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JAN
ORIGINAL RESEARCH

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: sophee@gw.cgust.edu.tw 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

Abstract
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

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J.-H. Shao et al.

Introduction
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...
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