The Effect of Mobile Self-monitoring on Self-care Behaviors in Heart Failure and COPD Patients: A Feasibility Study

Exacerbations of heart failure (HF) and chronic obstructive lung disease (COPD) are among the most costly illnesses. Patient recognition of changes in symptoms cueing imminent exacerbation is poor. Innovative strategies to improve patient symptom recognition, self-care behaviors and treatment seeking are necessary to improve overall health outcomes. The aim of this pilot study was to test the feasibility of a wireless health monitoring device and cell phone app in 10 patients (5 with COPD and 5 with HF). This collaborative multidisciplinary study is innovative in its inclusion of the patient as an active partner in the use of technology to monitor changes in physiologic indicators to alert them to baseline status changes and guide self-care decision-making. The nurse-engineer team worked to develop devices that met the data collection needs of the research team, while being mindful of comfort and body image concerns of the patient. Additionally, the engineers provided the nurse researchers essential training on troubleshooting technology problems in the field. Weekly home visits with participants provided ongoing feedback that impacted design decisions and revisions throughout the data collection period. Data were collected on self-care (SCHFI) at enrollment and post intervention. Participants had a mean age of 67.7 + 11.9 years, EF of 26.5 + 11.8, 60% male, 70% married. Mixed between-within subjects’ analysis of variance was conducted to test the impact of the intervention on the participant’s self-care scores. There was no significant interaction between group and time, Wilk’s Lambda = .97, F (1, 17) = .46, p = .51. There was no significant main effect for time Wilk’s Lambda = .94, F (1, 17) = 1.14, p = .30. Self-care maintenance (31 vs 31.7), management (49.2 vs 63) and confidence (58.2 vs 58.7) scores were inadequate at each time but did increase after intervention

Development and initial testing of the self‐care of chronic illness inventory

Aim The aim was to develop and psychometrically test the self‐care of chronic illness Inventory, a generic measure of self‐care. Background Existing measures of self‐care are disease‐specific or behaviour‐specific; no generic measure of self‐care exists. Design Cross‐sectional survey. Methods We developed a 20‐item self‐report instrument based on the Middle Range Theory of Self‐Care of Chronic Illness, with three separate scales measuring Self‐Care Maintenance, Self‐Care Monitoring, and Self‐Care Management. Each of the three scales is scored separately and standardized 0–100 with higher scores indicating better self‐care. After demonstrating content validity, psychometric testing was conducted in a convenience sample of 407 adults (enrolled from inpatient and outpatient settings at five sites in the United States and ResearchMatch.org). Dimensionality testing with confirmatory factor analysis preceded reliability testing. Results The Self‐Care Maintenance scale (eight items, two dimensions: illness‐related and health‐promoting behaviour) fit well when tested with a two‐factor confirmatory model. The Self‐Care Monitoring scale (five items, single factor) fitted well. The Self‐Care Management scale (seven items, two factors: autonomous and consulting behaviour), when tested with a two‐factor confirmatory model, fitted adequately. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model. Conclusion The self‐care of chronic illness inventory is adequate in reliability and validity. We suggest further testing in diverse populations of patients with chronic illnesses

Ethnic Differences in Quality of Life in Persons with Heart Failure

Background Chronic illness burdens some groups more than others. In studies of ethnic/racial groups with chronic illness, some investigators have found differences in health-related quality of life (HRQL), whereas others have not. Few such comparisons have been performed in persons with heart failure. The purpose of this study was to compare HRQL in non-Hispanic white, black, and Hispanic adults with heart failure. Methods Data for this longitudinal comparative study were obtained from eight sites in the Southwest, Southeast, Northwest, Northeast, and Midwest United States. Enrollment and 3- and 6-month data on 1212 patients were used in this analysis. Propensity scores were used to adjust for sociodemographic and clinical differences among the ethnic/racial groups. Health-related quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. Results Significant ethnic/racial effects were demonstrated, with more favorable Minnesota Living with Heart Failure Questionnaire total scores post-baseline for Hispanic patients compared with both black and white patients, even after adjusting for baseline scores, age, gender, education, severity of illness, and care setting (acute vs. chronic), and estimating the treatment effect (intervention vs. usual care). The models based on the physical and emotional subscale scores were similar, with post hoc comparisons indicating more positive outcomes for Hispanic patients than non-Hispanic white patients. Conclusion Cultural differences in the interpretation of and response to chronic illness may explain why HRQL improves more over time in Hispanic patients with heart failure compared with white and black patients

Electrocardiogram Classification Sensor System Supporting an Autonomous Mobile Cardiovascular Disease Detection Aid

Current healthcare mobile monitoring solutions do not offer the ability to autonomously recognize cardiac arrhythmias. The proposed electrocardiogram detection and classification software is designed to run on a mobile cardiovascular disease detection sensor suite alleviating the need for human interpretation. The electrocardiogram is filtered using the Wavelet Transform; the principally important wave points detected using a modified version of the Pan Tompkins rule set and the cardiac rhythm is classified using an N-ary tree. Implemented on a custom designed printed circuit board, testing results show autonomous classifications are possible using a three lead electrocardiogram system while the patient is at rest. The proposed solution serves as a stepping stone towards a fully reliable patient disease management teaching tool with the potential to serve as an aid to the cardiovascular healthcare industry

Factors associated with delay in seeking care for acute decompensated heart failure

Background: Despite reports that persons with heart failure (HF) symptoms delay up to 7 days before seeking treatment, few studies have prospectively explored specific factors influencing treatment-seeking delay in this population. Objective: The purpose of this study was to explore how factors related to the symptom experience, such as perception (number and intensity), evaluation (attribution and understanding), and response (behaviors of patients and others) influence delay in seeking treatment for symptoms of acute decompensated HF. Methods: Patients hospitalized for acute HF were enrolled into an exploratory, descriptive study. Only those who had HF for 3 months or longer and a previous HF admission were eligible. Data on factors related to the symptom experience, response to symptoms, and delay time were collected by interview during hospitalization. Delay time measured in hours was analyzed using generalized linear modeling. Results: The sample of 131 adults was predominately older (77 ± 11.3 years) men (55.7%). The median delay time was 60 hours (2.5 days), with a range of 1 to 336 hours (14 days). Only 34 (25.9%) sought care in less than 12 hours. Three variables were statistically significant determinants of long delay time—waiting to see if the symptoms would abate, receiving a passive response to symptoms from others, and living in a rural environment. These variables explained 13.9% of the variance in delay time. Clinical characteristics were not significant predictors of delay. Conclusions: The response of patients (wait-and-see) and others (eg, don’t worry) contributed to delay, as did living in a rural environment. Evaluative characteristics of attribution and understanding were not significant determinants of delay, suggesting that patient education alone will not effectively decrease delay. Instead, interventions directed toward decision making in response to symptoms and inclusion of family members in such discussions may be more effective

Nurses\u27 attitudes and emotions toward caring for adults with intellectual disabilities: Results of a cross-sectional, correlational-predictive research study

BACKGROUND: Negative healthcare provider attitudes may contribute to healthcare disparities in adults with intellectual disabilities. This study identified predictors of nurses\u27 attitudes and emotions toward caring for adults with intellectual disabilities in the United States. METHOD: A convenience sample of 248 nurses was used to collect nurses\u27 attitudes and emotions toward caring for adults with intellectual disabilities (Adapted Caring for Adults with Disabilities Questionnaire) and quality of life beliefs (Prognostic Beliefs Scale). RESULTS: Overall, nurses held less positive attitudes toward caring for an adult with intellectual disability versus a physical disability. Intellectual disability nurses held more positive attitudes and emotions and less negative emotions than non-intellectual disability nurses. Quality of life beliefs predicted nurse attitude, positive emotions and negative emotions. The number of adults with intellectual disabilities cared for during the nurse\u27s career predicted negative emotions. CONCLUSIONS: Future interventions should focus on improving nurses\u27 understanding of the quality of life of adults with intellectual disabilities

Symptom clusters of heart failure

Patients with heart failure (HF) report multiple symptoms. Change in symptoms is an indicator of HF decompensation. Patients have difficulty differentiating HF symptoms from comorbid illness or aging. The study purpose was to identify the number, type, and combination of symptoms in hospitalized HF patients and test relationships with comorbid illness and age. A secondary analysis from a HF registry (N=687) was conducted. The sample was 51.7% female, mean age 71±12.5 years. The theory of unpleasant symptoms informed the study regarding the multidimensional nature of symptoms. Factor analysis of 9 items from the Minnesota Living with HF Questionnaire resulted in three factors, acute and chronic volume overload and emotional distress. Clusters occurred more frequently in older patients, but caused less impact