Feasibility and acceptability of a nursing intervention with family caregiver on self-care among heart failure patients: a randomized pilot trial

Abstract

BackgroundSelf-care practices in heart failure (HF) contribute to quality of life, symptom stabilization, and extended life expectancy. However, adherence to practices such as liquid and salt restriction or symptom monitoring require high motivation on a daily basis. The aim was to assess the feasibility, acceptability, and potential effectiveness of a nursing intervention with family caregivers, aimed at improving self-care practice of HF patients.MethodsThis pilot study involved 32 HF patient-caregiver dyads (16/group) randomized to an experimental (EG) or control group (CG). The intervention, based on the Self-Determination Theory, was designed to enhance patients’ autonomy and motivation in self-care practices, by involving their caregivers’ support. Five encounters were planned with the EG dyads—two face-to-face during hospitalization and three by telephone after discharge. The feasibility of delivering the protocol was evaluated as well as the acceptability of the intervention. The potential effectiveness of the intervention was assessed based on patient outcomes, including general self-care management and self-care specific to HF, perceived competence to manage HF, autonomous motivation (A-motivation, external extrinsic motivation, internal extrinsic motivation, and intrinsic motivation), and perceived support from the caregiver. Caregiver outcomes included level of support provided to the patient.ResultsDespite recruitment challenges, the intervention was feasible, with 12 of the 16 dyads receiving all 5 encounters delivered per protocol. The 4 other dyads received the two hospital encounters, but at least 1 of the 3 post-discharge planned telephone encounters was not feasible because the patients had been re-hospitalized or was deceased. Participant’s satisfaction with the intervention was high. Outcomes favoring the EG include self-care specific to HF, internal extrinsic motivation, intrinsic motivation, and caregiver’s feeling that they provide a higher level of support.ConclusionsCaregiver involvement was found to be both a feasible and acceptable means of supporting self-care practice in HF patients. This approach presents a potential avenue for enhancing patients’ efforts in this regard. However, this pilot study offers preliminary findings only, which need to be replicated in a phase 3 clinical trial.

Understanding informal caregivers' motivation from the perspective of self‐determination theory: an integrative review

“…helping because you enjoy/value this behaviour and experience volition and choice), or controlled motivation, understood as extrinsic motivation (i.e. helping because you believe you should) . One qualitative study reported that in real life, the constructs and categories of motivation are more ambiguous than, and not as easy to identify as, in the theory .…”

“…This could lead to greater identification with caregiving and could foster enthusiasm and well‐being among caregivers. Several studies found that caregivers' feelings of caregiving as voluntary and that the need for autonomy was fulfilled, was especially important for high quality of motivation .…”

“…Two studies explicitly concluded that the autonomous helping motivation was positively associated with the satisfaction of basic psychological needs , while most of the other studies merely implied it. Several studies found that autonomously motivated help compared with controlled motivated help, had beneficial effects on caregivers .…”

“…Some studies pointed out that considering the reasons for providing informal care is important to identify caregivers who experience diminished well‐being and who might benefit from support services or counselling . Caregivers' helping motivation predicted , described or supported their health outcomes. Strekalova addressed the psychological needs for competence (i.e.…”

“…Several studies concluded that the development and testing of SDT‐based support services and interventions in a caregiver context might be useful for development of effective motivational support to caregivers . Only two studies had developed, tested and evaluated interventions to support motivation in caregivers.…”