Date of Submission

9-2016

Abstract

Introduction: Heart failure is a major public health problem, affecting over 26 million people worldwide. It is associated with a high rate of mortality, symptom burden and diminished quality of life. Best practice guidelines for the management of chronic heart failure recommend that patients and carers/family members are educated about heart failure self-care. Effective heart failure self-care has the potential to improve health outcomes. Studies conducted in Thailand addressing heart failure self-care are limited and none have investigated the potential benefits of education programs on the health outcomes of both parties within the dyad: the patient with heart failure and their carer.

Aims: The primary aim of this research was to examine the effectiveness of a family-based education program for patients with heart failure and their carers in rural Thailand. The research comprises a series of studies, each with specific aims: i) to investigate current heart failure family-based education provision – a global review, ii) to develop a family-based heart failure education program, and iii) to evaluate the effectiveness of this program in rural Thailand.

Methods: After completing a systematic review of the literature, a study protocol for development and evaluation of a culturally specific family-based education program was developed. A randomised controlled trial was then conducted in rural Thailand to examine the effectiveness of the program. For patients, the primary outcome was heart failure knowledge as measured by the Dutch Heart Failure Knowledge Scale (DHFKS). The main outcome for carers was perceived control over managing patients’ heart failure symptoms as measured by the Control Attitudes Scale-Revised (CAS-R). Secondary outcomes for patients were self-care as measured by the Self-Care of Heart Failure Index (SCHFI) and health-related quality of life as measured by the Minnesota Living with Heart Failure (MLHF) questionnaire. For carers, additional outcomes were heart failure knowledge as measured by the Dutch Heart Failure Knowledge Scale (DHFKS) and health-related quality of life as measured by the Short Form 12-Item (SF-12) Health Survey. In total, 100 dyads from two public hospitals in Thailand were randomly assigned in a 1:1 ratio in blocks of 10 to the intervention (family-based education program) or usual care (control) group. The education group received usual care in addition to a family-based education program, which consisted of face-to-face education and counselling sessions, a manual, a DVD, and telephone support. Data were collected at baseline, three months, and six months.

Results: The systematic review identified six trials reported in nine papers. A dearth of HF studies was found that specifically developed and evaluated an education intervention for both patient and carer. There was a wide variation in the quality of the studies.

A family-based HF education program, underpinned by adult learning theory, was developed in strict adherence to CONSORT guidelines. This comprised a culturally specific heart failure manual and DVD that were reviewed for content and cultural validity by a Thai cardiologist and heart failure nurses; minimal changes were recommended.

Patients and carers in the education group (those who received the heart failure manual and DVD) had higher knowledge scores than the usual care group at three and six months (p < 0.01). Patients in the education group had better self-care maintenance, confidence, and quality of life scores than the usual care group (p < 0.05) at three and six months, as well as better self-care management scores (p < 0.05) at six months. Carers in the education group had higher perceived control over managing patients’ heart failure symptom scores than the usual care group (p < 0.05) at three months.

Conclusion: This is the first ramdonised controlled trial to evaluate a family-based heart failure education program developed for patients and their carers in rural Thailand. The education program improved heart failure knowledge (in patients and carers), patients’ self-care behaviours and emotional dimension of quality of life, and carers’ perceived control over managing patients’ heart failure symptoms. This program provides evidence supporting the positive influence of self-care education by engaging family members/carers. Despite the lack of access to heart failure disease management programs in rural Thailand, it may be possible to improve patient engagement in self-care through educational programs that can be easily introduced, guided and followed-up by a Thai nurse, and which are predominantly self-administered (i.e. manual and DVD) in the patient’s home.

School/Institute

School of Nursing, Midwifery & Paramedicine

Document Type

Thesis

Access Rights

Open Access

Extent

282 pages

Degree Name

Doctor of Philosophy (PhD)

Faculty

Faculty of Health Sciences

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