title: A simplified education program improves knowledge, self-care behavior, and disease severity in heart failure patients in rural settings.
abstract: BACKGROUND
  Self-monitoring by heart failure (HF) patients of worsening symptoms caused by fluid overload is a cornerstone of HF care. Disease management has improved outcomes in HF; however, these resource-intensive programs are limited to urban centers and are generally unavailable in rural or limited health care access areas. This pilot study sought to determine whether a simplified education program focused on a single component of disease management (symptom recognition and management of fluid weight) could improve knowledge, patient-reported self-care behavior, and HF severity in a rural setting.
  
  
  METHODS
  This randomized clinical trial enrolled 36 rural HF patients into an intervention or control group. The intervention group received a simplified education program with a follow-up phone call focusing on symptom management delivered by a non-cardiac-trained nurse. Patient knowledge, self-care behaviors, and HF severity (B-natriuretic peptide [BNP]) were measured at enrollment and at 3 months.
  
  
  RESULTS
  The sample was primarily white men and married with a mean age of 71 years and ejection fraction of 47%. There were no differences between groups in knowledge, self-care behaviors and BNP at baseline; however, knowledge and self-care behavior related to daily weights improved significantly at 3 months in the intervention group (P = .01 and .03, respectively). Although the changes in mean BNP at 3 months were in the hypothesized direction, the difference between the 2 groups was not significant.
  
  
  CONCLUSIONS
  A simplified education program designed for use in resource scarce settings improves knowledge and patient-reported self-care behaviors. These findings are important in providing care to patients with HF in limited access settings but should be studied for longer periods in more heterogeneous populations.
authors.affiliation: University of California, San Francisco, California, USA. mary.caldwell@nursing.ucsf.edu
authors.forename: Mary A
authors.initials: MA
authors.lastname: Caldwell
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Peters
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Dracup
mesh_terms: D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods; D010865:Pilot Projects; D015397:Program Evaluation; D012424:Rural Population; D012648:Self Care; D012720:Severity of Illness Index