Tailoring of Self-Management Interventions in Patients With Heart Failure

Bos-Touwen, Irene D.; Jonkman, Nini H.; Westland, Heleen; Schuurmans, Marieke J.; Rutten, Frans H.; Wit, Niek de; Trappenburg, Jaap C.A.

doi:10.1007/s11897-015-0259-3

Cited by 44 publications

(45 citation statements)

References 118 publications

(109 reference statements)

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“…Our findings are supported by multiple observational studies, reporting that both self-efficacy and activation have effects on SM(Bos-Touwen et al 2015a, Peters-Klimm et al 2013, Wolever et al 2011, Cooper et al 2011, Begum et al 2011). However, the positive effect of self-efficacy on SM shown in the observational study was not present in the intervention studies aimed to promote SM behavior through efficacy-enhancing interventions (van Dijk-de Vries et al 2015, Paradis et al 2010).…”

Section: Discussionsupporting

confidence: 87%

“…Non-experimental studies showed significant correlations between self-efficacy and SM in HF patients(van der Wal. 2010, Bos-Touwen et al 2015a, Peters-Klimm et al 2013, Schnell-Hoehn et al 2009). However, experimental studies failed to demonstrate that increased knowledge and self-efficacy led to increased SM behaviors in HF patients(Riegel.…”

Section: Introductionmentioning

confidence: 99%

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Mechanism of engaging self-management behavior in rural heart failure patients

Young¹,

Barnason²,

Kupzyk³

2016

Applied Nursing Research

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Aim The purpose of this study was to examine the relationships among self-efficacy, patient activation and SM in rural heart failure patients discharged from critical access hospitals. Background Heart failure is one of the most disabling and resource-consuming chronic conditions. Compared to their urban counterparts, rural heart failure patients had higher healthcare utilizations and worse health outcomes. Self-management (SM) plays a significant role in improving patients’ outcomes and reducing healthcare use. Despite persistent recommendations of SM, engagement in SM still remains low in rural heart failure patients. SM is a complex behavior, which is influenced by various factors. Evidence on the efficacy of interventions to promote SM is limited and inconsistent. One reason is that the mechanism of engagement of SM in the rural heart failure population has not been fully understood. Methods A correlational study was conducted using secondary data from a randomized control trial aimed to improve SM adherence. Path analysis was used to test the hypothesis of patient activation mediating the effect of self-efficacy on SM. Results Data were collected from a sample of 101 heart failure patients (37% males) with an average age of 70 years. The final model provided a good fit to the data, supporting the hypothesis that self-efficacy contributes to SM through activation. Conclusion The results of this study showed that effective SM interventions should be designed to include strategies to promote both self-efficacy and activation.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Mechanism of engaging self-management behavior in rural heart failure patients

Young¹,

Barnason²,

Kupzyk³

2016

Applied Nursing Research

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“…Clinically relevant potential effect modifiers (i.e., variables, such as sex or age, that modify the effect of self-management interventions) were selected based on the self-management literature in HF patients 19 and availability of comparable data across trials. The selected patient characteristics are presented along with the baseline data in Table 1.…”

Section: Methodsmentioning

confidence: 99%

Do Self-Management Interventions Work in Patients With Heart Failure?

et al. 2016

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Background Self-management interventions are widely implemented in care for patients with heart failure (HF). Trials however show inconsistent results and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in HF patients and whether subgroups of patients respond differently. Methods and Results Systematic literature search identified randomized trials of self-management interventions. Data of twenty studies, representing 5624 patients, were included and analyzed using mixed effects models and Cox proportional-hazard models including interaction terms. Self-management interventions reduced risk of time to the combined endpoint HF-related hospitalization or all-cause death (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.71–0.89), time to HF-related hospitalization (HR, 0.80; 95%CI, 0.69–0.92), and improved 12-month HF-related quality of life (standardized mean difference 0.15; 95%CI, 0.00–0.30). Subgroup analysis revealed a protective effect of self-management on number of HF-related hospital days in patients <65 years (mean number of days 0.70 days vs. 5.35 days; interaction p=0.03). Patients without depression did not show an effect of self-management on survival (HR for all-cause mortality, 0.86; 95%CI, 0.69–1.06), while in patients with moderate/severe depression self-management reduced survival (HR, 1.39; 95%CI, 1.06–1.83, interaction p=0.01). Conclusions This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death, HF-related hospitalization alone, and elicited a small increase in HF-related quality of life. The findings do not endorse limiting self-management interventions to subgroups of HF patients, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients.

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“…Supported by observational studies, 4,9–11 increased self-efficacy results in the improvement in SM behaviors. However, experimental studies have not demonstrated that increased knowledge and self-efficacy lead to increased SM behaviors in HF patients 1,7,12 …”

Section: Introductionmentioning

confidence: 99%

The Impact of Self-management Knowledge and Support on the Relationships Among Self-efficacy, Patient Activation, and Self-management in Rural Patients With Heart Failure

2017

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Background: Self-management (SM) is an essential component of heart failure (HF) management. The mechanisms to improve SM behaviors are unclear. Objective: The objective of this study is to examine whether patient activation mediates the effect of self-efficacy on SM behaviors in rural HF patients. Methods: A secondary analysis was conducted using data collected from a randomized controlled trial aimed to improve SM behaviors. The main variables included were SM knowledge, self-efficacy, patient activation, and SM behaviors. Results: Mediation analysis showed patient activation mediated the effect of self-efficacy on SM. Both self-efficacy and patient activation were significantly related to SM behaviors, respectively (r = 0.46, P < .001; β = .48, P = .001). However, self-efficacy was no longer directly related to SM behaviors when patient activation was entered into the final model (β = .17, P = .248). Self-management knowledge and support were significant moderators. In patients with high levels of SM knowledge, patient activation did not mediate the effect of self-efficacy on SM behaviors (β = .15, P = .47). When SM support was entered in the path model, patient activation was not a significant mediator between self-efficacy and SM behavior at high (β = .27, P = .27) or low (β = .27, P = .25) levels of SM support. Conclusions: Study findings suggest that targeted SM support for high-risk HF patients with low SM knowledge and support may be useful. In addition, strategies to increase patient activation may improve HF patients’ SM confidence.

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Tailoring of Self-Management Interventions in Patients With Heart Failure

Cited by 44 publications

References 118 publications

Mechanism of engaging self-management behavior in rural heart failure patients

Mechanism of engaging self-management behavior in rural heart failure patients

Do Self-Management Interventions Work in Patients With Heart Failure?

The Impact of Self-management Knowledge and Support on the Relationships Among Self-efficacy, Patient Activation, and Self-management in Rural Patients With Heart Failure

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