JOURNAL OF ADVANCED NURSING
A randomized controlled trial of self-management programme improves health-related outcomes of older people with heart failure Jung-Hua Shao, Anne M. Chang, Helen Edwards, Yea-Ing Lotus Shyu & Su-Hui Chen Accepted for publication 2 February 2013
Correspondence to Su-Hui Chen: e-mail: firstname.lastname@example.org Jung-Hua Shao PhD RN Assistant Professor School of Nursing, College of Medicine, Chang Gung University, Taiwan Anne M. Chang PhD RN Professor, Professor of Clinical Nursing School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia Helen Edwards PhD RN OAM Professor, Head of School School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia Yea-Ing Lotus Shyu PhD RN Professor School of Nursing, College of Medicine, Chang Gung University, Taiwan Su-Hui Chen PhD RN Associate Professor Department of Nursing, Chang Gung University of Science and Technology, Taiwan
SHAO J.-H., CHANG A.M., EDWARDS H., SHYU Y.-I.L. & CHEN S.-H. (2013)
A randomized controlled trial of self-management programme improves healthrelated outcomes of older people with heart failure. Journal of Advanced Nursing 00(0), 000–000. doi: 10.1111/jan.12121
Aims. This paper is a report on the effectiveness of a self-management programme based on the self-efﬁcacy construct, in older people with heart failure. Background. Heart failure is a major health problem worldwide, with high mortality and morbidity, making it a leading cause of hospitalization. Heart failure is associated with a complex set of symptoms that arise from problems in ﬂuid and sodium retention. Hence, managing salt and ﬂuid intake is important and can be enhanced by improving patients’ self-efﬁcacy in changing their behaviour. Design. Randomized controlled trial. Methods. Heart failure patients attending cardiac clinics in northern Taiwan from October 2006–May 2007 were randomly assigned to two groups: control (n = 46) and intervention (n = 47). The intervention group received a 12-week self-management programme that emphasized self-monitoring of salt/ﬂuid intake and heart failure-related symptoms. Data were collected at baseline as well as 4 and 12 weeks later. Data analysis to test the hypotheses used repeated-measures ANOVA models. Results. Participants who received the intervention programme had signiﬁcantly better self-efﬁcacy for salt and ﬂuid control, self-management behaviour and their heart failure-related symptoms were signiﬁcantly lower than participants in the control group. However, the two groups did not differ signiﬁcantly in health service use. Conclusion. The self-management programme improved self-efﬁcacy for salt and ﬂuid control, self-management behaviours, and decreased heart failure-related symptoms in older Taiwanese outpatients with heart failure. Nursing interventions to improve health-related outcomes for patients with heart failure should emphasize self-efﬁcacy in the self-management of their disease. Keywords: heart failure, nurse, nursing, older adult, randomized controlled trial, self-efﬁcacy, self-management
© 2013 Blackwell Publishing Ltd
J.-H. Shao et al.
Heart failure (HF), a major worldwide public health problem, is the end stage of heart disease and has been linked with an increased risk of death (Rich 2005). Furthermore, HF is associated with older age and, given the dramatic increase in the population of older people worldwide, the prevalence of HF is increasing among older persons in the United States (American Heart Association 2008) and in Taiwan (Department of Statistics 2006). In Europe, a survey of 24 countries revealed that 24% of patients admitted with conﬁrmed or suspected HF were readmitted to hospital (Clelanda et al. 2003). In fact, HF is one of the leading causes of hospitalization and readmission in the US (American Heart Association 2008). In Taiwan, HF was found to be a leading...