Increasing Self‐Management Skills in Heart Failure Patients: A Pilot Study

Abstract

Nonadherence to medical treatment among heart failure patients is high and results in frequent exacerbations and premature death. This treatment-only pilot study examined whether a year-long group-based self-management intervention is feasible and improves self-management skills in patients with mild-to-moderate heart failure (ejection fraction < or =40% and New York Heart Association functional class I, II, or III). A total of 31 of 100 recruited patients (31%) agreed to participate. Twenty-six (84%) completed the year-long self-management program. Compared with baseline, the intervention was associated with an increase in overall self-efficacy in practicing self-management skills (p<0.001) and in four of five specific self-management skills. Patients and their group leaders also reported an increase in actual use of self-management skills (p<0.001) and in several psychosocial outcomes. The success of this pilot study suggests the need for a randomized clinical trial to test the efficacy of group-based self-management training on medical outcomes.

A systematic review of the main mechanisms of heart failure disease management interventions

“…This occurred predominantly when interventions increased self-efficacy 19 20 28 33 38 46. Other psychological changes associated with effective interventions were increased personal confidence,22 24 improved hope38 and lower depression 36 38 40…”

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

“…The authors commented that because self-care confidence is a mediator of self-care behaviors, ''self-care behaviors may not improve as a function of increased knowledge, but more as a function of confidence'' (p. 1047). In fact, those trials where the approach was based on improving self-care confidence and not only knowledge (Flynn et al, 2005;Pozehl et al, 2010;Smeulders et al, 2010a,b) were successful in improving self-care behaviors. Also, in other populations where patients were all affected by mild cognitive impairment (Cox et al, 2013), interventions aimed at improving self-efficacy improved patients' outcomes such as physical activity.…”

“…(2015), http:// dx.doi.org/10.1016/j.ijnurstu.2015.06.013 with specific interventions, self-efficacy can be improved. In fact, three trials (Flynn et al, 2005;Pozehl et al, 2010;Smeulders et al, 2010a,b) in which the interventions were based on social cognitive theory have demonstrated that self-efficacy can be improved in heart failure patients. In these studies the four determinants of self-efficacy defined by Bandura (1995), performance accomplishments, vicarious experience, verbal persuasion, and emotional arousal, were adapted to heart failure care and improved selfefficacy.…”

A Trial of Family Partnership and Education Interventions in Heart Failure

“…14–20 FMs may share or take full responsibility for preparing low sodium meals, and/or they may set up medication schedules and refills. Thus provision of family education seems a logical component of HF care, yet little evidence on family care in HF is available to guide practice.…”