Improving Heart Failure Self-care Through a Community-Based Skill-Building Intervention: A Study Protocol.
BACKGROUND
Self-care is the cornerstone of heart failure (HF) management. Numerous approaches to improving HF self-care, which involves adherence to the treatment plan, routine symptom monitoring, and the response to symptoms when they occur, have been developed with little impact on HF outcomes. On the basis of HF practice recommendations that patients receive education and counseling that emphasizes self-care and targets skill building of critical target behaviors, we are conducting a clinical trial designed to improve self-care among community-dwelling older adults using an innovative group-based, skill-building approach led by a trained health educator.


OBJECTIVE
This article describes the study design and research methods used to implement and evaluate the intervention.


METHODS
The study uses a staggered randomized controlled design to assess feasibility of providing an HF self-care intervention in a community group setting to improve HF self-care, knowledge, and health-related quality of life at 1 and 3 months. A community engagement approach is used to partner with the community throughout all phases of the project. Seventy-five older adults with HF are randomly assigned to the intervention consisting of six to eight 60-minute sessions held in community senior centers or to the wait-list control group. Focus groups are used to elicit feedback on the participants' experience in the program.


RESULTS
Preliminary study participation data (n=60; women, 48%; black, 27%; Hispanic, 32%; mean [SD] age, 70 [10] years) and focus group feedback suggest that the delivery approach is feasible and acceptable, and the participants are very satisfied with the program.


CONCLUSIONS
Implementation of a community-based HF self-care intervention delivered in partnership with established community-based centers is an innovative approach to intervention. If efficacy is demonstrated, this intervention has far-reaching implications for helping the growing population of HF patients in ethnically diverse communities.
Victoria Vaughan Dickson, PhD, CRNP Assistant Professor, College of Nursing, New York University. Gail D'Eramo Melkus, EdD Florence & William Downs Professor in Nursing Research, College of Nursing, New York University. Caroline Dorsen, MS Doctoral Student, College of Nursing, New York University. Stuart Katz, MD Helen L. and Martin S. Kimmel Professor of Advanced Cardiac Therapeutics, School of Medicine, New York University. Barbara Riegel, PhD, RN, FAHA, FAAN Professor and Edith Clemmer Steinbright Chair of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia.
Victoria Vaughan
VV
Dickson
Gail D'Eramo
GD
Melkus
Caroline
C
Dorsen
Stuart
S
Katz
Barbara
B
Riegel
D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D057187:Independent Living; D008297:Male; D010353:Patient Education as Topic; D012648:Self Care