1
|
Maddox TM, Januzzi JL, Allen LA, Breathett K, Brouse S, Butler J, Davis LL, Fonarow GC, Ibrahim NE, Lindenfeld J, Masoudi FA, Motiwala SR, Oliveros E, Walsh MN, Wasserman A, Yancy CW, Youmans QR. 2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2024; 83:1444-1488. [PMID: 38466244 DOI: 10.1016/j.jacc.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
|
2
|
Mavragani A, Löf M, Maddison R, Nourse R. Feasibility and Acceptability of Wearable Cameras to Assess Self-care in People With Heart Failure: Pilot Study. JMIR Form Res 2023; 7:e40536. [PMID: 36800215 PMCID: PMC9984995 DOI: 10.2196/40536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a common chronic condition that affects over 26 million people worldwide. It is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. People with HF generally do not self-manage their condition well (eg, monitoring symptoms, taking medications regularly, physical activity, etc). A better understanding of self-care activities and what factors may indicate deterioration is warranted. OBJECTIVE The aim of this study was to determine the feasibility and acceptability of using wearable cameras to assess self-care activities in people with HF. The study objectives were to (1) explore whether changes in self-care activities could be identified prior to hospitalization and (2) determine the acceptability of wearable cameras to people with HF. METHODS A total of 30 people recently diagnosed with HF wore a camera for a maximum of 30 days; the camera took a photo every 30 seconds in the forward-facing direction. At the end of the study, all 30 participants were presented with 8 statements of acceptability, scored on a 5-point Likert scale. To determine whether camera images could identify changes in self-care activities and lifestyle risk factors before hospitalization, we analyzed images from participants (n=8) who were hospitalized during the 30-day study period. Images from the period immediately prior to hospitalization and a comparison were selected for each participant. Images were manually coded according to 9 different event categories relating to self-care and lifestyle risk factors, and events were compared between the 2 periods. RESULTS The participants reported high acceptability for wearing the cameras, as most strongly agreed or agreed that they were comfortable to wear (28/30, 93%) and easy to use (30/30, 100%). The results of the camera image analysis showed that participants undertook fewer activities of daily living (P=.008) and were more sedentary (P=.02) prior to being hospitalized, compared to a period nonadjacent to hospitalization. CONCLUSIONS Adults with HF were accepting of using a wearable camera for periods within a 30-day time frame. Wearable cameras were a feasible approach for providing data on selected self-care activities and lifestyle risk factors for HF and offer the potential to be a valuable tool for improving our understanding of self-care.
Collapse
Affiliation(s)
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Rebecca Nourse
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| |
Collapse
|
3
|
Chae S, Song J, Ojo M, Bowles KH, McDonald MV, Barrón Y, Hobensack M, Kennedy E, Sridharan S, Evans L, Topaz M. Factors associated with poor self-management documented in home health care narrative notes for patients with heart failure. Heart Lung 2022; 55:148-154. [PMID: 35597164 PMCID: PMC11021173 DOI: 10.1016/j.hrtlng.2022.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with heart failure (HF) who actively engage in their own self-management have better outcomes. Extracting data through natural language processing (NLP) holds great promise for identifying patients with or at risk of poor self-management. OBJECTIVE To identify home health care (HHC) patients with HF who have poor self-management using NLP of narrative notes, and to examine patient factors associated with poor self-management. METHODS An NLP algorithm was applied to extract poor self-management documentation using 353,718 HHC narrative notes of 9,710 patients with HF. Sociodemographic and structured clinical data were incorporated into multivariate logistic regression models to identify factors associated with poor self-management. RESULTS There were 758 (7.8%) patients in this sample identified as having notes with language describing poor HF self-management. Younger age (OR 0.982, 95% CI 0.976-0.987, p < .001), longer length of stay in HHC (OR 1.036, 95% CI 1.029- 1.043, p < .001), diagnosis of diabetes (OR 1.47, 95% CI 1.3-1.67, p < .001) and depression (OR 1.36, 95% CI 1.09-1.68, p < .01), impaired decision-making (OR 1.64, 95% CI 1.37-1.95, p < .001), smoking (OR 1.7, 95% CI 1.4-2.04, p < .001), and shortness of breath with exertion (OR 1.25, 95% CI 1.1-1.42, p < .01) were associated with poor self-management. CONCLUSIONS Patients with HF who have poor self-management can be identified from the narrative notes in HHC using novel NLP methods. Meaningful information about the self-management of patients with HF can support HHC clinicians in developing individualized care plans to improve self-management and clinical outcomes.
Collapse
Affiliation(s)
- Sena Chae
- College of Nursing, University of Iowa, 50 Newton Rd, Iowa City, IA 52242, United States.
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, United States
| | - Marietta Ojo
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Kathryn H Bowles
- Department of Biobehavioral Health Sciences Philadelphia PA, Center for Home Care Policy & Research, University of Pennsylvania School of Nursing, Visiting Nurse Service of New York, New York, NY, United States
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Yolanda Barrón
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Mollie Hobensack
- Columbia University School of Nursing, New York, NY, United States
| | - Erin Kennedy
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, United States
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Lauren Evans
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States
| | - Maxim Topaz
- Center for Home Care Policy & Research, Columbia University School of Nursing, Data Science Institute, Columbia University, Visiting Nurse Service of New York, New York, NY, United States
| |
Collapse
|
4
|
Nourse R, Cartledge S, Tegegne T, Gurrin C, Maddison R. Now you see it! Using wearable cameras to gain insights into the lived experience of cardiovascular conditions. Eur J Cardiovasc Nurs 2022; 21:750-755. [PMID: 35714119 DOI: 10.1093/eurjcn/zvac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022]
Abstract
Wearable cameras offer an innovative way to discover new insights into the lived experience of people with cardiovascular conditions. Wearable cameras can be used alone or supplement more traditional research methods, such as interviews and participant observations. This paper provides an overview of the benefits of using wearable cameras for data collection and outlines some key considerations for researchers and clinicians interested in this method. We provide a case study describing a study design using wearable cameras and how the data were used.
Collapse
Affiliation(s)
- Rebecca Nourse
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Susie Cartledge
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Teketo Tegegne
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Cathal Gurrin
- School of Computing, Dublin City University, Dublin, Ireland
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| |
Collapse
|
5
|
Hussey AJ, McKelvie RS, Ferrone M, To T, Fisk M, Singh D, Faulds C, Licskai C. Primary care-based integrated disease management for heart failure: a study protocol for a cluster randomised controlled trial. BMJ Open 2022; 12:e058608. [PMID: 35551078 PMCID: PMC9109105 DOI: 10.1136/bmjopen-2021-058608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Heart failure (HF) is a common chronic disease that increases in prevalence with age. It is associated with high hospitalisation rates, poor quality of life and high mortality. Management is complex with most interactions occurring in primary care. Disease management programmes implemented during or after an HF hospitalisation have been shown to reduce hospitalisation and mortality rates. Evidence for integrated disease management (IDM) serving the primary care HF population has been investigated but is less conclusive. The aim of this study is to evaluate the efficacy of IDM, focused on, optimising medication, self-management and structured follow-up, in a high-risk primary care HF population. METHODS AND ANALYSIS 100 family physician clusters will be recruited in this Canadian primary care multicentre cluster randomised controlled trial. Physicians will be randomised to IDM or to care as usual. The IDM programme under evaluation will include case management, medication management, education, and skills training delivered collaboratively by the family physician and a trained HF educator. The primary outcome will measure the combined rate (events/patient-years) of all-cause hospitalisations, emergency department visits and mortality over a 12-month follow-up. Secondary outcomes include other health service utilisation, quality of life, knowledge assessments and acute HF episodes. Two to three HF patients will be recruited per physician cluster to give a total sample size of 280. The study has 90% power to detect a 35% reduction in the primary outcome. The difference in primary outcome between IDM and usual care will be modelled using a negative binomial regression model adjusted for baseline, clustering and for individuals experiencing multiple events. ETHICS AND DISSEMINATION The study has obtained approval from the Research Ethics Board at the University of Western Ontario, London, Canada (ID 114089). Findings will be disseminated through local reports, presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04066907.
Collapse
Affiliation(s)
- Anna J Hussey
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Robert S McKelvie
- Department of Medicine, Western University, London, Ontario, Canada
- St Joseph's Health Care, London, Ontario, Canada
| | - Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | - Teresa To
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Fisk
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
| | | | - Cathy Faulds
- St Joseph's Health Care, London, Ontario, Canada
- Family Medicine, Western University, London, Ontario, Canada
| | - Christopher Licskai
- Asthma Research Group Windsor-Essex County Inc, Windsor, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| |
Collapse
|
6
|
OUP accepted manuscript. J Am Med Inform Assoc 2022; 29:1400-1408. [DOI: 10.1093/jamia/ocac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/08/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
|
7
|
Meng X, Wang Y, Tang X, Gu J, Fu Y. Self-management on heart failure: A meta-analysis. Diabetes Metab Syndr 2021; 15:102176. [PMID: 34186372 DOI: 10.1016/j.dsx.2021.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Heart failure (HF) is a severe public health problem all over the World. Self-management is an effective method to progress self-care ability. However, the role of self-management in heart failure has not been thoroughly elucidated. METHODS The research articles related to heart failure were searched by the PubMed, Embase, Cochrane databases, and China National Knowledge Database on articles published through March 2020. The average 95% of confidence intervals (CIs) were used to calculate using random-effects or fixed-effects. Review Manager (version 5.2) was adopted for meta-analysis, sensitivity analysis, and bias analysis. RESULTS Eight (8) eligible studies with 1707 patients with HF were included in this analysis. In the Meta-analysis showed significant differences for Self-management (SM) groups in Dutch Heart Failure Knowledge Scale (DHFK) (MD = 1.36, 95%CI [-0.03, 2.75], P = 0.04; I2 = 83%), in Self-Care of Heart Failure Index (SCHFI) (MD = 5.51, 95%CI [0.62, 10.40], P = 0.03; I2 = 70%), and in Self-Efficacy for Managing Chronic Disease Scale (SEMCDI) (I2 = 47%, Z = 5.43, P of over effect < 0.0001) than control groups. One bias is detected as attrition bias, and another one is reporting bias. Sensitivity analysis satisfied the stability of the results. CONCLUSION Self-management was associated with significant outcomes in patients with HF through knowledge, attitude, and practice (KAP).
Collapse
Affiliation(s)
- Xianghong Meng
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Yuping Wang
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Xiaowen Tang
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Jianfang Gu
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Yonghua Fu
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China.
| |
Collapse
|
8
|
Intersectionality and heart failure: what clinicians and researchers should know and do. Curr Opin Support Palliat Care 2021; 15:141-146. [PMID: 33905386 DOI: 10.1097/spc.0000000000000547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW To review the application of intersectionality to heart failure. Intersectionality refers to the complex ways in which disenfranchisement and privilege intersect to reproduce and influence health and social outcomes. RECENT FINDINGS Intersectionality challenges approaches that focus on a single or small number of socio-demographic characteristics, such as sex or age. Instead, approaches should take account of the nature and effects of a full range of socio-demographic factors linked to privilege, including: race and ethnicity, social class, income, age, gender identity, disability, geography, and immigration status. Although credible and well established across many fields - there is limited recognition of the effects of intersectionality in research into heart disease, including heart failure. This deficiency is important because heart failure remains a common and burdensome syndrome that requires complex pharmacological and nonpharmacological care and collaboration between health professionals, patients and caregivers during and at the end-of-life. SUMMARY Approaches to heart failure clinical care should recognize more fully the nature and impact of patients' intersectionality- and how multiple factors interact and compound to influence patients and their caregivers' behaviours and health outcomes. Future research should explicate the ways in which multiple factors interact to influence health outcomes.
Collapse
|
9
|
Zhong C, Wong C, Cheung W, Yeoh EK, Hung CT, Yip B, Wong E, Wong S, Chung V. Peri-discharge complex interventions for reducing 30-day hospital readmissions among heart failure patients: overview of systematic reviews and network meta-analysis. Perspect Public Health 2021; 142:263-277. [PMID: 33719733 DOI: 10.1177/1757913920985258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS An overview of systematic reviews (SRs) and network meta-analysis (NMA) was conducted to synthesize evidence of comparative effectiveness of different peri-discharge complex interventions for reducing 30-day hospital readmissions among heart failure (HF) patients. METHODS We searched five databases for SRs from their inception to August 2019 and conducted additional search for randomized controlled trials (RCTs) published between 2003 and 2020. We used random-effect pairwise meta-analysis with pooled risk ratios (RRs) and 95% confidence intervals (CIs) to quantify the effect of complex interventions, and NMA to evaluate comparative effectiveness among complex interventions. Primary outcome was 30-day all-cause hospital readmissions, while secondary outcomes were 30-day HF-related hospital readmissions, 30-day mortality, and 30-day emergency department visits. RESULTS From 20 SRs and additional RCT search, 21 eligible RCTs (n = 5362) assessing eight different peri-discharge complex interventions were included. Pairwise meta-analysis showed no significant difference between peri-discharge complex interventions and controls on all outcomes, except that peri-discharge complex interventions were significantly more effective than controls in reducing 30-day mortality (pooled RR = 0.68, 95% CI: 0.49-0.95, 5 RCTs). NMA indicated that for reducing 30-day all-cause hospital readmissions, supportive-educative intervention had the highest probability to be the best intervention, followed by disease management; while for reducing 30-day HF-related hospital readmissions, disease management is likely to be the best intervention. CONCLUSIONS Our results suggest that disease management has the best potential to reduce 30-day all-cause and HF-related hospital readmissions. Benefits of the interventions may vary across health system contexts. Evidence-based complex interventions require local adaptation prior to implementation.
Collapse
Affiliation(s)
- Ccw Zhong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chl Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Rm 509, Prince of Wales Hospital, Shatin, Hong Kong
| | - Wkw Cheung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - E-K Yeoh
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - C T Hung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Bhk Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ely Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sys Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vch Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong; School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
10
|
Maddox TM, Januzzi JL, Allen LA, Breathett K, Butler J, Davis LL, Fonarow GC, Ibrahim NE, Lindenfeld J, Masoudi FA, Motiwala SR, Oliveros E, Patterson JH, Walsh MN, Wasserman A, Yancy CW, Youmans QR. 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol 2021; 77:772-810. [DOI: 10.1016/j.jacc.2020.11.022] [Citation(s) in RCA: 233] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
11
|
Tighe SA, Ball K, Kensing F, Kayser L, Rawstorn JC, Maddison R. Toward a Digital Platform for the Self-Management of Noncommunicable Disease: Systematic Review of Platform-Like Interventions. J Med Internet Res 2020; 22:e16774. [PMID: 33112239 PMCID: PMC7657720 DOI: 10.2196/16774] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/25/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Digital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the individual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change. OBJECTIVE This review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change. METHODS A literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool. RESULTS A total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD; n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69% (SD 20%). Of the 7 studies, 4 with the highest adherence rates (80%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score. CONCLUSIONS Iterative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care.
Collapse
Affiliation(s)
- Sarah A Tighe
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Finn Kensing
- Department of Computer Science, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Lars Kayser
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| |
Collapse
|
12
|
Austin RC, Schoonhoven L, Richardson A, Kalra PR, May CR. How do SYMPtoms and management tasks in chronic heart failure imPACT a person's life (SYMPACT)? Protocol for a mixed-methods study. ESC Heart Fail 2020; 7:4472-4477. [PMID: 32940966 PMCID: PMC7754908 DOI: 10.1002/ehf2.13010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/16/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022] Open
Abstract
Aims Patients with chronic heart failure (CHF) struggle to follow self‐care plans, which may lead to worsening illness and poor quality of life. Burden of treatment (BoT) describes this workload and its impact on patients' lives. Suggesting the balance between a patient's treatment workload and their capability to manage it is crucial. If BoT is reduced, self‐care engagement and quality of life may improve. This article describes the SYMPACT study design and methods used to explore how symptoms and management tasks impact CHF patients' lives. Methods and results We used a sequential exploratory mixed‐methods design to investigate the interaction between symptoms and BoT in CHF patients. Conclusions If symptoms and BoT are intrinsically linked, then the high level of symptoms experienced by CHF patients may lead to increased treatment burden, which likely decreases patients' engagement with self‐care plans. SYMPACT may identify modifiable factors to improve CHF patients' experience.
Collapse
Affiliation(s)
- Rosalynn C. Austin
- School of Health Sciences, Faculty of Environmental and Life SciencesUniversity of SouthamptonSouthamptonUK
- Department of CardiologyPortsmouth Hospitals University NHS TrustHampshireUK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
| | - Lisette Schoonhoven
- School of Health Sciences, Faculty of Environmental and Life SciencesUniversity of SouthamptonSouthamptonUK
- Julius Center for Health Sciences and Primary CareUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life SciencesUniversity of SouthamptonSouthamptonUK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Clinical Academic FacilityUniversity Hospital Southampton NHS Foundation TrustTremona RoadSouthamptonUK
| | - Paul R. Kalra
- Department of CardiologyPortsmouth Hospitals University NHS TrustHampshireUK
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life SciencesUniversity of Glasgow and the University of PortsmouthGlasgowUK
| | - Carl R. May
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| |
Collapse
|
13
|
“A montanha-russa da insuficiência cardíaca”: a percepção de dignidade pelas equipes de enfermagem. ACTA PAUL ENFERM 2020. [DOI: 10.37689/acta-ape/2020ao0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
14
|
Koirala B, Dennison Himmelfarb CR, Budhathoki C, Davidson PM. Heart failure self-care, factors influencing self-care and the relationship with health-related quality of life: A cross-sectional observational study. Heliyon 2020; 6:e03412. [PMID: 32149197 PMCID: PMC7031642 DOI: 10.1016/j.heliyon.2020.e03412] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/31/2019] [Accepted: 02/10/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Self-care helps maintain health, prevents complications and improves the quality of life of patients living with heart failure (HF). Self-care is critical to HF management but has received limited attention in Nepal. Identification of the sociodemographic and clinical characteristics associated with self-care is crucial to tailoring appropriate self-care programs to improve health outcomes including patients' quality of life. AIMS The aims of this study were to describe self-care including the factors influencing self-care and the relationship between self-care and health-related quality of life in patients living with HF in Kathmandu, Nepal. METHODS We used a cross-sectional observational study design to measure self-care maintenance, self-care management, and self-care confidence using the Nepali Self-Care of Heart Failure Index. To analyze data, we used descriptive statistics, bivariate associations and regression modeling. RESULTS We recruited 221 patients with HF: mean age 57.5 ± 15.76 years, 62% male. The results in this sample indicated poor self-care maintenance (38.5 ± 11.56), management (45.7 ± 15.14), and confidence (40.9 ± 16.31). Patients with higher education were associated with higher self-care maintenance and management. Living alone and a better New York Heart Association functional classification for HF were related to higher self-care confidence. Higher social support was associated with better self-care. Self-care confidence was an independent predictor of self-care maintenance, management and health-related quality of life on adjusted analyses. CONCLUSION Self-care was limited among patients living with HF in Nepal yet was associated with better quality of life. The study identified various sociodemographic and clinical factors related to self-care, which could be crucial while developing self-care interventions.
Collapse
Affiliation(s)
- Binu Koirala
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205 United States
| | - Cheryl R. Dennison Himmelfarb
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205 United States
- Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, 2024 E Monument St, Baltimore, MD 21205 United States
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205 United States
| | - Patricia M. Davidson
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205 United States
| |
Collapse
|
15
|
Tarte VP, Amirehsani KA. Perceptions of Mobile Technology for Heart Failure Education and Self-Management Among Middle-Aged and Older Adults. J Gerontol Nurs 2019; 45:30-38. [DOI: 10.3928/00989134-20191011-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/29/2019] [Indexed: 11/20/2022]
|
16
|
Rakhshan M, Najafi H, Valizadeh GA. Lifestyle of Patients with Atrial Fibrillation Following Self-Management Interventions: a Randomized Clinical Trial. J Caring Sci 2019; 8:83-88. [PMID: 31249817 PMCID: PMC6589479 DOI: 10.15171/jcs.2019.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 07/21/2018] [Indexed: 01/14/2023] Open
Abstract
Introduction: Cardiovascular diseases are the most common cause of death in most countries, such as Iran. Cardiac arrhythmias, including Atrial Fibrillation (AF) comprise an important category of these diseases. During recent years, AF has become a serious medical condition. This study aimed to investigate the effect of self-management interventions on the lifestyle of patients with AF. Methods: In this Randomized Clinical Trial study, 88 patients were selected and randomly assigned to intervention and control groups. The intervention group received self-management interventions, including education and telephone follow-ups. The data were collected using a demographic questionnaire and Walker's health-promoting lifestyle profile II, before the intervention and four and twelve weeks after the intervention. The significance level was considered to be 0.05. Results: The results showed a significant increase in the intervention group's lifestyle mean score, four and twelve weeks after the intervention as compared with control group However, this increase was not similar in all the lifestyle dimensions. Conclusion: In conclusion, implementation of self-management interventions could improve the lifestyle of the patients with Atrial Fibrillation. The results can help nurses to conduct self-management interventions into such patients' care plan and prevent many physical, psychological, and social problems that negatively affect patients and their lifestyle.
Collapse
Affiliation(s)
- Mahnaz Rakhshan
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hojatolah Najafi
- Department of Nursing, Faculty of Nursing and Midwifery, Shiraz University of Medical sciences, Shiraz, Iran
| | - Gholam Abbas Valizadeh
- Department of Cardiovascular, Faculty of Medicine, Fasa University of Medical sciences, Fasa, Iran
| |
Collapse
|
17
|
Maddison R, Cartledge S, Rogerson M, Goedhart NS, Ragbir Singh T, Neil C, Phung D, Ball K. Usefulness of Wearable Cameras as a Tool to Enhance Chronic Disease Self-Management: Scoping Review. JMIR Mhealth Uhealth 2019; 7:e10371. [PMID: 30609985 PMCID: PMC6682294 DOI: 10.2196/10371] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/13/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022] Open
Abstract
Background Self-management is a critical component of chronic disease management and can include a host of activities, such as adhering to prescribed medications, undertaking daily care activities, managing dietary intake and body weight, and proactively contacting medical practitioners. The rise of technologies (mobile phones, wearable cameras) for health care use offers potential support for people to better manage their disease in collaboration with their treating health professionals. Wearable cameras can be used to provide rich contextual data and insight into everyday activities and aid in recall. This information can then be used to prompt memory recall or guide the development of interventions to support self-management. Application of wearable cameras to better understand and augment self-management by people with chronic disease has yet to be investigated. Objective The objective of our review was to ascertain the scope of the literature on the use of wearable cameras for self-management by people with chronic disease and to determine the potential of wearable cameras to assist people to better manage their disease. Methods We conducted a scoping review, which involved a comprehensive electronic literature search of 9 databases in July 2017. The search strategy focused on studies that used wearable cameras to capture one or more modifiable lifestyle risk factors associated with chronic disease or to capture typical self-management behaviors, or studies that involved a chronic disease population. We then categorized and described included studies according to their characteristics (eg, behaviors measured, study design or type, characteristics of the sample). Results We identified 31 studies: 25 studies involved primary or secondary data analysis, and 6 were review, discussion, or descriptive articles. Wearable cameras were predominantly used to capture dietary intake, physical activity, activities of daily living, and sedentary behavior. Populations studied were predominantly healthy volunteers, school students, and sports people, with only 1 study examining an intervention using wearable cameras for people with an acquired brain injury. Most studies highlighted technical or ethical issues associated with using wearable cameras, many of which were overcome. Conclusions This scoping review highlighted the potential of wearable cameras to capture health-related behaviors and risk factors of chronic disease, such as diet, exercise, and sedentary behaviors. Data collected from wearable cameras can be used as an adjunct to traditional data collection methods such as self-reported diaries in addition to providing valuable contextual information. While most studies to date have focused on healthy populations, wearable cameras offer promise to better understand self-management of chronic disease and its context.
Collapse
Affiliation(s)
- Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Susie Cartledge
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michelle Rogerson
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Nicole Sylvia Goedhart
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Science, VU University, Amsterdam, Netherlands
| | - Tarveen Ragbir Singh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Christopher Neil
- Department of Medicine, Western Health, University of Melbourne, Melbourne, Australia.,Department of Cardiology, Western Health, Melbourne, Australia
| | - Dinh Phung
- Centre for Pattern Recognition and Data Analytics, Deakin University, Geelong, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| |
Collapse
|
18
|
Abstract
The purpose of this descriptive, exploratory study was to assess the perceptions of older adults with heart failure regarding the use of mobile technology and to identify potential facilitators of and barriers to mHealth adoption. Semistructured interviews were used to collect data. Transcripts were analyzed using qualitative content analysis. The findings indicated that older adults do not base their intention to use mHealth solely on perceived ease of use and perceived usefulness, as outlined in the Technology Acceptance Model. The following themes emerged from the content analysis: facilitators included previous experience with mobile technology, willingness to learn mHealth, ease of use, presence of useful features, adequate training, free equipment, and doctor's recommendation; barriers included lack of knowledge regarding how to use mHealth, decreased sensory perception, lack of need for technology, poorly designed interface, cost of technology, and limited/fixed income. Overall, the findings suggest that older adults are willing to use mobile health technology, albeit with reservations. Future researchers who seek to implement mHealth-based interventions should address person-related, technology-related, and contextual barriers, and simultaneously capitalize on the influence of potential facilitators, such as a physician's recommendation, to promote mHealth adoption.
Collapse
|
19
|
Asgari S, Roohani M, Amini K, Faghihzadeh S. Investigating Death Anxiety and its Relationship with Some Demographic Variables in Patients with Heart Failure in Zanjan 2018. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2018. [DOI: 10.29252/pcnm.8.2.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
20
|
Enhanced Patient-Centered Educational Program for HF Self-care management in Sub-acute settings. Appl Nurs Res 2018; 42:22-34. [PMID: 30029711 DOI: 10.1016/j.apnr.2018.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/22/2018] [Indexed: 11/22/2022]
Abstract
Heart Failure (HF) is a complex condition that leads to inadequate blood circulation causing shortness of breath, fatigue, and weakness. It is one of the leading causes of death in the United States. Heart failure is associated with adverse outcomes such as high rates of hospitalization, readmission, mortality, and poor quality of life. However, despite the establishment of interventions to assist with the control of HF, numerous patients are still being readmitted to the hospital. The main purpose of this evidence-based practice (EBP) project was to implement and evaluate the effectiveness of patient centered educational program on self-care management among HF patients in sub-acute settings. The EBP was implemented in two sub-acute units at Alaris Health located at Cedar Grove. A total of 20 participants completed the pretest and 14 participants completed the post test. The Expanded Chronic Care Model of 2003 (ECCM) was utilized as the theoretical framework to coordinate the health determinants which is the "self-care management." This EBP project used a pretest and post-test using the tool Self-care of Heart Failure Index V6.2(SCHFI). The data was analyzed using the descriptive statistics using the mean and the difference between the pre- and post-test scores. Educational intervention was provided based on the survey scores. The intervention involved provision of educational program related to effective self-care management among HF patients, their families, and care providers. The results of the study demonstrated a statically significant increase in the mean score between the pre-and post-survey related to self-care maintenance, self-care management, and self-confidence. The results of the project suggested that patient-centered educational program can enhance self-care maintenance, management, and confidence among heart failure patients.
Collapse
|
21
|
Jacobson AF, Sumodi V, Albert NM, Butler RS, DeJohn L, Walker D, Dion K, Tai HLL, Ross DM. Patient activation, knowledge, and health literacy association with self-management behaviors in persons with heart failure. Heart Lung 2018; 47:447-451. [PMID: 29910065 DOI: 10.1016/j.hrtlng.2018.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/26/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND More evidence is needed about factors that influence self-management behaviors in persons with heart failure. OBJECTIVE To test a correlational mediation model of the independent variables of health literacy, patient activation, and heart failure knowledge with heart failure self-management behaviors. METHODS The study used a prospective, cross-sectional, correlational design. Correlation and multiple regression were used to analyze associations among variables. RESULTS Of 151 participants, 57% were male, and mean age was 68 years. Heart failure self-management behaviors was positively correlated with patient activation level (p = .0008), but not with health literacy or heart failure knowledge. CONCLUSIONS Persons with heart failure may better manage their condition if sufficiently activated, regardless of their level of health literacy or knowledge of heart failure disease and management processes.
Collapse
Affiliation(s)
- Ann F Jacobson
- Cleveland Clinic Hillcrest Chronic Care, 6801 Mayfield Rd., Mayfield Heights, OH 44124.
| | - Veronica Sumodi
- Cleveland Clinic Hillcrest Chronic Care, 6801 Mayfield Rd., Mayfield Heights, OH 44124
| | - Nancy M Albert
- Cleveland Clinic, 9500 Euclid Avenue, Mail code J3-4, Cleveland OH 44195
| | - Robert S Butler
- Cleveland Clinic Quantitative Health Sciences, 9500 Euclid Avenue/JJN3-01, Cleveland, OH 44195
| | - Lori DeJohn
- Cleveland Clinic Hillcrest Chronic Care, 6801 Mayfield Rd., Mayfield Heights, OH 44124
| | - Donna Walker
- Cleveland Clinic Euclid Hospital Chronic Care, 18901 Lakeshore Blvd, Euclid, OH 44119
| | - Kelly Dion
- Cleveland Clinic South Pointe Hospital Chronic Care, 20000 Harvard Ave, Warrensville Heights, OH 44122
| | - Hua-Li Lin Tai
- Cleveland Clinic South Pointe Hospital Chronic Care, 20000 Harvard Ave, Warrensville Heights, OH 44122
| | - Donna M Ross
- Cleveland Clinic Lakewood Chronic Care, 14519 Detroit Ave., Lakewood, OH 44107
| |
Collapse
|
22
|
Kandola DK, Banner D, Araki Y, Bates J, Hadi H, Lear SA. The Participant Recruitment Outcomes (PRO) study: Exploring contemporary perspectives of telehealth trial non-participation through insights from patients, clinicians, study investigators, and study staff. Contemp Clin Trials Commun 2018; 11:75-82. [PMID: 29998203 PMCID: PMC6008707 DOI: 10.1016/j.conctc.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/13/2018] [Accepted: 05/03/2018] [Indexed: 11/23/2022] Open
Abstract
Background Telehealth has been proposed as an alternative means to providing traditional modes of care while alleviating the need for participant travel and reducing overall healthcare costs. The purpose of this study was to explore contemporary perspectives of patients and stakeholders regarding non-participation in telehealth trials. Methods We undertook a two-phase exploratory qualitative study to understand the reasons behind patient non-participation in telehealth. Data were collected through semi-structured interviews with non-participating patient participants (n = 8) and stakeholders (n = 27) including clinicians, study investigators, and study staff. An analysis of interview data were undertaken and guided by a qualitative descriptive approach. Findings Patients and stakeholders reported many barriers to telehealth participation including technological barriers, limited understanding of disease, and an understated need for services. Both groups had some overlap in their concerns but also provided unique insights. Conclusion The analysis of study findings revealed perspectives of patients and stakeholders including barriers to participation as well as suggestions for future telehealth initiatives. Further research is needed to explore non-participation including patient readiness to assist in the development of future telehealth programs.
Collapse
Affiliation(s)
- Damanpreet K Kandola
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, V2N 4Z9, Canada.,School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, V2N 4Z9, Canada
| | - Davina Banner
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, V2N 4Z9, Canada
| | - Yuriko Araki
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, V5A 1S6, Canada
| | - Joanna Bates
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Haidar Hadi
- Northern Medical Program, Department of Medicine, University of Northern British Columbia, V2N 4Z9, Canada.,Northern Health Authority, Prince George, British Columbia, V2L 5B8, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, V5A 1S6, Canada.,Division of Cardiology, Providence Healthcare, Vancouver, British Columbia, V6Z 1Y6, Canada
| |
Collapse
|
23
|
|
24
|
Maddison R, Stewart R, Doughty R, Scott T, Kerr A, Benatar J, Whittaker R, Rawstorn JC, Rolleston A, Jiang Y, Estabrooks P, Sullivan RK, Bartley H, Pfaeffli Dale L. Text4Heart II - improving medication adherence in people with heart disease: a study protocol for a randomized controlled trial. Trials 2018; 19:70. [PMID: 29370829 PMCID: PMC5785898 DOI: 10.1186/s13063-018-2468-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/11/2018] [Indexed: 01/01/2023] Open
Abstract
Background Cardiac rehabilitation (CR) is an essential component of contemporary management for patients with coronary heart disease, including following an acute coronary syndrome (ACS). CR typically involves education and support to assist people following an ACS to make lifestyle changes and prevent subsequent events. Despite its benefits, uptake and participation in tradition CR programs is low. The use of mobile technologies (mHealth) offers the potential to improve reach, access, and delivery of CR support. We aim to determine the effectiveness and cost-effectiveness of a text-messaging intervention (Text4Heart II) to improve adherence to medication and lifestyle change in addition to usual care in people following an ACS. A second aim is to use the RE-AIM framework to inform the potential implementation of Text4Heart II within health services in New Zealand. Methods Text4Heart II is a two-arm, parallel, superiority randomized controlled trial conducted in two large metropolitan hospitals in Auckland, New Zealand. Three hundred and thirty participants will be randomized to either a 24-week theory- and evidence-based personalized text message program to support self-management in addition to usual CR, or usual CR alone (control). Outcomes are assessed at 6 and 12 months. The primary outcome is the proportion of participants adhering to medication at 6 months as measured by dispensed records. Secondary outcomes include medication adherence at 12 months, the proportion of participants adhering to self-reported healthy behaviors (physical activity, fruit and vegetable consumption, moderating alcohol intake and smoking status) measured using a composite health behavior score, self-reported medication adherence, cardiovascular risk factors (lipids, blood pressure), readmissions and related hospital events at 6 and 12 months. A cost-effectiveness analysis will also be conducted. Using the RE-AIM framework, we will determine uptake and sustainability of the intervention. Discussion The Text4Heart II trial will determine the effectiveness of a text-messaging intervention to improve adherence to medication and lifestyle behaviors at both 6 and 12 months. Using the RE-AIM framework this trial will provide much needed data and insight into the potential implementation of Text4Heart II. This trial addresses many limitations/criticisms of previous mHealth trials; it builds on our Text4Heart pilot trial, it is adequately powered, has sufficient duration to elicit behavior change, and the follow-up assessments (6 and 12 months) are long enough to determine the sustained effect of the intervention. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12616000422426. Registered retrospectively on 1 April 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2468-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
| | - Ralph Stewart
- Department of Cardiology, Auckland District Health Board, Auckland, New Zealand
| | - Rob Doughty
- Heart Health Research Group, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tony Scott
- Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand
| | - Andrew Kerr
- Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Jocelyne Benatar
- Department of Cardiology, Auckland District Health Board, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | | | - Yannan Jiang
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Paul Estabrooks
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Centre, Omaha, NE, USA
| | - Rachel Karen Sullivan
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Hannah Bartley
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Leila Pfaeffli Dale
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
25
|
Yancy CW, Januzzi JL, Allen LA, Butler J, Davis LL, Fonarow GC, Ibrahim NE, Jessup M, Lindenfeld J, Maddox TM, Masoudi FA, Motiwala SR, Patterson JH, Walsh MN, Wasserman A. 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol 2018; 71:201-230. [DOI: 10.1016/j.jacc.2017.11.025] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
26
|
Ell K, Aranda MP, Wu S, Oh H, Lee PJ, Guterman J. Promotora assisted depression and self-care management among predominantly Latinos with concurrent chronic illness: Safety net care system clinical trial results. Contemp Clin Trials 2017; 61:1-9. [DOI: 10.1016/j.cct.2017.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/08/2017] [Accepted: 07/02/2017] [Indexed: 10/19/2022]
|
27
|
Gibert SH, DeGrazia D, Danis M. Ethics of patient activation: exploring its relation to personal responsibility, autonomy and health disparities. JOURNAL OF MEDICAL ETHICS 2017; 43:670-675. [PMID: 28774956 DOI: 10.1136/medethics-2017-104260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/19/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
Discussions of patient-centred care and patient autonomy in bioethics have tended to focus on the decision-making context and the process of obtaining informed consent, leaving open the question of how patients ought to be counselled in the daily maintenance of their health and management of chronic disease. Patient activation is an increasingly prominent counselling approach and measurement tool that aims to improve patients' confidence and skills in managing their own health conditions. The strategy, which has received little conceptual or ethical analysis, raises important questions about how clinicians ought to foster confidence and a sense of control in their patients without exposing them to blame, stigma and other harms. In this paper, we describe patient activation, discuss its relationship to personal responsibility, autonomy and health disparities, and make recommendations regarding its use and measurement.
Collapse
Affiliation(s)
- Sophia H Gibert
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - David DeGrazia
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
28
|
Breathett K, D'Amico R, Adesanya TMA, Hatfield S, Willis S, Sturdivant RX, Foraker RE, Smith S, Binkley P, Abraham WT, Peterson PN. Patient Perceptions on Facilitating Follow-Up After Heart Failure Hospitalization. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004099. [PMID: 28615367 DOI: 10.1161/circheartfailure.117.004099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Timely follow-up after hospitalization for heart failure (HF) is recommended. However, follow-up is suboptimal, especially in lower socioeconomic groups. Patient-centered solutions for facilitating follow-up post-HF hospitalization have not been extensively evaluated. METHODS AND RESULTS Face-to-face surveys were conducted between 2015 and 2016 among 83 racially diverse adult patients (61% African American, 34% Caucasian, and 5% Other) hospitalized for HF at a university hospital centered in a low-income area of Columbus, Ohio. Patient perceptions of methods to facilitate follow-up post-HF hospitalization and likelihood of using interventions were investigated using a Likert scale: 1=very much to 5=not at all. Results were analyzed by Wilcoxon signed-rank test with Bonferroni correction. The response rate was 82%. The annual household income was <$35 000 for 49% of patients. An appointment near the patient's home was the most desired intervention (77%), followed by reminder message (73%), transportation to appointment (63%), and elimination of copayment (59%). Interventions most likely to be used if provided were similarly ranked: reminder message (48%), appointment near home (46%), elimination of copay (46%), and transportation to appointment (39%). There were significant differences (P=0.001) in high-ranking interventions related to location (appointment near home, transportation, home appointment) and reminder for visit compared with low-ranking interventions related to time (weekend appointment, appointment after 5 pm) and telemedicine. CONCLUSIONS Among this cohort of racially diverse low-income patients hospitalized with HF, an appointment near the patient's home and a reminder message were the most desired interventions to facilitate follow-up. Further study of similar populations nationwide is warranted.
Collapse
Affiliation(s)
- Khadijah Breathett
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.).
| | - Rachel D'Amico
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - T M Ayodele Adesanya
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Stefanie Hatfield
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Shannon Willis
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Rodney X Sturdivant
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Randi E Foraker
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Sakima Smith
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Philip Binkley
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - William T Abraham
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Pamela N Peterson
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| |
Collapse
|
29
|
Affiliation(s)
- Mehnosh Toback
- Foothills Hospital, Libin Cardiovascular Institute of Alberta, 1403, 29 Street N.W., Calgary,ABT2N 2T9, Canada
| | - Nancy Clark
- Foothills Hospital, Libin Cardiovascular Institute of Alberta, 1403, 29 Street N.W., Calgary,ABT2N 2T9, Canada
| |
Collapse
|
30
|
Comorbidity "depression" in heart failure - Potential target of patient education and self-management. BMC Cardiovasc Disord 2017; 17:48. [PMID: 28196484 PMCID: PMC5310056 DOI: 10.1186/s12872-017-0487-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/27/2017] [Indexed: 11/10/2022] Open
Abstract
The progress of the pharmacological and device treatment of heart failure (HF) has led to a substantial improvement of mortality and rehospitalization. Further potential for improvement may be heralded in the post-discharge management of HF patients, including patient education for self-management of HF. The study by Musekamp et al. is among the first publications providing evidence that improvements in self-management skills may improve outcomes of HF patients. It is concluded that multimodal approaches addressing comorbidities in HF patients with novel concepts, and by optimal and specific HF management, including patient education, may ultimately contribute to substantial improvement of HF prognosis.
Collapse
|
31
|
Ngooi BX, Packer TL, Warner G, Kephart G, Koh KWL, Wong RCC, Lim SP. How adults with cardiac conditions in Singapore understand the Patient Activation Measure (PAM-13) items: a cognitive interviewing study. Disabil Rehabil 2016; 40:587-596. [PMID: 27973921 DOI: 10.1080/09638288.2016.1261413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Validation studies of the PAM-13 have found differences in scale performance, suggesting that health beliefs embedded in different cultures and/or self-management needs of different client groups influence how people respond to the items. The purpose of this study was to examine how adults with cardiac conditions in Singapore interpreted and responded to the PAM-13, to investigate possible reasons for differences in responses and to propose solutions to overcome them. METHODS We conducted retrospective cognitive interviews with 13 participants in an out-patient heart center. Interviews were transcribed and analyzed based on the framework approach to qualitative analysis. The four stages from Tourangeau's cognitive model were used as a framework to index the data from each item. RESULTS There was variation in comprehension of questions leading to variation in responses. Comprehension issues were due to terms perceived by participants to be vague and the use of English terms uncommon in Singapore. Cultural influences impacted decision processes and problems with response processes of the self-rating Likert scale surfaced. CONCLUSIONS This study reinforces the need to culturally adapt the tool, even when language translation is not necessary. Providing Likert scales with a larger number of may widen the relevance of PAM-13 in Singapore. Implications for rehabilitation Need to culturally adapt assessment tool, even when language translation is not necessary. Consider using Likert scales with a larger number of categories when using in Asian countries such as Singapore. Caution must be taken when using PAM-13 levels to decide interventions for each individual.
Collapse
Affiliation(s)
- Bi Xia Ngooi
- a Department of Rehabilitation , National University Hospital , Singapore , Singapore.,b School of Occupational Therapy, Dalhousie University , Halifax , NS , Canada
| | - Tanya L Packer
- b School of Occupational Therapy, Dalhousie University , Halifax , NS , Canada
| | - Grace Warner
- b School of Occupational Therapy, Dalhousie University , Halifax , NS , Canada
| | - George Kephart
- c Department of Community Health and Epidemiology , Dalhousie University , Halifax , NS , Canada
| | - Karen Wei Ling Koh
- d Department of Nursing , National University Hospital , Singapore , Singapore
| | | | - Serene Peiying Lim
- a Department of Rehabilitation , National University Hospital , Singapore , Singapore
| |
Collapse
|
32
|
Iyngkaran P, Toukhsati SR, Harris M, Connors C, Kangaharan N, Ilton M, Nagel T, Moser DK, Battersby M. Self Managing Heart Failure in Remote Australia - Translating Concepts into Clinical Practice. Curr Cardiol Rev 2016; 12:270-284. [PMID: 27397492 PMCID: PMC5304248 DOI: 10.2174/1573403x12666160703183001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/28/2015] [Accepted: 01/11/2016] [Indexed: 11/23/2022] Open
Abstract
Congestive heart failure (CHF) is an ambulatory health care condition characterized by episodes of decompensation and is usually without cure. It is a leading cause for morbidity and mortality and the lead cause for hospital admissions in older patients in the developed world. The long-term requirement for medical care and pharmaceuticals contributes to significant health care costs. CHF management follows a hierarchy from physician prescription to allied health, predominately nurse-led, delivery of care. Health services are easier to access in urban compared to rural settings. The differentials for more specialized services could be even greater. Remote Australia is thus faced with unique challenges in delivering CHF best practice. Chronic disease self-management programs (CDSMP) were designed to increase patient participation in their health and alleviate stress on health systems. There have been CDSMP successes with some diseases, although challenges still exist for CHF. These challenges are amplified in remote Australia due to geographic and demographic factors, increased burden of disease, and higher incidence of comorbidities. In this review we explore CDSMP for CHF and the challenges for our region.
Collapse
|
33
|
Bagheri H, Yaghmaei F, Ashktorab T, Zayeri F. Relationship between illness-related worries and social dignity in patients with heart failure. Nurs Ethics 2016; 25:618-627. [PMID: 27694547 DOI: 10.1177/0969733016664970] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure is a major growing problem and affects not only patients but also their families and community networks and reduces the functional capacity of patients and impairs their social life. RESEARCH QUESTIONS This study was conducted to investigate relationship between illness-related worries and social dignity in patients with heart failure. DESIGN The study had a descriptive-analytic design, and data collection was carried out by means of two specific questionnaires. Participants and context: A total of 130 inpatients from cardiac wards in hospitals affiliated with Tehran and Shahid Beheshti University of Medical Sciences participated. Ethical consideration: This study was approved by the Research Committee of Shahid Beheshti University of Medical Sciences. RESULTS The highest mean score of illness-related worries was attributed to the dimension of patient's worry of physical-mental complications, and the least mean score was related to the dimension of the worry about the future of disease. The highest mean score of social dignity was associated with the dimension of social communication and support, and the least is attributed to the dimension of burden to others (economic). Pearson's statistical test showed a significant correlation (r = 0.455, p < 0.05) between the score of illness-related worries and social dignity. DISCUSSION As the result of this study showed that reducing illness-related worries in patients with heart failure can improve their social dignity, using strategies to decrease worries and promote social dignity in these patients is recommended. CONCLUSION This study affirms the importance of careful evaluation of individual patients to determine their needs related to dignity. We hope these results will help to promote actions by patient-care staff that honor and support patient dignity, resulting in benefits to patients and developing the quality of care based on human rights.
Collapse
Affiliation(s)
- Hossein Bagheri
- Shahroud University of Medical Sciences, Shahroud, Iran.,Shahid Beheshti University of Medical Sciences, Iran
| | | | | | - Farid Zayeri
- Shahid Beheshti University of Medical Sciences, Iran
| |
Collapse
|
34
|
Ngooi BX, Packer TL, Kephart G, Warner G, Koh KWL, Wong RCC, Lim SP. Validation of the Patient Activation Measure (PAM-13) among adults with cardiac conditions in Singapore. Qual Life Res 2016; 26:1071-1080. [PMID: 27645458 DOI: 10.1007/s11136-016-1412-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE The Patient Activation Measure (PAM-13) measures patients' knowledge, skill, and confidence in chronic condition self-management. The purpose of this study was to assess the validity of PAM-13 (English version) among English-speaking adults with cardiac conditions in Singapore. METHODS A cross-sectional study was conducted in a convenient sample of 270 heart clinic patients. Using the unitary concept of validity, evidence of (1) internal structure via data quality, unidimensionality, differential item functioning, and internal consistency, (2) response process through item difficulty and item fit using Rasch modeling, and (3) relationship to other variables via correlations with depression and self-efficacy were examined. RESULTS The item response was high with only one missing answer. All items had a small floor effect, but nine out of 13 items had a ceiling effect larger than 15 %. Cronbach's α was 0.86, and average inter-item correlations was 0.324. Results suggested unidimensionality; however, differences in item difficulty ranking were found. A low, negative correlation was found with depression, while a moderate, positive correlation was found with self-efficacy. CONCLUSION Evidence in all three areas of validity were mixed. Caution should be exercised when using categorical activation "level" to inform clinical decisions.
Collapse
Affiliation(s)
- Bi Xia Ngooi
- Department of Rehabilitation, National University Hospital, 5 Lower Kent Ridge Road, Main Building 1, Level 1, Singapore, 119074, Singapore. .,School of Occupational Therapy, Dalhousie University, Room 214 Forrest Building, 5869 University Ave, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Tanya L Packer
- School of Occupational Therapy, Dalhousie University, Room 214 Forrest Building, 5869 University Ave, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, Room 416, 5790 University Ave, Halifax, NS, B3H 1V7, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Room 214 Forrest Building, 5869 University Ave, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Karen Wei Ling Koh
- Department of Nursing, National University Hospital, 5 Lower Kent Ridge Wing, Singapore, 119074, Singapore
| | - Raymond Ching Chiew Wong
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Wing, Singapore, 119074, Singapore
| | - Serene Peiying Lim
- Department of Rehabilitation, National University Hospital, 5 Lower Kent Ridge Road, Main Building 1, Level 1, Singapore, 119074, Singapore
| |
Collapse
|
35
|
Abstract
BACKGROUND Identifying, maintenance, and promotion of dignity in different patients of various cultures is an ethical responsibility of healthcare workers. RESEARCH QUESTIONS This study was conducted to investigate factors related to dignity in patients with heart failure and test the validity of Dignity Model. DESIGN The study had a descriptive-correlational design, and data collection was carried out by means of four specific questionnaires. Participants and context: A total of 130 in-patients from cardiac wards in hospitals affiliated with Tehran and Shahid Beheshti University of Medical Sciences participated. Ethical consideration: This study was approved by the Research Committee of Shahid Beheshti University of Medical Sciences. FINDINGS Significant correlation showed the following: between illness related worries with dignity conserving repertoire score, between illness related worries with social dignity, between illness related worries with dignity conserving repertoire score, and between social dignity with dignity score. Goodness Fit Index and Comparative Fit Index were calculated greater than 0.9. DISCUSSION This study affirms the importance of careful evaluation of individual patients to determine their needs related to dignity. CONCLUSION According to the results, the necessity of using appropriate tools to assess various aspects of patients' dignity by clinical healthcare staff and design activities with particular focus on the main factors affecting dignity such as illness related worries and social dignity is recommended. Attention to this issue in everyday clinical practice can facilitate health professionals/nurses to potentially improve their patients' dignity, develop quality of care and treatment, and improve patients' satisfaction.
Collapse
Affiliation(s)
- Hossein Bagheri
- Shahroud University of Medical Sciences, Shahroud, Iran
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Farid Zayeri
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
36
|
Bos-Touwen I, Jonkman N, Westland H, Schuurmans M, Rutten F, de Wit N, Trappenburg J. Tailoring of self-management interventions in patients with heart failure. Curr Heart Fail Rep 2016; 12:223-35. [PMID: 25929690 PMCID: PMC4424272 DOI: 10.1007/s11897-015-0259-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The effectiveness of heart failure (HF) self-management interventions varies within patients suggesting that one size does not fit all. It is expected that effectiveness can be optimized when interventions are tailored to individual patients. The aim of this review was to synthesize the literature on current use of tailoring in self-management interventions and patient characteristics associated with self-management capacity and success of interventions, as building blocks for tailoring. Within available trials, the degree to which interventions are explicitly tailored is marginal and often limited to content. We found that certain patient characteristics that are associated with poor self-management capacity do not influence effectiveness of a given intervention (i.e., age, gender, ethnicity, disease severity, number of comorbidities) and that other characteristics (low: income, literacy, education, baseline self-management capacity) in fact are indicators of patients with a high likelihood for success. Increased scientific efforts are needed to continue unraveling success of self-management interventions and to validate the modifying impact of currently known patient characteristics.
Collapse
Affiliation(s)
- Irene Bos-Touwen
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Nini Jonkman
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Heleen Westland
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marieke Schuurmans
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Frans Rutten
- />Julius Center, Department of General Practice, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Niek de Wit
- />Julius Center, Department of General Practice, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Jaap Trappenburg
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| |
Collapse
|
37
|
Patient-perceived self-management tasks and support needs of people with chronic illness: generic or disease specific? Ann Behav Med 2015; 49:221-9. [PMID: 25199663 DOI: 10.1007/s12160-014-9649-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Self-management is widely accepted as an essential component of chronic care. Nevertheless, little is known about patients' perceptions of self-management. PURPOSE This study aims to explore which self-management tasks and support needs people with chronic illness perceive for themselves, and to establish whether these tasks and support needs are disease specific. METHODS A nationwide representative sample of 2,064 people with chronic disease filled in the Patient Assessment of Self-management Tasks questionnaire. RESULTS Many respondents perceive self-management tasks in the daily management of their condition, although few indicate a need for support. Respondents who feel a need for support in one aspect of self-management are likely to feel a need for support in other aspects as well. Type of disease has a small effect on self-management tasks and even smaller on support needs. CONCLUSION Although the self-management tasks patients perceive may be partly disease specific, self-management support does not necessarily need to be disease specific.
Collapse
|
38
|
Ell K, Aranda MP, Wu S, Oh H, Lee PJ, Guterman J. Promotora assisted depression care among predominately Hispanic patients with concurrent chronic illness: Public care system clinical trial design. Contemp Clin Trials 2015; 46:39-47. [PMID: 26600285 DOI: 10.1016/j.cct.2015.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
Depression frequently negatively affects patient overall self-care and social stress management within United States safety net care systems. Rates of major depression are significantly high among low-income predominantly Hispanic/Latino with chronic illness, such as diabetes and heart disease. The study design of the A Helping Hand to Activate Patient-Centered Depression Care among Low-income Patients (AHH) randomized clinical trial aims to enhance patient depression care receipt and overall bio-psychosocial self-care management. The AHH trial is conducted in collaboration with three Los Angeles County Department of Health Services (DHS) safety net clinics that provide Patient-Centered Medical Home (PCMH) care. The study compares AHH intervention (AHH) in which community-based bilingual promotoras provide in-person or telephone patient engagement and intervention aimed to reduce the burden and strain on patients, families, and care providers by assessing, enhancing, and facilitating patient depression and co-morbid illness self-care management skill, and activating patient communication with clinic medical providers versus DHS PCMH team usual care (PCMHUC). AHH independent bilingual recruiters screened 1957 and enrolled 348 predominantly Hispanic/Latino patients, of whom 296 (85%) had diabetes, 14 (4%) with heart disease, and 38 (11%) with both diseases. Recruiters identified depressed patients by baseline Patient Health Questionnaire-9 scores of 10 or more, completed baseline assessments, and randomized patients to either AHH or PCMHUC study group. The comprehensive assessments will be repeated at 6 and 12months by an independent bilingual follow-up interviewer. Baseline and outcome data include mental health assessment and treatment receipt, co-morbid illness self-care, social relationships, and environmental stressor assessments.
Collapse
Affiliation(s)
- Kathleen Ell
- School of Social Work, University of Southern California, United States.
| | - María P Aranda
- School of Social Work, University of Southern California, United States.
| | - Shinyi Wu
- School of Social Work, University of Southern California, United States; Edward R. Roybal Institute on Aging, University of Southern California, United States; Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States.
| | - Hyunsung Oh
- School of Social Work, Arizona State University, United States.
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California, United States.
| | - Jeffrey Guterman
- Los Angeles County Department of Health Services, Research and Innovation, David Geffen School of Medicine, University of California Los Angeles, United States.
| |
Collapse
|
39
|
Zhang KM, Dindoff K, Arnold JMO, Lane J, Swartzman LC. What matters to patients with heart failure? The influence of non-health-related goals on patient adherence to self-care management. PATIENT EDUCATION AND COUNSELING 2015; 98:927-934. [PMID: 25979423 DOI: 10.1016/j.pec.2015.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/02/2015] [Accepted: 04/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe the life goals of heart failure (HF) patients and to determine whether adherence is influenced by the extent to which these priorities are perceived as compatible with HF self-care regimens. METHOD Forty HF outpatients identified their top-five life goals and indicated the compatibility of HF self-care regimens (diet, exercise, weighing) with these priorities. HF knowledge, self-efficacy and reported adherence were also assessed. RESULTS Patients valued autonomy and social relationships as much as physical health. However, the rated importance of these domains did not predict adherence. Adherence positively correlated with the extent to which the regimen, specifically exercise, was considered compatible with life goals (r=.34, p<.05). Exercise adherence also correlated with illness severity and self-efficacy (rs=-.42 and .36, p<.05, respectively). The perceived compatibility of physical activity with personal goals predicted 11% of the variance in exercise adherence above and beyond that accounted for by illness severity and self-efficacy (FΔ (1, 36)=7.11, p<.05). CONCLUSIONS Patients' goals outside of the illness management context influence self-care practices. PRACTICE IMPLICATIONS Exploring patients' broad life goals may increase opportunities to resolve ambivalence and enhance motivation for self-care adherence.
Collapse
Affiliation(s)
- Karen M Zhang
- Department of Psychology, University of Western Ontario, London, ON, Canada.
| | - Kathleen Dindoff
- School of Language & Liberal Studies, Fanshawe College, London, ON, Canada
| | - J Malcolm O Arnold
- Division of Cardiology, London Health Sciences Centre, London, ON, Canada
| | - Jeanine Lane
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Leora C Swartzman
- Department of Psychology, University of Western Ontario, London, ON, Canada
| |
Collapse
|
40
|
Vellone E, Fida R, D'Agostino F, Mottola A, Juarez-Vela R, Alvaro R, Riegel B. Self-care confidence may be the key: A cross-sectional study on the association between cognition and self-care behaviors in adults with heart failure. Int J Nurs Stud 2015; 52:1705-13. [PMID: 26169451 DOI: 10.1016/j.ijnurstu.2015.06.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 06/22/2015] [Accepted: 06/26/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Self-care, a key element of heart failure care, is challenging for patients with impaired cognition. Mechanisms through which cognitive impairment affects self-care are not currently well defined but evidence from other patient populations suggests that self-efficacy, or task-specific confidence, mediates the relationship between cognitive functioning and patient behaviors such as self-care. OBJECTIVE The aim of this study was to test the mediating role of self-care confidence in the relationship between cognition and self-care behaviors. DESIGN A secondary analysis of data from a cross-sectional study. SETTING Outpatient heart failure clinics in 28 Italian provinces. PARTICIPANTS 628 Italian heart failure patients. METHODS We used the Self-Care of Heart Failure Index v.6.2 to measure self-care maintenance, self-care management, and self-care confidence. Cognition was assessed with the Mini Mental State Examination. Structural equation modeling was used to analyze the data. RESULTS Participants were 73 years old on average (SD=11), mostly (58%) male and mostly (77%) in New York Heart Association functional classes II and III. The mediation model showed excellent fit (comparative fit index=1.0; root mean square error of approximation=0.02): Self-care confidence totally mediated the relationship between cognition and self-care maintenance and management. CONCLUSION Cognition affects self-care behaviors indirectly, through self-care confidence. Interventions aimed at improving self-care confidence may improve self-care, even in heart failure patients with impaired cognition.
Collapse
Affiliation(s)
- Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Roberta Fida
- Department of Psychology, Sapienza University of Rome, Italy
| | - Fabio D'Agostino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Antonella Mottola
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Raul Juarez-Vela
- Faculty of Health Sciences, University San Jorge, Zaragoza, Spain
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Riegel
- Edith Clemmer Steinbright Chair of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
41
|
Shaw JD, O'Neal DJ, Siddharthan K, Neugaard BI. Pilot program to improve self-management of patients with heart failure by redesigning care coordination. Nurs Res Pract 2014; 2014:836921. [PMID: 24864206 PMCID: PMC4017732 DOI: 10.1155/2014/836921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/05/2014] [Accepted: 03/24/2014] [Indexed: 11/17/2022] Open
Abstract
Objectives. We tested both an educational and a care coordination element of health care to examine if better disease-specific knowledge leads to successful self-management of heart failure (HF). Background. The high utilization of health care resources and poor patient outcomes associated with HF justify tests of change to improve self-management of HF. Methods. This prospective study tested two components of the Chronic Care Model (clinical information systems and self-management support) to improve outcomes in the self-management of HF among patients who received intensive education and care coordination during their acute care stay. A postdischarge follow-up phone call assessed their knowledge of HF self-management compared to usual care patients. Results. There were 20 patients each in the intervention and usual care groups. Intervention patients were more likely to have a scale at home, write down their weight, and practice new or different health behaviors. Conclusion. Patients receiving more intensive education knew more about their disease and were better able to self-manage their weight compared to patients receiving standard care.
Collapse
Affiliation(s)
- Jessica D. Shaw
- James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
| | - Daniel J. O'Neal
- James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
| | - Kris Siddharthan
- James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
| | - Britta I. Neugaard
- James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
| |
Collapse
|
42
|
Iyngkaran P, Harris M, Ilton M, Kangaharan N, Battersby M, Stewart S, Brown A. Implementing guideline based heart failure care in the Northern Territory: challenges and solutions. Heart Lung Circ 2013; 23:391-406. [PMID: 24548637 DOI: 10.1016/j.hlc.2013.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 12/08/2013] [Indexed: 10/25/2022]
Abstract
The Northern Territory of Australia is a vast area serviced by two major tertiary hospitals. It has both a unique demography and geography, which pose challenges for delivering optimal heart failure services. The prevalence of congestive heart failure continues to increase, imposing a significant burden on health infrastructure and health care costs. Specific patient groups suffer disproportionately from increased disease severity or service related issues often represented as a "health care gap". The syndrome itself is characterised by ongoing symptoms interspersed with acute decompensation requiring lifelong therapy and is rarely reversible. For the individual client the overwhelming attention to heart failure care and the impact of health care gaps can be devastating. This gap may also contribute to widening socio-economic differentials for families and communities as they seek to take on some of the care responsibilities. This review explores the challenges of heart failure best practice in the Northern Territory and the opportunities to improve on service delivery. The discussions highlighted could have implications for health service delivery throughout regional centres in Australia and health systems in other countries.
Collapse
Affiliation(s)
- Pupalan Iyngkaran
- Consultant Cardiologist, Senior Lecturer Flinders University, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811.
| | - Melanie Harris
- Senior Research Fellow, Flinders Human Behaviour and Health Research Unit, Flinders University, GPO Box 2100 Adelaide SA 5001.
| | - Marcus Ilton
- Director of Cardiology, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811.
| | - Nadarajan Kangaharan
- Director of Medicine/Consultant Cardiologist, Royal Darwin Hospital, Rocklands Drive, Tiwi, PO Box 41326, Casuarina NT 0811.
| | - Malcolm Battersby
- Flinders Human Behaviour and Health Research Unit (FHBHRU), Margaret Tobin Centre, Flinders University, Bedford Park, South Australia, Australia 5001.
| | - Simon Stewart
- Director NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC, 3004, Australia.
| | - Alex Brown
- Professor of Population Health and Research Chair Aboriginal Health School of Population Health, University of South Australia & South Australian Health & Medical Research Institute, Adelaide.
| |
Collapse
|
43
|
van Houtum L, Rijken M, Heijmans M, Groenewegen P. Self-management support needs of patients with chronic illness: do needs for support differ according to the course of illness? PATIENT EDUCATION AND COUNSELING 2013; 93:626-632. [PMID: 24029582 DOI: 10.1016/j.pec.2013.08.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 08/06/2013] [Accepted: 08/19/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine whether chronically ill patients' needs for self-management support depend on their course of illness. METHODS Cross-sectional and longitudinal linear regression analyses were conducted using data from 1300 patients with chronic disease(s) who participated in a nationwide Dutch panel-study. Self-management support needs were assessed by the Patient Assessment of Self-management Tasks questionnaire (PAST). Course of illness was operationalized as: illness duration, patients' perception of the course of illness and changes in self-rated general health (RAND-36). RESULTS Self-management support needs are not related to illness duration. Patients who perceive their illness as episodic and/or progressively deteriorating have greater self-management support needs than patients who perceive their illness as stable. Deterioration of self-rated health is related to increased support needs. The effect of the course of illness on support needs depends on the type of self-management activities. CONCLUSION How chronically ill patients perceive the course of illness and actual changes in self-rated health are predictive for their need for support for self-management activities. Illness duration is not. PRACTICE IMPLICATIONS Helping patients to self-manage should not be confined to the first years after diagnosis. Healthcare providers should be alert to patients' own perceptions of their course of illness and health status.
Collapse
Affiliation(s)
- Lieke van Houtum
- NIVEL - Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
| | | | | | | |
Collapse
|
44
|
Zamanzadeh V, Valizadeh L, Jamshidi F, Namdar H, Maleki A. Self-Care Behaviors among Patients with Heart Failure in Iran. J Caring Sci 2012; 1:209-14. [PMID: 25276697 DOI: 10.5681/jcs.2012.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 07/21/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Recovery from heart failure and dealing with its effects is significantly influenced by patient's self-care. In order to maximize the effects of behavioral interventions and for educational planning, it is essential to know how much experience and information do patients with heart failure have about their disease and self-care behaviors. The present study aimed to identify self-care behaviors in patients with heart failure. METHODS Eighty heart failure patients hospitalized in Shahid Madani Training Center in Tabriz, Iran, participated in this study. Data collection was done through Self-Care of Heart Failure Index (SCHFI) that contained 22 questions in three sections including self-care behaviors, self-care management and confidence in performing self-care behaviors. RESULTS The patient's self-care behaviors in three behavioral sub categories of maintaining, managing and confidence were low. The most repeated self-care behavior in the participating patients was taking medication and visiting the doctor. CONCLUSION The results of the study showed low levels of self-care behaviors in patients with heart failure, which notes the need for patient empowerment. It is necessary to develop appropriate strategies in this regard by the authorities.
Collapse
Affiliation(s)
- Vahid Zamanzadeh
- Department of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Valizadeh
- Department of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Jamshidi
- Department of Nursing, International Aras Branch, Tabriz University of Medical Sciences Tabriz, Iran
| | - Hossein Namdar
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahdieh Maleki
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
45
|
Disease management interventions for improving self-management in lower-limb peripheral arterial disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
46
|
Convery E, Keidser G, Dillon H, Hartley L. A self-fitting hearing aid: need and concept. Trends Amplif 2011; 15:157-66. [PMID: 22143873 DOI: 10.1177/1084713811427707] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The need for reliable access to hearing health care services is growing globally, particularly in developing countries and in remotely located, underserved regions in many parts of the developed world. Individuals with hearing loss in these areas are at a significant disadvantage due to the scarcity of local hearing health care professionals and the high cost of hearing aids. Current approaches to making hearing rehabilitation services more readily available to underserved populations include teleaudiology and the provision of amplification devices outside of the traditional provider-client relationship. Both strategies require access to such resources as dedicated equipment and/or specially trained staff. Another possible strategy is a self-fitting hearing aid, a personal amplification device that is equipped with an onboard tone generator to enable user-controlled, automated, in situ audiometry; an onboard prescription to determine the initial hearing aid settings; and a trainable algorithm to enable user-controlled fine-tuning. The device is thus assembled, fitted, and managed by the user without the need for audiological or computer support. This article details the self-fitting concept and its potential application in both developing and developed countries. Potential advantages and disadvantages of such a device are discussed, and considerations for further investigations into the concept are presented. Overall, the concept is considered technologically viable with the main challenges anticipated to be development of clear, simple user instructions and a delivery model that ensures reliable supplies of instant-fit ear tips and batteries.
Collapse
Affiliation(s)
- Elizabeth Convery
- National Acoustic Laboratories, Chatswood New South Wales, Australia.
| | | | | | | |
Collapse
|