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Development of Core Educational Content for Heart Failure Patients in Transition from Hospital to Home Care: A Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116550. [PMID: 35682133 PMCID: PMC9180106 DOI: 10.3390/ijerph19116550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023]
Abstract
Heart failure (HF) patients should be systematically educated before discharge on how to manage with standard written materials for patient self-management. However, because of the absence of readily available written materials to reinforce their learned knowledge, patients with HF feel inadequately informed in terms of the discharge information provided to them. This study aimed to develop core content to prepare patients with HF for transition from hospital to home care. The content was validated by expert panelists using Delphi methods. Nineteen draft items based on literature review were developed. We established a consensus on four core sections, including 47 categories and 128 subcategories through the Delphi survey: (1) understanding HF (five categories and 23 subcategories), (2) HF medication (19 categories and 45 subcategories), (3) HF management (20 categories and 47 subcategories), and (4) HF diary (three categories and 13 subcategories). Each section provided easy-to-understand educational contents using cartoon images and large or bold letters for older patients with HF. The developed core HF educational contents showed high consensus between the experts, along with clinical validity. The contents can be used as an educational booklet for both planning discharge education of patients with HF and for post-discharge management when transitioning from hospital to home. Based on this study, a booklet series for HF patients was first registered at the National Library of Korea. Future research should focus on delivering the core content to patients with HF in convenient and accessible format through various media.
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Burgermaster M, Rudel R, Seres D. Dietary Sodium Restriction for Heart Failure: A Systematic Review of Intervention Outcomes and Behavioral Determinants. Am J Med 2020; 133:1391-1402. [PMID: 32682866 PMCID: PMC7704603 DOI: 10.1016/j.amjmed.2020.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022]
Abstract
The 1500 mg/d dietary sodium restriction commonly recommended for patients with heart failure has recently been questioned. Poor adherence to sodium-restricted diets makes assessing the efficacy of sodium restriction challenging. Therefore, successful behavioral interventions are needed. We reviewed sodium restriction trials and descriptive studies of sodium restriction to: 1) determine if sodium restriction was achieved in interventions among heart failure patients; and 2) characterize predictors of successful dietary sodium restriction. Among 638 identified studies, 10 intervention trials, and 25 descriptive studies met inclusion criteria. We used content analysis to extract information about sodium restriction and behavioral determinants of sodium restriction. Dietary sodium was reduced in 7 trials; none achieved 1500 mg/d (range 1938-4564 mg/d). The interventions implemented in the interventional trials emphasized knowledge, skills, and self-regulation strategies, but few addressed the determinants correlated with successful sodium restriction in the descriptive studies (eg, social/cultural norms, social support, taste preferences, food access, self-efficacy). Findings suggest that incorporating determinants predictive of successful dietary sodium restriction may improve the success of interventional trials. Without effective interventions to deploy in trials, the safety and efficacy of sodium restriction remains unknown.
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Affiliation(s)
- Marissa Burgermaster
- Departments of Nutritional Sciences and Population Health, College of Natural Sciences and Dell Medical School, University of Texas at Austin.
| | | | - David Seres
- Department of Medicine, Columbia University Medical Center, New York, NY; Institute of Human Nutrition, Columbia University, New York, NY
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Smith JL, Estus S, Lennie TA, Moser DK, Chung ML, Mudd-Martin G. TAS2R38 PAV Haplotype Predicts Vegetable Consumption in Community-Dwelling Caucasian Adults at Risk for Cardiovascular Disease. Biol Res Nurs 2020; 22:326-333. [PMID: 32207317 DOI: 10.1177/1099800420913935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION A heart-healthy diet might reduce cardiovascular disease (CVD) risk. Genetic variants that affect taste are associated with food choices. This study aims to investigate the associations of the TAS2R38 haplotype with consumption of sodium, sugar, saturated fats, and vegetables. HYPOTHESIS We hypothesized that, compared to people who are alanine-valine-isoleucine (AVI) homozygous for the TAS2R38 gene, those who are heterozygous or homozygous for the proline-alanine-valine (PAV) haplotype would have (a) a higher intake of sodium, sugar, and saturated fat, and (b) a lower vegetable intake. METHODS DNA from participants at risk for CVD was genotyped, and participants were assigned to groups by haplotype. Intake for sodium, sugar, saturated fat, and vegetables was assessed using the Viocare Food Frequency Questionnaire. Intake was categorized as higher versus lower consumption, divided at the median, and examined by logistic regressions. All models controlled for age, sex, smoking status, body mass index, education level, and financial status. RESULTS The 175 participants had a mean age of 52 ± 13 years, 72.6% were female, 100% were Caucasian, 89.1% were overweight or obese, and 82.9% were nonsmokers. Participants with one or two PAVs were grouped together, as PAV is the dominant gene, and comprised a majority of the sample (80.6%). Haplotype did not predict intake of sodium, sugar, or saturated fats. Compared to AVI homozygotes, participants with PAV homozygous or heterozygous haplotype had lower odds of being in the higher vegetable intake group (95% CI [0.17, 0.92], p = .032). CONCLUSIONS PAV haplotype predicted lower consumption of vegetables. Variants of taste-related genes appear to play a role in food choices.
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Affiliation(s)
| | - Steven Estus
- Department of Physiology and Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Terry A Lennie
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Debra K Moser
- Linda C. Gill Endowed Chair of Nursing, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, Lexington, KY, USA
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Mock MS, Sethares KA. Concurrent validity and acceptability of health literacy measures of adults hospitalized with heart failure. Appl Nurs Res 2019; 46:50-56. [PMID: 30853076 DOI: 10.1016/j.apnr.2019.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/28/2018] [Accepted: 02/10/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To test concurrent validity and acceptability of the Single Item Literacy Screener (SILS), Test of Functional Health Literacy (S-TOFHLA) and the Newest Vital Sign (NVS) in hospitalized adults with heart failure (HF). BACKGROUND Health literacy is not routinely evaluated in adults hospitalized with HF. Low health literacy is linked to poor HF self-care and hospital readmissions. METHODS SILS, NVS and S-TOFHLA were completed by 85 patients with HF. Measures were examined for internal consistency reliability and acceptability. The NVS and S-TOFHLA were correlated with the SILS to establish concurrent validity. RESULTS The NVS (α = 0.70) and S-TOFHLA (α = 0.88) were reliable. The SILS significantly correlated with the S-TOFHLA (r = -0.308). The S-TOFHLA (M = 6.16) and NVS (M = 6.10) were acceptable measures. CONCLUSION The S-TOFHLA and NVS were reliable and acceptable measures of health literacy in hospitalized HF population. The SILS correlated with the S-TOFHLA and may predict low health literacy when hospitalized. NVS total scores in this population aligned with the recent NAAL survey. Hospitalized adults with HF agreed to share the health literacy scores with their providers.
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Affiliation(s)
- Margaret S Mock
- School of Nursing, Graduate Department, Rhode Island College, Providence, RI, United States of America.
| | - Kristen A Sethares
- Adult Nursing Department, University of Massachusetts Dartmouth, North Dartmouth, MA, United States of America
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Karimi M, Clark AM. How do patients' values influence heart failure self-care decision-making?: A mixed-methods systematic review. Int J Nurs Stud 2016; 59:89-104. [PMID: 27222454 DOI: 10.1016/j.ijnurstu.2016.03.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 02/14/2016] [Accepted: 03/12/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Values are central to ethical and effective nursing and health care. However, in relation to heart failure, an extremely common and burdensome syndrome, the role that patients' values have in influencing self-care is poorly understood. METHODS A mixed methods systematic review was conducted using a critical meta-narrative synthesis approach to synthesizing qualitative and qualitized data. Nine databases were searched (14 March 2014). To be included in the review, studies had to contain data on heart failure patients' values and self-care behaviors, include adults aged ≥18 years with symptomatic heart failure, and be published ≥2000 as full articles or theses. Study quality was assessed using a mixed-methods appraisal tool. FINDINGS Of 6467 citations identified, 54 studies were included (30 qualitative, 8 mixed methods, and 16 quantitative; 6045 patients, 38 lay caregivers, and 96 health care professionals). The synthesis identified multiple bi-directional interactions between heart failure, patients' values, and self-care. Patients are motivated by self-related and other-related values. Self-related values are tied directly to intimate personal feelings (self-direction, pleasure, and being healthy) or related to individuals' life circumstances (maintaining a healthy lifestyle and financial balance). Other-related values, which are fundamentally socially-based, are related to benefits received from society (social recognition and socialization) and social obligations (responsibility, observing traditions, and obedience). For each decision, several values are involved; some are incompatible and some are in conflict. Patients make their self-care decision based on the values they prioritize and those that are blocked. CONCLUSION Values are integral to how patients approach and undertake HF self-care. These values both affect and respond to this self-care and the severity of HF symptoms. Values extend to those relating to the self and others and incorporate a range of personal, life, and social dimensions. Values cannot be assumed to be fixed, normative or similar to those held by nurses and other health professionals. Future interventions to improve HF self-care must address and respond to the complexity of patients' values and how they influence patient behavior in undertaking heart failure self-care.
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Affiliation(s)
- Mehri Karimi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Abstract
Persons with heart failure (HF) symptoms delay up to 7 days before seeking treatment. Delay can result in worse symptoms and potentially impact outcomes. The purpose of this review was to describe predictors and outcomes of delay in HF patients. Demographic factors, increased symptom number, social factors, greater HF knowledge, lower anxiety, and depression predicted increased delay. HF patients had difficulty recognizing and interpreting symptoms of HF. Results are conflicting related to symptom pattern, time of care seeking, and history of HF as predictors of delay. The only outcome predicted by delay was length of stay with those delaying longer reporting longer lengths of stay. Future research related to delay should include theoretical frameworks and larger, more ethnically diverse samples from multiple sites and link delay to outcomes. Valid and reliable instruments are needed to measure delay and related factors. HF education should include supportive others.
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Abstract
BACKGROUND The prevention of fluid retention is important to reduce hospitalizations in patients with heart failure (HF). Following a low-sodium diet helps to reduce fluid retention. OBJECTIVE The primary objective of this study was to use growth mixture modeling to identify distinct classes of sodium adherence-characterized by shared growth trajectories of objectively measured dietary sodium. The secondary objective was to identify patient-level determinants of the nonadherent trajectory. METHODS This was a secondary analysis of data collected from a prospective longitudinal study of 279 community-dwelling adults with previously or currently symptomatic HF. Growth mixture modeling was used to identify distinct trajectories of change in 24-hour urinary sodium excretion measured at 3 time points over 6 months. Logistic modeling was used to predict membership in observed trajectories. RESULTS The sample was predominantly male (64%), had a mean age of 62 years, was functionally compromised (59% New York Heart Association class III), and had nonischemic HF etiology. Two distinct trajectories of sodium intake were identified and labeled adherent (66%) and nonadherent (34%) to low-sodium diet recommendations. Three predictors of the nonadherent trajectory were identified, confirming our previous mixed-effect analysis. Compared with being normal weight (body mass index <25 kg/m2), being overweight and obese was associated with a 4-fold incremental increase in the likelihood of being in the nonadherent trajectory (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.66-12.91; P < .002). Being younger than 65 years (OR, 4.66; 95% CI, 1.04-20.81; P = .044) or having diabetes (OR, 4.15; 95% CI, 1.29-13.40; P = .016) were both associated with more than 4 times the odds of being in the nonadherent urine sodium trajectory compared with being older than 65 years or not having diabetes, respectively. CONCLUSIONS Two distinct trajectories of sodium intake were identified in patients with HF. The nonadherent trajectory was characterized by an elevated pattern of dietary sodium intake shown by others to be associated with adverse outcomes in HF. Predictors of the nonadherent trajectory included higher body mass index, younger age, and diabetes.
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Kara B. Health Beliefs Related to Salt-Restricted Diet in Patients on Hemodialysis: Psychometric Evaluation of the Turkish Version of the Beliefs About Dietary Compliance Scale. J Transcult Nurs 2014; 25:256-64. [PMID: 24381119 DOI: 10.1177/1043659613514114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the reliability and validity of the Turkish version of the Beliefs about Dietary Compliance Scale (BDCS-T). METHODS This methodological study enrolled a sample of 140 patients. Data were collected by using a questionnaire form, the BDCS-T, and the Dialysis Diet and Fluid Restrictions Nonadherence Questionnaire. Descriptive statistics, the one-sample Kolmogorov-Smirnov test, Mann-Whitney U test, correlation coefficients, and psychometric tests were used for the analysis of data. RESULTS The factor analysis confirmed that the BDCS-T had a two-factor structure (perceived benefits and perceived barriers) explaining 58.7% of the total variance. The BDCS-T had acceptable internal consistency (Cronbach's alpha coefficients: perceived benefits = .91; perceived barriers = .66), test-retest reliability (intraclass correlation coefficients: perceived benefits = .93; perceived barriers = .79), concurrent validity with the Dialysis Diet and Fluid Restrictions Nonadherence Questionnaire scores, and known group validity with intensity of diet nonadherence. CONCLUSIONS The BDCS-T was found to be a reliable and valid tool for assessing the beliefs related to salt-restricted diet in patients on hemodialysis. IMPLICATIONS FOR PRACTICE Nurses are recommended to make tailored interventions by taking the benefits and barriers that the patients perceive toward low-salt dietary adherence into account.
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Dunbar SB, Clark PC, Reilly CM, Gary RA, Smith A, McCarty F, Higgins M, Grossniklaus D, Kaslow N, Frediani J, Dashiff C, Ryan R. A trial of family partnership and education interventions in heart failure. J Card Fail 2013; 19:829-41. [PMID: 24331203 DOI: 10.1016/j.cardfail.2013.10.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 10/12/2013] [Accepted: 10/23/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Lowering dietary sodium and adhering to medication regimens are difficult for persons with heart failure (HF). Because these behaviors often occur within the family context, this study evaluated the effects of family education and partnership interventions on dietary sodium (Na) intake and medication adherence (MA). METHODS AND RESULTS HF patient and family member (FM) dyads (n = 117) were randomized to: usual care (UC), patient-FM education (PFE), or family partnership intervention (FPI). Dietary Na (3-day food record), urinary Na (24-hour urine), and MA (Medication Events Monitoring System) were measured at baseline (BL) before randomization, and at 4 and 8 months. FPI and PFE reduced urinary Na at 4 months, and FPI differed from UC at 8 months (P = .016). Dietary Na decreased from BL to 4 months, with both PFE (P = .04) and FPI (P = .018) lower than UC. The proportion of subjects adherent to Na intake (≤2,500 mg/d) was higher at 8 months in PFE and FPI than in UC (χ(2)(2) = 7.076; P = .029). MA did not differ among groups across time. Both FPI and PFE groups increased HF knowledge immediately after intervention. CONCLUSIONS Dietary Na intake, but not MA, was improved by PFE and FPI compared with UC. The UC group was less likely to be adherent with dietary Na. Greater efforts to study and incorporate family-focused education and support interventions into HF care are warranted.
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Affiliation(s)
- Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia; School of Medicine, Emory University, Atlanta, Georgia.
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
| | - Carolyn M Reilly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Rebecca A Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Andrew Smith
- School of Medicine, Emory University, Atlanta, Georgia
| | | | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | | | - Nadine Kaslow
- School of Medicine, Emory University, Atlanta, Georgia
| | | | - Carolyn Dashiff
- College of Nursing, University of Alabama, Birmingham, Alabama
| | - Richard Ryan
- Department of Psychology, University of Rochester, Rochester, New York
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Yayehd K, Damorou F, N'cho Mottoh MP, Tchérou T, Johnson A, Pessinaba S, Tété Y, Diziwiè AM. [Compliance to treatment in heart failure patients in Lomé]. Ann Cardiol Angeiol (Paris) 2013; 62:22-27. [PMID: 22560891 DOI: 10.1016/j.ancard.2012.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 03/17/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND The incidence and prevalence rates of the heart failure in the world approach epidemic proportions. The evaluation of the follow-up of the treatment of heart failure can allow the setting up of strategies to reduce the frequency of decompensations and improve the quality of life of these patients. OBJECTIVES To estimate the compliance to treatment and factors liable to influence it in Togolese patients suffering from heart failure. PATIENTS AND METHODS This study was carried out from January 1st, 2008 to June 30th, 2009 in the department of cardiology of the university teaching hospital Campus in Lomé and included prospectively, patients with chronic heart failure hospitalized for acute decompensation and of which the heart failure was diagnosed and treated for at least 3 months. Questionnaires were filled to estimate the compliance to medication, to diet, as well as knowledge of the patients on their disease and their relationship with their doctor and their family. RESULTS In the 103 patients included, we noticed no good compliance to medication; there were 74.7% of bad compliance to medication, 47.3% of good compliance to diet; 62.1% of patients had enough knowledge on their disease, 29.1% considered that their doctor did not grant them enough time; 57.3% estimated to have no necessary support of their family. Bad compliance to treatment was correlated to the existence or not of a health care insurance (OR=115.5; 95% CI=21.51-620.08; P<0.0001); this difference persisted after adjusting for age, sex and monthly income (OR=99.65; 95% CI=18.87-587.21; P=0.001). Bad compliance was not associated with monthly income (OR=0.93; 95% CI=0.37-2.28; P=0.944); it was neither influenced by traditional therapy (OR=1.58 95% CI=0.64-3.91; P=0.43), nor recovery prayers (OR=1.6; 95% CI=0.62-4.13; P=0.45), nor frequency of tablets intake (≥3 intake day), OR=0.169; 95% CI=0.05-0.49; P=0.43. CONCLUSION The compliance to medication in Togolese heart failure patients was very low and essentially correlated to the absence of health care insurance.
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Affiliation(s)
- K Yayehd
- Service de cardiologie, centre hospitalier universitaire Campus de Lomé, 03 BP 30284 Lomé, Togo.
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Moczygemba LR, Kennedy AK, Marks SA, Goode JVR, Matzke GR. A qualitative analysis of perceptions and barriers to therapeutic lifestyle changes among homeless hypertensive patients. Res Social Adm Pharm 2012; 9:467-81. [PMID: 22835705 DOI: 10.1016/j.sapharm.2012.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 05/14/2012] [Accepted: 05/15/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Homeless individuals have higher rates of hypertension when compared to the general population. Therapeutic lifestyle changes (TLCs) have the potential to decrease the morbidity and mortality associated with hypertension, yet TLCs can be difficult for homeless persons to implement because of competing priorities. OBJECTIVES To identify: (1) Patients' knowledge and perceptions of hypertension and TLCs and (2) Barriers to implementation of TLCs. METHODS This qualitative study was conducted with patients from an urban health care for the homeless center. Patients ≥18 years old with a diagnosis of hypertension were eligible. Three focus groups were conducted at which time saturation was deemed to have been reached. Focus group sessions were audio recorded and transcribed for data analysis. A systematic, inductive analysis was conducted to identify emerging themes. RESULTS A total of 14 individuals participated in one of the 3 focus groups. Most were female (n=8) and African-American (n=13). Most participants were housed in a shelter (n=8). Others were staying with family or friends (n=3), living on the street (n=2), or had transitioned to housing (n=1). Participants had a mixed understanding of hypertension and how TLCs impacted hypertension. They were most familiar with dietary and smoking recommendations and less familiar with exercise, alcohol, and caffeine TLCs. Participants viewed TLCs as being restrictive, particularly with regard to diet. Family and friends were viewed as helpful in encouraging some lifestyle changes such as healthy eating, but less helpful in having a positive influence on quitting smoking. Participants indicated that they often have difficulty implementing lifestyle changes because of limited meal choices, poor access to exercise equipment, and being uninformed about recommendations. CONCLUSIONS Despite the benefits of TLCs, homeless individuals experience unique challenges to implementing TLCs. Future research should focus on developing and testing interventions that facilitate TLCs among homeless persons. The findings from this study should assist health care practitioners, including pharmacists, with providing appropriate and effective education.
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Affiliation(s)
- Leticia R Moczygemba
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Walsh E, Lehane E. An exploration of the relationship between adherence with dietary sodium restrictions and health beliefs regarding these restrictions in Irish patients receiving haemodialysis for end-stage renal disease. J Clin Nurs 2011; 20:331-40. [PMID: 21219516 DOI: 10.1111/j.1365-2702.2010.03348.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To measure adherence levels with dietary restrictions in Irish patients with end-stage renal disease receiving haemodialysis and to explore the relationships between adherence with dietary sodium restrictions and health beliefs in relation to following these restrictions in this group. BACKGROUND Non-adherence to medical regimes is an important healthcare issue and an ever-present problem, particularly in patients with a chronic illness. The literature revealed a lack of studies measuring adherence with the sodium component of the renal dietary restrictions and associated factors; despite the fact that adherence with sodium restrictions is essential to the optimal management of end-stage renal disease. Furthermore, despite increased emphasis on 'the patients' view' in healthcare no study to date has contextualised health beliefs and adherence in end-stage renal disease from an Irish perspective. DESIGN A quantitative, descriptive, correlational design was employed using the Health Belief Model as a theoretical framework. METHODS A convenience sample (n = 79) was recruited from the haemodialysis units of a large hospital. Data were collected using self-report questionnaires. Data were analysed using descriptive and correlational statistics. RESULTS Non-adherence with dietary restrictions was a problem among a proportion of the sample. Greater adherence levels with dietary sodium restrictions were associated with greater 'perceived benefits' and fewer 'perceived barriers.' CONCLUSION For the Irish patient, beliefs in relation to following a low sodium diet significantly affected adherence levels with this diet. This is an important finding as delineating key beliefs, particularly key barriers, facilitates an increased understanding of non-adherence for nurses. RELEVANCE FOR CLINICAL PRACTICE These findings have implications for the care of patients with end-stage renal disease in that they can provide guidance in terms of developing interventions designed to improve adherence.
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Affiliation(s)
- Ella Walsh
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.
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Affiliation(s)
- Nancy M. Albert
- Nancy M. Albert is the director of Nursing Research and Innovation, Nursing Institute, and a clinical nurse specialist at George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio
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Affiliation(s)
- Julie MacInnes
- Department of Nursing and Applied Clinical Studies Canterbury Christ Church University, Canterbury, Kent CT1 1QU
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Paul S. Hospital Discharge Education for Patients With Heart Failure: What Really Works and What Is the Evidence? Crit Care Nurse 2008. [DOI: 10.4037/ccn2008.28.2.66] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Sara Paul
- Sara Paul is a nurse practitioner at Western Piedmont Heart Centers in Hickory, North Carolina. She manages patients with heart failure and runs the heart failure program/clinic
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van der Wal MHL, Jaarsma T, Moser DK, van Gilst WH, van Veldhuisen DJ. Unraveling the mechanisms for heart failure patients' beliefs about compliance. Heart Lung 2007; 36:253-61. [PMID: 17628194 DOI: 10.1016/j.hrtlng.2006.10.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 10/13/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Compliance with medication, diet, and monitoring symptoms is a problem in heart failure (HF) patients. Noncompliance can lead to worsening symptoms and is associated with personal beliefs about compliance. To intervene effectively, knowledge of factors related to patients' beliefs about compliance is needed. OBJECTIVES The aims of this study are to: (1) gain insight into patients' beliefs about compliance; (2) examine the association of demographic variables and depressive symptoms to beliefs; (3) assess compliance with medication, diet, and daily weighing; and (4) examine the association of compliance to patients' beliefs. METHODS Nine hundred fifty-four HF patients completed questionnaires on beliefs about medication and diet; 297 patients also completed a questionnaire on beliefs about symptom monitoring. Most important barriers and benefits were assessed as well as differences in beliefs between subgroups and the association between compliance and beliefs. RESULTS The most important barriers were diuresis during the night (57%), the taste of food (51%), and limited ability to go out (33%). A barrier related to failure to weigh daily was forgetfulness (26%). Patients with depressive symptoms and patients with a low level of HF knowledge experienced more barriers to compliance with the HF regimen. Self-reported compliance with medication was almost 99%, compliance with diet 77%, and with daily weighing 33%. CONCLUSIONS AND IMPLICATIONS In order to improve compliance, it is important that interventions should be directed to those patients who experience more barriers to compliance, such as patients with depressive symptoms and patients with a low level of knowledge on the HF regimen. Improvement of knowledge, therefore, will remain an important issue in HF management programs.
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Affiliation(s)
- Martje H L van der Wal
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Albert NM, Zeller RA. Development and testing of the Survey of Illness Beliefs in Heart Failure tool. ACTA ACUST UNITED AC 2007; 22:63-71. [PMID: 17541315 DOI: 10.1111/j.0889-7204.2007.06539.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study establishes reliability and construct validity of the Survey of Illness Beliefs in Heart Failure (HF) tool, which measures the accuracy and certainty of illness beliefs people have about HF. Factor analysis produced a 2-component structure of 14 items that revealed accurate and inaccurate illness beliefs (alpha=0.87 and 0.71, respectively). Construct validity was supported with significantly greater accuracy in illness belief scores in patients evaluated or listed for heart transplantation or enrolled in an HF research study (P=.008 and .02, respectively). The reliability and validity of the tool is sufficient to support its use in clinical research.
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Affiliation(s)
- Brooke Bentley
- Baccalaureate and Graduate Nursing Program, Eastern Kentucky University, 203 Stonewall Court, Richmond, KY 40475, USA.
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Response by Welch, Bennett, Delp, and Agarwal. West J Nurs Res 2006. [DOI: 10.1177/0193945905282327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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