title: Self-care Barriers Reported by Emergency Department Patients With Acute Heart Failure: A Sociotechnical Systems-Based Approach.
abstract: OBJECTIVE
  We pilot tested a sociotechnical systems-based instrument that assesses the prevalence and nature of self-care barriers among patients presenting to the emergency department (ED) with acute heart failure.
  
  
  METHODS
  A semistructured instrument for measuring self-reported self-care barriers was developed and administered by ED clinicians and nonclinician researchers to 31 ED patients receiving a diagnosis of acute heart failure. Responses were analyzed with descriptive statistics and qualitative content analysis. Feasibility was assessed by examining participant cooperation rates, instrument completion times, item nonresponse, and data yield.
  
  
  RESULTS
  Of 47 distinct self-care barriers assessed, a median of 15 per patient were indicated as "sometimes" or "often" present. Thirty-four specific barriers were reported by more than 25% of patients and 9 were reported by more than 50%. The sources of barriers included the person, self-care tasks, tools and technologies, and organizational, social, and physical contexts. Seven of the top 10 most prevalent barriers were related to patient characteristics; the next 3, to the organizational context (eg, life disruptions). A preliminary feasibility assessment found few item nonresponses or comprehension difficulties, good cooperation, and high data yield from both closed- and open-ended items, but also found opportunities to reduce median administration time and variability.
  
  
  CONCLUSIONS
  An instrument assessing self-care barriers from multiple system sources can be feasibly implemented in the ED. Further research is required to modify the instrument for widespread use and evaluate its implementation across institutions and cultural contexts. Self-care barriers measurement can be one component of broader inquiry into the distributed health-related "work" activity of patients, caregivers, and clinicians.
authors.affiliation: Department of BioHealth Informatics, Indiana University School of Informatics and Computing, and the Center for Health Informatics Research and Innovation, Indianapolis, IN. Electronic address: rjholden@iupui.edu.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Holden
authors.affiliation: Department of Medical Education, Loma Linda University School of Medicine, Loma Linda, CA.
authors.forename: Christiane C
authors.initials: CC
authors.lastname: Schubert
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Eugene C
authors.initials: EC
authors.lastname: Eiland
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Storrow
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Karen F
authors.initials: KF
authors.lastname: Miller
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015995:Prevalence; D012648:Self Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013597:Systems Analysis; D016903:Drug Monitoring