Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
National University Heart Centre Singapore, National University Hospital, Singapore, Singapore.
J Med Internet Res. 2021 Apr 27;23(4):e28216. doi: 10.2196/28216.
BACKGROUND: Heart failure (HF) is a major public health problem that places a significant disease burden on society. Self-care is important in the management of HF because it averts disease progression and reduces the number of hospitalizations. Effective nursing interventions promote HF self-care. OBJECTIVE: This study aims to explore participants' perspectives on a nurse-led, home-based heart failure self-management program (HOM-HEMP) in a randomized controlled trial conducted in Singapore to gain insight into the effectiveness of the study intervention. METHODS: A descriptive, qualitative approach was used. English- or Chinese-speaking participants from the intervention arms were recruited through a purposive sampling method from January 2019 to July 2019. Individual, face-to-face, semistructured interviews were conducted with 11 participants. All interviews were audio recorded and transcribed verbatim, with the participant identifiers omitted to ensure confidentiality. The thematic analysis approach was used to identify, analyze, and report patterns (themes) within the data. RESULTS: A total of six themes emerged from the process evaluation interviews and were categorized according to the Donabedian structure-process-outcome framework as intervention structure, intervention process, and intervention outcome. These six themes were manageability of the intervention, areas for improvement, benefits of visiting, personal accountability in self-care, empowered with knowledge and skills in self-care after the intervention, and increased self-efficacy in cardiac care. CONCLUSIONS: The findings of the process evaluation provided additional information on participants' perceptions and experiences with the HOM-HEMP intervention. Although a home visit may be perceived as resource intensive, it remains to be the preferred way of engagement for most patients. Nurses play an important role in promoting HF self-care. The process of interaction with the patient can be an important process for empowering self-care behavior changes.
背景：心力衰竭（HF）是一个重大的公共卫生问题，给社会带来了巨大的疾病负担。自我护理在 HF 的管理中很重要，因为它可以避免疾病进展，减少住院次数。有效的护理干预措施可以促进 HF 的自我护理。
目的：本研究旨在探讨参与者对新加坡一项随机对照试验中护士主导的基于家庭的心力衰竭自我管理计划（HOM-HEMP）的看法，以深入了解研究干预的效果。
方法：采用描述性、定性方法。2019 年 1 月至 7 月，通过目的抽样法从干预组中招募讲英语或中文的参与者。对 11 名参与者进行了单独的、面对面的半结构化访谈。所有访谈均进行了录音，并逐字转录，为了确保机密性，省略了参与者标识符。采用主题分析方法，根据 Donabedian 结构-过程-结果框架，识别、分析和报告数据中的模式（主题）。
结果：共有六个主题从过程评估访谈中出现，并根据 Donabedian 结构-过程-结果框架分类为干预结构、干预过程和干预结果。这六个主题是干预的可管理性、改进的领域、家访的好处、自我护理中的个人责任、干预后自我护理知识和技能的增强以及心脏护理的自我效能感增加。
结论：过程评估的结果提供了关于参与者对 HOM-HEMP 干预的看法和经验的额外信息。虽然家访可能被认为是资源密集型的，但它仍然是大多数患者首选的参与方式。护士在促进 HF 自我护理方面发挥着重要作用。与患者互动的过程可以是增强自我护理行为改变的重要过程。
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