Construction and evaluation of self-management in Heart failure elderly

Background: Heart failure (HF) is a chronic, disabling disorder which is seen as one of the most common causes of hospitalization, hospital readmission, and death around the world. The long-term nature of HF regimens and the complexity of symptoms result in inadequate perfusion of fluid and sodium retention. There is hence an urgent need of careful sodium and fluid control and symptoms and weight management program design in order to enhance patients’ self-efficacy in the change of their behaviors. Self-management (SM) is world widely reported as an effective approach to utilize for those with HF. Moreover, more adults with chronic conditions and disabilities are living with family caregivers who provide unpaid care at home than ever before, and family caregivers have an even higher level of responsibility. Therefore, teaching caregivers the knowledge and skills may assist patients more effectively to manage their disease. However, there are still many questions that remain unanswered in regards to incorporation caregivers, SM and HF elderly. To incorporate the caregivers in the SM intervention for elderly with HF should be guaranteed in advance. Aim: The primary purpose of the study is to develop and examine the effectiveness of a SM program, based on self-efficacy model, involving HF patients and caregivers. This three-year experimental study design will be divided into two phases. Phase I is designed to psychometric test of the instruments (self-management DVD and booklet) and implement the pilot study. The aims of phase II are to develop, implement, and examine the effects of a SM intervention incorporate the caregivers for people with HF, over a 12 months follow-up. Methods: A randomized controlled trial with data collection at baseline and after months 3, 6 and 12 will be applied to the effects among the three groups. Total 180 HF outpatients in the medical center will be randomly assigned to three groups: Experimental group I (N=60, patients with SM intervention); Experimental group II (N=60, patients and caregivers with SM intervention); and control group (N=60, patients with routine care). The SM intervention is developed based on Bundura’s self-efficacy theory, which provides four sources of information for SM: mastery experience, social modeling, social persuasion, and physical and emotional states. The strategies of the SM consist of appraisal, goal setting and self-monitoring of diet control, symptoms and daily weight. The “diet control” strategy in this study will be focused on sodium and fluid restriction. In order to examine the effects of SM intervention, data will be collected 4 time points following seven health-related outcomes: self-efficacy for salt and fluid control, HF self-management behavior, HF-related symptoms, depressive symptoms, HF-related quality of life, daily weight monitoring, and HF-related health services utilization and death. Demographic and disease information (i.e. age, gender, marital state, readmission rate, and body weight and New York Heart Association [NYHA] functional classification) will also be collected. Outcome measures of this study will be analyzed using descriptive and inferential statistics with the generalized estimating equations (GEE) analysis. The findings of this study would generate an effective SM model for health professional to facilitate HF patients the development of self-care capability and improvement of health-related outcomes.

Project ID:PC10202-0342
External Project ID:NSC101-2314-B182-055-MY3