Effect of a self-care educational intervention to improve self-care adherence among patients with chronic heart failure: a clustered randomized controlled trial in Northwest Ethiopia

Abstract

Background As the burden of cardiovascular disease increases in sub-Saharan Africa, there is a growing need for low-cost interventions to mitigate its impact. Providing self-care health education to patients with chronic heart failure (CHF) is recommended as an intervention to prevent complications, improve quality of life, and reduce financial burdens on fragile health systems. However, little is known about health education’s effectiveness at improving CHF self-management adherence in sub-Saharan Africa. Therefore the present study aimed to assess the effectiveness of an educational intervention to improve self-care adherence among patients with CHF at Debre Markos and Felege Hiwot Referral Hospitals in Northwest Ethiopia. Methods To address this gap, we adapted a health education intervention based on social cognitive theory comprising of intensive four-day training and, one-day follow-up sessions offered every four months. Patients also received illustrated educational leaflets. We then conducted a clustered randomized control trial of the intervention with 186 randomly-selected patients at Debre Markos and Felege Hiwot referral hospitals. We collected self-reported data on self-care behavior before each educational session. We analyzed these data using a generalized estimating equations model to identify health education's effect on a validated 8-item self-care adherence scale. Results Self-care adherence scores were balanced at baseline. After the intervention, patients in the intervention group (n = 88) had higher adherence scores than those in the control group (n = 98). This difference was statistically significant (β = 4.15, p < 0.05) and increased with each round of education. Other factors significantly associated with adherence scores were being single (β = − 0.25, p < 0.05), taking aspirin (β = 0.76, p < 0.05), and having a history of hospitalization (β = 0.91, p < 0.05). Conclusions We find that self-care education significantly improved self-care adherence scores among CHF patients. This suggests that policymakers should consider incorporating self-care education into CHF management. Trial registration number: PACTR201908812642231

Unplanned readmission to hospital and its predictors in heart failure patients, Ethiopia: a retrospective cohort study

“…The goal of treatment for heart failure patients includes reducing symptoms and disease progression, prolonging survival, and improving quality of life. However, in Ethiopia, heart failure patent came after NYHA Class III and IV with limited knowledge about their disease, poor medication adherence practice, and transitional care (13)(14)(15). Furthermore, risky lifestyles such as smoking, a sedentary lifestyle, excessive salt intake, and alcohol consumption are most common in Ethiopia, which are predictors of unplanned hospitalizations for HF patients (16,17).…”

“…The goal of treatment for heart failure patients includes reducing symptoms and disease progression, prolonging survival, and improving quality of life. However, in Ethiopia, heart failure patent came after NYHA Class III and IV with limited knowledge about their disease, poor medication adherence practice, and transitional care (13-15).…”

Usability and feasibility assessment of a smartphone application (Suhriday) for heart failure self-care remote monitoring in an Indian tertiary health care setting: a pilot mixed-methods study

“…3 A cluster randomised controlled trial conducted in Ethiopia concluded that self-care education significantly improved self-care adherence score among patients with HF. 4 The 2022 ACC/AHA/HFSA (American College of Cardiology/American Heart Association/Heart Failure Society of America) guidelines for the management of HF documented the role of interventions that aim to improve self-care knowledge and skill, and those that focus on enhancing medication adherence or reinforcing self-care with structured telephone support (STS) as being effective in patients with HF. In addition to improving HF selfcare significantly, such strategies also reduce the risk of HF-related hospitalisation, all-cause hospitalisation and all-cause mortality.…”

“… 3 A cluster randomised controlled trial conducted in Ethiopia concluded that self-care education significantly improved self-care adherence score among patients with HF. 4 …”

“…Patients need to learn to take medications as prescribed, understand how to monitor signs and symptoms of worsening HF, as well as what to do in response to such symptoms when they occur 3. A cluster randomised controlled trial conducted in Ethiopia concluded that self-care education significantly improved self-care adherence score among patients with HF 4…”