Howie-Esquivel Jill, Bibbins-Domingo Kirsten, Clark Robyn, Evangelista Lorraine, Dracup Kathleen
Department of Physiological Nursing, University of California, San Francisco, CA, USA.
Department of Medicine, University of California, San Francisco General Hospital, San Francisco, CA, USA.
Cardiol Res. 2014 Aug;5(3-4):91-100. doi: 10.14740/cr346w. Epub 2014 Jul 20.
Hispanics constitute the largest US ethnic group and have been shown to have more frequent heart failure (HF) hospitalizations than non-Hispanic whites. Disease management programs can reduce HF hospitalizations and mortality by increasing patient self-care, but most programs are limited to patients who speak English. Therefore, we hypothesize that Project Fluido, a culturally appropriate self-care education intervention, will improve self-care behaviors and knowledge in Hispanic patients with HF compared with usual care (UC).
Project Fluido (N = 42) was a randomized controlled pilot trial over 3 months. Patients in the experimental group (n = 22) received individualized education in Spanish using the "teach-back" method on the following: high salt foods, when to call the physician, when to report weight gain and the use of diuretics. They also received a nurse-initiated phone call every 2 weeks, a script for calling their physician with increased symptoms, a weight scale and a daily diary to complete. The UC group (n = 20) received a scale and written information. Self-care was measured using the self-care heart failure index and knowledge using teach-back scores. Four knowledge topics were included when using teach-back.
Participants' mean age was 57 ± 14 years, 57% (24) were male, 64% (27) had hypertension, 86% (36) were New York Heart Association Class I-III and 65% (26) had HF with reduced ejection fraction. Participant health literacy scores showed poor health literacy in 31% (n = 13) and 67% (n = 28) spoke Spanish only. Household income was reported as < $20,000 in 93% (n = 39). Self-care and knowledge scores significantly improved (P < 0.04 and P < 0.02, respectively) in the intervention group compared to UC.
The intervention utilized in Project Fluido was a remarkably effective method to improve self-care and HF knowledge in a group of Spanish-speaking HF patients. This improvement is in spite of low physical function, health literacy, acculturation and economic challenges. In addition, teach-back was an effective teaching strategy to improve HF knowledge. Future work is needed to investigate the relationship between increased self-care knowledge, readmissions, and mortality in Spanish-speaking patients with HF.
西班牙裔是美国最大的种族群体，研究表明，他们比非西班牙裔白人更频繁地因心力衰竭（HF）住院。疾病管理项目可以通过增强患者自我护理来减少HF住院率和死亡率，但大多数项目仅限于说英语的患者。因此，我们假设，“流体计划”（Project Fluido），一种符合文化背景的自我护理教育干预措施，与常规护理（UC）相比，将改善西班牙裔HF患者的自我护理行为和知识。
“流体计划”（N = 42）是一项为期3个月的随机对照试验。实验组（n = 22）的患者使用“反馈教学”法接受西班牙语的个性化教育，内容包括：高盐食物、何时致电医生、何时报告体重增加以及利尿剂的使用。他们还每两周接到一次护士发起的电话、一份症状加重时致电医生的脚本、一台体重秤和一本待填写的日常日记。UC组（n = 20）收到一台体重秤和书面信息。使用自我护理心力衰竭指数测量自我护理情况，使用反馈教学分数测量知识掌握情况。使用反馈教学时涵盖四个知识主题。
参与者的平均年龄为57±14岁，57%（24人）为男性，64%（27人）患有高血压，86%（36人）为纽约心脏协会I - III级，65%（26人）的HF患者射血分数降低。参与者的健康素养得分显示，31%（n = 13）健康素养较差，67%（n = 28）仅说西班牙语。93%（n = 39）报告家庭收入低于20,000美元。与UC组相比，干预组的自我护理和知识得分显著提高（分别为P < 0.04和P < 0.02）。
“流体计划”中采用的干预措施是提高一组说西班牙语的HF患者自我护理和HF知识的显著有效方法。尽管存在身体功能差、健康素养低、文化适应和经济方面的挑战，但仍实现了这种改善。此外，反馈教学是提高HF知识的有效教学策略。未来需要开展工作，以研究说西班牙语的HF患者自我护理知识增加与再入院率和死亡率之间的关系。
