Department of Pharmacology, St. John's Medical College, Bengaluru, Karnataka, India.
Division of Clinical Research and Training, St. John's Research Institute, Koramangala, Bengaluru, India.
PLoS One. 2021 Jan 27;16(1):e0245659. doi: 10.1371/journal.pone.0245659. eCollection 2021.
Prior reports have documented extremely poor adherence to evidence-based medications among South Asian patients with established chronic cardiovascular diseases. Treatment adherence is now considered a part of the 'self-care' process, the determinants of which have not been adequately explored or explained among South Asian patients with chronic heart failure (CHF). Our objective was to qualitatively ascertain the determinants of the self-care process among Indian patients with a lived experience of heart failure.
We conducted in-depth interviews (audio-recorded) among 22 purposively sampled patients living with chronic heart failure, diagnosed at least 4 weeks prior to the interview and 17 caregivers (n = 39) in a tertiary care teaching hospital in Southern India. We employed an inductive analytical approach using Charmaz's constructivist grounded theory. Initial line-by-line coding and categorization was followed by memo writing, reflexive analysis after interviewing and analyzing four, eight and twelve patients, and at each stage further theoretical sampling was carried out until we reached thematic saturation. We used NVivo ver. 12 to analyze and organize data.
The mean age of our patients was 61 years and they represented 5 Indian states and spoke seven languages, distributed across socio-economic strata and literacy levels. We classified self-care determinants into 3 broad, simple categories and defined underlying themes namely, negative determinants (passivity, entrenched beliefs, negative affect, lack of knowledge, financial difficulties, and fatalism), intermediate factors (patient expectations, provider/hospital hopping) and facilitators or positive self-care determinants (intrinsic and extrinsic facilitators). Gender and the cultural background of patients' upbringing appear to shape these determinants, thereby affecting self-care decision making in chronic heart failure.
We have empirically described a unique set of self-care determinants among Indian chronic heart failure patients, which in turn are shaped by economic and socio-cultural factors. Assessing for and addressing these determinants during clinical interactions through multi-factorial approaches may help improve self-care among Indian CHF patients, thus improving treatment adherence and clinical outcomes.
先前的报告记录了南亚有明确慢性心血管疾病的患者对循证药物的服用率极低。如今，治疗依从性被认为是“自我护理”过程的一部分，而南亚慢性心力衰竭（CHF）患者中，该过程的决定因素尚未得到充分探索或解释。我们的目的是从定性角度确定有心力衰竭体验的印度患者自我护理过程的决定因素。
我们在印度南部的一家三级护理教学医院中，对 22 名有慢性心力衰竭诊断（在访谈前至少 4 周）且生活经历的患者（n=39）和 17 名护理人员进行了深入访谈（录音）。我们采用 Charmaz 的建构主义扎根理论进行了归纳分析方法。初始逐行编码和分类后，进行了备忘录写作、访谈和分析 4、8 和 12 名患者后的反思性分析，并且在每个阶段都进行了进一步的理论抽样，直到达到主题饱和。我们使用 NVivo ver.12 对数据进行分析和组织。
我们患者的平均年龄为 61 岁，他们代表了 5 个印度邦，讲 7 种语言，分布在社会经济阶层和文化程度不同的人群中。我们将自我护理决定因素分为 3 个广泛的简单类别，并定义了潜在的主题，即负面决定因素（被动性、固有信念、负面情绪、缺乏知识、经济困难和宿命论）、中间因素（患者期望、频繁更换医生和医院）和促进因素或积极的自我护理决定因素（内在和外在促进因素）。患者的性别和成长背景似乎塑造了这些决定因素，从而影响慢性心力衰竭的自我护理决策。
我们通过实证描述了印度慢性心力衰竭患者自我护理决定因素的独特集合，而这些决定因素又受到经济和社会文化因素的影响。通过多因素方法在临床互动中评估和解决这些决定因素，可能有助于改善印度 CHF 患者的自我护理，从而提高治疗依从性和临床结局。
