Jom Suwanno

Comparison of self-care behaviors of heart failure patients in 15 countries worldwide

OBJECTIVE Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents. METHODS Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale. RESULTS In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries. CONCLUSION Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide. PRACTICE IMPLICATIONS Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior.

Heart Failure Self-care in Developed and Developing Countries

BACKGROUND Heart failure (HF) self-care is poor in developed countries like the United States, but little is known about self-care in developing countries. METHODS AND RESULTS A total of 2082 adults from 2 developed (United States and Australia) and 2 developing countries (Thailand and Mexico) were studied in a descriptive, comparative study. Self-care was measured using the Self-Care of HF Index, which provided scores on self-care maintenance, management, and confidence. Data were analyzed using regression analysis after demographic (age, gender, education), clinical (functional status, experience with the diagnosis, comorbid conditions), and setting of enrollment (hospital or clinic) differences were controlled. When adequate self-care was defined as a standardized score >or=70%, self-care was inadequate in most scales in most groups. Self-care maintenance was highest in the Australian sample and lowest in the Thai sample (P < .001). Self-care management was highest in the US sample and lowest in the Thai sample (P < .001). Self-care confidence was highest in the Mexican sample and lowest in the Thai sample (P < .001). Determinants differed for the three types of self-care (eg, experience with HF was associated only with self-care maintenance). CONCLUSION Interventions aimed at improving self-care are greatly needed in both the developed and the developing countries studied.

Gender differences in heart failure self-care: a multinational cross-sectional study.

BACKGROUND Despite a common view that women are better at self-care, there is very little evidence to support or challenge this perspective in the heart failure (HF) population. OBJECTIVE The purpose of this study was to determine if there are cross-cultural gender differences in self-reported HF self-care and to describe gender differences in the determinants of HF self-care. DESIGN, SETTING, AND PARTICIPANTS A secondary analysis was completed of cross-sectional study data collected on 2082 adults with chronic HF from the United States, Australia and Thailand. METHODS Comparisons were made between men and women regarding self-care maintenance, management and confidence as assessed by the Self-Care of Heart Failure Index, as well as the proportion of subjects engaged in adequate self-care. Multivariate comparisons were made to determine if gender explained sufficient variance in HF self-care and the likelihood of reporting adequate self-care, controlling for nine model covariates. RESULTS The sample was comprised of 1306 men and 776 women. Most (73.5%) had systolic or mixed systolic and diastolic HF and 45% had New York Heart Association class III or IV HF. Although small and clinically insignificant gender differences were found in self-care maintenance, gender was not a determinant of any aspect of HF self-care in multivariate models. Married women were 37% less likely to report adequate self-care maintenance than unmarried women. Comorbidities only influenced the HF self-care of men. Being newly diagnosed with HF also primarily affected men. Patients with diastolic HF (predominantly women) had poorer self-care maintenance and less confidence in self-care. CONCLUSION Differences in HF self-care are attributable to factors other than gender; however, there are several gender-specific determinants of HF self-care that help identify patients at risk for practicing poor self-care.

The Relationship Between Self-Care and Health Status Domains in Thai Patients with Heart Failure

Background: Little is known about the relationship between self-care in heart failure (HF) and outcomes like health status. The purpose of this study was to describe the relationship between HF self-care and Short Form-36 (SF-36) health status domains. Methods and results: A secondary analysis of cross-sectional data collected on 400 HF patients living in southern Thailand was completed using bivariate comparisons and hierarchical multiple regression modeling. Thai population norm-based SF-36 scores and Self-Care of Heart Failure Index (SCHFI) scores were used in the analysis. The sample was in older adulthood (65.7 ± 13.8 years), a slight majority of subjects were male (52%); the majority of subjects (62%) had class III or IV HF. Each health domain was low in this sample compared to the general population. SCHFI maintenance and confidence scores were correlated significantly with each health status domain. SCHFI scores explained a significant amount of variance all domains, both in bivariate and multivariate models, except social functioning. In multivariate models, higher levels of self-care were associated with better health in certain domains, but only when both SCFHI management and confidence were high. Conclusion: Improving HF self-care may be a mechanism through which future interventions can improve health in this population.

A model predicting health status of patients with heart failure.

Objective:To test the causal relationships among the components of sociodemographic (age, gender, education, and income), illness characteristics (duration of illness, severity of illness, and comorbid diseases), and self-management ability, and health status in the model of health status of patients with heart failure (HSHF). Design:Descriptive cross-sectional study. Materials and Methods:Participants were 400 heart failure patients hospitalized or attending an out patient clinic at six hospitals in southern Thailand. A survey-interview method was used for data collection. Questionnaires were related to study factors including sociodemographics, duration of illness, the New York Heart Association Functional Classification (NYHA-FC), the Charlson Comorbidity Index, the Self-Care of Heart Failure Index (SCHFI), the Short Form-36 Health Survey (SF-36). The relationship of the study variables was tested and modified under the structural equation modeling (SEM) technique by using LISREL. Results:The initial hypothesized model did not fit the data. The modified model adequately fit the data and accounted for 64% of the variance in health status. Age had a direct negative effect on health status (&bgr; = −0.20, P < 0.01) and had an indirect negative effect on health status through self-management ability, severity of illness and comorbid disease (&bgr; = −0.13, P < 0.01). Education had a direct positive effect on health status (&bgr; = 0.12, P < 0.01). Gender and income had indirect negative effects on health status through severity of illness (&bgr; = −0.05; −0.05, P < 0.05). Duration of illness had an indirect positive effect on health status through self-management ability (&bgr; = 0.09, P < 0.05). Severity of illness and comorbid disease had a direct negative effect on health status (&bgr; = −0.31; −0.16, P < 0.01, respectively) and indirect negative effect on health status through self-management ability (&bgr; = −0.06; −0.05, P < 0.05, respectively). Self-management ability had a direct positive effect on health status (&bgr; = 0.38, P < 0.01). Conclusions:This model provides a guideline for explaining and predicting health status of patients with heart failure. Continuity care programs promoting self-management ability should be developed and implemented both in hospital-based and home-based settings in order to improve health status.