The development and pilot study of a nurse-led HOMe-based HEart failure self-Management Programme (the HOM-HEMP) for patients with chronic heart failure, following Medical Research Council guidelines

Abstract

Background: Chronic heart failure (CHF) is one of the most common causes of hospital admissions and readmissions. Managing CHF requires a comprehensive treatment plan that consists of medication treatment and behavioural change. However, patients often feel unprepared for their self-management role in the community, especially during the period of transition after discharge from hospital. Therefore, an effective intervention to promote CHF self-management is needed. Aims: This paper describes the development and pilot testing of a multicomponent nursing intervention (i.e. the HOM-HEMP) for a randomised controlled trial to assess its effectiveness in improving self-care behaviour among CHF patients in Singapore. A description of the study intervention is also delineated in detail. Methods: The HOM-HEMP was developed based on the UK Medical Research Council framework for developing and evaluating complex interventions. After the development of the study intervention, a single group pre- and post-repeated measure pilot test was conducted to evaluate the study intervention package for its acceptability and the feasibility of the data collection procedure. Ten participants were recruited through consecutive sampling. All of the participants received the full intervention package with the supplementary mobile application. The data were collected at baseline and immediately after the study intervention (i.e. 6 weeks from baseline). The outcome measures included the Self-Care Heart Failure Index, Cardiac Self-Efficacy Scale, Minnesota Living with Heart Failure Questionnaire, Hospital Anxiety and Depression Scale and Short Form of the Social Support Questionnaire. Results: The results from the pilot testing showed that the programme was feasible and potentially effective in improving patient’s self-care management, psychological outcomes and health-related quality of life. Conclusion: A self-management psychosocial education approach is the preferred choice for many patients with chronic diseases. The effectiveness of the HOM-HEMP will next be tested in a full scale randomised control trial.

Patients’ Experiences of a Nurse-Led, Home-Based Heart Failure Self-management Program: Findings From a Qualitative Process Evaluation

“…We recently conducted a 3-arm stratified randomized controlled trial to evaluate the effectiveness of a newly developed, nurse-led, home-based psychosocial and educational intervention (home-based heart failure self-management program [HOM-HEMP]) for patients with HF in Singapore (ClinicalTrials.gov NCT03108235) [Jiang Y, unpublished data, 2021]. The development of the intervention and its detailed description have been published previously [ 9 ]. In brief, the HOM-HEMP intervention is a 6-week, multicomponent self-management program designed to promote HF self-care.…”

“…This study details the process evaluation of the study intervention, which is part of the HOM-HEMP research project [ 9 ]. Process evaluations are recommended by the UK Medical Research Council guidance to provide additional information to understand how an intervention might or might not work in a specific context or whether the outcomes of the trial can be reproduced [ 10 ].…”

Process evaluation of complex cardiovascular interventions: How to interpret the results of my trial?

“…In the European Journal of Cardiovascular Nursing there have been several studies investigating the effects of complex interventions, such as self-management programs for chronic conditions, 2–4 tele-rehabilitation after hospital discharge, 5,6 complementary methods for symptom management, 7 and interventions utilizing peer support for postoperative recovery. 8 The ultimate goal of these complex interventions is to achieve a meaningful and sustainable change of clinical practice.…”

Evaluation of simplified fluid intake and output recording schemes for the self-management in patients with heart failure: a randomized controlled trial

“…More than 1 million of HF patients are hospitalized each year, which almost occupy the top reason for elderly subjects admitted to hospital and account for more than $30 billion of health care expenditure in USA [6,7]. HF decreases the quality of life, and the effective treatment and care could remarkably alleviate their signs and discomforts [8]. Although fostering self-management skills in HF patients seems to be useless to reduce their mortalities, it could improve the quality of life and decrease the readmission rates [9].…”