IMPORTANCEStrategies that enhance self-care of patients with heart failure reduce mortality and health care use. OBJECTIVE To examine whether an empowerment-based self-care education program was more effective and cost-effective to improve self-care, health status, and hospital service use than a didactic education program in patients with heart failure. DESIGN, SETTING, AND PARTICIPANTS In this double-blind randomized clinical trial, a consecutive sample of 988 patients with heart failure from the cardiac clinics of 2 regional hospitals underwent eligibility screening from February 1, 2017, to May 31, 2019, using the criteria of age of 55 years or older, heart failure diagnosed 6 months before screening, and New York Heart Association class II to IV. A total of 236 participants were randomized to the empowerment (n = 118) or education (n = 118) group. INTERVENTIONS The 12-week, group-based, empowerment-based education program included self-care assessment, goal-orientated actions in symptom recognition and response, fluid and dietary modification, and lifestyle management. Didactic education covered the same topics without empowerment strategies. MAIN OUTCOMES AND MEASURESThe primary outcome was self-care measured by the Self-care Heart Failure Index (SCHFI) maintenance, management, and symptom perception subscales at posttest and 3-month end points. Secondary outcomes included measures of knowledge, confidence, health-related quality of life, and health service use. Direct, indirect, and social costs of the 2 programs were collected for cost-effectiveness analysis. RESULTSA total of 236 Chinese patients (mean [SD] age, 70 [8.0] years; 149 [63.1%] men) were included in the study. The empowerment group reported significantly greater improvement in SCHFI management scores (mean difference, 13.76; 95% CI, 5.89-21.62; Cohen d = 0.46 at posttest and Cohen d = 0.35 at 3 months) and symptom perception scores (mean difference, 20.36; 95% CI, 13.98-26.75; Cohen d = 0.84 at posttest and Cohen d = 0.61 at 3 months). The empowerment group had lower risks of emergency department attendance (incidence rate ratio, 0.55; 95% CI, 0.31-0.95; P = .03) and hospital admission (incidence rate ratio, 0.38; 95% CI, 0.21-0.68; P = .001) and better improved self-care knowledge (change in score [empowerment minus education], 1.29; 95% CI, 0.48-2.09) and confidence (change in score [empowerment minus education], 7.98; 95% CI, 1.91-14.05). Empowerment was cost-saving and cost-effective at T2 compared with the education group for quality-adjusted life-years, with an incremental cost-effectiveness ratio of −114 485.(continued) Key Points Question What are the effectiveness and cost-effectiveness of a 12-week, empowerment-based self-care intervention on health outcomes and health care use among patients with heart failure? Findings In this randomized clinical trial of 236 patients with heart failure, when compared with didactic education, an empowerment-based self-care intervention was effective and costeffective, resulting in improvement in s...

Aim This study aims to evaluate the effects of a 12‐week empowerment‐based self‐care programme on the cognitive, psychological and behavioural aspects of self‐care, health‐related quality of life and unplanned hospital service use of chronic heart failure patients and to estimate its cost‐effectiveness in reducing unplanned service use. Study design Randomized controlled trial with cost‐effectiveness analysis. Methods The study will recruit 236 community‐dwelling Chinese patients with chronic heart failure from regional hospitals in Hong Kong. Patients will be randomized in blocks to attend either the 12‐week empowerment‐based self‐care programme or a didactic education programme. Central to the empowerment‐based model is that the patients are the primary decision makers in self‐care and act autonomously to manage the disease. Collaborative approach and interactive teaching strategies are used to optimize patients' engagement and knowledge translation to real‐life practice. Outcome evaluation on self‐care maintenance and management, symptom perception, self‐care confidence, self‐care knowledge, health‐related quality of life and health service use will take place at baseline, on completion of the programme and at 12 weeks thereafter. Generalized estimating equations and Cox regression examine the intervention effects. Bootstrapping technique will be conducted to examine the cost‐effectiveness of the intervention. The study is formally funded in December 2016. Discussion Chronic heart failure is associated with high level of hospital admissions, of which 40% is avoidable through effective self‐care. Although self‐care confidence is known to improve self‐care, no structured educative method has been developed to enhance this attribute. This study addresses this research gap with a stringent application of theory and research design. Impact The study illustrates the application of the empowerment model for self‐care enhancement in patients with chronic heart failure. The findings will inform the ways and values of this care model to enhance the disease management of this expanding clinical cohort.

ImportanceDespite decades of educational efforts, patients’ prolonged delays in seeking care for symptoms of acute myocardial infarction (AMI) remain the greatest obstacle to successful management of the condition.ObjectiveTo compare the effects of a narrative-based psychoeducational intervention with a didactic educative approach on AMI survivors’ intention to seek care for AMI symptoms and on AMI knowledge.Design, Setting, and ParticipantsA multisite randomized clinical trial recruited community-dwelling patients aged 18 years or older with a history of AMI from 4 hospitals in Hong Kong from January 1, 2018, to January 22, 2021, and followed up participants for 1 year.InterventionsAn 8-week narrative-based psychoeducational intervention aimed to create a vivid cognitive experience of complex decision-making and modeled desirable behavioral changes through nurse-led, interactive video sessions using model patients. The control group received 4 nurse-led sessions comprising education about AMI and care seeking delivered using a didactic approach.Main Outcomes and MeasuresThe primary outcome was the behavioral intention between the 2 groups, reflected by participants’ attitudes and beliefs about care seeking for AMI measured using the Acute Coronary Syndrome Response Index—Chinese version. The secondary outcome was AMI knowledge.ResultsSix hundred and eight participants (mean [SD] age, 67.2 [8.3] years; 469 [77.1%] male) were randomized to either the narrative-based psychoeducation group (n = 304) or the didactic education group (n = 304). The psychoeducational intervention group reported greater positive changes than the control group in their attitudes (β = −1.053 [95% CI, −1.714 to −0.391]; P < .001) and beliefs (β = −0.686 [95% CI, −1.354 to −0.180]; P = .04) toward care seeking at the 3-month follow-up, and the difference was sustained at 12 months for both attitudes (β = −0.797 [95% CI, −1.477 to −0.117]; P = .02) and beliefs (β = −0.692 [95% CI, −1.309 to −0.012]; P = .047). There were no significant differences in AMI knowledge between the 2 study groups at the 3-month and 12-month time points.Conclusions and RelevanceThe results of this randomized clinical trial found that a novel approach of narrative-based psychoeducation was effective in improving patients’ behavioral intention to seek care for AMI symptoms. Longer-term follow-up to evaluate actual care-seeking behavior and clinical outcomes in patients with AMI is warranted to determine the sustained effects of this intervention.Trial RegistrationChiCTR Identifier: ChiCTR-IIC-17010576

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