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

Mary Boyde (2011). Efficacy of a Self-Care Manual for People with Chronic Heart Failure PhD Thesis, School of Nursing and Midwifery, The University of Queensland.

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Author Mary Boyde
Thesis Title Efficacy of a Self-Care Manual for People with Chronic Heart Failure
School, Centre or Institute School of Nursing and Midwifery
Institution The University of Queensland
Publication date 2011-05
Thesis type PhD Thesis
Supervisor Professor Catherine Turner
Professor Simon Stewart
Professor David Thompson
Total pages 210
Total colour pages 18
Total black and white pages 192
Subjects 11 Medical and Health Sciences
Abstract/Summary 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 (p<0.0001). The mean scores for the three subscales of the SCHFI demonstrated positive improvements from pre to post test results: self-care maintenance (p=0.027), self-care management (p<0.0001) and self-care confidence (p=0.051). Secondly participants attended two focus groups, one after initially viewing the DVD and then a follow-up focus group 8 weeks later. Patients found the DVD beneficial. Five evaluative statements emerged confirming the DVD demonstrated role-modelling of health-related behaviours with real life experiences, focused on achievable health-related behaviours and outcomes, provided a self-directed learning environment, met learning needs and linked to previously learnt knowledge and behaviours. The development of this self-care manual and the implementation of the educational intervention have been effective in developing knowledge and self-care abilities in this pilot study involving a cohort of patients with CHF. Further research is required to confirm the findings of this pilot study. Implementing an effective educational intervention is likely to further enhance CHF-MP service organisation and delivery, and improve health outcomes for CHF patients by improving their knowledge and self-care abilities. Although not without limitations this thesis has provided knowledge and insight regarding patient education for people with CHF.
Keyword Heart failure, patient education, educational intervention, learning needs, learning style, multimedia education.
Additional Notes Colour pages - 16-24, 36, 75, 80,82, 83, 89, 164, 168, 170 Landscape - 118, 119, 120

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Created: Thu, 08 Sep 2011, 17:35:59 EST by Mrs Mary Boyde on behalf of Library - Information Access Service