Medication Adherence and Associated Factors among Chronic Heart Failure Clients on Follow Up Oromia Region, West Ethiopia

Background: Chronic heart failure is a complex clinical syndrome with typical symptoms that can occur at rest or on effort. It requires patients to manage their lifestyle with their disease and when to notify their healthcare provider. The study was aimed to identify medication adherence and associated factors among chronic heart failure clients on follow up Oromia region, West Ethiopia, 2017. Methods: Institutional based cross-sectional study design was employed, after selecting three hospitals by lottery method and allocating respondents to the three hospitals proportionally. A total of 424 patients were admitted to the medical ward and/or chronic follow up of Nekemte referral, Gimbi, and Shambu hospitals. The data was collected using a structured questionnaire. The data was entered into Epi-data version 3.1, cleared, explored, and then exported to SPSS windows version 24.0 for further analysis. Variable having a p-value less than 0.05 in the bivariate analysis was a candidate for multivariable analysis and the effect of confounding variables was observed. Variables having a p-value less than 0.05 in the multivariable analysis were assumed significant. Results: A total of 424 respondents were included in the final analysis giving a 95.3% response rate. The result indicated that more than half of the study participants have adhered to prescribed medication. Respondents with good medication adherence were more likely to adhere to good self-care behavior [AOR (95% CI of OR) = 3.5(2.044, 5.96)]. Respondents whose limited fluid intake was one or half-liter per day were more likely to adhere to the medication [AOR (95% CI of OR) = 2.5(1.43, 4.49)]. It was also found that those patients who avoided spices, sauces and others in food are more likely to adhere to the medication [AOR (95% CI of OR) = 2.2 (1.152, 4.039)]. Conclusion and Recommendation: Even if more than half of the study respondents have good medication and self-care adherence, still it needs great attention in health education over their visit. Health institutions are strongly recommended to give health education for clients and researchers to use advanced study design for measuring medication adherence and self-care behaviors.

Download Full-text

Self-care behaviour and associated factors among chronic heart failure clients on follow up at selected hospitals of Wollega zones, Ethiopia

International Journal of Africa Nursing Sciences ◽

10.1016/j.ijans.2021.100355 ◽

2021 ◽

Vol 15 ◽

pp. 100355

Author(s):

Getahun Fetensa ◽

Ginenus Fekadu ◽

Ebisa Turi ◽

Tadesse Tolossa ◽

Bizuneh Wakuma ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Associated Factors ◽

Self Care

Download Full-text

Association between self-care and prognosis in 1123 patients with chronic heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1041 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Calero ◽

E Hidalgo ◽

R Marin ◽

L Rosenfeld ◽

I Fernandez ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Acute Heart Failure ◽

Nyha Class ◽

Self Care ◽

P Value ◽

Funding Source ◽

Class Iii ◽

Cox Models ◽

Lower Tertile

Abstract Background Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF. Aims and methods The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF. We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline. Results We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour. Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception. Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028] Conclusion Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure. These results highlight the importance of assessing self-care and provide measures to improve them. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge

Download Full-text

Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-021966 ◽

2018 ◽

Vol 8 (9) ◽

pp. e021966 ◽

Cited By ~ 10

Author(s):

Federica Dellafiore ◽

Cristina Arrigoni ◽

Francesco Pittella ◽

Gianluca Conte ◽

Arianna Magon ◽

...

Keyword(s):

Heart Failure ◽

Gender Differences ◽

Chronic Heart Failure ◽

Real World ◽

Self Care ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Caregiver Relationship

AimThe aim of this study was to critically analyse and describe gender differences related to self-care among patients with chronic heart failure (HF).Methods and resultsA monocentric real-world cohort of 346 patients with chronic HF in follow-up was used for this cross-sectional study. We report data related to the cohort’s demographic and clinical characteristics. Self-care was assessed using the Self-Care of Heart Failure Index before patients’ discharge. After bivariate analysis, logistical regression models were used to describe the relationship between gender, self-care behaviours and self-care confidence. While men were found to have more than quadruple the risk of poor self-care than women (OR 4.596; 95% CI 1.075 to 19.650), men were also found to be approximately 60% more likely to have adequate self-care confidence than women (OR 0.412; 95% CI 0.104 to 0.962). Considering that self-care confidence is described as a positive predictor of behaviours, our results suggest a paradox. It is possible that the patient–caregiver relationship mediates the effect of confidence on behaviours. Overall, adequate levels of self-care behaviours are a current issue, ranging 7.6%–18.0%.ConclusionThis study sets the stage for future research where elements of the patient–caregiver relationship ought to be considered to inform the planning of appropriate educational interventions. We recommend routinely measuring patients’ self-care behaviours to guide their follow-up and as a basis for any changes in their daily life behaviours.

Download Full-text

Effect of a self-care educational intervention to improve self-care adherence among patients with chronic heart failure: a clustered randomized controlled trial in Northwest Ethiopia

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02170-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Getenet Dessie ◽

Sahai Burrowes ◽

Henok Mulugeta ◽

Dessalegn Haile ◽

Ayenew Negess ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Health Education ◽

Educational Intervention ◽

Self Care ◽

Northwest Ethiopia ◽

Sub Saharan Africa ◽

Care Education ◽

Referral Hospitals ◽

Sub Saharan

Abstract Background As the burden of cardiovascular disease increases in sub-Saharan Africa, there is a growing need for low-cost interventions to mitigate its impact. Providing self-care health education to patients with chronic heart failure (CHF) is recommended as an intervention to prevent complications, improve quality of life, and reduce financial burdens on fragile health systems. However, little is known about health education’s effectiveness at improving CHF self-management adherence in sub-Saharan Africa. Therefore the present study aimed to assess the effectiveness of an educational intervention to improve self-care adherence among patients with CHF at Debre Markos and Felege Hiwot Referral Hospitals in Northwest Ethiopia. Methods To address this gap, we adapted a health education intervention based on social cognitive theory comprising of intensive four-day training and, one-day follow-up sessions offered every four months. Patients also received illustrated educational leaflets. We then conducted a clustered randomized control trial of the intervention with 186 randomly-selected patients at Debre Markos and Felege Hiwot referral hospitals. We collected self-reported data on self-care behavior before each educational session. We analyzed these data using a generalized estimating equations model to identify health education's effect on a validated 8-item self-care adherence scale. Results Self-care adherence scores were balanced at baseline. After the intervention, patients in the intervention group (n = 88) had higher adherence scores than those in the control group (n = 98). This difference was statistically significant (β = 4.15, p < 0.05) and increased with each round of education. Other factors significantly associated with adherence scores were being single (β = − 0.25, p < 0.05), taking aspirin (β = 0.76, p < 0.05), and having a history of hospitalization (β = 0.91, p < 0.05). Conclusions We find that self-care education significantly improved self-care adherence scores among CHF patients. This suggests that policymakers should consider incorporating self-care education into CHF management. Trial registration number: PACTR201908812642231

Download Full-text

Structured Telephone Support Intervention: Improved Heart Failure Outcomes

JMIR Aging ◽

10.2196/13513 ◽

2020 ◽

Vol 3 (1) ◽

pp. e13513

Author(s):

Marcia Johansson ◽

Ponrathi Athilingam

Keyword(s):

Mental Health ◽

Heart Failure ◽

Medication Adherence ◽

Self Care ◽

Self Management ◽

Telephone Support ◽

Physical And Mental Health ◽

Pinellas County ◽

At Home

Background Presently, 6.5 million Americans are living with heart failure (HF). These patients are expected to follow a complex self-management regimen at home. Several demographic and psychosocial factors limit patients with HF in following the prescribed self-management recommendations at home. Poor self-care is associated with increased hospital re-admissions. Under the Affordable Care Act, there are financial implications related to hospital re-admissions for hospitals and programs such as the Program of All-Inclusive Care for the Elderly (PACE) in Pinellas County, Florida. Previous studies and systematic reviews demonstrated improvement in self-management and quality of life (QoL) in patients with HF with structured telephone support (STS) and short message service text messaging (SMS). Objective This study aimed to evaluate the effects of STS and SMS on self-care, knowledge, medication adherence, and QoL of patients with HF. Methods A prospective quality improvement project using a pre-post design was implemented. Data were collected at baseline, 30 days, and 3 months from 51 patients with HF who were enrolled in PACE in Pinellas County, Florida. All participants received STS and SMS for 30 days. The feasibility and sustained benefit of using STS and SMS was assessed at a 3-month follow-up. Results A paired t test was used to compare the mean difference in HF outcomes at the baseline and 30-day follow-up, which demonstrated improved HF self-care maintenance (t49=0.66; P=.01), HF knowledge (t49=0.71; P=.01), medication adherence (t49=0.92; P=.01), and physical and mental health measured using Short-Form-12 (SF-12; t49=0.81; P=.01). The results also demonstrated the sustained benefit with improved HF self-care maintenance, self-care management, self-care confidence, knowledge, medication adherence, and physical and mental health (SF-12) at 3 months with P<.05 for all outcomes. Living status and social support had a strong correlation with HF outcomes. Younger participants (aged less than 65 years) performed extremely well compared with older adults. Conclusions STS and SMS were feasible to use among PACE participants with sustained benefits at 3 months. Implementing STS and SMS may serve as viable options to improve HF outcomes. Improving outcomes with HF affects hospital systems and the agencies that monitor and provide care for outpatients and those in independent or assisted-living facilities. Investigating viable options and support for implementation will improve outcomes.

Download Full-text

Investigating the Effect of Education on Self-Care among Chronic Heart Failure Patients Admitted to Shahid Mostafa Khomeini Hospital of Ilam

Global Journal of Health Science ◽

10.5539/gjhs.v9n5p79 ◽

2016 ◽

Vol 9 (5) ◽

pp. 79

Author(s):

Samira Miss Qavam ◽

Ali Sahebi ◽

Masoumeh Shohani ◽

Firoz Balavandi ◽

Ramak Qavam ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Self Care ◽

Statistical Correlation ◽

P Value ◽

Common Cause ◽

Heart Failure Patients ◽

Before And After ◽

Discharge From Hospital ◽

Care Behavior

BACKGROUND: Congestive heart failure is a common cause of hospitalization. If patients can adhere to self-care behaviors, the progression of the disease can be prevented. The aim of this study is to evaluate the effect of education on self-care in chronic heart failure patients admitted to Shahid Mostafa Khomeini Hospital of Ilam in 2016.METHODS: This study is of intervention typeand 40 patient’s sufferingfrom heart failure were selected. Research tools include a standard indicator questionnaire for measuring self-care by patients. The questionnaire contains 22 questions about their certainty ofself-care. Four point Likert scale was used for scoring and SPSS V.19 was used for data analysis.RESULTS: The sample consisted of 16 men (40%) and 24 women (60%) most of which were married (75%). The statistical correlation between the total score of self-care behavior before and after education was significant (P VALUE = 0.003), which shows that the education conducted on the patients was effective and caused more scores in all areas.CONCLUSION: Self-care behavior can be attained and spread through education. It is recommended that the patients suffering are given enough information about their diet and activities after their discharge from hospital.

Download Full-text

Self-care practice and associated factors among type 2 adult diabetic patients on follow up clinic of Dessie referral hospital, Northeast Ethiopia

Clinical Journal of Nursing Care and Practice ◽

10.29328/journal.cjncp.1001034 ◽

2021 ◽

Vol 5 (1) ◽

pp. 031-037

Author(s):

Addis Sisay Gedamu ◽

Kassahun Sewunet Ademe ◽

Ayele Samuel Anteneh ◽

Nega Abebe Dires ◽

Tegegne Kirubel Dagnaw

Keyword(s):

Associated Factors ◽

Self Care ◽

Education Level ◽

Referral Hospital ◽

Care Practice ◽

P Value ◽

Diabetic Patients ◽

Dessie Referral Hospital

Background: Diabetes mellitus is a common health problem in the world and Africa including Ethiopia. Its complication is the major cause of morbidity and mortality of people due to improper self-care practice. Objective: To assess self-care practices and associated factors among type 2 adult diabetic patients on follow-up clinic of Dessie referral hospital, Ethiopia. Method: Institutional based cross sectional study was conducted. Total of 278 type 2 diabetic patients was selected by systematic random sampling technique and data was collected by interviewer administered pretested questionnaire. Epidata 3.1 and SPSS version 23 software were used for data entry and analysis, respectively. In bivariate analysis, variables having a p - value of < 0.2 were entered to multivariate analysis model and statistical significance was declared at p - value of < 0.05 and 95% confidence interval. Results: The response rate was 269 (96.76%) of the total 278 participants. Among the respondents 150(55.8%) had good diabetic self-care practice. This study showed that primary school education level (AOR=2.592, 95%CI=1.104-6.087, p = 0.029), secondary school education level (AOR=3.873, 95%CI=1.325-11.323, p = 0.013), college/university graduate (AOR=3.030, 95%CI=1.276-7.197, 0.012), attended diabetic education regularly (AOR=2.981, 95%CI=1.050-8.462, p = 0.040), member of diabetic association (AOR=3.496, 95%CI=1.440-8.483, p = 0.006) and having glucometer at home (AOR=2.634, 95%CI=1.357-5.111, p = 0.004) were significantly associated with diabetes self-care practice. Conclusion: Nearly half of diabetic patients had poor self care practice. Hence, there is a need to improve diabetic self-care practice. Attention should be given by policy makers, Dessie referral hospital, health care professionals, diabetic associations and researchers.

Download Full-text

Self-Care Practices of Primary Health Care Patients Diagnosed with Chronic Heart Failure: A Cross-Sectional Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16091625 ◽

2019 ◽

Vol 16 (9) ◽

pp. 1625 ◽

Cited By ~ 2

Author(s):

Rosalia Santesmases-Masana ◽

Luis González-de Paz ◽

Elvira Hernández-Martínez-Esparza ◽

Belchin Kostov ◽

Maria Dolors Navarro-Rubio

Keyword(s):

Heart Failure ◽

Health Literacy ◽

Chronic Heart Failure ◽

Primary Healthcare ◽

Self Care ◽

Cross Sectional ◽

Heart Failure Patients ◽

Care Practices ◽

Primary Healthcare Centers

Chronic heart failure patients require self-care behaviors and active monitoring of signs and symptoms to prevent worsening. Most patients with this condition are attended in primary healthcare centers. This study aimed to evaluate the endorsement of and adherence to self-care behaviors in primary health care patients with chronic heart failure. We conducted a multicenter cross-sectional study. We randomly included chronic heart failure patients from 10 primary healthcare centers in the Barcelona metropolitan area (Spain). Patients completed the European Heart Failure Self-Care Behaviour Scale, a health literacy questionnaire. Differences between groups were studied using ANOVA tests. We included 318 patients with a mean age of 77.9 years, mild limitations in functional activity New York Heart Association scale (NYHA) II = 51.25%), and a low health literacy index of 79.6%. The endorsement of self-care behaviors was low in daily weighing (10.66%), contacting clinicians if the body weight increased (22.57%), and doing physical exercise regularly (35.58%). Patients with lower educational levels and a worse health literacy had a lower endorsement. The screening of individual self-care practices in heart failure patients might improve the clinician follow-up. We suggest that primary healthcare clinicians should routinely screen self-care behaviors to identify patients requiring a closer follow-up and to design and adapt rehabilitation programs to improve self-care.

Download Full-text