Review Strategies to Recruit and Retain Rural Patient Participating Self-management Behavioral Trials

Self-management plays a vital role in improving health outcomes and reducing costs in patient with cardiovascular disease (CVD) and associated risk factors. Based on existing studies, rural residents with CVD and/or risk factors show low engagement in self-management behaviors. Due to low participation in behavioral intervention trials, the most promising mechanism to promote self-management among rural populations is unknown. In turn, the purpose of this article is to review the evidence that supports strategies to recruit and retain rural patients to participate in behavioral intervention trials aimed to promote self-management of CVD and its risk factors. This review is expected to assist researchers in identifying effective solutions to overcome barriers in the recruitment and retention processes when conducting intervention research studies on the self-management of CVD in rural communities

A Conceptual Framework for Barriers to the Recruitment and Retention of Rural CVD Participants in Behavior Intervention Trials

Rural residents diagnosed with cardiovascular disease (CVD) or with CVD-related risks are underrepresented in behavioral intervention trials based on an extensive review of published studies. The low participation rate of rural residents weakens both the internal and external validity of published studies. Moreover, compared to urban residents, limited research exists to describe the unique barriers that limit the participation of rural residents in behavioral intervention trials.Objective: The purpose of this review is to identify a conceptual framework (CF) underpinning common barriers faced by rural CVD patients to enroll in behavioral intervention trials.Methods: We conducted a literature review using several electronic databases to obtain a representative sample of research articles, synthesized the evidence, and developed a CF to explain the barriers that may affect the research participation rate of rural residents with CVD or related risks.Results: We found our evidence-based CF well explained the barriers for rural CVD patients to take part in behavioral intervention trials. Besides contextual factors (i.e. patient, community and research levels), other common factors impacting rural patients’ intent to enroll are lack of awareness and understanding about behavioral trials, limited support from their healthcare providers and social circles, unfavorable attitudes, and the lack of opportunity to participating research.Conclusion and Implication of result: the findings demonstrate the evidence-based model consisting of interlinked multi-level factors may help our understanding of the barriers encountered by rural CVD patients participating interventions to promote behavioral change. The implication for researchers is that identifying and developing strategies to overcome the barriers precedes conducting studies in rural communities

Systematic review of symptom clusters in cardiovascular disease

Background: Although individual symptoms and symptom trajectories for various cardiovascular conditions have been reported, there is limited research identifying the symptom clusters that may provide a better understanding of patients’ experiences with heart disease. Aims: To summarize the state of the science in symptom cluster research for patients with acute coronary syndrome, myocardial infarction, coronary artery bypass surgery, and heart failure through systematic review and to provide direction for the translation of symptom cluster research into the clinical setting. Methods: Databases were searched for articles from January 2000 through to May 2015 using MESH terms “symptoms, symptom clusters, acute coronary syndrome (ACS), myocardial infarction (MI), coronary heart disease (CHD), ischemic heart disease (IHD), heart failure (HF), coronary artery bypass surgery (CABS), cluster analyses, and latent classes.” The search was limited to human studies, English language articles, and original articles investigating symptom clusters in individuals with heart disease. Fifteen studies meeting the criteria were included. Results: For patients with ACS and MI, younger persons were more likely to experience clusters with the most symptoms. Older adults were more likely to experience clusters with the lowest number of symptoms and more diffuse and milder symptom clusters that are less reflective of classic ACS presentations. For HF patients, symptom clusters frequently included physical and emotional/cognitive components; edema clustered in only three studies. Symptom expression was congruent across geographical regions and cultures. Conclusions: The findings demonstrated similarities in symptom clusters during ACS, MI, and HF, despite multiple methods and analyses. These results may help clinicians to prepare at-risk patients for proper treatment-seeking and symptom self-management behaviors

A comparison of cardiac teaching on learning variables among cardiac surgical patients

This research investigated the effect of three different teaching approaches on patient teaching outcomes among patients who had undergone coronary artery bypass graft (CABG) surgery. The specific teaching methods utilized in the study included an inhospital teaching program, a post-discharge telephone follow up program and post-discharge group teaching program. The study included a total of 90 participants who were assigned to one of the three teaching modalities. All participants were patients at a large midwestern community hospital and had undergone elective CABG surgery. Data collection for the study included the use of post-test measures to determine patient teaching outcomes. The instruments used in the study included: (a) Cardiac Surgical Patient Self Efficacy (CSPPSE) tool to measure participant perception of their self efficacy, (b) Heart Disease Management Questionnaire (HDMQ) to measure the subject\u27s cognitive knowledge related to heart disease management and (c) Cardiac Surgical Patient Teaching Satisfaction Inventory (CSPTI) to measure the perception of patients\u27 satisfaction with the teaching they had received. Analyses of the data revealed similar patient teaching outcomes regardless of the type of teaching program the participant had received. This finding supported the effectiveness of the inhospital teaching protocol which focused on survival skills for self-care management post-discharge. The more traditional patient education approaches reported in the literature had advocated the inclusion of heart disease physiology and emphasis on risk factor modification. The findings of the study also revealed that those patients who had longer lengths of stay and those patients who had larger numbers of coronary vessels bypassed were the least satisfied which their teaching. The younger participants in the study (ie. less than 70 years of age) overall had higher cognitive knowledge scores than the older cohort group in the study. The implications of this research were described in relation to the validation of a shortened inhospital teaching protocol and possible alternative approaches for older patients and those patients who have longer lengths of stay following cardiac surgery

Feasibility of Using Accelerometer Measurements to Assess Habitual Physical Activity in Rural Heart Failure Patients

(1) Background: Physical inactivity is prevalent in rural heart failure (HF) patients. To evaluate the effectiveness of interventions aimed at improving physical activity (PA), we need an accurate, reliable PA assessment tool that is feasible and acceptable to HF patients. The purpose of this study was to examine the feasibility and reliability of using an accelerometer to assess HF patients’ PA. (2) Method: A total of 100 HF patients discharged from a rural hospital participated in the study and wore an accelerometer at baseline, 3, and 6 months following discharge. (3) Result: The daily average wear time across all three time points was 15.7 (±3.3) h for weekdays, and 15.8 (±3.7) h for weekends. Approximately 50% of the participants adhered to the device wear protocol at baseline, 3, and 6 months. Factors related to wear time were also examined. Acceptable reliability assessed by intra-class correlation (ICC > 0.879) was found for daily activity calories, activity counts per minutes, and time spent on moderate or greater PA. (4) Conclusion: The present findings suggest that an accelerometer is a feasible and reliable measure of habitual PA in rural HF patients over time

Editorial: Nursing research in the 21st century - who sets the agenda?

Once upon a time life was uncomplicated - clinicians cared for patients, government-sponsored laboratories investigated the cure for diseases, and universities prepared the next generations of clinicians and scientists to continue the work. It was a simpler time and everyone knew his or her role. However the 21st century has seen a blurring of those boundaries and this has resulted in a significant change in the research arena. One of the drivers of this change was the evolution of nursing into an evidence-based profession, which led to clinicians and practitioners becoming more aware of the role of research in underpinning their activities

Editorial: Nursing research in the 21st century - who sets the agenda?

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