title: A Culturally Appropriate Educational Intervention Can Improve Self-Care in Hispanic Patients With Heart Failure: A Pilot Randomized Controlled Trial.
abstract: BACKGROUND
  Hispanics constitute the largest US ethnic group and have been shown to have more frequent heart failure (HF) hospitalizations than non-Hispanic whites. Disease management programs can reduce HF hospitalizations and mortality by increasing patient self-care, but most programs are limited to patients who speak English. Therefore, we hypothesize that Project Fluido, a culturally appropriate self-care education intervention, will improve self-care behaviors and knowledge in Hispanic patients with HF compared with usual care (UC).
  
  
  METHODS
  Project Fluido (N = 42) was a randomized controlled pilot trial over 3 months. Patients in the experimental group (n = 22) received individualized education in Spanish using the "teach-back" method on the following: high salt foods, when to call the physician, when to report weight gain and the use of diuretics. They also received a nurse-initiated phone call every 2 weeks, a script for calling their physician with increased symptoms, a weight scale and a daily diary to complete. The UC group (n = 20) received a scale and written information. Self-care was measured using the self-care heart failure index and knowledge using teach-back scores. Four knowledge topics were included when using teach-back.
  
  
  RESULTS
  Participants' mean age was 57 ± 14 years, 57% (24) were male, 64% (27) had hypertension, 86% (36) were New York Heart Association Class I-III and 65% (26) had HF with reduced ejection fraction. Participant health literacy scores showed poor health literacy in 31% (n = 13) and 67% (n = 28) spoke Spanish only. Household income was reported as < $20,000 in 93% (n = 39). Self-care and knowledge scores significantly improved (P < 0.04 and P < 0.02, respectively) in the intervention group compared to UC.
  
  
  CONCLUSIONS
  The intervention utilized in Project Fluido was a remarkably effective method to improve self-care and HF knowledge in a group of Spanish-speaking HF patients. This improvement is in spite of low physical function, health literacy, acculturation and economic challenges. In addition, teach-back was an effective teaching strategy to improve HF knowledge. Future work is needed to investigate the relationship between increased self-care knowledge, readmissions, and mortality in Spanish-speaking patients with HF.
authors.affiliation: Department of Physiological Nursing, University of California, San Francisco, CA, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Howie-Esquivel
authors.affiliation: Department of Medicine, University of California, San Francisco General Hospital, San Francisco, CA, USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.affiliation: School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Clark
authors.affiliation: Program in Nursing Science, University of California, Irvine, CA, USA.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Evangelista
authors.affiliation: Department of Physiological Nursing, University of California, San Francisco, CA, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dracup
keywords: Health literacy; Heart failure; Hispanic; Patient knowledge; Self-care