Efficacy of a Self-Care Manual for People with Chronic Heart Failure

Abstract

Abstract Chronic Heart Failure (CHF) has become a major health problem reaching epidemic proportions and imposing a considerable burden on health care systems. Chronic Heart Failure Management Programs (CHF-MPs), which have been developed to optimise care delivery, have proven to be cost-effective in reducing recurrent hospitalisations, morbidity and mortality. These programs include patient education however educational strategies vary considerably. Further research is required to inform decisions regarding the most effective intervention for patient education. This program of research aimed firstly to investigate education for people with CHF including a comprehensive assessment of their learning style, learning needs and learning preferences. Secondly a self-care education manual was developed as the building block for an educational intervention. Finally further research was undertaken to investigate the effectiveness of this educational intervention. This research has been guided by the principles of andragogy underpinned by an education process involving fours steps: assessment, planning, implementation and evaluation. For the initial assessment a systematic review of randomised controlled trials that had implemented an educational intervention for CHF patients was completed to identify effective educational interventions - Educational interventions for patients with heart failure: a systematic review of randomised controlled trials. This systematic review of 19 studies found that studies used a variety of outcome measures to evaluate their effectiveness with 15 studies demonstrating a significant effect in at least one of their outcome measures. While a variety of different educational interventions were implemented it was difficult to establish the most effective strategy as studies varied considerably in delivery methods, duration and outcome measures. To complete the assessment phase of this research two studies were undertaken. The first study investigated the learning style and learning needs of 55 patients with CHF using a Heart Failure Learning Style and Needs Inventory - The Learning Style and Learning Needs of Heart Failure Patients (The Need2Know Study). This needs assessment indicated 64% of participants preferred multimodal learning, 18% preferred read/write, 11% preferred auditory, and 7% preferred kinesthetic. In relation to educational topics signs and symptoms was ranked as the most important topic to learn followed by prognosis, risk factors, and fourthly medications. The second study investigated the learning preferences of patients with CHF - The Learning for Heart Failure Patients (The L-HF patient study.) This study involved a purposive sample of 12 participants, diagnosed with CHF, who participated in semi-structured interviews. Four themes emerged; knowledge quest, barriers to learning, facilitators for learning and meeting educational needs. Patients advocated a design of educational resources which support ‘Read, Experience, Relationship and Record’. The next step, the planning of the intervention, involved developing a self-care manual for people with CHF– the ‘GO-Getting On with Heart Failure’ manual. The need for a comprehensive written manual was supported by patients identifying they preferred to read, record and refer back to written information. The content was designed according to the patients identified learning needs. Integrating these ‘need to know’ topics into the manual aimed to engage patients in their own learning. An educational intervention based on the self-care manual with the addition of a DVD was implemented and evaluated in two studies. Firstly a pilot study using a pre-test post-test design assessed changes in knowledge and self-care abilities of 38 patients diagnosed with CHF who participated in this educational intervention. Knowledge was evaluated with the Dutch Heart Failure Knowledge Scale (DHFKS) while self-care abilities were evaluated with the Self-Care Heart Failure Index (SCHFI). Results demonstrated a statistically significant difference in the pre and post scores for knowledge (