title: Effects of tailored telemonitoring on heart failure patients' knowledge, self-care, self-efficacy and adherence: a randomized controlled trial.
abstract: BACKGROUND
  The education of patients with heart failure (HF) is an essential part of disease management. The perspectives of an increasing number of patients and a shortage of professionals force healthcare to explore new strategies in supporting patients to be better informed and more active.
  
  
  METHODS
  Three hundred and eighty-two patients with HF (age 71±SD 11.2 years) were randomly assigned to either a telemonitoring or a usual care group. Patients received four postal questionnaires to assess their levels of self-reported knowledge, self-care, self-efficacy and adherence. Generalized estimating equations analysis was performed to assess the effects of telemonitoring during the 1-year follow-up. Corrections for baseline were performed if needed.
  
  
  RESULTS
  Baseline differences between groups were found for self-care (p=0.001) and self-efficacy (p=0.024). Knowledge of patients in the telemonitoring group significantly improved with 0.9 point on a 15-points scale (p<0.001). Their self-care abilities improved with 1.5 point on a 10-item scale whereas no changes were found in patients receiving usual care (p<0.001). Self-efficacy of patients in the intervention group improved significantly after 6 months yet was not significantly different after 3 months and 1 year. For patients in the intervention group adherence improved for daily weighing (p<0.001) during the whole follow-up and for fluid intake (p=0.019) after 3 months and after 12 months (p=0.086). Adherence for activity recommendations improved (p=0.023) after 3 months and importance of medication adherence increased after 6 (p=0.012) and 12 months (p=0.037). No effects were found regarding appointments, diet, smoking and use of alcohol.
  
  
  CONCLUSIONS
  Tailored telemonitoring was found to educate patients with HF and to improve their self-care abilities and sense of self-efficacy.
authors: 1Department of Patient and Care, Maastricht University Medical Centre, and CAPHRI, Department of Health Services Research, Maastricht University, The Netherlands.
authors: Josiane J J
authors: JJ
authors: Boyne
authors: Hubertus J M
authors: HJ
authors: Vrijhoef
authors: Marieke
authors: M
authors: Spreeuwenberg
authors: Gerjan
authors: G
authors: De Weerd
authors: Johannes
authors: J
authors: Kragten
authors: Anton P M
authors: AP
authors: Gorgels
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064646:Cardiovascular Nursing / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000451:nursing / Q000523:psychology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*
keywords: Heart failure; adherence; knowledge; self-care; self-efficacy; telemonitoring