Carolyn Deighan

Adherence to self-care in patients with heart failure in the HeartCycle study.

Purpose The purpose of this study was to evaluate a novel online education and coaching program to promote self-care among patients with heart failure. In this program, education and coaching content is automatically tailored to the knowledge and behavior of the patient. Patients and methods The evaluation of the program took place within the scope of the HeartCycle study. This multi-center, observational study examined the ability of a third generation telehealth system to enhance the management of patients recently (<60 days) admitted to the hospital for worsening heart failure or outpatients with persistent New York Heart Association (NYHA) Functional Classification III/IV symptoms. Self-reported self-care behavior was assessed at baseline and study-end by means of the 9-item European Heart Failure Self-care Behavior scale. Adherence to daily weighing, blood pressure monitoring, and reporting of symptoms was determined by analyzing the system’s database. Results Of 123 patients enrolled, the mean age was 66±12 years, 66% were in NYHA III and 79% were men. Self-reported self-care behavior scores (n=101) improved during the study for daily weighing, low-salt diet, physical activity (P<0.001), and fluid restriction (P<0.05). Average adherence (n=120) to measuring weight was 90%±16%, to measuring blood pressure was 89%±17% and to symptom reporting was 66%±32%. Conclusion Self-reported self-care behavior scores improved significantly during the period of observation, and the objective evidence of adherence to daily weight and blood pressure measurements was high and remained stable over time. However, adherence to daily reporting of symptoms was lower and declined in the long-term.

An m-Health system for education and motivation in cardiac rehabilitation: the experience of HeartCycle guided exercise:

Introduction Home-based programmes for cardiac rehabilitation play a key role in the recovery of patients with coronary artery disease. However, their necessary educational and motivational components have been rarely implemented with the help of modern mobile technologies. We developed a mobile health system designed for motivating patients to adhere to their rehabilitation programme by providing exercise monitoring, guidance, motivational feedback, and educational content. Methods Our multi-disciplinary approach is based on mapping “desired behaviours” into specific system’s specifications, borrowing concepts from Fogg’s Persuasive Systems Design principles. A randomised controlled trial was conducted to compare mobile-based rehabilitation (55 patients) versus standard care (63 patients). Results Some technical issues related to connectivity, usability and exercise sessions interrupted by safety algorithms affected the trial. For those who completed the rehabilitation (19 of 55), results show high levels of both user acceptance and perceived usefulness. Adherence in terms of started exercise sessions was high, but not in terms of total time of performed exercise or drop-outs. Educational level about heart-related health improved more in the intervention group than the control. Exercise habits at 6 months follow-up also improved, although without statistical significance. Discussion Results indicate that the adopted design methodology is promising for creating applications that help improve education and foster better exercise habits, but further studies would be needed to confirm these indications.

Design and Usage of the HeartCycle Education and Coaching Program for Patients With Heart Failure.

BACKGROUND Heart failure (HF) is common, and it is associated with high rates of hospital readmission and mortality. It is generally assumed that appropriate self-care can improve outcomes in patients with HF, but patient adherence to many self-care behaviors is poor. OBJECTIVE The objective of our study was to develop and test an intervention to increase self-care in patients with HF using a novel, online, automated education and coaching program. METHODS The online automated program was developed using a well-established, face-to-face, home-based cardiac rehabilitation approach. Education is tailored to the behaviors and knowledge of the individual patient, and the system supports patients in adopting self-care behaviors. Patients are guided through a goal-setting process that they conduct at their own pace through the support of the system, and they record their progress in an electronic diary such that the system can provide appropriate feedback. Only in challenging situations do HF nurses intervene to offer help. The program was evaluated in the HeartCycle study, a multicenter, observational trial with randomized components in which researchers investigated the ability of a third-generation telehealth system to enhance the management of patients with HF who had a recent (<60 days) admission to the hospital for symptoms or signs of HF (either new onset or recurrent) or were outpatients with persistent New York Heart Association (NYHA) functional class III/IV symptoms despite treatment with diuretic agents. The patients were enrolled from January 2012 through February 2013 at 3 hospital sites within the United Kingdom, Germany, and Spain. RESULTS Of 123 patients enrolled (mean age 66 years (SD 12), 66% NYHA III, 79% men), 50 patients (41%) reported that they were not physically active, 56 patients (46%) did not follow a low-salt diet, 6 patients (5%) did not restrict their fluid intake, and 6 patients (5%) did not take their medication as prescribed. About 80% of the patients who started the coaching program for physical activity and low-salt diet became adherent by achieving their personal goals for 2 consecutive weeks. After becoming adherent, 61% continued physical activity coaching, but only 36% continued low-salt diet coaching. CONCLUSIONS The HeartCycle education and coaching program helped most nonadherent patients with HF to adopt recommended self-care behaviors. Automated coaching worked well for most patients who started the coaching program, and many patients who achieved their goals continued to use the program. For many patients who did not engage in the automated coaching program, their choice was appropriate rather than a failure of the program.

Using ‘Stage of Change’ and ‘Business Activity Models’ to Assess and Improve Health and Safety Behaviours in SMEs

Abstract This paper reports on a UK study aimed at investigating the engagement of small and medium-sized enterprises with health and safety activity at all stages of their business processes. The study was based on telephone interviews with 50 small and medium-sized enterprises, and the findings indicate that their overall level of health and safety activity is low compared to larger enterprises. Further consideration of the data reveals two cohorts: one well engaged with health and safety activity and the other largely unaware of its obligations and poorly engaged. The health and safety of these heterogeneous organisations was explored using frameworks that addressed generic business practices and readiness to engage in health and safety-related activity. The frameworks proved valuable in eliciting responses. However, several methodological areas for refinement were apparent. The prevalence of a policy statement in these businesses was identified as a frequent and central feature that could be used to develop positive health and safety practice.

Psychosocial influences on health and safety behaviour among small and medium sized enterprises.

Abstract This paper reports on a study undertaken to identify the psychosocial features associated with health and safety activity in small and medium-sized enterprises. These enterprises, which encompass the vast majority of businesses in the European Union, have been shown to engage in less health and safety activity compared to larger enterprises. Considering demographic and organisational factors, the study investigates the degree to which psychosocial features may predict health and safety activity. A questionnaire — developed using examples of everyday health and safety practice — was administered to 313 participants from a representative range of geographic locations and business sectors. In addition to collecting demographic data, three health and safety areas were explored: attitudes, engagement and activity. Results were subjected to a principal component analysis that identified five factors: negative beliefs about resources; positive beliefs about resources; relationships with suppliers; emotional aspects of behaviour; and beliefs about consequences. Hierarchical regression revealed that the first three of these derived attitudinal factors were significantly predictive. The introduction of decision-making and organisational factors only modestly improved the model. However, the inclusion of demographic features substantially improved the variance accounted for. The results of the study suggest that there are benefits in encouraging the enhancement of positive beliefs regarding resources over, for example, the allocation of more time to health and safety. In this context, the ‘carrot’ may be more effective that the ‘stick’ in improving health and safety activity in small and medium-sized businesses.