Predictors of Adherence to Self-Care in Rural Patients With Heart Failure

The symptom perception processes of monitoring, awareness, and evaluation in patients with heart failure: a qualitative descriptive study

AIMS

Patients with heart failure (HF) experience various signs and symptoms and have difficulties in perceiving them. Integrating insights from patients who have engaged in the process of symptom perception is crucial for enhancing our understanding of the theoretical concept of symptom perception. This study aimed to describe how patients with HF perceive symptoms through the processes of monitoring, awareness, and evaluation and what influences the process.

METHODS AND RESULTS

Using a qualitative descriptive design, we conducted in-person semi-structured interviews with a purposeful sample of 40 adults experiencing an unplanned hospitalization for a HF symptom exacerbation. We elicited how patients monitor, become aware of, and evaluate symptoms prior to hospitalization. Data were analysed using directed qualitative content analysis. One overarching theme and three major themes emerged. Patients demonstrated Body listening, which involved active and individualized symptom monitoring tactics to observe bodily changes outside one's usual range. Trajectory of bodily change involved the patterns or characteristics of bodily changes that became apparent to patients. Three subthemes-sudden and alarming change, gradual change, and fluctuating change emerged. Patients evaluated symptoms through an Exclusionary process, sequentially attributing symptoms to a cause through a cognitive process of excluding possible causes until the most plausible cause remained. Facilitators and barriers to symptom monitoring, awareness, and evaluation were identified.

CONCLUSION

This study elaborates the comprehensive symptom perception process used by adults with HF. Tailored nursing interventions should be developed based on the factors identified in each phase of the process to improve symptom perception in HF.

The long-term effect of an m-health tool on self-care in patients with heart failure: a pre-post interventional study with a mixed-method analysis

AIMS

The aims of this study were (i) to evaluate the effects of using an m-health tool on self-care behaviour at 3 and 12 months and (ii) to explore the experiences and perceptions of heart failure (HF) patients about the m-health tool.

METHODS AND RESULTS

In this pre-post interventional study with a mixed-method analysis, 71 patients diagnosed with HF [49% female, mean age 76.7 years, New York Heart Association (NYHA) II 31%, NYHA III 69%] were enrolled and had the m-health tool installed in their home for 1 year. The tool consisted of a pre-programmed tablet including a weighing scale and interactive education about HF self-care. At baseline, and at 3 and 12 months, self-care was assessed using the European Heart Failure Self-care Behaviour (EHFScB-9) Scale, an eight-item self-administered questionnaire assessing the experiences of the m-health tool. The mean EHFScB-9 at baseline was 63.8 ± 2.8 and it improved to 67.6 ± 7.6 after 3 months (P < 0.05). After 1 year, the score had decreased to 63.2 ± 7.1 (P = 0.68). Most patients rated the tool as 'good', both at 3 months (92%) and after 12 months (93%). Some found the system to be unnecessary to some degree, and this number increased between 3 and 12 months (P < 0.001). Most patients felt that m-health increased their feelings of security, and 85% responded that the system increased their family members' sense of security.

CONCLUSION

The m-health tool significantly improved patients' self-care behaviour after 3 months, but this effect did not persist after 1 year. For achieving long-term effects and outcomes, additional and regularly updated self-care support may be needed.

REGISTRATION

ClinicalTrials.gov: NCT04955600.

Hospital-Based Electrocardiographic Monitoring: The Good, the Not So Good, and Untapped Potential

Continuous electrocardiographic (ECG) monitoring was first introduced into hospitals in the 1960s, initially into critical care, as bedside monitors, and eventually into step-down units with telemetry capabilities. Although the initial use was rather simplistic (ie, heart rate and rhythm assessment), the capabilities of these devices and associated physiologic (vital sign) monitors have expanded considerably. Current bedside monitors now include sophisticated ECG software designed to identify myocardial ischemia (ie, ST-segment monitoring), QT-interval prolongation, and a myriad of other cardiac arrhythmia types. Physiologic monitoring has had similar advances from noninvasive assessment of core vital signs (blood pressure, respiratory rate, oxygen saturation) to invasive monitoring including arterial blood pressure, temperature, central venous pressure, intracranial pressure, carbon dioxide, and many others. The benefit of these monitoring devices is that continuous and real-time information is displayed and can be configured to alarm to alert nurses to a change in a patient's condition. I think it is fair to say that critical and high-acuity care nurses see these devices as having a positive impact in patient care. However, this enthusiasm has been somewhat dampened in the past decade by research highlighting the shortcomings and unanticipated consequences of these devices, namely alarm and alert fatigue. In this article, which is associated with the American Association of Critical-Care Nurses' Distinguished Research Lecture, I describe my 36-year journey from a clinical nurse to nurse scientist and the trajectory of my program of research focused primarily on ECG and physiologic monitoring. Specifically, I discuss the good, the not so good, and the untapped potential of these monitoring systems in clinical care. I also describe my experiences with community-based research in patients with acute coronary syndrome and/or heart failure.

Self-care Problems and Management Strategies Experienced by Rural Patient/Caregiver Dyads Living With Heart Failure: A Qualitative Study

BACKGROUND

Rural patients with heart failure (HF) have higher mortality and hospitalization rates compared with their urban counterparts. Although research supports the inclusion of informal caregivers in daily self-care activities, data are limited regarding the problems encountered by rural patient/caregiver dyads living with HF in managing HF in the home and how these problems are managed.

OBJECTIVE

The aim of this study was to identify and describe HF self-care problems experienced by rural dyads in the home and how these problems are managed.

METHODS

Using a descriptive qualitative design, data were collected from rural patient/caregiver dyads living with HF via individual, semistructured, telephone interviews and analyzed using schematic content analysis. Interviews and data analysis occurred concurrently until data saturation was reached.

RESULTS

Thematic data saturation was obtained with 11 dyads. On average, patients were 65.3 (±13.9) years old, and caregivers were 62 (±12.37) years old. Four themes illustrating dyadic HF self-care problems and management strategies emerged: (1) HF self-care components, namely, maintenance, symptom monitoring, and management (diet, exercise, activities, strategies); (2) environment (rural barriers, COVID-19); (3) caregiver contributors (confidence, role); and (4) dyadic contributors (dyadic relationship). Dyads described various self-care problems, with the type of relationship and presence of mutuality influencing the problem-solving process and development of management strategies.

CONCLUSIONS

The identified themes emphasize the self-care problems experienced by rural dyads living with HF and the contributions of both dyad members to effectively manage these challenges. Findings support the need for culturally sensitive, tailored interventions targeting self-care in rural dyads living with HF.

Mediation by Fatalism of the Association Between Symptom Burden and Self-care Management in Patients With Heart Failure

BACKGROUND

Clinicians and researchers often assume that symptom burden is associated with self-care management (SCM) in patients with heart failure (HF). However, that association is often not borne out in simple regression analyses and may be because another variable mediates the association. Fatalism is an appropriate candidate for mediation and is the belief that circumstances are predetermined without opportunity for control by individuals.

OBJECTIVE

Our objective was to determine whether fatalism mediated the relationship of symptom burden with SCM among adults with HF.

METHODS

We conducted a secondary analysis (N = 95) from a clinical trial. We used Self-care of HF Index to measure SCM, the Memorial Symptom Assessment Scale-HF for symptom burden, and the Cardiovascular Disease Fatalism Instrument to measure fatalism. We used the PROCESS macro to evaluate mediation.

RESULTS

Symptom burden was not directly associated with SCM (effect coefficient [ C '] = 0.0805; 95% confidence interval, -0.048 to 0.209; P = .217). There was, however, an indirect pathway between symptom burden and SCM through fatalism ( ab = -0.040; 95% confidence interval, -0.097 to -0.002). Those with higher symptom burden were more fatalistic ( a = 0.004, P = .015), and greater fatalism was associated with worse SCM ( b = -9.132, P = .007).

CONCLUSION

Symptom burden, not directly associated with SCM, is associated through the mediator of fatalism. Interventions to improve SCM should include strategies to mitigate fatalistic views. Self-care management interventions should focus on promoting internal locus of control or increasing perceptions of perceived control to decrease fatalism and improve engagement in self-care.

Control Attitudes Scale-Revised-Brazilian Version

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.

Determinants of medication adherence in hemodialysis patients: a cross-sectional study based on capability-opportunity-motivation and behavior model

BACKGROUND

Medication adherence is a key component of successful dialysis in end-stage renal disease (ESRD). The aim of this study was to use the Capability-Opportunity-Motivation and Behavior (COM-B) model in order to identify the most important determinants of medication adherence among ESRD patients.

METHODS

This research was a cross-sectional design that was conducted in two steps in 2021. In the first step, COM-B components of patients undergoing hemodialysis (HD) therapy were extracted through literature review. The second step was a cross-sectional study among 260 ESRD patients referred to the dialysis unit from Kermanshah, in the west of Iran. Data was collected using a written questionnaire by interviews. The data was analyzed in SPSS version 16 software.

RESULTS

The mean age of respondents was 50.52 years [95% CI: 48.71, 52.33], ranged from 20 to 75 years. The mean score of medication adherence was 11.95 [95% CI: 11.64, 12.26], ranged from 4 to 20. Medication adherence is higher among patients with higher education (P = 0.009) and those who were employed (P < 0.001) and was significantly related to income (r = 0.176), while it was inversely and significantly related to the medication duration (r=-0.250). Motivation (Beta: 0.373), self-efficacy (Beta: 0.244), and knowledge (Beta: 0.116) are stronger determinants of medication adherence.

CONCLUSION

COM-B model can be proposed as an integrated framework in predicting medication adherence among ESRD patients. Our findings provide theory-based recommendations that can help future clinical and research decision-making for the development, implementation, and evaluation of treatment adherence interventions in Iranian ESRD patients. The use of COM-B model can provide a comprehensive explanation about medication adherence in ESRD patients. Future research should be focus on increasing motivation, self-efficacy and knowledge of Iranian ESRD patients in order to increasing medication adherence.

Associations between continuity of care, perceived control and self-care and their impact on health-related quality of life and hospital readmission-A structural equation model

AIM

The aim of this study is to examine whether a conceptual model including the associations between continuity of care, perceived control and self-care could explain variations in health-related quality of life and hospital readmissions in people with chronic cardiac conditions after hospital discharge.

DESIGN

Correlational design based on cross-sectional data from a multicentre survey study.

METHODS

People hospitalized due to angina, atrial fibrillation, heart failure or myocardial infarction were included at four hospitals using consecutive sampling procedures during 2017-2019. Eligible people received questionnaires by regular mail 4-6 weeks after discharge. A tentative conceptual model describing the relationship between continuity of care, self-care, perceived control, health-related quality of life and readmission was developed and evaluated using structural equation modelling.

RESULTS

In total, 542 people (mean age 75 years, 37% females) were included in the analyses. According to the structural equation model, continuity of care predicted self-care, which in turn predicted health-related quality of life and hospital readmission. The association between continuity of care and self-care was partly mediated by perceived control. The model had an excellent model fit: RMSEA = 0.06, 90% CI, 0.05-0.06; CFI = 0.90; TLI = 0.90.

CONCLUSION

Interventions aiming to improve health-related quality of life and reduce hospital readmission rates should focus on enhancing continuity of care, perceived control and self-care.

IMPACT

This study reduces the knowledge gap on how central factors after hospitalization, such as continuity of care, self-care and perceived control, are associated with improved health-related quality of life and hospital readmission in people with cardiac conditions. The results suggest that these factors together predicted the quality of life and readmissions in this sample. This knowledge is relevant to researchers when designing interventions or predicting health-related quality of life and hospital readmission. For clinicians, it emphasizes that enhancing continuity of care, perceived control and self-care positively impacts clinical outcomes.

PATIENT OR PUBLIC CONTRIBUTION

People and healthcare personnel evaluated content validity and were included in selecting items for the short version.

Consequences of Psychological Aspects: From Jordanian Heart Failure Patients' Beliefs

Introduction

Psychological aspects are common in patients with heart failure (HF). Psychological aspects have negative consequences in patients with HF.

Objective

This study was conducted to gain a deeper understanding of the consequences of psychological aspects in Jordanian patients with HF.

Methods

This study is a qualitative study conducted with the participation of 24 patients with HF. Data were collected using semi-structured interviews.

Results

The main theme of the findings can be expressed as "Consequences of psychological aspects of HF." The following four sub-themes emerged from the data: social isolation, disturbance of feelings, being non-compliant, and growing burden on the health care system.

Conclusion

The findings revealed the need for informing healthcare providers about the negative consequences of psychological aspects and develop clinical guidelines to evaluate psychological aspects to support these patients.

The Role of Depression on Treatment Adherence in Patients with Heart Failure-a Systematic Review of the Literature

INTRODUCTION

Although poor medication adherence is considered an impacting risk factor for worsening heart failure (HF) outcomes, adherence rates in HF patients continue to be considerably low. To improve this condition, several studies investigated the impact of many determinants on medication adherence; however, few authors explored the role of depression on it.

PURPOSE OF REVIEW

The purpose of this systematic review was to explore the association between depressive symptoms and medication adherence in HF patients. In particular, the research question was is depression a barrier to medication adherence in HF patients?

METHODS

A systematic review of quantitative analysis studies was undertaken. Six electronic databases were searched between the end of October and March 2022. Thirty-one trials were included, all of them assessed depression, adherence to medication, and their possible relationship.

RESULTS

As was intended, findings showed that the impact of a mild to moderate level of depression was significant on adherence to treatment in HF patients. However, many other risk factors emerged, like family support and health practices (es. low sodium diet).

CONCLUSION

The detection of depression in the setting of HF should be crucial to HF patients' physical health and quality of life. Future research should take depression into account, exploring this area through self-report and qualitative interview as well.

The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care

Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care.

OBJECTIVE

The aim of this study was to describe the manner in which characteristics of the problem, person, and environment interact to influence decisions about self-care made by adults with chronic HF.

METHODS

This study is a theoretical update. Literature on the influence of the problem, person, and environment on HF self-care is summarized.

RESULTS

Consistent with naturalistic decision making, the interaction of the problem, person, and environment creates a situation in which a self-care decision is needed. Problem factors influencing decisions about HF self-care include specific conditions such as cognitive impairment, diabetes mellitus, sleep disorders, depression, and symptoms. Comorbid conditions make HF self-care difficult for a variety of reasons. Person factors influencing HF self-care include age, knowledge, skill, health literacy, attitudes, perceived control, values, social norms, cultural beliefs, habits, motivation, activation, self-efficacy, and coping. Environmental factors include weather, crime, violence, access to the Internet, the built environment, social support, and public policy.

CONCLUSIONS

A robust body of knowledge has accumulated on the person-related factors influencing HF self-care. More research on the contribution of problem-related factors to HF self-care is needed because very few people have only HF and no other chronic conditions. The research on environment-related factors is particularly sparse. Seven new propositions are included in this update. We strongly encourage investigators to consider the interactions of problem, person, and environmental factors affecting self-care decisions in future studies.

Examining the underlying processes of different dimensions of self-care behavior among persons with heart failure

Purpose

This study was conducted to compare how potential predictors differentially contribute to the different dimensions of self-care in persons with heart failure.

Methods

A cross-sectional design was used in this study. Purposive sampling was used to recruit a sample (N = 252) in this study. The data were collected from three major referral hospitals in Jordan. Data analysis was performed using multiple linear regression.

Results

The results showed that around 89% of our sample had insufficiency in at least one dimension of self-care. The initial regression models showed that different combinations of predictors were significantly associated with different dimensions of self-care. These models were also different in terms of the variance explained and the coefficients of the significant predictors. After the follow-up analysis of the best fit models for these dimensions, these differences were maintained.

Conclusion

Despite the similarities in the proposed variables predicting different self-care dimensions, their differences may suggest variations in the underlying processes controlling different self-care dimensions. The current study showed that seven out of the nine proposed variables predicted different dimensions of self-care either in the initial or best-fit models.

Adherence to self-care recommendations and associated factors among adult heart failure patients in public hospitals, Addis Ababa, Ethiopia, 2021: cross-sectional study

BACKGROUND

Adherence to self-care recommendations in heart failure (HF) patients is essential to improve the patients' quality of life, prevent hospital admission, and reduce mortality and morbidity. Nevertheless, poor adherence to self-care recommendations remains to be an extensive problem for HF patients. Thus, the aim was to assess adherence to self-care recommendations and associated factors among HF patients in public hospitals, Addis Ababa, Ethiopia, 2021.

METHODS

An institutional-based cross-sectional study was conducted among adult HF patients from February 15 to April 15, 2021, in five public hospitals, in Addis Ababa, Ethiopia. A total of 294 adult HF patients completed an interviewer-administered questionnaire in the Amharic language. The Revised HF Compliance Questionnaire was used to measure the adherence to self-care recommendations of HF patients. Data was collected using the Revised HF Compliance Questionnaire, the Japanese heart failure knowledge scale, the multidimensional scale of perceived social support, and the chronic diseases self-efficacy scale. Study participants were selected through a systematic random sampling technique. Data were entered into Epi-info version 7.1 and then exported to SPSS Version 25 for analysis. Descriptive and logistic regression analyses were performed and the statistical significance of associations between the variables was determined using ORs with 95% CI and p-values < 0.05.

RESULTS

Adherence to self-care recommendations among adult HF patients in public hospitals, in Addis Ababa, Ethiopia was 32.70%. Being female (AOR 4.66, 95% CI 1.58-13.67), patients who had high family monthly income (AOR 10.32, 95% CI 2.00-5.13), NYHA class III (AOR: 7.01, 95% CI 2.18-22.57) and class IV (AOR: 6.30, 95% CI 1.01-39.22), who had good self-efficacy (AOR 7.63, 95% CI 2.64-21.97), and who had good knowledge about HF (AOR 3.95, 95% CI 1.56-9.95) were more likely to have good adherence to self-care recommendations, p-value < 0.05.

CONCLUSION

This study revealed that 32.70% of adult HF patients had good adherence to self-care recommendations. Factors associated with adherence to self-care recommendations of adult HF patients are sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF. Therefore, interventions focused on sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF are required to improve adherence to self-care recommendations of adult HF patients.

Factors related to treatment adherence behaviors among old-age hemodialysis patients in Hamadan, Iran: the application of the extended theory of planned behavior during Covid-19 pandemic

Purpose

This study aimed to identify the factors related to treatment adherence behaviors among old-age hemodialysis patients in Hamadan based on the Extended Theory of Planned Behavior (ETPB) during the covid-19 pandemic.

Methods

This cross-sectional study was conducted from January to March 2021 in Hamadan, Iran. 191 hemodialysis patients were recruited who were referred to hemodialysis centers via the census method. Data were collected by a questionnaire containing items on socio-demographic information, End-Stage Renal Disease Adherence (ESRD-Adherence) Questionnaire, and ETPB constructs scale. Data analysis was performed using descriptive statistics and structural equation modeling.

Results

The mean (SD) age of participants was 62.49 (10.66). Also, the mean (SD) hemodialysis vintage/Month of them was 36.56 (43.34). Moreover, Treatment Adherence Behaviors are associated with education level, sex, and marital status (p < 0.001). Besides, Perceive Behavior Control (β = 0.414, t-value = 3.810) associated with intention. Also, intention (β = 0.158, t-value = 1.976) was associated to adherence behaviors. No significant associations were observed between positive attitudes, subjective norms, a perceived threat with intention, and adherence behaviors. The model explained about 54% of the variance of adherence behaviors. Finally, the goodness of fit index of 0.78, indicating the model good fit.

Conclusion

The present study demonstrates that some of the ETPB constructs such as perceived behavior control and intention are useful to improve adherence among the oldest hemodialysis patients. Also. This framework is revealed alongside the theory of planned behavior (TPB) applicable in the treatment adherence of old-age hemodialysis patients.

Patient-centered mobile health technology intervention to improve self-care in patients with chronic heart failure: Protocol for a feasibility randomized controlled trial

This randomized controlled trial aims to determine the feasibility and preliminary efficacy of a patient-centered, mobile health technology intervention (iCardia4HF) in patients with chronic Heart Failure (HF). Participants (n = 92) are recruited and randomized 1:1 to the intervention or control group. The intervention group receives a commercial HF self-care app (Heart Failure Storylines), three connected health devices that interface with the app (Withings weight scale and blood pressure monitor, and Fitbit activity tracker), and a program of individually tailored text-messages targeting health beliefs, self-care self-efficacy, HF-knowledge, and physical activity. The control group receives the same connected health devices, but without the HF self-care app and text messages. Follow-up assessments occur at 30 days and 12 weeks. The main outcome of interest is adherence to HF self-care assessed objectively through time-stamped data from the electronic devices and also via patient self-reports. Primary measures of HF self-care include medication adherence and adherence to daily weight monitoring. Secondary measures of HF self-care include adherence to daily self-monitoring of HF symptoms and blood pressure, adherence to low-sodium diet, and engagement in physical activity. Self-reported HF self-care and health-related quality of life are assessed with the Self-care Heart Failure Index and the Kansas City Cardiomyopathy Questionnaire, respectively. Hospitalizations and emergency room visits are tracked in both groups over 12 weeks as part of our safety protocol. This study represents an important step in testing a scalable mHealth solution that has the potential to bring about a new paradigm in self-management of HF.

Major depression and clinical outcomes in patients with heart failure with preserved ejection fraction

OBJECTIVE

Limited data have been published concerning about depression in heart failure with preserved ejection fraction (HFpEF). Besides, among HFpEF patients with depression, the efficacy of antidepressants is poorly defined. Therefore, our current study was aimed to examine the relationship between major depression and clinical outcomes in HFpEF patients and further address the effects of antidepressants on prognosis in patients with major depression and HFpEF.

METHODS

A total of 1431 patients enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial (TOPCAT) were divided into 2 groups according to the baseline depression status. Major depression was diagnosed if the Patient Health Questionnaire-9 score (PHQ-9) ≥ 10. Univariable and multivariable Cox proportional hazards models tested the association of major depression with outcomes and the effects of antidepressants among HFpEF patients with major depression during a follow-up of 6 years.

RESULTS

26.7% (382/1431) of patients were diagnosed with major depression. After multivariable adjustment, major depression at baseline was not significantly associated with cardiovascular outcomes (fully adjusted hazard ratio (aHR) 0.95 [0.76-1.18] for primary outcomes; aHR: 0.86 [0.67-1.10] for HF hospitalization; aHR: 1.06 [0.91-1.23] for any hospitalization; aHR: 1.00 [0.70-1.43] for cardiovascular death; aHR: 1.24 [0.96-1.61] for all-cause death). Additionally, among HFpEF patients with major depression, the use of antidepressants was not associated with adverse events (P > .05 for all analyses).

CONCLUSIONS

In HFpEF patients, major depression at baseline did not increase mortality or rehospitalization. Additionally, treatment with antidepressants might not improve prognosis among HFpEF patients with major depression. Future studies are warranted to explore the effects of antidepressants on HFpEF patients with depression.

Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology

Self-care is essential in the long-term management of chronic heart failure. Heart failure guidelines stress the importance of patient education on treatment adherence, lifestyle changes, symptom monitoring and adequate response to possible deterioration. Self-care is related to medical and person-centred outcomes in patients with heart failure such as better quality of life as well as lower mortality and readmission rates. Although guidelines give general direction for self-care advice, health care professionals working with patients with heart failure need more specific recommendations. The aim of the management recommendations in this paper is to provide practical advice for health professionals delivering care to patients with heart failure. Recommendations for nutrition, physical activity, medication adherence, psychological status, sleep, leisure and travel, smoking, immunization and preventing infections, symptom monitoring, and symptom management are consistent with information from guidelines, expert consensus documents, recent evidence and expert opinion.

The role of health literacy, depression, disease knowledge, and self-efficacy in self-care among adults with heart failure: An updated model

BACKGROUND

Patients with inadequate health literacy and heart failure face high healthcare costs, more hospitalizations, and greater mortality. To address these negative consequences, patients need to improve heart failure self-care. Multiple factors may influence self-care, but the exact model by which they do so is not fully understood.

OBJECTIVES

The objective of this study was to examine a model exploring the contribution of health literacy, depression, disease knowledge, and self-efficacy to the performance of heart failure self-care.

METHODS

Using a cross-sectional design, patients were recruited from a heart failure clinic and completed validated assessments of their cognition, health literacy, depression, knowledge, self-efficacy and self-care. Patients were separated into two groups according to their health literacy level: inadequate/marginal and adequate. Differences between groups were assessed with an independent t-test. Hypothesized paths and mediated relationships were estimated and tested using observed variable path analysis.

RESULTS

Participants (n = 100) were mainly male (67%), white (93%), and at least had a high school education (85%). Health literacy was associated with disease knowledge (path coefficient=0.346, p = 0.002), depression was negatively associated with self-efficacy (path coefficient=-0.211, p = 0.037), self-efficacy was positively associated with self-care (path coefficient=0.402, p<0.0005), and there was evidence that self-efficacy mediated the link between depression and self-care. There was no evidence of: mediation of the link between health literacy and self-care by knowledge or self-efficacy; positive associations between knowledge and self-efficacy or self-care; or mediation of the disease knowledge and self-care relationship by self-efficacy. Further, depression was associated with self-care indirectly rather than also directly as hypothesized.

CONCLUSIONS

Self-efficacy and depression are associated with heart failure self-care. Data generated from the model suggest that healthcare professionals should actively engage all patients to gain self-efficacy and address depression to positively affect heart failure self-care.

The mediating effect of resilience on the relationship between Type D personality and self-care behavior in patients with heart failure

AIM

There have been few studies done looking at the relationship between resilience, Type D personality, and self-care behavior in patients with heart failure. The purpose of this study was to identify the mediating effect of resilience on the relationship between Type D personality and self-care behavior in patients with heart failure.

METHODS

The subjects consisted of a sample of 90 heart failure patients aged ≥20 years who visited the cardiology outpatient clinic in the Chungbuk area of South Korea.

RESULTS

Among 90 patients, 49 subjects (54.0%) were classified as Type D personality, who exhibited statistically significant differences in resilience and self-care behavior (p < .001). A statistically significant correlation was also observed between self-care behavior score and resilience score (p < .01). The resilience had full mediation effects on the relationship between Type D personality and self-care behavior. In other words, the higher their resilience, the better their self-care behavior.

CONCLUSIONS

The study showed that resilience and Type D personality have important effects on self-care behavior.