Alice Lee Centre for Nursing Studies, Yong Loo Lin, School of Medicine, National University of Singapore.
Alice Lee Centre for Nursing Studies, Yong Loo Lin, School of Medicine, National University of Singapore; National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore.
Int J Nurs Stud. 2021 Mar;115:103872. doi: 10.1016/j.ijnurstu.2021.103872. Epub 2021 Jan 12.
Heart failure self-care is crucial for sustainable heart failure management but its adherence remains poor worldwide. Despite having an intention to change, individuals often face difficulties in modifying existing lifestyle habits and sustaining change motivations.
To examine the effectiveness of a novel theory-driven nurse-led self-regulation program on improving heart failure self-care behaviours, future-thinking and behavioural automaticity.
A two-arm randomized controlled trial.
SETTINGS & PARTICIPANTS: 144 patients with heart failure were recruited from September 2018 to July 2019 at a tertiary hospital in Singapore.
Participants were randomly assigned to a self-regulation intervention (n = 72) or usual care group (n = 72). The three-month intervention was developed based on the temporal self-regulation theory and consisted of one face-to-face session, a print booklet and three reinforcement telephone follow-ups at week 3, 6 and 9. Outcomes were measured at baseline (T0), immediate after a three-month intervention (T1) and a further three-month follow-up (T2). heart failure self-care was measured using the Self-Care of Heart Failure Index (SCHFI) maintenance subscale, future-thinking was measured using the Consideration of Future Consequences Scale (CFCS) and behaviour automaticity was measured using the Self-Reported Behavioural Automaticity Index (SRBAI). The outcomes were compared between groups by using generalized estimating equations (GEE) based on intention-to-treat principle.
No significant differences were found between the groups at baseline except for age. Participants were on average 61 years old, men (79.2%), had mild heart failure symptoms (50.7%) and had three comorbidities (66.0% dyslipidaemia; 65.3% hypertension; 61.8% history of myocardial infarction). Baseline scores indicated poor heart failure self-care (52.9±17.2, cut off ≥70). GEE results showed significantly higher heart failure self-care improvements in intervention group than control group at both T1 (regression coefficient, B = 13.9, 95% CI: 8.02 to 19.9, p < 0.001) and T2 (B = 8.34, 95% CI: 1.68 to 15.0, p = 0.014) after adjusting for gender, living alone, education level, comorbidity and age. Results also showed significantly higher increase in future-thinking (B[95% CI]=0.694[.123, 1.26], p = 0.017) and behaviour automaticity (B[95% CI]=0.656[.085, 1.23], p = 0.024) at T1 and only increase in behaviour automaticity (B[95% CI]=0.674[.099, 1.25], p = 0.022) at T2. However, only the differences in self-care scores at T1 remained significant after Bonferroni correction. No significant differences were found for intention, quality of life and clinical biomarkers.
The program was effective in improving heart failure self-care and has potential for clinical implementation and generalisation to other chronic illnesses. Longer follow-up study is needed to uncover its long-term benefits on clinical outcomes.
心力衰竭自我护理对于可持续的心力衰竭管理至关重要，但全球范围内的依从性仍然很差。尽管有改变的意愿，但个体在改变现有生活方式习惯和维持改变动机方面往往会面临困难。
检验一种新的基于理论的护士主导的自我调节方案对改善心力衰竭自我护理行为、未来思维和行为自动性的有效性。
一项两臂随机对照试验。
2018 年 9 月至 2019 年 7 月，在新加坡一家三级医院招募了 144 名心力衰竭患者。
参与者被随机分配到自我调节干预组（n=72）或常规护理组（n=72）。为期三个月的干预措施是基于时间自我调节理论制定的，包括一次面对面的会议、一本印刷小册子和三次强化电话随访，分别在第 3、6 和 9 周进行。在基线（T0）、三个月干预后的即刻（T1）和进一步的三个月随访（T2）时测量结局。使用心力衰竭自我护理指数（SCHFI）维持分量表测量心力衰竭自我护理，使用未来思维量表（CFCS）测量未来思维，使用自我报告行为自动性量表（SRBAI）测量行为自动性。采用基于意向治疗原则的广义估计方程（GEE）比较组间差异。
除了年龄，组间在基线时没有显著差异。参与者的平均年龄为 61 岁，男性（79.2%），心力衰竭症状较轻（50.7%），合并三种合并症（血脂异常 66.0%；高血压 65.3%；心肌梗死史 61.8%）。基线评分表明心力衰竭自我护理较差（52.9±17.2，临界值≥70）。GEE 结果显示，干预组在 T1（回归系数，B=13.9，95%CI：8.02 至 19.9，p<0.001）和 T2（B=8.34，95%CI：1.68 至 15.0，p=0.014）时，心力衰竭自我护理的改善明显高于对照组，在调整了性别、独居、教育水平、合并症和年龄后。结果还显示，在 T1 时未来思维（B[95%CI]=0.694[.123, 1.26]，p=0.017）和行为自动性（B[95%CI]=0.656[.085, 1.23]，p=0.024）的增加显著更高，而仅在 T2 时行为自动性的增加（B[95%CI]=0.674[.099, 1.25]，p=0.022）更高。然而，仅 T1 时的自我护理评分差异在 Bonferroni 校正后仍有统计学意义。意向、生活质量和临床生物标志物无显著差异。
该方案在改善心力衰竭自我护理方面是有效的，具有临床实施和推广到其他慢性病的潜力。需要进行更长时间的随访研究，以揭示其对临床结局的长期益处。
