The effect of education through motivational interviewing compared with conventional education on self-care behaviors in heart failure patients with depression

ObjectiveTo determine the effect of education based on motivational interviewing on self-care behaviors in heart failure patients with depression.MethodsIn this study, 82 patients suffering from heart failure whose depression had been confirmed were selected and divided into two groups. The Self-Care Heart Failure Index was utilized to evaluate self-care behavior. The intervention group received four sessions of self-care behavior education based on the principles of motivational interviewing, and the control group received four sessions of conventional education on self-care behavior. At 8 weeks after finishing the interventions, the self-care behaviors of both groups were evaluated. Data were analyzed using paired and independent t-tests, Chi-square, and analysis of covariance, as appropriate.ResultsThe average increase in the overall scores and the scores on the three sub-scales of self-care behavior (maintenance, management, and confidence) of the heart failure patients with depression were significantly higher after education based on motivational interviewing than after conventional self-care education (p < 0.05).ConclusionsMotivational interviewing had a significant positive effect on self-care behaviors in patients with heart failure and depression.Practice implicationsDue to the effectiveness of the MI, using motivational interviewing for education in depressed HF patients is recommended.     

跟进式电话随访在出院心肌梗死患者中的应用

目的:探讨跟进式电话随访在出院心肌梗死(myocardial infarction,MI)患者中的应用价值.方法:选取2015年1月至2016年5月滨州医学院烟台附属医院收治的MI患者128例.采用随机数字表法将患者分为观察组和对照组,每组64例.对照组只进行出院健康教育,观察组接受为期6个月的跟进式电话随访.结果:干预前,两组健康调查简表(short from health survey,SF-36)量表各维度得分比较差异均无统计学意义(P＞0.05).干预6个月后,观察组生活质量显著上升,差异有统计学意义(P＜0.05),对照组无明显变化,差异无统计学意义(P＞0.05).干预前,两组自护能力测定量表(exercise of selfcare agency scale,ESCA)各维度得分比较差异均无统计学意义(P＞0.05).干预6个月后,观察组自护能力显著上升,差异有统计学意义(P＜0.05),对照组无明显变化(P＞0.05).干预前,两组焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-depression anxiety scale,SDS)得分比较差异均无统计学意义(P＞0.05).干预6个月后,观察组焦虑、抑郁状况显著改善(P＜0.05),对照组无明显变化(P＞0.05).结论:跟进式电话随访有助于提高MI出院患者的生活质量和自护能力,改善心理健康状况,值得临床推荐.     

A peer support intervention in improving glycemic control in patients with type 2 diabetes

Objective

This study aims to assess the effectiveness of a peer support intervention, in which patients with T2DM were provided ongoing self-management support by trained peers with diabetes directed at improving self-care behaviors, self-efficacy and life quality.

Impact of telephone counseling on the quality of life of patients discharged after coronary artery bypass grafts

BackgroundThis study aimed to assess the impact of telephone counseling on quality of life in patients with coronary artery bypass graft.MethodsA quasi-experimental study was conducted with 71 discharged patients after coronary artery bypass graft surgery at Ekbatan Edcuational hospital in Hamadan, Iran, in 2014. The patients were randomly allocated into intervention (n = 36) and control group (n = 35). The intervention group received education and counseling about therapeutic plan via telephone after discharge. Patients in the control group received only routines. All patients completed the quality of life questionnaire before and after the intervention period of five weeks.ResultsThere was no significant difference between intervention and control group about quality of life before intervention (p = 0.696). However, there was significant and positive deference between the two groups in favor of the telephone counseling after the intervention (P = 0.01) and control group (P = 0.04). Quality of life in the intervention group was significantly better compared to control group (P = 0.01).ConclusionsTelephone counseling could be a cost-effective patient counseling plan for therapeutic adherence after coronary artery bypass surgery in order to improve the patients’ quality of life.Practice implicationsTelephone counseling is feasible to implement and well accepted for patient counseling for many diseases.     

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

ObjectivesTo test effects of an educational intervention on patient-reported outcomes among rural heart failure (HF) patients and to examine whether effects differed between patients with and without depression.MethodsPatients (N = 614) were randomized to usual care (UC) or 1 of 2 intervention groups. Both intervention groups received face-to-face education, followed by either 2 phone calls (LITE) or biweekly calls until they demonstrated content competency (PLUS). Follow-up lasted 24 months. Statistical analyses included linear mixed models and subgroup analyses by depression status.ResultsBoth intervention groups showed improvement in HF knowledge at 3 months (LITE–UC, p = 0.003; PLUS–UC, p < 0.001). Improvement lasted 24 months only in the PLUS group. Compared to UC, both intervention groups exhibited better self-care at 3 months (LITE–UC, p < 0.001; PLUS–UC, p < 0.001) and 12 months (LITE–UC, p = 0.001; PLUS–UC, p = 0.002). There were no differences in health-related quality of life (HRQOL) among groups. In subgroup analyses, similar effects were found among non-depressed, but not among depressed patients.ConclusionThe educational intervention improved HF knowledge and self-care, but not HRQOL. No intervention effects were observed in patients with depressive symptoms.Practice ImplicationsThe simple educational intervention is promising to improve HF knowledge and self-care. Additional strategies are needed for depressed patients.     

Impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft surgery: A quasi-experimental study in Iran

Background and aimsCoronary artery bypass graft is a major surgery and has complications that require professional and long term follow-up and nursing care that if do not properly handled, could reduce the quality of life and increase post-operative complications. On the other hand Tele-nursing is a cost-effective way to educate and follow-up of patients. This study aimed to assess the impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft.Materials and methodsA quasi-experimental study was carried out at Ekbatan Therapeutic and Educational Center of Hamadan University of Medical Sciences at Hamadan, Iran, in 2013. In this study, 71 patients who had undergone coronary artery bypass graft surgery and had inclusion criteria were randomly divided into two experimental group (n = 36), and control group (n = 35). They completed questionnaire before discharging from Therapeutic and Educational Center. In the experimental group on days 2, 4, 7, second week (day 11), third week (day 18) and fourth week (day 25) after discharge, follow-up interventions and nursing education with Tele-nursing was done, but in the in the control groups, patients received only routine interventions. After completion of the intervention period, both groups completed the questionnaire and the results were compared.ResultsAdherence of treatment plan in both groups did not have significant difference before intervention (P = 0.696), but had a significant difference with regard to baseline after intervention in aromatherapy group (P <  0.01) and with control group after intervention (P < 0.01). Adherence to treatment plan in the aromatherapy group was better in compared to control group (P < 0.01).ConclusionTele-nursing is a convenient way, cost effective training and follow-up care for patients after coronary artery bypass surgery, which can improve patients’ adherence to treatment plan in developing countries such as Iran.     

Effects of educational intervention on mortality and patient-reported outcomes in individuals with heart failure: A randomized controlled trial

ObjectiveTo examine the effects of an educational intervention on patient-reported outcomes and all-cause mortality in heart failure (HF) patientsMethodsIn this randomized controlled trial, we enrolled 122 hospitalized patients with HF. The intervention group (n = 60) received an individual nurse-led education session on HF self-management during hospitalization and three telephone calls after discharge. The control group (n = 62) received care as usual. Patient-reported outcomes were measured at baseline and at 3 and 6 months. Mortality status was determined using the National Death Records. Intervention effects were evaluated using the Cox proportional hazards regression model and linear mixed models.ResultsDuring the follow-up (median: 568 days), 7 deaths (12%) in the intervention group and 15 deaths (24%) in the control group occurred (adjusted hazard ratio, 0.40; 95% confidence interval, 0.16–0.98; P = .046). From baseline to 3 and 6 months, the intervention group showed greater improvements in HF knowledge (difference=6.14, P = .03; difference=5.76, P = .02, respectively), self-care (difference=?6.08, P < .001; difference=?6.16, P < .001, respectively), and health-related quality of life (difference=?11.90, P = .01; difference=?14.57, P = .004, respectively) than the control group.ConclusionEducational intervention with telephone follow-up reduced all-cause mortality and improved patient-reported outcomes.Practice implicationEducational intervention should be considered as part of routine care for HF patients.     

Effect of peer support on adults with diabetes-related peripheral neuropathy

ObjectiveTo explore the effect of peer support on exercise self-efficacy, physical activity level, and neuropathic symptoms in patients with diabetes-related peripheral neuropathy (DPN).MethodsA total of 60 adults with DPN were assigned to groups. Patients in the control group received routine education (RE), while patients in the intervention group received peer support (PS) combined with routine diabetes education. Data were collected at baseline and after intervention (12 weeks).ResultsAt 12 weeks, better outcomes were found in the PS group compared to the RE group for the following aspects: exercise self-efficacy, steps, total physical activity, fasting blood glucose and 2-hour postprandial blood glucose. Decreases in scores on Toronto Clinical Scoring System occurred between baseline and post-intervention in both groups.ConclusionPeer support is an effective way to improve exercise self-efficacy, number of steps, and general physical activity and to reduce blood glucose for patients with DPN. But the effects of peer support on neuropathic symptoms is are obvious. Further research is needed.Practice implicationsAs a low-cost, effective education approach, peer support strategies should be integrated into our healthcare system to meet the minimum needs of patients with DPN.     

Randomized study of the effect of video education on heart failure healthcare utilization,symptoms, and self-care behaviors

ObjectiveAdherence to self-care behaviors improves heart failure (HF) morbidity and life quality. We examined short-term impact of video education (VE) in addition to standard education (SE) on HF healthcare utilization and self-care behavior adherence.MethodsOne hundred and twelve hospitalized patients were randomly assigned to SE (n = 53) or SE plus VE (n = 59). Differences between groups were analyzed in patients who underwent 3-month follow-up (39 SE and 37 VE patients). Mean age was 60 ± 14 years; mean HF length was 57 months.ResultsThree-month healthcare utilization was similar between groups but VE patients needed less extra diuretic dosing (P < 0.02), received more HF literature (P < 0.03), and had less healthcare team telephone communication (P < 0.04). VE patients had greater sign/symptom reduction (P < 0.04); especially related to edema (P < 0.01) and fatigue (P < 0.01) and initiated more actions for edema (P < 0.05) and dyspnea (with exercise or rest, both P < 0.01). Overall, VE patients had a higher mean self-care behavior score (P < 0.01), reflecting greater self-care adherence.ConclusionVideo education prompts self-care behavior adherence to control worsening signs/symptoms of volume overload. During 3-month follow-up, utilization of most healthcare resources was unchanged.Practice implicationsVE is a useful adjunct to in-person education.     

Evaluation of a standardized patient education program for inpatient asthma rehabilitation: Impact on patient-reported health outcomes up to one year

ObjectivesTo modify and evaluate a patient education program for adult asthma patients in consideration of quality criteria for teaching.MethodsThis was a prospective single-center controlled trial in an inpatient rehabilitation center. The control group (n = 215) received the usual lecture-based education program, and the intervention group (n = 209) the modified patient education program. Data were assessed at admission, discharge, 6 and 12 months post discharge. The primary outcome was asthma control, the secondary outcomes were asthma knowledge, quality of life, and program acceptance. Analysis of change was performed by ANCOVA for each follow-up, adjusting for baseline values.ResultsStatistically significant increases in all health outcomes and in asthma control were maintained in both groups at 12 months: CG: +1.9 (95%-CI 1.3–2.6) IG: +1.6 (95%-CI 0.8–2.3). We observed no significant differences between the programs for asthma control and quality of life. Regarding practical asthma knowledge, after 12 months, a group*time interaction emerged with a small effect size (P = 0.06, η2 = 0.01).ConclusionThe modified program was not superior to traditional patient education concerning asthma control. It permanently increased self-management knowledge.Practical implicationsStructured and behavioral patient education fosters patient’s disease management ability. Possible ways of improving asthma control need to be explored.     

Evaluation of the effectiveness of the healthy heart tracker on heart failure self-care

ObjectiveWe evaluated the effectiveness of a newly designed patient education booklet, the Health Heart Tracker (HHT), in promoting Heart Failure Self-Care (HFSC) behaviors compared to usual patient discharge handouts.MethodsWe conducted a quasi-experimental, comparative two-group study using patients admitted for HF to four intermediate care units. The HHT was instituted on two units; patients on the other units served as control. We analyzed HFSC measured prior to HF discharge education and at two and six weeks post discharge using repeated measures ANOVA.ResultsEighty-four 84 patients completed the study. The sample was 72.6 (+ 12.9) years old, white (75%), educated, and retired (85.8%). All HFSC behaviors improved significantly over time, but there were no significant time by group interactions in HFSC maintenance, symptom perception, and confidence. A notable increase in HFSC management in the HHT group between baseline and 2 weeks was evident, but not sustained to 6 weeks.ConclusionsA focused, singular intervention in the form of a patient education booklet designed specifically to improve HFSC did not significantly improve self-care behaviors over time compared to a control group.Practice ImplicationsMore work is needed to determine optimal written resources for patients with HF.     

早期心脏康复运动治疗方案对急性非ST段抬高 心肌梗死的效果观察

目的 研究早期心脏康复运动治疗方案对急性非ST段抬高心肌梗死的效果。方法 选择我院于2016年1月~12月收治的78例急性非ST段抬高心肌梗死患者,按照随机数字表法将患者分为研究组与对照组,各39例。研究组接受早期心脏康复运动治疗,对照组接受常规治疗,评价两组患者干预后生活质量评分及日常活动能力评分。结果 治疗后,研究组患者生理机能、社会功能、一般健康、精神、精力等生活质量评分均优于对照组,差异具有统计学意义（P＜0.05）。干预后,研究组患者日常活动功能评分为（69.46±5.10）分,优于对照组的（61.52±4.70）分,差异具有统计学意义（P＜0.05）。结论 临床为NSTEMI患者术后提高早期心脏康复运动治疗,可有效提高患者生活质量及日常活动功能。     

Randomized clinical trial of computerized PAINRelieveIt® for patients with sickle cell disease: PAINReportIt® and PAINUCope®

ObjectiveTo compare effects of a tailored multimedia education program versus usual-care on barriers to pain management of adult patients with SCD.MethodsPretest/posttest randomized controlled trial (RCT) of 228 outpatients with SCD randomized to the tablet-based PAINUCope intervention focused on barriers to pain management, pain, and analgesic adherence or selection of games (control). Outcomes were barriers to pain management, pain, and analgesic adherence.ResultsThe barriers to pain management and pain scores did not change significantly from pretest to posttest for either condition. Changes in analgesic adherence rates from pretest to posttest were statistically significant for the intervention group (p = .046) but not for the usual care group (p = .419). The group difference was not statistically significant.ConclusionsThis first RCT of a tailored multimedia education intervention with adult patients with SCD did not significantly reduce the outcomes of interest compared to the control group. Findings provide insights for improving intervention delivery and reinforcement of patient behaviors.Practice implicationsStudy redesign is warranted with modifications that include theoretical and methodological approaches and patient-centered delivery of the intervention that take advantage of recent technology developments.     

Effectiveness of question prompt lists in patients with breast cancer: A randomized controlled trial

ObjectivesTo evaluate the effectiveness of a question prompt list (QPL) in decision self-efficacy, decision-making participation, patient–physician communication, decisional conflict or regret, and health status in patients with breast cancer.MethodsA total of 240 patients with breast cancer were randomly assigned to a QPL group or control group (n = 120 each). The intervention and control groups received an additional educational QPL booklet and routine care, respectively.ResultsThe intervention group exhibited significant improvements in decision self-efficacy, perceived patient–physician interactions, and patient–physician communication compared with the control group. Multilevel modeling analyses revealed significant group–time interaction effects on decision self-efficacy (β = 9.99, P < 0.01), perceived patient–physician interactions (β = 8.10, P < 0.01), patient–physician communication (β = 5.02, P < 0.01), and anxiety status (β = ?3.78, P < 0.05). The QPL intervention exerted more favorable effects than routine care, with repeated measurements of the same patients and the data of patients under the care of the same surgeons accounted for.ConclusionsThe QPL intervention exerted multidimensional effects on decision-making outcomes among patients with breast cancer.Practical implicationsClinicians can integrate a QPL into routine care for patients with breast cancer.     

Effectiveness of a nurse-led multidisciplinary self-management program for patients with coronary heart disease in communities: A randomized controlled trial

ObjectiveTo examine the effectiveness of a nurse-led multidisciplinary self-management program (NMSP) on self-management behaviors, self-efficacy, health-related quality of life (HRQoL) and unplanned health service utilization (HSU) among Chinese patients with coronary heart disease (CHD) in communities.MethodsA randomized controlled trial with repeated measurements was used. A convenience sample of 144 participants was recruited from a community health center in China. All participants were randomly assigned to an intervention group (n = 72) in the newly developed NMSP or a control group (n = 72) in routine care. Outcome measurement was performed at baseline, 3 months and 6 months using Coronary Artery Disease Self-Management Scale (CADSs), Self-efficacy for Chronic Disease 6-item Scale (SECD6), and Short Form-12 health survey questionnaire (SF-12).ResultsOver the six months, the two groups reported significant differences in disease medical and emotional management of CADSs, confidence in symptom and disease management of SECD6, physical and mental component summary of SF-12, as well as emergency and outpatient visits of unplanned HSU.ConclusionsThe NMSP improves self-management behaviors, self-efficacy, HRQoL and reduces unplanned HSU among CHD patients in communities.Practice implicationsThis study provides an effective approach to empower CHD patients with emphasizing on collaboration support of health professionals in communities.     

The effectiveness of clinical pharmacist’s intervention in improving asthma care in children and adolescents: Randomized controlled study in Jordan

ObjectiveTo evaluate the effectiveness of clinical pharmacist’s intervention on achieving better asthma control, quality of life and other clinical parameters.MethodsA prospective randomized controlled study in north Jordan was conducted. Pediatric patients with asthma (aged 7–18 years old) were included and randomly allocated into two groups, intervention and control. Both groups were interviewed at the first visit and followed up twice by phone (at 3 and 6 months). Education was provided to patients and their caregivers in the intervention group only.ResultsOf 206 eligible patients recruited and randomized to our study, 178 patients completed the study (48.3% intervention versus 51.7% control). There were no significant differences in all baseline data between both groups. We identified significant differences in the improvement of asthma control (p < 0.001) and consequently pediatric and caregiver quality of life (p < 0.001) between both groups at the end of study. Significant differences were also detected in other clinical parameters (p < 0.05).ConclusionImplementation of clinical pharmacy service can positively influence asthma control, pediatric and caregiver’s quality of life, and other clinical parameters.Practice implicationsTo maintain a good asthma status, education of pediatric patients and their caregivers should be part of routine assessment during clinic visit.     

基于结构-过程-结果的三维质量评价模式的延续性护理在糖尿病肾病患者中的应用

目的 探讨基于结构-过程-结果的三维质量评价模式的延续性护理在糖尿病肾病患者中的应用效果。方法 以2017年6月~2018年5月我院肾内科收治的96例糖尿病肾病患者为研究对象,采用随机数字表法分成两组,各48例,对照组进行出院后常规护理,干预组进行基于结构-过程-结果的三维质量评价模式的延续性护理,干预后比较两组患者的自护能力及生活质量。结果 干预组的生活质量、自护能力各维度及总分均高于对照组,差异有统计学意义（P＜0.05）。结论 基于结构-过程-结果的三维质量评价模式是提升延续性护理质量的有效途径。     

The effectiveness of the information-motivation-behavioral skills model-based intervention on preventive behaviors against respiratory infection among community-dwelling older adults

ObjectiveTo evaluate the effectiveness of an information–motivation–behavioral skills (IMB) model-based multi-component intervention on engagement and the quality of preventive behaviors against respiratory infections among community-dwelling older adults.MethodsThis study was a controlled pretest–posttest study in which 91 community-dwelling older adults aged above 65 years were included. The intervention group (n = 42) received the six-week intervention theoretically based on the IMB model that comprised weekly group education and 5–10 min of tele-counseling per week.ResultsThe results showed that, after the intervention, the improvement in the level of knowledge, self-efficacy, self-reported engagement, and the quality of respiratory infection preventive behaviors was significantly greater in the intervention group compared to the control group. There was no significant difference between the two groups for the perceived threat of respiratory infection.ConclusionThe IMB model-based intervention improved the engagement and quality of preventive behaviors by increasing the level of knowledge and self-efficacy in community-dwelling older adults.Practice implicationsThe IMB model-based multi-component intervention can be an effective approach to improve preventive behaviors and will contribute to the preparation of communities for outbreaks of respiratory infections.     

Impact of personal genomic risk information on melanoma prevention behaviors and psychological outcomes: a randomized controlled trial

PurposeWe evaluated the impact of personal melanoma genomic risk information on sun-related behaviors and psychological outcomes.MethodsIn this parallel group, open, randomized controlled trial, 1,025 Australians of European ancestry without melanoma and aged 18–69 years were recruited via the Medicare database (3% consent). Participants were randomized to the intervention (n = 513; saliva sample for genetic testing, personalized melanoma risk booklet based on a 40-variant polygenic risk score, telephone-based genetic counseling, educational booklet) or control (n = 512; educational booklet). Wrist-worn ultraviolet (UV) radiation dosimeters (10-day wear) and questionnaires were administered at baseline, 1 month postintervention, and 12 months postbaseline.ResultsAt 12 months, 948 (92%) participants completed dosimetry and 973 (95%) the questionnaire. For the primary outcome, there was no effect of the genomic risk intervention on objectively measured UV exposure at 12 months, irrespective of traditional risk factors. For secondary outcomes at 12 months, the intervention reduced sunburns (risk ratio: 0.72, 95% confidence interval: 0.54–0.96), and increased skin examinations among women. Melanoma-related worry was reduced. There was no overall impact on general psychological distress.ConclusionPersonalized genomic risk information did not influence sun exposure patterns but did improve some skin cancer prevention and early detection behaviors, suggesting it may be useful for precision prevention. There was no evidence of psychological harm.