|Year : 2020 | Volume
| Issue : 1 | Page : 60-68
Educational intervention for improving self-care behaviors in patients with heart failure: A narrative review
Maryam Karami Salahodinkolah1
, Jila Ganji2, Sedigheh Hasani Moghadam3, Vida Shafipour4
, Hedayat Jafari5, Susan Salari6
1 Department of Intensive Care Nursing, Nasibeh Nursing and Midwifery Faculty, Sexual and Reproductive Health Research Center, Sari, Iran
2 Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center, Sari, Iran
3 Student Research Committee, Master Student in Midwifery Counseling, Sari, Iran
4 Assistant Professor, Department of Nursing, Cardiovascular Research Center, Sari, Iran
5 Associate Professor, Traditional and Complementary Medicine Research Center, Addiction Institute, Sari, Iran
6 Psychiatry and Behavioral Sciences Research Center, Addicition Instiute, Mazandaran University of Medical Sciences, Sari, Iran
|Date of Submission||07-May-2019|
|Date of Acceptance||25-Aug-2019|
|Date of Web Publication||27-Dec-2019|
Dr. Vida Shafipour
Department of Nursing, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari
Source of Support: None, Conflict of Interest: None
Heart failure is one of the most common cardiovascular disorders, and as a chronic and progressive disorder, it can disrupt with interpersonal and social relationships, reduce physical activity, and in fact, impair self-care. Therefore, it is necessary to improve the self-care behavior of the patients with heart failure with effective interventions. There are several ways to improve self-care behavior, and educational interventions are one of these methods. Review of educational interventions causes promotion in self-care behaviors of patients with heart failure. The aim of this study was reviewing the educational intervention for improving self-care behaviors in patients with heart failure. The present study is a narrative review study that uses a search in databases such as Google Scholar, Cochrane, Science Direct, ProQuest, Springer, SID, Magiran, IranMedex, Web of science, Scopus, and PubMed from 2000 to 2018. Search for articles using Keywords: heart failure, self care, education and training. All articles with educational intervention and clinical trial in Persian and English and articles with full-text of individual or group training in the database of internal and library were included in the study, and unrelated articles with just abstract were excluded from the study. Seventy-one articles were finally included, after removing repetitive and nonrelated items. Initially 340 articles were obtained and after reviewing the articles for inclusion criteria, finally 71 articles were included in the study. Educational interventions were divided into four groups: face-to-face teach-back training and home visitation by follow-up phone call, group training, and e-learning. The results of this study showed that four abovementioned educational methods significantly improved self-care behaviors in patients with heart failure. According to the findings of this study, it is recommended to improve self-care behaviors in patients with heart failure Based on the findings of the study, it is recommended to use one-to-one face-to-face, teach back, home visits with telephone follow-up, group training, and e-learning to improve self-care behaviors in patients with heart failure.
Keywords: Education, Heart failure, Patient, Self-care
|How to cite this article:|
Karami Salahodinkolah M, Ganji J, Hasani Moghadam S, Shafipour V, Jafari H, Salari S. Educational intervention for improving self-care behaviors in patients with heart failure: A narrative review. J Nurs Midwifery Sci 2020;7:60-8
|How to cite this URL:|
Karami Salahodinkolah M, Ganji J, Hasani Moghadam S, Shafipour V, Jafari H, Salari S. Educational intervention for improving self-care behaviors in patients with heart failure: A narrative review. J Nurs Midwifery Sci [serial online] 2020 [cited 2020 Jan 27];7:60-8. Available from: http://www.jnmsjournal.org/text.asp?2020/7/1/60/274171
| Introduction|| |
Cardiovascular disease (CVD) is a common and chronic disease, contrary to many advances in its treatment and prevention; it is still considered a public health problem in the world. Congestive heart failure is a clinical syndrome in which the structural or functional disorder of the heart causes the heart inability in pumping blood at a rate proper with the metabolic needs of the body. Myocardial dysfunction causes increased intraventricular pressure and decreases cardiac output, eventually leading to pulmonary edema and peripheral edema. Heart failure exacerbating factors are failure in compliance with the medication and food regimen, uncontrolled blood pressure, inadequate treatment, and smoking and drug addiction. Heart failure is the only common CVD that its prevalence and incidence is increasing. More than 37 million people in the world and 15 million in Europe and 6 million in the United States are suffering from heart failure. Precise information is not available in Iran. Given the changes in age pyramid of our society due to the population aging in the near future, the current outbreak of the disease will be increased to 3500/100,000 people. At that time, the progression of this disease can be prevented to a large extent by self-care against exacerbating factors. Self-care is a comprehensive concept and process in which the patient uses his/her knowledge and skills to conduct recommended behaviors to maintain his/her life and promote his or her health., Therefore, patients need to have enough information about their illness and take appropriate care so that they can use their knowledge in different circumstances. Inadequate self-care causes poor health outcomes and rehospitalization of these patients. Instead, effective self-care increases satisfaction, independence in everyday activities and reduces stress and complications of the disease. Self-care in heart failure implies the issues such as medication and food regimen management, sodium and fluid intake limitations, daily weighing, regular exercise, signs monitoring, and symptoms of exacerbation of the disease, search, and decision-making for appropriate treatments. One of the factors affecting self-care is having enough knowledge about the disease, factors affecting it and how to prevent it. The researches have shown that patient education has a considerable impact on the reduction of risk-related behaviors and the increase in the health behaviors, and in general, it is economically feasible., The use of supportive educational interventions to improve self-care behaviors in patients with heart failure significantly decreased the symptoms and complaints of the patients. Educational interventions in heart failure patients include face-to-face training sessions, educational writing tools, and home visitation by follow-up phone call. These interventions not only increase patient awareness of the disease but also play a key role in self-management of patients. Meanwhile, several studies have been done by different educational methods in the management of self-care of the patients with heart failure. With a lot of searches in the databases, we could not find any review narrative study which discuses about impact of educational interventions promoting self-care behavior of patients in heart failure. Accordingly, the purpose of this study was to investigate educational interventions promoting self-care behaviors in patients with heart failure.
| Materials and Methods|| |
The present study is a narrative review study using comprehensive search in the databases such as Google Scholar, Cochrane, Science Direct, ProQuest, Springer, Web of Science, Scopus, and PubMed from 2000 to 2018. The article searches were done using the keywords of heart failure, self-care, education, and training. and all Full-text studies about education as well Interventions and clinical trials in self-care behaviors Patients with heart failure were in Persian and English and educational intervention was Group and individual were included in the study. The exclusion criteria were also noninterventional studies and noneducational interventions and articles that had just abstract. The population included patients with heart failure who had educational interventions in self-care patients. In the first phase, based on this research question, what are the educational interventions for promoting self-care in patient with heart failure? A list of titles and abstracts of all the articles in the databases was prepared to determine the relevant topics. The papers were first obtained by two separate individuals in the databases. Then, the articles were reviewed by title, abstract, objectives, methodology, findings, type of study, participants, variables, and data; if there was a disagreement between the two researchers' opinions, the third person's opinions were used. In the third phase of this study, the researchers evaluated the data of the studies. Finally, related articles were reviewed. In the fourth step, the results of the studies were collected by the researcher for analysis and interpretation of the data. At the beginning of the search, 340 articles related to the self-care education of heart failure were obtained, and after deleting repetitive articles, 280 articles were left. After screening of articles, 100 articles were removed due to nonrelevance and abstract, and 180 full-text articles were investigated. After final reviewing, 109 articles were excluded due to repetition and similarity. Finally, 71 articles were included in the study [Figure 1].
The authors of the present study, while respecting ethical considerations in the translation, were loyal to the intellectual property of the articles and used the results derived from the translation of the articles in this article and avoided plagiarism.
| Results|| |
Although the number of published articles was more than the number of articles that were used in this research, only articles in this study were used that contained accessible full text. The noteworthy point is that effective educational interventions for improving self-care behavior included face-to-face teach-back training, home visitation by follow-up phone call, group training, and e-learning [Table 1].
|Table 1: Educational interventions affecting self-care behaviors in patients with heart failure|
Click here to view
The findings of this study were organized in four categories:
Categories: 1: Face-to-face/teach-back training
The first category, which examines face-to-face and teach-back training on self-care behaviors, includes 25 articles. Self-care education in patients with heart failure is done by face-to-face and teach-back training. These two methods are carried out at the presence of the person. In teach-back training, the essential information for the patient is expressed so that they have an understanding of the educational contents, and the questioner ascertains the accuracy of the information received by the patient. In this way, it allows the educator to examine, understand and fix memory while memorizing patient information, errors and errors, and managing messages through managing an open conversation with patients. After each training session, educational materials are asked from patients, and the purpose of this questioning is to understand that the patients learned the educational materials correctly. In most studies, teach-back training is being used for heart failure patients' self-care.,, Self-care behaviors in heart failure patients include adherence to the pharmaceutical and nonpharmaceutical regime and follow-up and decision-making for proper therapeutic measures during the onset of the disease in the acute phase. Self-care is one of therapeutic methods for heart failure. Face-to-face education is also one of the best teaching methods for educating learners to change their behavior. In this type of training, the trainer and the trainee communicate directly and face-to-face with each other and the learner can talk, ask questions, and provide comments freely. My biggest education is to be an individual who can sleep with a person and help them change their behavior. Individual training makes an opportunity to raise questions about the trainees' particular interests. In this method, the training is given to patients individually or in group with face-to-face teach-back training.,,,,,,,,,, Various studies have shown that in-person training with face-to-face interaction has increased awareness and knowledge self-care.,,,,,,,,, Delivering materials in a comprehensible manner based on individual needs and using individual education and face-to-face and teach-back training can provide better results and most importantly have been effective in sustaining health behaviors. Face-to-face and teach-back training improved all aspects of physical and emotional life and sports, emotional and social aspects, increased awareness and knowledge of patients in self-care, social support, reduced the number of hospitalized days, and improved the behavior of self-care.,,,,,,,,,,,,,,,,,,,,, In a study, this method of training was effective in reducing the fatigue score of patients but did not influence on the mean of their activity tolerance. The results of some studies showed that self-care training has improved the patients' daily weight control and fluid intake., In some studies face-to-face education has improved the self-care of patients and reduced the mortality of heart failure patients.,, In another study, face-to-face teaching style had increased motivations, improved self-care, self-management, and self-confidence in therapy, reduced depression and anxiety, and improved sleep. Face-to-face education has also increased social support and self-care in cardiac patients.
Categories: 2: Home visitation by follow-up phone call
The second category, which examines the impact of home visiting training with phone call follow-up on self-care behaviors in heart failure patients, includes 16 articles. Other educational methods that are effective in promoting self-care behaviors of patients with heart failure is home visitation by follow-up phone call. Telephone follow-up by a nurse is a useful tool for exchanging information, controlling symptom, rapid complication diagnosing, improving the clinical status, promoting of life quality,,,, and ensuring the patient and his family, and reducing the hospital costs. Readmission of the patients can be due to the factors such as failure to observe diet and medication, lack of knowledge about disease and treatment, recurrence and course of illness and its progress. The patient needs care after hospital discharge. Improving the knowledge of the patient and his/her care at home is important and requires the ability of caregivers through home-based training. Various studies have shown that the use of home visitation by follow-up phone call has increased the self-care of the patients.,,, Home Visiting improves quality of life, increases patient and carer awareness, increases self-care, and self-management and self-esteem in self-care, and reduces patient readmission.,,,,,, Some studies home visits with telephone follow-up have not been effective on self-care, quality of life, and readmission.,,,,,,,,
Categories: 3: Group training
The third category includes 8 articles which studies the impact of group training on self-care behaviors. One of the recommended teaching methods in small groups is due to the positive features of this method, such as active participation, face-to-face contact, and head activity. One of the recommended teaching methods is teaching in small groups. Group training facilitates communication and raise and strengthen the spirit, creativity, and more initiative in deciding the treatment process, improving the patient's performance when needed, reducing the costs, and saving the time. Group training increases knowledge and awareness about the disease, improves quality of life, improves self-care behavior, and increases social support and adherence to diet and better management of the disease.,,,,,,, The use of this training program also has improved the reception of low-sodium diet in patients. Using group training in rehabilitation intervention in patients with heart failure increased their understanding and self-care and improved the symptoms and physical activity and reduced the readmission. Using group training has increased perceived social support and self-care in patients with heart failure. Group training as a workplace and telephone follow-up of patients improved the quality of life of the elderly but had no effect on reducing mortality in the elderly.
Categories: 4: E-learning training
The fourth category includes 22 articles which examines the impact of e-learning on self-care behaviors. Educational aids are one of the most important and effective teaching methods. A large number of patients can be trained with relatively little time and without trained personnel by adding the image. Adding images related to the words can contribute to involvement of the learner's mind and his active learning. The use of e-learning tools provides 24-h access to educational materials. Training by using electronic instruments increases knowledge and awareness about self-care behavior, improves self-care behavior, reduces cognitive impairment, reduces depression, improves quality of life, increases adherence to diet and drug orders, reduces the rate of admission, increases the participation of fellows in self-care, and increases self-care and self-care management.,,,,,,,,,,,, In some studies, the use of media was not effective in self-care of the patients.,,,,,, The use of e-learning in rehabilitation programs for patients with heart failure improved the patients' quality of life, which is economically affordable. DVD training along with follow-up phone call in self-care and self-management of heart failure patients has reduced the readmission of the patients. A study showed that patients registered on mobile phones improved self-care by controlling patients' daily weight but were not effective in adhering to diet, smoking and alcohol. In the study, media education for patients with heart failure in three areas of self-care (self-preservation, self-management, and self-trust) was not significant.
| Discussion|| |
The purpose of this study was to investigate educational interventions' self-care behaviors in patients with heart failure that was performed on valid internal and external databases. The results of this study showed that education in face-to-face teach-back training, home visitation by follow-up phone call, group training, and e-learning improved self-care behaviors in patients with heart failure.
The first category: In this category also, the effect of face-to-face teach-back training on self-care in heart failure patients has been studied. The findings suggest that this kind of education improves self-care behaviors in patients with heart failure., Training is also one of the effective ways to promote self-care behaviors. In teach back-based training, the trainer due to receiving teach back from patients after training is informed about the accuracy of the transfer of information to the patient, and if patients find misconceptions and misunderstandings, the content is again expressed in plain language. Various studies have shown that teach back-based training has increased awareness about the disease and how to care for themselves at home and observing the diet and ultimately improving the patients' self-care behaviors., Face-to-face training is done because of the presence of the educator and according to the needs of the patients and the questions of the patients and their caregivers. The researcher based on the results of the studies,,,,,,,,,, believes that self-care education for patients with heart failure can be used with confidence face-to-face and teach-back training. Delivering materials in a comprehensible manner based on individual needs and using individual education and face-to-face and teach-back training can provide better results and most importantly have been effective in sustaining health behaviors.,,, [21,,,,,,,,,,,,,,,,,,,
Home visitation by follow-up phone call
The second category: The findings indicated that home-visiting education and phone-call training improved clinical status, quality of life, control of disease symptoms, and a reliable way to transfer information to the patients and their family members., Because of the chronic nature of the disease and spending more time at home, patients and their caregivers need to be trained about self-care behaviors and how to deal with the patient in the acute and critical phase of the disease at home so that they can take appropriate action., In-home education training combined with monitoring telephones has helped patients gain better control over their weight. Ultimately, it increases the awareness and knowledge of patients and their family members about the disease. Moreover, in some studies, home visitation by follow-up phone call has not been effective self-care in heart failure patients.,,,,,, Moreover, the contradictions of these studies were the lack of familiarity of nurses with the monitoring system and the high age of participants in these studies. In another study, home visitation by follow-up phone call and sending health message were not effective on quality of life and hospitalization, and the cause of the dissimilarity of the results of this study was the patient's age and duration of the disease. Based on these studies, it seems that providing training, institutionalizing with repetition and monitoring in a familiar environment like home for the patient and monitoring in a familiar environment like home can be a factor in promoting self-care behavior in patients with heart failure. An important goal in education should be the creation of healthy, right, and lasting behaviors to be effective with the continuity of care in promoting a behavior, and this is the continuity of care which is valuable to the patient.,
The third category: Findings indicated that group-based training motivates more patients and caregivers, activates participation in self-care, increases, and exchanges more information by other patients. The findings showed that group training has increased awareness and health literacy of the patients; therefore, the patients adhere to the low sodium diet, and they pay more attention in their diet to limit the fluid and sodium intake. Observing these factors makes patients to have better self-care.,,,,,,,, Low sodium diet and liquid constraints reduce the edema and dyspnea in patients, and they are less likely to be admitted to the hospital. Studies have shown that increasing the awareness of the patients and their caregivers has improved their health behaviors such as physical activity and athletic performance. Physical activity enhances vitality, improves sleeping, alacrity, and improves their quality of life. Studies have shown that group training improves the rehabilitation of patients with heart failure. Heart failure patients require rehabilitation interventions such as getting familiar with medicines and physical activity. With the participation of patients in group rehabilitation, their motivation for self-care will increase.,, Various studies showed that group training has been effective on self-care in heart failure patients.,,,,,,,, Group education leads to increased health awareness and literacy as well as greater understanding of the benefits and barriers of self-care in patients. But it has not reduced patients' morbidity and behavior change, such as smoking cessation and weight loss. Factors such as high age and patient culture not affect mortality and health habits. The researcher believes that if self-care activities are activated with educational methods by recognizing the attitudes and beliefs of patients and providing a favorable environment by creating confidence and comfort for the client, using the group training method can play an effective role in promoting good health behaviors.,
The fourth category: Findings indicated that e-learning education has improved self-care behaviors in patients with heart failure.,, Given the age of technology, the use of electronic equipment makes it possible to transfer more information between individuals at any time and place; on the other hand, accessibility of the educational materials and the use of images and related words will increase the motivation of individuals in learning., A research showed that e-learning has improved the cognitive status of the patients. On the other hand, e-learning in patients' rehabilitation program has improved the patients' quality of life. A study also found that telemonitoring of patients by cell phone improves self-care behaviors, daily weight control, liquid restriction, physical activity improvement, and appropriate interventions in critical situations. According to the results of the studies, this method can be used to educate the patients. It also will help the training cost to be saved, and patients and their caregivers can identify the symptoms of the disease and make appropriate decision. Studies have shown that using of educational tools (laptops and DVDs, power point), telephone follow-up, mobile virtual system, and e-mail is effective in self-care for heart failure patients.,,,,,,,,,,,, However, in some studies, the use of media was not effective in self-care of the patients.,,,,, Factors such as high age, severity of the patient, and cognitive and psychological disorders disrupt the learning of patients. The reasons for these inconsistencies with the present study were the lack of retraining during telephone follow-up during the follow-up period, factors such as the age of the patients, the presence of comorbidities, routine home visits by a trained nurse. It seems that according to the results of the previous studies, this method can be used to train patients. This method will help to save on education costs, and nurses spend less time teaching self-care for the patients with heart failure and prevented the patient and staff from wasting time.,,,,
| Conclusion|| |
The results of this study showed that educational interventions using face-to-face and teach-back training, home visitation by follow-up phone call, group training, and e-learning have a significant effect on self-care behaviors in patients with heart failure. Given the high prevalence of heart failure and the importance of self-care in heart failure, it is recommended to use one-on-one face-to-face training, home-based feedback, home visits with telephone follow-up, group training, and e-learning. Considering the importance of self-care in patients with heart failure, nurses need to be aware of the different educational methods in self-care of these patients so that they can use any of the educational methods according to the level of literacy and culture of the patients. It is also recommended that hospitals and nurses be aware of the advantages and disadvantages of educational methods so that they can train patients with heart failure by spending less time and money. It is recommended that in future studies, a systematic review and meta-analysis on each educational intervention on self-care behaviors in patients with heart failure should be conducted. The strengths of this study were to report various educational methods in promoting self-care behaviors in patients with heart failure. The limitations of this study were the studies that their full text was not available or there were language restrictions and abstracts of articles. Furthermore, due to language restrictions, articles that were not in Farsi and English were excluded.
The limitations of this study were the studies that their full text was not available or there were language restrictions and abstracts of articles.
Conflicts of interest
There are no conflicts of interest.
All authors contributed to this research.
Financial support and sponsorship
We are thankful and appreciate of Deputy of Research and Technology of Mazandaran University of Medical Sciences, as well as the Student Research Committee for funding this research.
This research was registered with the IR. MAZUMS. REC.1397.106 in the Student Research Committee of Mazandaran University of Medical Sciences. We are thankful and appreciate of Deputy of Research and Technology of Mazandaran University of Medical Sciences, as well as the Student Research Committee for funding this research.
| References|| |
Pramparo P, Montano CM, Barceló A, Avezum A, Wilks R. Cardiovascular diseases in Latin America and the Caribbean: The present situation. Prev Control 2006;2:149-57.
Moffat M, Frownfelter DL. Cardiovascular/pulmonary Essentials: Applying the Preferred Physical Therapist Practice Patterns: SLACK Incorporated; 2007.
Delavar SR, Tadayonfar M. Evaluation of the awareness of chronic heart failure patients in exacerbating factors of their disease in 2009-2010. J Res Committee Stud Sabzavar Univ Med Sci. 2011;15:16-20.
López-Sendón J. The heart failure epidemic. Medicographia 2011;33:363-9.
Smith LN, Lawrence M, Kerr SM, Langhorne P, Lees KR. Informal carers' experience of caring for stroke survivors. J Adv Nurs 2004;46:235-44.
Bagheri H, Yaghmaei F, Ashktorab T, Zayeri F. Development & psychometric properties of the social dignity questionnaire in heart failure patients. Iran J Med Ethhis Med 2014;6:20-32.
Albert NM. Promoting self-care in heart failure: State of clinical practice based on the perspectives of healthcare systems and providers. J Cardiovasc Nurs 2008;23:277-84.
Daehghan Nayeri N, Jalslinia F. Theorems Abd Nursing Theories. 1st
ed. Tehran: Boshra Publication; 2004. p. 74.
Rafiee Far A, Ahmadzadeh ASL M. Comprehensive system of empowering people for their health care. Tehran: Mehreravosh. Publication; 2005.
Adib-Hajbaghery M, Maghaminejad F, Abbasi A. The role of continuous care in reducing readmission for patients with heart failure. J Caring Sci 2013;2:255-67.
Salehzadeh A, Rahmatpour P. Self-care behaviors and related factors in patients with heart failure reffering to medical & educational center of heart in Rasht. J Holist Nurs Midwifery 2013;23:22-9.
Deaton C, Grady KL. State of the science for cardiovascular nursing outcomes: Heart failure. J Cardiovasc Nurs 2004;19:329-38.
Kandula NR, Nsiah-Kumi PA, Makoul G, Sager J, Zei CP, Glass S, et al.
The relationship between health literacy and knowledge improvement after a multimedia type 2 diabetes education program. Patient Educ Couns 2009;75:321-7.
Institute of Medicine. Health Literacy: A Prescription to end Confusion. Washington DC: National Academy of Sciences; 2004.
Shidfar MR, Hosseini M, Zadeh DS, Asasi N, Majlesi F, Nazemi S. Effectiveness of an educational program on knowledge and attitudes of angina patients in Mashhad, Iran: Results of an intervention. J Birjand Med Sci 2007. p. 9-15.
Rezaei-Louyeh H, Dalvandi A, Hosseini MA, Rahgozar M. The Effect of self care education on quality of life among patients with heart failure. Archives of Rehabilitation. 2009;2:21-26.
Rodríguez-Gázquez Mde L, Arredondo-Holguín E, Herrera-Cortés R. Effectiveness of an educational program in nursing in the self-care of patients with heart failure: Randomized controlled trial. Rev Lat Am Enfermagem 2012;20:296-306.
Mangolian SP, Shahnazari J, Mahmoodi M, Farokhzadian J. The effect of an educational self-care program on knowledge and performance in patients with heart failure. Iranian Journal of Med Edu 2012;11:619-90.
Zamanzadeh V, Heidarzadeh M, Oshvandi K, Lakdizaji S. Relationship Between Quality of Life and Social Support in Hemodialysis Patients in Imam Khomeini and Sina Educational Hospitals of Tabriz University of medical sciences. Med Journal of Tabriz University of Med Sci 2007;29:49-54.
Heidari M, Sarvandian S, Moradbeigi K, Akbari Nassaji N, Vafaizadeh M. Comparing the effect of tele nursing and education without follow-up in the caregivers of heart failure patients on the self-care behavior and clinical status of heart failure patients. J Hayat 2017;23:44-58.
Aghakhani NA, Hemmati Maslakpak M, Alinejad V, Khademvatan K. Study of the effect of self-care program model based on orem's pattern on the quality of life in patients with heart failure. J Urmia Nurs Midwifery Fac 2018;16:65-71.
Ghahramani A, Kamrani F, Mohamadzadeh S, Namadi M. Effect of self care education on knowledge, performance and readmission of heart failure patients admitted in city hospitals of Ardabil. Iranian Journal of Nur Research 2013;8:62-72.
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:E9-16.
Dinh H, Bonner A, Ramsbotham J, Clark R. Self-management intervention using teach-back for people with heart failure in Vietnam: A cluster randomized controlled trial protocol. Nurs Health Sci 2018;20:458-63.
Dalir Z, Reihani Z, Mazlom R, Vakilian F. Effect of training based on teach back method on self-care in patients with heart failure. J Maz Univ Med Sci 2016;25:209-20.
Wonggom P, Du H, Clark RA. Evaluation of the effectiveness of an interactive avatar-based education application for improving heart failure patients' knowledge and self-care behaviours: A pragmatic randomized controlled trial protocol. J Adv Nurs 2018;74:2667-76.
Smeulders ES, van Haastregt JC, van Hoef EF, van Eijk JT, Kempen GI. Evaluation of a self-management programme for congestive heart failure patients: Design of a randomised controlled trial. BMC Health Serv Res 2006;6:91.
Siabani S, Driscoll T, Davidson PM, Leeder SR. Efficacy of a home-based educational strategy involving community health volunteers in improving self-care in patients with chronic heart failure in Western Iran: A randomized controlled trial. Eur J Cardiovasc Nurs 2016;15:363-71.
Khaledi GH, Mostafavi F, Eslami AA, Rooh Afza H, Mostafavi F, Akbar H. Evaluation of the effect of perceived social support on promoting self-care behaviors of heart failure patients referred to the cardiovascular research center of Isfahan. Iran Red Crescent Med J 2015;17:e22525.
Otsu H, Moriyama M. Effectiveness of an educational self-management program for outpatients with chronic heart failure. Jpn J Nurs Sci 2011;8:140-52.
Dickson VV, Melkus GD, Dorsen C, Katz S, Riegel B. Improving heart failure self-care through a community-based skill-building intervention: A study protocol. J Cardiovasc Nurs 2015;30:S14-24.
DeWalt DA, Malone RM, Bryant ME, Kosnar MC, Corr KE, Rothman RL, et al.
A heart failure self-management program for patients of all literacy levels: A randomized, controlled trial [ISRCTN11535170]. BMC Health Serv Res 2006;6:30.
Deek H, Chang S, Newton PJ, Noureddine S, Inglis SC, Arab GA, et al.
An evaluation of involving family caregivers in the self-care of heart failure patients on hospital readmission: Randomised controlled trial (the FAMILY study). Int J Nurs Stud 2017;75:101-11.
Vellone E, Paturzo M, D'Agostino F, Petruzzo A, Masci S, Ausili D, et al.
Motivational interviewing to improve self-care in heart failure patients (MOTIVATE-HF): Study protocol of a three-arm multicenter randomized controlled trial. Contemp Clin Trials 2017;55:34-8.
Riegel B, Carlson B, Glaser D, Kopp Z, Romero TE. Standardized telephonic case management in a hispanic heart failure population. Dis Manag Health Outcom 2002;10:241-9.
Cossette S, Belaid H, Heppell S, Mailhot T, Guertin MC. Feasibility and acceptability of a nursing intervention with family caregiver on self-care among heart failure patients: A randomized pilot trial. Pilot Feasibility Stud 2016;2:34.
Caldwell MA, Peters KJ, Dracup KA. A simplified education program improves knowledge, self-care behavior, and disease severity in heart failure patients in rural settings. Am Heart J 2005;150:983.
Doughty RN, Wright SP, Pearl A, Walsh HJ, Muncaster S, Whalley GA, et al.
Randomized, controlled trial of integrated heart failure management: The Auckland heart failure management study. Eur Heart J 2002;23:139-46.
Saeidpour R, Khalkhali HR, Baghaei R, Shams S. The effect of pictorial training on self-care activities in patients with congestive heart failure hospitalized to the Abbasi hospital miandoab–2016. J Urmia Nurs Midwifery Fac 2017;15:460-8.
Moradi Y, Aghakarimi K, Rahmani A, Sheikhy N. Effect of applying follow-up care model on self-care management in heart failure patients: A randomized clinical trial. J Urmia Nurs Midwifery Fac 2017;15:208-17.
Delaney C, Apostolidis B, Bartos S, Morrison H, Smith L, Fortinsky R. A randomized trial of telemonitoring and self-care education in heart failure patients following home care discharge. Home Health Care Manage Pract 2013;25:187-95.
Pistoria M, Peter D, Robinson P, Jordan K, Lawrence S. Using teach back to reduce readmission rates in hopitalized heart failure patients. Lehigh Valley Health Network, LVHN Scholarly Works. Pennsylvania, US; 2012.
Ruschel KB, Souza E, Mussi CM, Polanczyk C, Clausell N, Rabelo-Silva ER. Cost-Effectiveness of Home Visit Program for Heart Failure in a Middle Income Country. Journal of Card Fail 2013;19:S89.
Trojahn MM, Ruschel KB, Nogueira de Souza E, Mussi CM, Naomi Hirakata V, Nogueira Mello Lopes A, et al.
Predictors of better self-care in patients with heart failure after six months of follow-up home visits. Nurs Res Pract 2013;2013:254352.
Bowles KH, Riegel B, Weiner MG, Glick H, Naylor MD. The effect of telehomecare on heart failure self care. AMIA Annu Symp Proc 2010;2010:71-5.
Young L, Barnason S, Kupzyk K. Mechanism of engaging self-management behavior in rural heart failure patients. Appl Nurs Res 2016;30:222-7.
Sethares KA, Elliott K. The effect of a tailored message intervention on heart failure readmission rates, quality of life, and benefit and barrier beliefs in persons with heart failure. Heart Lung 2004;33:249-60.
Masterson Creber R, Patey M, Lee CS, Kuan A, Jurgens C, Riegel B. Motivational interviewing to improve self-care for patients with chronic heart failure: MITI-HF randomized controlled trial. Patient Educ Couns 2016;99:256-64.
Paradis V, Cossette S, Frasure-Smith N, Heppell S, Guertin MC. The efficacy of a motivational nursing intervention based on the stages of change on self-care in heart failure patients. J Cardiovasc Nurs 2010;25:130-41.
Navidian A, Mobaraki H, Shakiba M. The effect of education through motivational interviewing compared with conventional education on self-care behaviors in heart failure patients with depression. Patient Educ Couns 2017;100:1499-504.
Arredondo Holguín E, Gázquez Mdl ÁR, Higuita Urrego LM. Improvement of self-care behaviors after a nursing educational intervention with patients with heart failure. Invest Educ Enferm 2012;30:188-97.
Lycholip E, Thon Aamodt I, Lie I, Šimbelytė T, Puronaitė R, Hillege H, et al.
The dynamics of self-care in the course of heart failure management: Data from the IN TOUCH study. Patient Prefer Adherence 2018;12:1113-22.
Hoban MB, Fedor M, Reeder S, Chernick M. The effect of telemonitoring at home on quality of life and self-care behaviors of patients with heart failure. Home Healthc Nurse 2013;31:368-77.
Bryant R, Gaspar P. Implementation of a self-care of heart failure program among home-based clients. Geriatr Nurs 2014;35:188-93.
Du HY, Newton PJ, Zecchin R, Denniss R, Salamonson Y, Everett B, et al.
An intervention to promote physical activity and self-management in people with stable chronic heart failure the home-heart-walk study: Study protocol for a randomized controlled trial. Trials 2011;12:63.
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;11:609-16.
Mamianloo H, Tol A, Khatibi N, Ahmadi Komoleleh S, Mohebbi B. Assessing the effect of small group intervention program on knowledge and health literacy among patients with heart failure. J Nurs Educ 2014;3:34-41.
Wu JR, Reilly CM, Holland J, Higgins M, Clark PC, Dunbar SB. Relationship of health literacy of heart failure patients and their family members on heart failure knowledge and self-care. J Fam Nurs 2017;23:116-37.
Shoja Fard J, Nadrian H, Baghiani Moghadam MH, Mazloomy Mahmoudabad SS, Santi HR, Asgarshahy M. The effect of education on self-care behavior, and the benefitis and barriers in patients with heart failure in Tehran. J Fac Tehran Univ Med Sci 2008;2:43-55.
Meng K, Musekamp G, Seekatz B, Glatz J, Karger G, Kiwus U, et al.
Evaluation of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation: Study protocol of a cluster randomized controlled trial. BMC Cardiovasc Disord 2013;13:60.
Meng K, Musekamp G, Schuler M, Seekatz B, Glatz J, Karger G, et al.
The impact of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation. Patient Educ Couns 2016;99:1190-7.
Vaillant-Roussel H, Laporte C, Pereira B, De Rosa M, Eschalier B, Vorilhon C, et al.
Impact of patient education on chronic heart failure in primary care (ETIC): A cluster randomised trial. BMC Fam Pract 2016;17:80.
Baert A, Clays E, Bolliger L, De Smedt D, Lustrek M, Vodopija A, et al.
A personal decision support system for heart failure management (HeartMan): Study protocol of the heartMan randomized controlled trial. BMC Cardiovasc Disord 2018;18:186.
Howie-Esquivel J, Bibbins-Domingo K, Clark R, Evangelista L, Dracup K. A culturally appropriate educational intervention can improve self-care in hispanic patients with heart failure: A pilot randomized controlled trial. Cardiol Res 2014;5:91-100.
Srisuk N, Cameron J, Ski CF, Thompson DR. Randomized controlled trial of family-based education for patients with heart failure and their carers. J Adv Nurs 2017;73:857-70.
Boyde M, Peters R, Hwang R, Korczyk D, Ha T, New N. The self-care educational intervention for patients with heart failure: A study protocol. J Cardiovasc Nurs 2017;32:165-70.
Cameron J, Rendell PG, Ski CF, Kure CE, McLennan SN, Rose NS, et al.
PROspective MEmory training to improve HEart failUre self-care (PROMETHEUS): Study protocol for a randomised controlled trial. Trials 2015;16:196.
Clark AP, McDougall G, Riegel B, Joiner-Rogers G, Innerarity S, Meraviglia M, et al.
Health status and self-care outcomes after an education-support intervention for people with chronic heart failure. J Cardiovasc Nurs 2015;30:S3-13.
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;51:1207-13.
Dunbar SB, Reilly CM, Gary R, Higgins MK, Culler S, Butts B, et al.
Randomized clinical trial of an integrated self-care intervention for persons with heart failure and diabetes: Quality of life and physical functioning outcomes. J Card Fail 2015;21:719-29.
Köberich S, Lohrmann C, Mittag O, Dassen T. Effects of a hospital-based education programme on self-care behaviour, care dependency and quality of life in patients with heart failure – A randomised controlled trial. J Clin Nurs 2015;24:1643-55.
Boyde M, Peters R, New N, Hwang R, Ha T, Korczyk D. Self-care educational intervention to reduce hospitalisations in heart failure: A randomised controlled trial. Eur J Cardiovasc Nurs 2018;17:178-85.
Smeulders ES, van Haastregt JC, Ambergen T, Stoffers HE, Janssen-Boyne JJ, Uszko-Lencer NH, et al.
Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme. Patient Educ Couns 2010;81:214-21.
Smith CE, Piamjariyakul U, Dalton KM, Russell C, Wick J, Ellerbeck EF. Nurse-led multidisciplinary heart failure group clinic appointments: Methods, materials, and outcomes used in the clinical trial. J Cardiovasc Nurs 2015;30:S25-34.
Stamp KD, Dunbar SB, Clark PC, Reilly CM, Gary RA, Higgins M, et al.
Family partner intervention influences self-care confidence and treatment self-regulation in patients with heart failure. Eur J Cardiovasc Nurs 2016;15:317-27.
Taylor RS, Hayward C, Eyre V, Austin J, Davies R, Doherty P, et al.
Clinical effectiveness and cost-effectiveness of the rehabilitation enablement in chronic heart failure (REACH-HF) facilitated self-care rehabilitation intervention in heart failure patients and caregivers: Rationale and protocol for a multicentre randomised controlled trial. BMJ Open 2015;5:e009994.
Veroff DR, Sullivan LA, Shoptaw EJ, Venator B, Ochoa-Arvelo T, Baxter JR, et al.
Improving self-care for heart failure for seniors: The impact of video and written education and decision aids. Popul Health Manag 2012;15:37-45.
Boyne JJ, Vrijhoef HJ, Spreeuwenberg M, De Weerd G, Kragten J, Gorgels AP, et al.
Effects of tailored telemonitoring on heart failure patients' knowledge, self-care, self-efficacy and adherence: A randomized controlled trial. Eur J Cardiovasc Nurs 2014;13:243-52.
Dansky KH, Vasey J, Bowles K. Use of telehealth by older adults to manage heart failure. Res Gerontol Nurs 2008;1:25-32.
Shively MJ, Gardetto NJ, Kodiath MF, Kelly A, Smith TL, Stepnowsky C, et al.
Effect of patient activation on self-management in patients with heart failure. J Cardiovasc Nurs 2013;28:20-34.
Boyde M, Song S, Peters R, Turner C, Thompson DR, Stewart S. Pilot testing of a self-care education intervention for patients with heart failure. Eur J Cardiovasc Nurs 2013;12:39-46.
Ross A, Ohlsson U, Blomberg K, Gustafsson M. Evaluation of an intervention to individualise patient education at a nurse-led heart failure clinic: A mixed-method study. J Clin Nurs 2015;24:1594-602.
Tamura-Lis W. Teach-back for quality education and patient safety. Urol Nurs 2013;33:267-71, 298.
Shojaee A, Nehrir B, Naderi N, Zareiyan A. Effect of patient education and telephone follow up by the nurse on the level of hope in patients suffering from heart failure. Journal of Nur Educ 2013;2:16-26.
Sherwood A, O'Connor CM, Routledge FS, Hinderliter AL, Watkins LL, Babyak MA, et al
. Coping effectively with heart failure (COPE-HF): Design and rationale of a telephone-based coping skills intervention. J Cardiac Fail 2011;17:201-7.
Safari M SD, Hofrani FG, Haidarnia A, Pakpour A. Theories, Models and methods in Health Education and Promotion, 1th edition, Theran, Asare Sobhan Publications, 2009.
Jessup M. Guidelines for the diagnosis and management of heart failure in adults. Circ 2009;119:1977-2016.
Dunbar SB, Clark PC, Quinn C, Gary RA, Kaslow NJ. Family influences on heart failure self-care and outcomes. J Cardiovasc Nurs 2008;23:258-65.
Arredondo Holguín E, Rodríguez Gázquez MdlÁ, Higuita Urrego LM. Improvement of self-care behaviors after a nursing educational intervention with patients with heart failure. Invest Educ Enferm. 2012;30:188-97.