A PILOT TEST OF AN INTEGRATED SELF-CARE INTERVENTION FOR PERSONS WITH HEART FAILURE AND CONCOMITANT DIABETES

摘要

Studies show 30-47% of persons with heart failure (HF) have concomitant diabetes mellitus (DM). Self-care for persons with both of these chronic conditions is conflicting, complex and often inadequate. This pilot study tested an integrated self-care program for its effects on HF and DM knowledge, self-care efficacy, self-care behaviors and Quality of Life (QOL). Hospitalized HF-DM participants (n=71) were randomized to usual care or intervention using a 1:2 allocation and followed at 30 and 90 days after intervention. Intervention was an integrated education and counseling program focused on HF-DM self-care. Variables included demographic and clinical data, knowledge about HF and DM, HF and DM specific self- efficacy, standard HF and DM QOL scales, and HF and DM self-care behaviors. Analysis included descriptive statistics, multilevel longitudinal models for group and time effects, post-hoc testing and effect size calculations. Sidak adjustments were used to control for Type 1 error inflation. The integrated HF-DM self-care intervention conferred effects on improved HF knowledge (30 days, p=.05), HF self-care maintenance (30 and 90 days, p<.001), self-care management (90 days, p=.05), DM self efficacy (30 days, p=.03; 90 days, p=.004), general diet (30 days, p=.05), HF physical QOL (p=.04) and emotional QOL scores (p=.05) at 90 days within the intervention group. UC also reported increased total and physical QOL. Greater percentages of participants in the intervention group improved self reported exercise between 0-30 days (p=.005 and moderate effect size ES=.47), and foot care between 0-90 days (p=.03, small ES=.36). No group differences or improvements in DM specific QOL were observed. An integrated HF-DM self-care intervention was effective in improving essential components of self-care and had sustained (90 day) effects on selected self-care behaviors. Future studies testing HF-DM integrated self-care interventions in larger samples, with longer follow-up, and on other outcomes such as hospitalization and clinical markers are warranted.