title: Patient participation in patients with heart failure receiving structured home care--a prospective longitudinal study.
abstract: BACKGROUND
  Patient participation is important for improving outcomes, respect for self-determination and legal aspects in care. However, how patients with heart failure view participation and which factors may be associated with participation is not known. The aim of this study was therefore to describe the influence of structured home care on patient participation over time in patients diagnosed with heart failure, and to explore factors associated with participation in care.
  
  
  METHODS
  The study had a prospective pre-post longitudinal design evaluating the influence of structured home care on participation in patients at four different home care units. Patient participation was measured using 3 scales and 1 single item. Self-care behavior, knowledge, symptoms of depression, socio- demographic and clinical characteristics were measured to explore factors associated with patient participation. Repeated measure ANOVA was used to describe change over time, and stepwise regression analyses were used to explore factors associated with patient participation.
  
  
  RESULTS
  One hundred patients receiving structured heart failure home care were included. Mean age was 82 years, 38 were women and 80 were in New York Heart Association functional class III. One aspect of participation, received information, showed a significant change over time and had increased at both six and twelve months. Better self-care behavior was associated with all four scales measuring different aspects of participation. Experiencing lower degree of symptoms of depression, having better knowledge, being of male sex, being of lower age, cohabiting and having home help services were associated with one or two of the four scales measuring different aspects of participation.
  
  
  CONCLUSIONS
  Patients experienced a fairly high level of satisfaction with participation in care at baseline, and there was a significant improvement over time for participation with regard to received information after being admitted to structured home care. Higher level of patient participation was consistently associated with better self-care behavior. This study shows that patient participation may need to be further focused upon, and that the association with self-care may be interesting to target in future interventions.
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, 581 85, Sweden. lena.nasstrom@liu.se.
authors.forename: Lena
authors.initials: L
authors.lastname: Näsström
authors.affiliation: Department of Social and Welfare studies, Linköping University, Norrköping, Sweden. tiny.jaarsma@liu.se.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Care Science, Malmö University, and Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Malmö, Sweden. ewa.idvall@mah.se.
authors.forename: Ewa
authors.initials: E
authors.lastname: Idvall
authors.affiliation: School of Health and Caring Sciences, Linnaeus University, Kalmar, and Palliative Research Centre, Ersta Sköndal University Collage and Ersta Hospital, Stockholm, Sweden. kristofer.arestedt@liu.se.|Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. kristofer.arestedt@liu.se.
authors.forename: Kristofer
authors.initials: K
authors.lastname: Årestedt
authors.affiliation: Department of Medical and Health Sciences, Linköping University, and Department of Cardiology, County Council of Östergötland, Linköping, Sweden. anna.stromberg@liu.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Strömberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression; D005260:Female; D006333:Heart Failure; D006699:Home Care Services; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D010358:Patient Participation; D011446:Prospective Studies; D012044:Regression Analysis; D012648:Self Care; D011795:Surveys and Questionnaires