Follow‐up study for a disease management program for chronic heart failure 24 months after program commencement

Aim: There are few studies dealing with comprehensive chronic heart failure (CHF) disease management programs, which are based on self‐management, in Japan. We developed and conducted a comprehensive educational program for CHF for 6 months that aimed to improve self‐management and prevent the deterioration of outpatients with CHF. Our follow‐up research focused on whether performance of self‐management in the intervention group continued for 24 months after commencement. Methods: Participants were selected from patients who went for follow‐up visits to one Japanese clinic, which specialized in cardiovascular internal medicine, that were diagnosed with CHF. During the first follow‐up period, 7 to 12 months after program commencement, 47 participants in the intervention group and 47 participants in the control group were analyzed. During the second follow‐up period, 13 to 24 months after program commencement, 41 participants in the intervention group were analyzed. Results: Participants in the intervention group acquired self‐management skills and activities and these continued up to 24 months after the program commencement. As a result, no deterioration in symptoms related to CHF was demonstrated. Meanwhile, quitting smoking and drinking depended on individual preference and it was difficult to improve. Conclusions: The educational program was effective in the long term and the program is significant for use in busy medical situations that do not offer sufficient follow‐up support for patients. Regular intervention and ways that produce longer‐lasting effects should be further developed.     

Improving self‐care efficacy and quality of life with a self‐management program among patients with chronic obstructive pulmonary disease: A quasi‐experimental study

Self‐management helps patients understand their illnesses and learn about disease‐related skills so they can better manage their situation. However, published studies on the effectiveness of self‐management for chronic obstructive pulmonary disease (COPD) are heterogeneous. Quasi‐experimental design was used to investigate the effectiveness of a self‐management program in self‐care efficacy and quality of life in patients with COPD. Sixty participants who had experienced COPD were assigned to control group (usual care) or experimental group (self‐care program) (1:1 ratio) according to a purposeful sampling at a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self‐Efficacy Scale, the Clinical COPD Questionnaire were used to analyze data. The Medical Research Council dyspnea scale was more significant improvement in the 2 months after discharge in the experimental group than in the control group. The COPD Self‐Efficacy Scale and Clinical COPD Questionnaire scores in the experimental group within 3 months after discharge were significantly improved compared with the control group. These findings demonstrate the application and initial effect of this self‐management program.     

Problematizing health coaching for chronic illness self‐management

To address the growing costs associated with chronic illness care, many countries, both developed and developing, identify increased patient self‐management or self‐care as a focus of healthcare reform. Health coaching, an implementation strategy to support the shift to self‐management, encourages patients to make lifestyle changes to improve the management of chronic illness. This practice differs from traditional models of health education because of the interactional dynamics between nurse and patient, and an orientation to care that ostensibly centres and empowers patients. The theoretical underpinnings of coaching reflect these differences, however in its application, the practices arranged around health coaching for chronic illness self‐management reveal the social regulation and professional management of everyday life. This becomes especially problematic in contexts defined by economic constraint and government withdrawal from activities related to the ‘care’ of citizens. In this paper, we trace the development of health coaching as part of nursing practice and consider the implications of this practice as an emerging element of chronic illness self‐management. Our purpose is to highlight health coaching as an approach intended to support patients with chronic illness and at the same time, problematize the tensions contained in (and by) this practice.     

Reconsidering the ‘self’ in self‐management of chronic illness: Lessons from relational autonomy

Self‐management is often presented as a panacea for chronic disease care. It plays an important role at the policy level and increasingly guides the delivery of health care services. Self‐management approaches to care are founded on traditional individualistic views of autonomy in which the patient is understood as being independent, rational, self‐interested, and self‐governing. This conceptualization of autonomy has been challenged, particularly by feminist scholars. In this paper I review predominant critiques of self‐management and the traditional individualistic view of autonomy. I propose that a relational approach to autonomy, which is premised on social embeddedness and attends to social, political, and material conditions, is a more sound conception of autonomy capable of taking into consideration the complexities of illness experiences. I suggest that integrating a relational perspective of autonomy into self‐management will be valuable in guiding its progression and elaborate ways in which self‐management research and practice could benefit from incorporating a relational approach to autonomy.     

Cluster randomized controlled trial testing the effectiveness of a self‐management intervention using the teach‐back method for people with heart failure

In this study, we examined the effectiveness of a self‐management intervention delivered to people with heart failure in Vietnam. It used teach‐back, a cyclical method of teaching content, checking comprehension, and re‐teaching to improve understanding. A single‐site cluster randomized controlled trial was conducted, and six hospital wards were randomized into two study groups. On the basis of ward allocation, 140 participants received either usual care or the teach‐back heart failure self‐management intervention plus usual care. The intervention involved, prior to discharge, an individual educational session on heart failure self‐care, with understanding reinforced using teach‐back, a heart failure booklet, weighing scales, diary, and a follow‐up phone call 2 weeks post‐discharge. The control group received usual care and the booklet. Outcomes were heart failure knowledge, self‐care (maintenance, management and confidence), and all‐cause hospitalizations assessed at 1 and 3 months (end‐point). Upon completion of the study, the intervention group had significantly greater knowledge and self‐care maintenance than the control group. Other outcomes did not differ between the two groups. The teach‐back self‐management intervention demonstrated promising benefits in promoting self‐care for heart failure patients.