were included. These studies were most frequently conducted in rehabilitation (58%) and geriatric medicine (24%) disciplines/populations. Sample sizes ranged from 8 to 468, with a median of 51 participants (IQR: 30-96). A number of studies did not report on implementation aspects such as the personnel involved (26%), the training provided (79%) and the calibration and review mechanisms (87%). Not all trials used the same scale, with 24% varying from the traditional five-point scale. Outcome attainment was scored in various manners (self-report: 21%; observed: 26%; both self-report and observed: 8%; and not reported: 45%), and the calculation of GAS scores differed between trials (raw score: 21%; T score: 47%; other: 21%; and not reported: 66%).

CONCLUSIONS

GAS has been used as an outcome measure across a wide range of disciplines and trial settings. However, there are inadequacies and inconsistencies in how it has been applied and implemented. Developing a cross-disciplinary practical guide to support a degree of standardisation in its implementation may be beneficial in increasing the reliability and comparability of trial results.

PROSPERO REGISTRATION NUMBER

CRD42021237541.

[Development and Evaluation of Health Empowerment Scale for North Korean Women Defectors]

PURPOSE

This study developed an instrument to evaluate the health empowerment of North Korean women refugees and examined its validity and reliability.

METHODS

Through literature review and focused group interviews, 66 preliminary items with three constructs, including perceived control, perceived competence, and goal internalization were selected based on Menon's psychological health empowerment model. A questionnaire survey was conducted with 239 North Korean women refugees in the community from August 31 to September 4, 2020. Content, construct, convergent, and discriminative validity were evaluated. Cronbach's α was used to evaluate the reliability of scale.

RESULTS

The final instrument consisted of 31 items with three factors that were identified through confirmatory factor analysis. The convergent validity showed that the correlation coefficient was .52 (p < .001), which confirmed the validity of the developed measurement tool. Cronbach's α for all the items was .94, and Cronbach's α for the factors was .76~.91.

CONCLUSION

This health empowerment scale has been developed to include aspects of health empowerment, provide a conceptual framework, and offer objective indicators to evaluate the effectiveness of a health education program.

Feasibility Study of the Health Empowerment Intervention in Older Adults With Heart Failure

BACKGROUND

Of almost 5.7 million Americans with heart failure, 80% are 65 years and older. Empowerment approaches facilitating recognition of personal and social contextual resources may improve well-being in this vulnerable population.

OBJECTIVE

This research evaluated the feasibility of the Health Empowerment Intervention (HEI) in older adults with heart failure, including effects on health empowerment, purposeful participation, self-management, functional health, and well-being.

METHODS

Twenty older adults with heart failure were randomly assigned to HEI or Attention Control conditions. The HEI consisted of 6 weekly sessions based on the Health Empowerment Theory. Outcomes were measured at baseline and at 6 weeks.

RESULTS

Feasibility of the HEI was supported; participants realized significant improvement in health empowerment and purposeful participation in goal attainment.ConclusionsThis research supports the feasibility of the HEI and provides a basis for continued evaluation.

Nurses' competencies in health promotion for homebound older people

OBJECTIVE

to identify competencies related to health promotion targeting homebound older people, as they appear in the literature.

METHOD

systematic review using the LILACS, Scopus, CINAHL, PubMed and Cochrane Library databases. The search was performed in November 2017. Selected articles were analyzed according to nine competency domains: enable change; advocate for health; mediate through partnership; communication; leadership; assessment; planning; implementation, and evaluation and research.

RESULTS

nine clinical trials were included. All health promotion competency domains were identified in the reviewed research interventions, performed with homebound older people.

CONCLUSION

studies showed that the employed treatments were beneficial for the homebound older population. Interventions based on health promotion competencies were positively identified, and are linked to an effective and high-quality health care practice.

Defining High Value Elements for Reducing Cost and Utilization in Patient-Centered Medical Homes for the TOPMED Trial

Introduction:

Like most patient-centered medical home (PCMH) models, Oregon’s program, the Patient-Centered Primary Care Home (PCPCH), aims to improve care while reducing costs; however, previous work shows that PCMH models do not uniformly achieve desired outcomes. Our objective was to describe a process for refining PCMH models to identify high value elements (HVEs) that reduce cost and utilization.

Methods:

We performed a targeted literature review of each PCPCH core attribute. Value-related concepts and their metrics were abstracted, and studies were assessed for relevance and strength of evidence. Focus groups were held with stakeholders and patients, and themes related to each attribute were identified; calculation of HVE attainment versus PCPCH criteria were completed on eight primary care clinics. Analyses consisted of descriptive statistics and criterion validity with stakeholder input.

Results:

2,126 abstracts were reviewed; 22 met inclusion criteria. From these articles and focus groups of stakeholders/experts (n = 49; 4 groups) and patients (n = 7; 1 group), 12 HVEs were identified that may reduce cost and utilization. At baseline, clinics achieved, on average, 31.3 percent HVE levels compared to an average of 87.9 percent of the 35 PCMH measures.

Discussion:

A subset of measures from the PCPCH model were identified as “high value” in reducing cost and utilization. HVE performance was significantly lower than standard measures, and may better calibrate clinic ability to reduce costs.

Conclusion:

Through literature review and stakeholder engagement, we created a novel set of high value elements for advanced primary care likely to be more related to cost and utilization than other models.

What are the contents of patient engagement interventions for older adults? A systematic review of randomized controlled trials

OBJECTIVE

To describe the contents of interventions reported in RCTs focusing on patient engagement of older adults.

METHODS

A systematic literature review based on a search for "patient engagement/activation/empowerment/involvement/participation". Interventions were classified according to: (i) specific components (micro level), (ii) single/multiple dimensions (educational, behavioral, affective) (meso level), and (iii) the studies' main educational, behavioral or affective dimension (macro level).

RESULTS

After screening 2749 articles, 35 were included. 20 unique components were identified, mostly behavioral or educational (45.5% each) (e.g., goal setting or written informational materials). Most interventions with a single-focus were classified as educational (31%), one was solely affective (3%). Half of the interventions covered more than one dimension, with four (11%) combining all three dimensions. Studies mainly focusing on the affective dimension included older participants (72 vs. 67 years), had a higher proportion of females (71% vs. 44%), and included other dimensions more frequently (67% vs. 31%) than did studies with a main focus on the educational dimension.

CONCLUSION

The contents of the interventions that focused on patient engagement of older adults tend to focus more on behavioral and educational dimensions than the affective dimension.

PRACTICE IMPLICATIONS

The possibility of adding the affective dimension into behavioral and/or educational interventions should be explored.

Effects of Birth Control Empowerment Program for Married Immigrant Vietnamese Women in South Korea

PURPOSE

Aims of the researchers were to develop an birth control empowerment program (BCEP) designed to help married immigrant women in Korea to plan their pregnancies.

METHODS

This study was as a randomized controlled trial to verify the effects of the BCEP. The BCEP was developed based on Falk-Rafael (2001)'s Empowerment caring model. The program was offered once a week, for 90 minutes per session, for a total of 10 weeks. The BCEP incorporated group instruction, group discussion, and counseling. The eligible participants were randomly assigned to either experimental group (n=23) or control group (n=23).

RESULTS

Participants in the intervention group had significantly better outcomes in contraceptive knowledge (p<.001), contraceptive self-efficacy (p=.014), perceived contraceptive control (p<.001), sex-related spousal communication (p<.001), and sexual autonomy (p=.009).

CONCLUSION

The BCEP was effective intervention method, which can promote family planning practices among married immigrant women.

Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial

BACKGROUND

Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management.

PURPOSE

To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery.

METHODS

This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups.

RESULTS

A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%.

CONCLUSION

Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.

Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

BACKGROUND

Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention.

OBJECTIVES

To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group.

SEARCH METHODS

We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed.

MAIN RESULTS

Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years).We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows.Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants).Adverse events: reablement may make little or no difference to mortality at 12 months' follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants).The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months' follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence.Neither study reported user satisfaction with the service.

AUTHORS' CONCLUSIONS

There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries.

[Development and Validation of the Empowerment Scale for Woman with Breast Cancer]

PURPOSE

The purpose of this study was to develop a scale to evaluate empowerment in woman with breast cancer and to examine the validity and reliability of the scale.

METHODS

The development process for the initial items included a literature review, interviews, and construction of a conceptual framework. The identified items were evaluated for content validity by experts, resulting in 3 factors and 48 preliminary items. Participants were 319 women with breast cancer recruited to test reliability and validity of the preliminary scale. Data were analyzed using item analysis, confirmatory factor analysis, criterion related validity, internal consistency and test-retest reliability.

RESULTS

The final scale consisted of 30 items and 3 factors. Factors, including 'intrapersonal factor' (14 items), 'interactional factor' (8 items), and 'behavioral factor' (8 items), were drawn up after confirmatory factor analysis. Goodness of fit of the final research model was very appropriate as shown by χ²/df=1.86, TLI=.90, CFI=.92, SRMR=.06, and RMSEA=.05. Criterion validity was evaluated by total correlation with the Cancer Empowerment Questionnaire .78. Cronbach's alpha for total items was .93 and test-retest reliability was .69.

CONCLUSION

Findings from this study indicate that the scale can be used in the development of nursing interventions to promote the empowerment of women having breast cancer.

Concept analysis of empowerment in old people with chronic diseases using a hybrid model

PURPOSE

The purpose of this study was to clarify the meaning and the nature of empowerment concept in some Iranian old people suffering from chronic diseases.

METHODS

Concept analysis was undertaken according to the hybrid model, which consists of three phases: an initial theoretical phase, a fieldwork phase and a final analytical phase. After an extensive review of the literature in order to describe the characteristics and definition of the concept, a fieldwork phase followed in order to empirically elucidate the empowerment concept in the Iranian old people with chronic diseases. In the third phase, attributes of empowerment were extracted from the first and second phases. Purposive sampling was done for 13 participants consisted of 7 old people with chronic diseases, 3 family caregivers of elderly adult with chronic disease and 3 health care providers with experience of care with elderly patients with chronic disease.

RESULTS

The review of literature in theoretical phase determined the attributes of the concept, including "active participation", "informed change", "knowledge to problem solve", "self-care responsibility", "presence of client competency", and "control of health or life". Fieldwork phase determined attributes such as "awareness promotion", "sense of control", "the development of personal abilities", "autonomy", and "coping". In the final analytical phase, the critical attributes of old people with chronic diseases were investigated. They included "social participation", "informed change", "awareness promotion to problem solve", "presence of client competency", and "control of health or life", "autonomy", "coping" and "the development of personal abilities".

CONCLUSION

The concept analysis of empowerment showed some of the required conditions for the empowerment of older people with chronic diseases in nursing care, which have not been mentioned in the literature.

Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis

BACKGROUND

Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalization and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services.

METHODS AND FINDINGS

DATA SOURCES

Ten databases including CENTRAL and Medline searched through December 2012.

STUDY SELECTION

Randomized controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge.

DATA EXTRACTION AND SYNTHESIS

Two authors independently extracted data. Outcomes were pooled using random effects.

MAIN OUTCOMES AND MEASURES

Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness.

RESULTS

Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programs may have small relative effects (relative risk = 0.93 [0.87 to 0.99]; absolute risk = 0.00 [-0.01 to 0.00]). There was moderate quality evidence of no overall effect on the number of people institutionalized (RR = 1.02 [0.88 to 1.18]) or hospitalized (RR = 0.96 [0.91 to 1.01]). There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect (odds ratio = 0.86 [0.73 to 1.01]), but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life (standardised mean difference = -0.06 [-0.11 to -0.01]) and physical functioning (SMD = -0.10 [-0.17 to -0.03]) respectively, but these may not be clinically important.

CONCLUSIONS

Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programs that are associated with consistent benefits. Due to poor reporting of intervention components and delivery, we cannot exclude the possibility that some programs may be effective.

Enhancing parents' confidence to care in acute childhood illness: triangulation of findings from a mixed methods study of Community Children's Nursing

BACKGROUND

Children's emergency hospital use is of concern internationally, but there has been little examination of home care by nurses.

AIMS

To examine the care provided by community children's nurses during acute illness.

DESIGN

Triangulation of findings from case studies of three Community Children's Nursing Teams.

METHODS

Parents or carers (n = 763) completed questionnaires between 2008-2010 about their contacts with nurses and satisfaction with aspects and overall assessment of nursing care provided. Eighty-one individuals participated in semi-structured interviews: 29 parents/carers described their experiences and explained their questionnaire responses in more detail; 13 children talked about their care both in hospital and at home; and 39 nurses and other healthcare providers explained how nurses supported care of children at home. Questionnaire data were analysed descriptively and interview data qualitatively. The findings were integrated by triangulation of methods (questionnaires and interviews) and of data from different informants (children, parents, healthcare providers).

RESULTS

Nursing care most frequently took the form of advice and education by either home visits or telephone contact. Parents and children were reassured by access to nurses and it gave them confidence to care at home. Most respondents thought that it reduced the time their children spent in hospital.

CONCLUSIONS

Nurses can make an important contribution to supporting parents to care confidently for their children at home to reduce or even to avoid hospitalization for acute conditions and give them confidence to manage future episodes of illness.

Gender differences in health education needs and preferences of Saudis attending Riyadh Military Hospital in the Kingdom of Saudi Arabia

Background and Aim:

Health reforms that tend to increase the participation of clients in decision-making requires them to be health-literate; hence, the importance of health education. However, not much research has been done to investigate the differences in health education needs according to demographic characteristics of the clients. The aim of this study was to find out any possible gender differences there may be in health education needs and preferences.

Subjects and Methods:

This cross-sectional study was conducted at Riyadh Military Hospital, Saudi Arabia, on a convenience sample of adult Saudis attending its clinics. Data was collected from April 2009 to May 2010 using a self-administered questionnaire covering demographic data, history and needs of health education, methods, and preferred educator.

Results:

Of the 1300 forms distributed, 977 were returned completed (75.2% response). Most men (74.0%) and women (77.9%) had had health education, but more women reported that it had been helpful (P = 0.014). More men mentioned health education needs relating to primary prevention (P = 0.027), and unhealthy practices (P = 0.003), and considered the different language a barrier (P = 0.002) even after adjustment for age and education. The one-to-one method was the most preferred health education method for men (72.7%) and women (67.9%). More women preferred group health education (P = 0.02) after adjustment for age and education. Significantly more men preferred pharmacists and dietitians as health educators.

Conclusion:

The results point to a few significant differences between men and women regarding their health education needs, barriers, and preferences. These must be taken into consideration when planning health education programs.

The feasibility of a telephone coaching program on heart failure home management for family caregivers

OBJECTIVES

To test the feasibility of delivery and evaluate the helpfulness of a coaching heart failure (HF) home management program for family caregivers.

BACKGROUND

The few available studies on providing instruction for family caregivers are limited in content for managing HF home care and guidance for program implementation.

METHOD

This pilot study employed a mixed methods design. The measures of caregiver burden, confidence, and preparedness were compared at baseline and 3 months post-intervention. Descriptive statistics were used to summarize program costs and demographic data. Content analysis research methods were used to evaluate program feasibility and helpfulness.

RESULTS

Caregiver (n = 10) burden scores were significantly reduced and raw scores of confidence and preparedness for HF home management improved 3 months after the intervention. Content analyses of nurse and caregiver post-intervention data found caregivers rated the program as helpful and described how they initiated HF management skills based on the program.

CONCLUSIONS

The program was feasible to implement. These results suggest the coaching program should be further tested with a larger sample size to evaluate its efficacy.

Ensayo clinico para la enfermeria basada en evidencia: un desafio alcanzable

El ensayo clínico aleatorio constituye el diseño de investigación más riguroso para estudios de intervenciones. En este tipo de estudios, el investigador está interesado en determinar si existe una relación causa-efecto entre un tratamiento y el resultado. Para ello debe comparar grupos de individuos que han sido asignados a recibir diferente nivel de exposición a la intervención, y así determinar si existe el efecto. Hoy en día, se reconoce como uno de los mejores estándares de evidencia para aplicar en la Enfermería Basada en Evidencia. En este contexto, este artículo plantea las principales características de los ensayos clínicos aleatorios, su aplicación, las consideraciones requeridas en su implementación así como sus limitaciones. Con esto se espera estimular su uso para las intervenciones de enfermería en que pueda ser aplicado, hecho relevante ya que desde una perspectiva empírica aportan las mejores pruebas para la Enfermería Basada en Evidencias.

Enhancing a sustainable healthy working life: design of a clustered randomized controlled trial

Background

To improve a sustainable healthy working life, we have developed the intervention 'Staying healthy at work', which endeavours to enhance work participation of employees aged 45 years and older by increasing their problem-solving capacity and stimulating their awareness of their role and responsibility towards a healthy working life. This research study aims to evaluate the process and the effectiveness of the intervention compared with care as usual.

Methods/design

The study is a cluster-randomized controlled trial design (randomized at the supervisor level), with a 1-year follow-up. Workers aged 45 years and older have been enrolled in the study. Workers in the intervention group are receiving the intervention 'Staying healthy at work'. The main focus of the intervention is to promote a healthy working life of ageing workers by: (1) changing workers awareness and behaviour, by emphasizing their own decisive role in attaining goals; (2) improving the supervisors' ability to support workers in taking the necessary action, by means of enhancing knowledge and competence; and (3) enhancing the use of the human resource professionals and the occupational health tools available within the organization. The supervisors in the intervention group have been trained how to present themselves as a source of support for the worker. Workers in the control group are receiving care as usual; supervisors in the control group have not participated in the training. Measurements have been taken at baseline and will be followed up at 3, 6 and 12 months. The primary outcome measures are vitality, work ability and productivity. The secondary outcomes measures include fatigue, job strain, work attitude, self-efficacy and work engagement. A process evaluation will be conducted at both the supervisor and the worker levels, and satisfaction with the content of the intervention will be assessed.

Discussion

The intervention 'Staying healthy at work' has the potential to provide evidence-based knowledge of an innovative method to promote a sustainable healthy working life in the older working population. The results of the study will be relevant for workers, employers, occupational health professionals and human resource professionals.

Trial registration

The trial is registered with the Dutch Trial Register under number NTR2270.