Effect of the self-management education program on the quality of life in people with chronic heart failure
A randomized controlled trial
Keywords:
Chronic, Heart failure, Education, Quality of life, Self-managementAbstract
Background: Chronic Heart Failure (CHF) is a syndrome that negatively affects a person’s Quality of Life (QOL). The efficient self-management education program increases the individual’s abilities and skills for following and participating in a long-term healthcare plan. Objective: The aim of this study was to determine the effect of the self-management education program on QOL in people with CHF. Methods: This randomized controlled trial study was conducted on 60 people with CHF and without sensory-cognitive problem from April-August 2015. They were selected using the convenience sampling method, and were randomly assigned into the intervention and control groups. The control group received the routine education presented to participants at discharge. However, besides the routine education, the intervention group received the self-management education program consisting of three sessions followed for a 3-month period. The Iranian heart failure QOL questionnaire was used for data collection before and after the intervention. The independent-samples and paired-samples t-tests, Chi-square and Fisher exact tests were used for data analysis via the SPSS v.16 software. P<0.05 was considered statistically significant. Results: No statistically significant differences were reported between the groups in terms of demographic and clinical characteristics, indicating that they were homogeneous. A statistically significant difference was reported between the two groups after the intervention in terms of the mean changes of total QOL (p<0.001) and its dimensions, including symptoms (p=0.002), social interference (p=0.01), psychological condition (p=0.013), and self-efficacy and knowledge (p<0.001). In addition, an improvement was observed in the total QOL in the intervention group after the education (p<0.001). Conclusions: According to the results of this study, the self-management education program can be considered an appropriate strategy for improving the QOL in people suffering from CHF by health care providers. Trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2015032021521N1. Funding: The authors received financial support for the research, authorship, and/or publication of this article from Iran University of Medical Sciences (No: 107/105/94/D, date April 11, 2015).
References
Clark AM, Wiens KS, Banner D, Kryworuchko J, Thirsk L, McLean L, et al. A systematic review of the
main mechanisms of heart failure disease management interventions. Heart. 2016; 102(9): 707-11. doi:
1136/heartjnl-2015-308551. PMID: 26908100.
Matsuoka S, Tsuchihashi-Makaya M, Kayane T, Yamada M, Wakabayashi R, Kato NP, et al. Health
literacy is independently associated with self-care behavior in patients with heart failure. Patient Educ
Couns. 2016; 99(6): 1026-32. doi: 10.1016/j.pec.2016.01.003. PMID: 26830514.
Ponikowski P, Anker SD, AlHabib KF, Cowie MR, Force TL, Hu S, et al. Heart failure: preventing disease
and death worldwide. ESC Heart Failure. 2014; 1: 4–25. doi: 10.1002/ehf2.12005. PMID: 28834669.
Sakata Y, Shimokawa H. Epidemiology of heart failure in Asia. Circ J. 2013; 77: 2209–17. doi:
1253/circj.CJ-13-0971. PMID: 23955345.
Scott MC, Winters ME. Congestive Heart Failure. Emerg Med Clin North Am. 2015; 33(3): 553-62. doi:
1016/j.emc.2015.04.006.
Bingham A, Thompson C, Kell C. A nurse-led initiative to reduce heart failure hospitalizations by
improving patient’s self-management skills. Heart Lung. 2015; 44(6). doi: 10.1016/j.hrtlng.2015.10.024.
Adebayo SO, Olunuga TO, Durodola A, Ogah OS. Quality of life in heart failure: A review. Nig J Cardiol
; 14: 1-8. doi: 10.4103/0189-7969.201914.
Rahnavard Z, Nodeh ZH, Hatamipour K. Congestive heart failure: Predictors of health-related quality of
life in Iranian women. Contemp Nurse. 2014; 47(1-2): 159-67. doi: 10.5172/conu.2014.47.1-2.159. PMID:
Currie K, Rideout A, Lindsay G, Harkness K. The association between mild cognitive impairment and self- care in adults with chronic heart failure: a systematic review and narrative synthesis. J Cardiovasc Nurs.
; 30 (5): 382-93. doi: 10.1097/JCN.0000000000000173. PMID: 24988321.
Gallagher R. Self management, symptom monitoring and associated factors in people with heart failure
living in the community. Eur J Cardiovasc Nurs. 2010; 9(3): 153-60. doi: 10.1016/j.ejcnurse.2009.12.006.
PMID: 20093092.
Ryan P, Sawin KJ. The individual and family self-management theory: background and perspectives on
context, process, and outcomes. Nurs Outlook. 2009; 57(4): 217-25. doi: 10.1016/j.outlook.2008.10.004.
PMID: 19631064, PMCID: PMC2908991.
Jonkman NH, Westland H, Trappenburg JC, Groenwold RH, Effing-Tijdhof TW, Troosters T, et al.
Towards tailoring of self-management for patients with chronic heart failure or chronic obstructive
pulmonary disease: a protocol for an individual patient data meta-analysis. BMJ open. 2014; 4(5): e005220.
doi: 10.1136/bmjopen-2014-005220.
Kenning C, Coventry PA, Gibbons C, Bee P, Fisher L, Bower P. Does patient experience of multimorbidity
predict self-management and health outcomes in a prospective study in primary care? Fam Pract. 2015;
(3): 311-6. doi: 10.1093/fampra/cmv002. PMID: 25715962 PMCID: PMC4445135.
Najafi Ghezeljeh T, Yadavar Nikravesh M, Emami A. Coronary heart disease patients transitioning to a
normal life: perspectives and stages identified through a grounded theory approach. J Clin Nurs. 2014;
(3-4): 571-85. doi: 10.1111/jocn.12272.
Najafi-Ghezeljeh T, Kassaye Tessama M, Yadavar-Nikravesh M, Ekman I, Emami A. The Iranian version
of Angina Pectoris characteristics questionnaire: reliability assessment. J Clin Nurs. 2009; 18(5): 694-9.
doi: 10.1111/j.1365-2702.2008.02573.x. PMID: 19239536.
Tung HH, Lin CY, Chen KY, Chang CJ, Lin YP, Chou CH. Self-management intervention to improve self- care and quality of life in heart failure patients. Congest Heart Fail. 2013; 19(4): E9-16. doi:
1111/chf.12014. PMID: 23279120.
Gaeeni M, Farahani MA, Seyedfatemi N, Mohammadi N. Informational support to family members of
intensive care unit patients: the perspectives of families and nurses. Glob J Health Sci. 2014; 7(2): 8-19.
doi: 10.5539/gjhs.v7n2p8. PMID: 25716373 PMCID: PMC4796373.
Baljani E, Rahimi Z, Heydari S, Azimpour A. The effect of self-management interventions on medication
adherence and lifestyle in cardiovascular patients. Scientific Journal of Hamadan Nursing & Midwifery
Faculty. 2012; 20(3): 58-68.
Rezasefat Balesbaneh A, Mirhaghjou N, Jafari Asl M, Kohmanaee S, Kazemnezhad LE, Monfared A.
Correlation between self-care and self-efficacy in adolescents with diabetes type 1. Holistic Nursing and
Midwifery. 2014; 24(2): 18-24.
Ditewig JB, Blok H, Havers J, van Veenendaal H. Effectiveness of self-management interventions on
mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with
chronic heart failure: a systematic review. Patient Educ Couns. 2010; 78(3): 297-315. doi:
1016/j.pec.2010.01.016. PMID: 20202778.
Do V, Young L, Barnason S, Tran H. Relationships between activation level, knowledge, self-efficacy, and
self-management behavior in heart failure patients discharged from rural hospitals. F1000Research. 2015;
: 150. doi: 10.12688/f1000research.6557.1. PMID: 26213616, PMCID: PMC4505779.
Otsu H, Moriyama M. Effectiveness of an educational self-management program for outpatients with
chronic heart failure. Jpn J Nurs Sci. 2011; 8(2): 140-52. doi: 10.1111/j.1742-7924.2010.00166.x. PMID:
Jovicic A, Holroyd-Leduc JM, Straus SE. Effects of self-management intervention on health outcomes of
patients with heart failure: a systematic review of randomized controlled trials. BMC cardiovascular
disorders. 2006; 6: 43. doi: 10.1186/1471-2261-6-43.
Naderi N, Bakhshandeh H, Amin A, Taghavi S, Dadashi M, Maleki M. Development and Validation of the
First Iranian Questionnaire to Assess Quality of Life in Patients With Heart Failure: IHF-QoL. Res
Cardiocvasc Med. 2012; 1(1): 10-6. doi: 10.5812/cardiovascmed.4186. PMID: 25478482, PMCID:
PMC4253883.
Buck HG, Lee CS, Moser D, Albert NM, Lennie T, Bentley B, et al. Relationship between self-care and
health-related quality of life in older adults with moderate to advanced heart failure. J Cardiovasc Nurs.
; 27(1): 8-15. doi: 10.1097/JCN.0b013e3182106299. PMID: 21558868.
Cockayne S, Pattenden J, Worthy G, Richardson G, Lewin R. Nurse facilitated self-management support
for people with heart failure and their family carers (SEMAPHFOR): a randomised controlled trial. Int J
Nurs Stud. 2014; 51(9): 1207-13. doi: 10.1016/j.ijnurstu.2014.01.010. PMID: 24508285.
Smeulders ES, van Haastregt JC, Ambergen T, Uszko-Lencer NH, Janssen-Boyne JJ, Gorgels AP, et al.
Nurse-led self-management group programme for patients with congestive heart failure: randomized
controlled trial. J Adv Nurs. 2010; 66(7): 1487-99. doi: 10.1111/j.1365-2648.2010.05318.x. PMID:
Jonkman NH, Westland H, Groenwold RH, Agren S, Atienza F, Blue L, et al. Do self-Management
interventions work in patients with heart failure? An individual patient data meta-analysis. Circulation.
; 133(12): 1189-98. doi: 10.1161/CIRCULATIONAHA.115.018006. PMID: 26873943, PMCID:
PMC5180429.
Smith ML, Cho J, Salazar CI, Ory MG. Changes in quality of life indicators among Chronic Disease Self- Management Program participants: an examination by race and ethnicity. Ethn Dis. 2013; 23(2): 182-8.
PMID: 23530299.
Cook J, Horrocks S. Evaluation of a heart failure self-management programme. BJCN. 2015; 10(12): 603- 8. doi: 10.12968/bjca.2015.10.12.603.
Wang TC, Huang JL, Ho WC, Chiou AF. Effects of a supportive educational nursing care programme on
fatigue and quality of life in patients with heart failure: a randomised controlled trial. Eur J Cardiovasc
Nurs. 2016; 15(2): 157-67. doi: 10.1177/1474515115618567. PMID: 26585292.
Ory MG, Smith ML, Ahn S, Jiang L, Lorig K, Whitelaw N. National study of chronic disease self- management: age comparison of outcome findings. Health Educ Behav. 2014; 41(1 Suppl): 34S-42. doi:
1177/1090198114543008. PMID: 25274709.
McGillion M, O'Keefe-McCarthy S, Carroll SL, Victor JC, Cosman T, Cook A, et al. Impact of self- management interventions on stable angina symptoms and health-related quality of life: a meta-analysis.
BMC cardiovascular disorders. 2014; 14: 14. doi: 10.1186/1471-2261-14-14. PMID: 24483947, PMCID:
PMC3945741.
Smeulders ES, van Haastregt JC, Ambergen T, Janssen-Boyne JJ, van Eijk JT, Kempen GI. The impact of a
self-management group programme on health behaviour and healthcare utilization among congestive heart
failure patients. Eur J Heart Fail. 2009; 11(6): 609-16. doi: 10.1093/eurjhf/hfp047. PMID: 19359326.
Turner A, Anderson JK, Wallace LM, Bourne C. An evaluation of a self-management program for patients
with long-term conditions. Patient Educ Couns. 2015; 98(2): 213-9. doi: 10.1016/j.pec.2014.08.022. PMID:
Baker DW, DeWalt DA, Schillinger D, Hawk V, Ruo B, Bibbins-Domingo K, et al. “Teach to goal”:
theory and design principles of an intervention to improve heart failure self-management skills of patients
with low health literacy. J Health Commun. 2011; 16(3): 73-88. doi: 10.1080/10810730.2011.604379.
PMID: 21951244.
Musekamp G, Bengel J, Schuler M, Faller H. Improved self-management skills predict improvements in
quality of life and depression in patients with chronic disorders. Patient Educ Couns. 2016; 99(8): 1355-61.
doi: 10.1016/j.pec.2016.03.022. PMID: 27050107.
Kuppens P, Realo A, Diener E. The role of positive and negative emotions in life satisfaction judgment
across nations. Pers Soc Psychol. 2008; 95(1): 66-75. doi: 10.1037/0022-3514.95.1.66. PMID: 18605852.
Allman E, Berry D, Nasir L. Depression and coping in heart failure patients: a review of the literature. J
Cardiovasc Nurs. 2009; 24(2): 106-17. doi: 10.1097/JCN.0b013e318197a985. PMID: 19242276.
Perez-Garcia AM, Olivan S, Bover R. Life satisfaction, depressive symptoms and perceived social support
in heart failure patients. Revista de Psicopatología y Psicología Clínica 2013; 18(2): 93-105. doi:
1002/smi.1378.
Liang SY, Chao TC, Tseng LM, Tsay SL, Lin KC, Tung HH. Symptom-management self-efficacy
mediates the effects of symptom distress on the quality of life among Taiwanese oncology outpatients with
breast cancer. Cancer Nurs. 2016; 39(1): 67-73. doi: 10.1097/NCC.0000000000000244. PMID: 25730592.
Gholami M, Fallahi Khoshknab M, Khankeh HR, Ahmadi F, Maddah SS, Mousavi Arfaa N. The
motivations of Iranian patients with cardiovascular disease to seek health information: a qualitative study.
Iran Red Crescent Med J. 2016; 18(5): e26039. doi: 10.5812/ircmj.26039. PMID: 27437128, PMCID:
PMC4939227.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.