The effect of health literacy promotion through virtual education on the self-care behaviors in patients with heart failure: A Clinical Trial

Document Type : Original Article

Authors

1 Ph.D. in Nursing, Assistant Professor, Department of Nursing, School of Medical Sciences, Yazd Branch, Islamic Azad University, Yazd, Iran

2 M.Sc. student of Critical Care Nursing, Department of Nursing, School of Medical Sciences, Yazd Branch, Islamic Azad University, Yazd, Iran.

3 Ph.D. in Nursing, Associate Professor, Department of Nursing, Nursing and Midwifery Research, Center, Research Center for Neonate & Mother, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.

Abstract

Background & Objective: Paying due attention to educational intervention based self-care skills in patients with chronic diseases, especially cardiovascular patients, can predispose them to improve their condition. This study investigates the effect of promotion of health literacy through virtual education on the self-care behaviors in patients with heart failure.

Materials and Methods: This clinical trial was conducted on 56 heart failure patients. The participants were selected using the convenience sampling method and then randomly assigned into two groups (28 in the experimental group and 28 in the control group). The experimental group received a health literacy promotion program via the iSpring Play app. The intervention consisted of four major topics on self-care issues in the form of text, photos, animation, and short videos. Each week, a topic link was made available to participants. After sending the link, through the cyberspace system, the necessary follow-ups on accessing and understanding the information and its application and emphasizing the correct points of self-care were performed and the participants' questions were answered. Data were collected with demographics questionnaire and Riegel et al.’s Self-care Index before and after the intervention. The collected data were analyzed with SPSS19 using descriptive and inferential statistics.

Results: The overall self-care mean score increased in both groups after intervention compared to before the intervention indicating a significant difference on the basis of results of paired t-test (p <0.05). The mean score of overall self-care was greater in the experimental group (48.75±5.5) after the intervention compared to the control group (39.96±6.16). Independent t-test showed a significant difference between the two groups (p <0.05).

Conclusion: The results demonstrated a significant increase in the mean score of overall self-care in patients undergoing health literacy promotion programs with virtual education. Hence, innovative methods based on virtual education could be considered to improve self-care behaviors in cardiac failure patients.

Keywords

References

1. Rafii F, Shahpoorian F, Naasher Z, Azarbaad M, Hosseini F. The importance of learning needs of CHF patients from patients' and nurses' perspective. Iran Journal of Nursing. 2009;22(57):19-30.
 
2. Del Gobbo LC, Kalantarian S, Imamura F, Lemaitre R, Siscovick DS, Psaty BM, et al. Contribution of major lifestyle risk factors for incident heart failure in older adults: the Cardiovascular Health Study. JACC: Heart Failure. 2015;3(7):520-8.
https://doi.org/10.1016/j.jchf.2015.02.009
PMid:26160366 PMCid:PMC4508377
 
3. Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933-44.
https://doi.org/10.1161/CIR.0b013e31820a55f5
PMid:21262990
 
4. Hekmatpou D, Mohammadi E, Ahmadi F, Arefi SH. Termination of professional responsibility: Exploring the process of discharging patients with heart failure from hospitals. International journal of nursing practice. 2010;16(4):389-96.
https://doi.org/10.1111/j.1440-172X.2010.01856.x
PMid:20649671
 
5. Sheikh Sharafi H, Seyed amini B. Assessment of health literacy and self-care in heart failure patients. Journal of Health Literacy. 2017;1(4):203-19.
https://doi.org/10.22038/jhl.2017.10854
 
6. Gholian-Aval M, Tehrani H, Esmaily H. Evaluation of Self-Care Status and Its Relationship with Self-Efficacy of Patients with Hypertension. Iranian Journal of Health Education and Health Promotion. 2021;8(4):336-47.
https://doi.org/10.29252/ijhehp.8.4.336
 
7. Cameron J, Worrall-Carter L, Page K, Stewart S. Self-care behaviours and heart failure: Does experience with symptoms really make a difference? European Journal of Cardiovascular Nursing. 2010;9(2):92-100.
https://doi.org/10.1016/j.ejcnurse.2009.10.004
PMid:20441991
 
8. Nichols GA, Brown JB. Unadjusted and adjusted prevalence of diagnosed depression in type 2 diabetes. Diabetes care. 2003;26(3):744-9.
https://doi.org/10.2337/diacare.26.3.744
PMid:12610032
 
9. Nieuwenhuis MM, Jaarsma T, van Veldhuisen DJ, Postmus D, van der Wal MH. Long-term compliance with nonpharmacologic treatment of patients with heart failure. The American journal of cardiology. 2012;110(3):392-7.
https://doi.org/10.1016/j.amjcard.2012.03.039
PMid:22516525
 
10. Cocchieri A, Riegel B, D'Agostino F, Rocco G, Fida R, Alvaro R, et al. Describing self-care in Italian adults with heart failure and identifying determinants of poor self-care. European Journal of Cardiovascular Nursing. 2015;14(2):126-36.
https://doi.org/10.1177/1474515113518443
PMid:24366984
 
11. Buck HG, Mogle J, Riegel B, McMillan S, Bakitas M. Exploring the relationship of patient and informal caregiver characteristics with heart failure self-care using the actor-partner interdependence model: implications for outpatient palliative care. Journal of palliative medicine. 2015;18(12):1026-32.
https://doi.org/10.1089/jpm.2015.0086
PMid:26540092
 
12. Lin C-Y, Dracup K, Biddle M, Moser D. Heart Failure Symptom Knowledge Improves Heart Failure Self-Care in Rural Patients with Heart Failure. Journal of Cardiac Failure. 2016;22(8):S6.
https://doi.org/10.1016/j.cardfail.2016.06.028
 
13. Cajita MI, Cajita TR, Han H-R. Health literacy and heart failure: a systematic review. The Journal of cardiovascular nursing. 2016;31(2):121-30.
https://doi.org/10.1097/JCN.0000000000000229
PMid:25569150 PMCid:PMC4577469
 
14. de Melo Ghisi GL, da Silva Chaves GS, Britto RR, Oh P. Health literacy and coronary artery disease: A systematic review. Patient education and counseling. 2018;101(2):177-84.
https://doi.org/10.1016/j.pec.2017.09.002
PMid:28899710
 
15. Kazemi M, Barkhordari-Sharifabad M, Nasiriani K, Fallahzadeh H. The Correlation of Health Literacy with Quality of Life in Asthmatic Patients. Iran Journal of Nursing. 2019;32(121):50-62.
 
16. Rezaee N, Seraji M. Relationship Between Health Literacy and Self-Care in Heart Failure Patients. Journal of Health Literacy. 2019;4(1):18-24.
https://doi.org/10.22038/jhl.2019.39135.1044
 
17. Perrin A, Abdalla G, Viprey M, Delahaye F, Mewton N, Ovize M, et al. Prevalence of low health literacy levels in decompensated heart failure compared with acute myocardial infarction patients. ESC Heart Failure. 2021;8: 1446-59.
https://doi.org/10.1002/ehf2.13230
PMid:33544458 PMCid:PMC8006735
 
18. DeWalt DA, Hink A. Health literacy and child health outcomes: a systematic review of the literature. Pediatrics. 2009;124(Supplement 3):S265-S74.
https://doi.org/10.1542/peds.2009-1162B
PMid:19861480
 
19. Dervin B, Nilan M. Information needs and uses. Annual review of information science and technology. 1986;21:3-33.
 
20. Bowles KH, Dykes P, Demiris G. The use of health information technology to improve care and outcomes for older adults. Research in gerontological nursing. 2015;8(1):5-10.
https://doi.org/10.3928/19404921-20121222-01
PMid:25625621 PMCid:PMC4431690
 
21. Alotaibi YK, Federico F. The impact of health information technology on patient safety. Saudi medical journal. 2017;38(12):1173-80.
https://doi.org/10.15537/smj.2017.12.20631
PMid:29209664 PMCid:PMC5787626
 
22. 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. Cardiology research. 2014;5(3-4):91-100.
https://doi.org/10.14740/cr346w
PMid:28348704 PMCid:PMC5358169
 
23. Clark AP, McDougall G, Riegel B, Joiner-Rogers G, Innerarity S, Meraviglia M, et al. Health status and self-care outcomes following an education-support intervention for people with chronic heart failure. The Journal of cardiovascular nursing. 2015;30(4 0 1):S3-S13.
https://doi.org/10.1097/JCN.0000000000000169
PMid:24978157 PMCid:PMC4276559
 
24. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison's principles of internal medicine. 18 ed. Newyork: Mcgraw-hill New York; 2012.
 
25. Radović-Marković M. Advantages and disadvantages of e-learning in comparison to traditional forms of learning. Annals of the University of Petroşani, Economics. 2010;10(2):289-98.
 
26. Salehmoghaddam AR, Khosravi Bonjar A, Karimi Moonaghi H, Gholami H. An investigation of the Effect of E-learning education method on dietary regimen in type 2 diabetic patients. Evidence Based Care. 2013;3(3):51-8.
 
27. 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. The J Urmia Nurs Midwifery Fac. 2017;15(3):208-17
 
28. Lopes AP, Soares F, Teles C, Rodrigues A, Torres C, Lopes IC. Creating interactive learning materials to promote statistical skills in higher education Proceedings of INTED2020 Conference; Valencia, Spain2020. p. 4160-6.
https://doi.org/10.21125/inted.2020.1155
 
29. Anwar MS, Choirudin C, Ningsih EF, Dewi T, Maseleno A. Developing an Interactive Mathematics Multimedia Learning Based on Ispring Presenter in Increasing Students' Interest in Learning Mathematics. Al-Jabar: Jurnal Pendidikan Matematika. 2019;10(1):135-50.
https://doi.org/10.24042/ajpm.v10i1.4445
 
30. Riegel B, Carlson B, Moser DK, Sebern M, Hicks FD, Roland V. Psychometric testing of the self-care of heart failure index. Journal of cardiac failure. 2004;10(4):350-60.
https://doi.org/10.1016/j.cardfail.2004.06.409
https://doi.org/10.1016/j.cardfail.2003.12.001
PMid:15309704
 
31. Riegel B, Moser DK, Anker SD, Appel LJ, Dunbar SB, Grady KL, et al. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation. 2009;120(12):1141-63.
https://doi.org/10.1161/CIRCULATIONAHA.109.192628
PMid:19720935
 
32. 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. Congestive Heart Failure. 2013;19(4):E9-E16.
https://doi.org/10.1111/chf.12014
PMid:23279120
 
33. Moadab F, Ghanbari A, Salari A, Kazemnejad E, Sadaghi Sabet M, Pariad E. Study status of self-care behaviors and gender differences in patients with heart failure. Journal of Payavard Salamat. 2014;8(3):220-34.
 
34. Wu J-R, Moser DK, DeWalt DA, Rayens MK, Dracup K. Health literacy mediates the relationship between age and health outcomes in patients with heart failure. Circulation: Heart Failure. 2016;9(1):e002250.
https://doi.org/10.1161/CIRCHEARTFAILURE.115.002250
 
35. Seraji M, Tabatabaie P, Rakhshani F, Shahrakipour M. The Effect of educating self-care behaviors to patients with heart failure in hospitals of Zahedan. Health Scope. 2013;2(1):104-9.
https://doi.org/10.17795/jhealthscope-11414
 
36. Krumholz HM, Amatruda J, Smith GL, Mattera JA, Roumanis SA, Radford MJ, et al. Randomized trial of an education and support intervention to preventreadmission of patients with heart failure. Journal of the American College of Cardiology. 2002;39(1):83-9.
https://doi.org/10.1016/S0735-1097(01)01699-0
 
37. Artinian NT, Magnan M, Sloan M, Lange MP. Self-care behaviors among patients with heart failure. Heart & Lung. 2002;31(3):161-72.
https://doi.org/10.1067/mhl.2002.123672
PMid:12011807
 
38. Strömberg A, Mårtensson J, Fridlund B, Levin L-Å, Karlsson J-E, Dahlström U. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial. European heart journal. 2003;24(11):1014-23.
https://doi.org/10.1016/S0195-668X(03)00112-X
 
39. Navidian A, Yaghoubinia F, Ganjali A, Khoshsimaee S. The effect of self-care education on the awareness, attitude, and adherence to self-care behaviors in hospitalized patients due to heart failure with and without depression. PloS one. 2015;10(6):e0130973.
https://doi.org/10.1371/journal.pone.0130973
PMid:26091101 PMCid:PMC4475047
 
40. Gheiasi SF, Roohani M, Hanifi N, Kamali K. The impact of a training program based on learning needs on self-care behaviors among patients with Heart failure. Evidence Based Care. 2017;7(1):15-24.
 
41. Hwang B, Pelter MM, Moser DK, Dracup K. Effects of an educational intervention on heart failure knowledge, self-care behaviors, and health-related quality of life of patients with heart failure: Exploring the role of depression. Patient Education and Counseling. 2020;103(6):1201-8.
https://doi.org/10.1016/j.pec.2020.01.007
PMid:31964579 PMCid:PMC7253326
 
42. Salahodinkolah MK, Ganji J, Moghadam SH, Shafipour V, Jafari H, Salari S. Educational intervention for improving self-care behaviors in patients with heart failure: A narrative review. Journal of Nursing and Midwifery Sciences. 2020;7(1):60-8.
https://doi.org/10.4103/JNMS.JNMS_19_19
 
43. Riegel B, Driscoll A, Suwanno J, Moser DK, Lennie TA, Chung ML, et al. Heart failure self-care in developed and developing countries. Journal of cardiac failure. 2009;15(6):508-16.
https://doi.org/10.1016/j.cardfail.2009.01.009
PMid:19643362 PMCid:PMC2745342
 
44. Riegel B, Dickson VV, Faulkner KM. The situation-specific theory of heart failure self-care: revised and updated. Journal of Cardiovascular Nursing. 2016;31(3):226-35.
https://doi.org/10.1097/JCN.0000000000000244
PMid:25774844
 
45. Cené CW, Haymore LB, Dolan-Soto D, Lin F-C, Pignone M, DeWalt DA, et al. Self-care confidence mediates the relationship between perceived social support and self-care maintenance in adults with heart failure. Journal of cardiac failure. 2013;19(3):202-10.
https://doi.org/10.1016/j.cardfail.2013.01.009
PMid:23482082 PMCid:PMC3596888
 
46. Liou H-L, Chen H-I, Hsu S-C, Lee S-C, Chang C-J, Wu M-J. The effects of a self-care program on patients with heart failure. Journal of the Chinese Medical Association. 2015;78(11):648-56.
https://doi.org/10.1016/j.jcma.2015.06.004
PMid:26190378
 
47. 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 cardiovascular disorders. 2018;18(186):1-9.
https://doi.org/10.1186/s12872-018-0921-2
PMid:30261836 PMCid:PMC6161437
 
48. 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. Journal of Cardiovascular Nursing. 2017;32(2):165-70.
https://doi.org/10.1097/JCN.0000000000000318
PMid:26696034
 
49. 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):1-14.
https://doi.org/10.1186/s13063-015-0721-2
PMid:25927718 PMCid:PMC4419391
 
50. 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. Journal of cardiac failure. 2015;21(9):719-29.
https://doi.org/10.1016/j.cardfail.2015.05.012
PMid:26028261 PMCid:PMC4554817
 
51. 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. Journal of clinical nursing. 2015;24(11-12):1643-55.
https://doi.org/10.1111/jocn.12766
PMid:25661470
 
52. 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. The Journal of cardiovascular nursing. 2015;30(4 0 1):S25-S34.
https://doi.org/10.1097/JCN.0000000000000255
PMid:25774836 PMCid:PMC4464953
 
53. 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. European Journal of Cardiovascular Nursing. 2016;15(5):317-27.
https://doi.org/10.1177/1474515115572047
PMid:25673525 PMCid:PMC4532663
 
54. 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(12):e009994.
https://doi.org/10.1136/bmjopen-2015-009994
PMid:26700291 PMCid:PMC4691763
 
55. 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. European Journal of Cardiovascular Nursing. 2014;13(3):243-52.
https://doi.org/10.1177/1474515113487464
PMid:23630403
 
56. Dansky KH, Vasey J, Bowles K. Use of telehealth by older adults to manage heart failure. Research in Gerontological Nursing. 2008;1(1):25-32.
https://doi.org/10.3928/19404921-20080101-01
PMid:20078015
 
57. 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. Journal of Cardiovascular Nursing. 2013;28(1):20-34.
https://doi.org/10.1097/JCN.0b013e318239f9f9
PMid:22343209
 
58. 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. European Journal of Cardiovascular Nursing. 2013;12(1):39-46.
https://doi.org/10.1177/1474515111430881
PMid:22357784
 
59. Srisuk N, Cameron J, Ski CF, Thompson DR. Randomized controlled trial of family‐based education for patients with heart failure and their carers. Journal of advanced nursing. 2017;73(4):857-70.
https://doi.org/10.1111/jan.13192
PMid:27779768
 
60. 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. International Journal of Nursing Studies. 2014;51(9):1207-13.
https://doi.org/10.1016/j.ijnurstu.2014.01.010
PMid:24508285
 
61. 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. European Journal of Cardiovascular Nursing. 2018;17(2):178-85.
https://doi.org/10.1177/1474515117727740
PMid:28832179
 
62. 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 education and counseling. 2010;81(2):214-21.
https://doi.org/10.1016/j.pec.2010.01.003
PMid:20153132
 
63. Veroff DR, Sullivan LA, Shoptaw E, 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. Population health management. 2012;15(1):37-45.
https://doi.org/10.1089/pop.2011.0019
PMid:22004181
 
64. 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. Journal of clinical nursing. 2015;24(11-12):1594-602.
https://doi.org/10.1111/jocn.12760
PMid:25753064
 
65. Wonggom P, Nolan P, Clark RA, Barry T, Burdeniuk C, Nesbitt K, et al. Effectiveness of an avatar educational application for improving heart failure patients' knowledge and self‐care behaviors: A pragmatic randomized controlled trial. Journal of advanced nursing. 2020;76(9):2401-15..
https://doi.org/10.1111/jan.14414
PMid:32395836

Files

Share

How to cite

Statistics