A systematic review of the effectiveness of current interventions to assist adults with heart failure to comply with therapy and enhance self-care behaviours.

Background Heart failure is a common chronic disease that is one of the leading causes of hospitalisations in many countries around the world. Poor compliance with recommended self-care behaviours, for example managing medication and diet regimes, rather than the deterioration of the cardiac condition, have contributed to a significant proportion of heart failure exacerbations. Patients with heart failure can benefit from interventions that aim to increase their knowledge of the disease and support them in managing their care. There is a need, however, to determine which interventions, if any, are more effective in achieving the aims of self-care. Objective This review examined the evidence to answer the question: What are the most effective interventions for helping adults with heart failure comply with therapy and enhance self care behaviours? Inclusion criteria Types of participants This review focused on adults (aged 18 years and over) diagnosed with heart failure. Types of interventions The review considered studies that evaluated interventions aimed to help people with heart failure to improve self-care behaviours. Types of studies Randomised control trials, quasi-randomised designs and pre-test post-test studies were included in the review. Types of outcomes The primary outcome measure was improvement in actual self-care behaviours, including adherence to medications, maintaining a healthy diet, daily weighing, reducing salt intake, recognising symptoms and contacting health professionals when assistance may be required. Search Strategy The search sought to identify published and unpublished, English language studies from 1990 until 2010. Databases searched included Medline, EMBASE, CINAHL, PsycInfo, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews & JBI COnNECT, PubMed, Informit - Health Collection, MEDNAR, Dissertations & Theses, and Google Scholar Methodological Quality Two independent reviewers independently used the standard critical appraisal tool, from the Joanna Briggs Institute, to assess the methodological quality of studies that matched with inclusion criteria. Data Collection The process of data extraction was undertaken independently by two reviewers using tools from the Joanna Briggs Institute Meta analysis of Statistic Assessment and Review Instrument. Data Synthesis Appropriate data were pooled for meta-analysis. The remaining studies were grouped according to outcome measures and type of intervention and presented descriptively. Results The review included thirteen studies; eight were randomised controlled trials and five were pre-test post-test studies. Conclusions The review confirmed that education alone is less effective than a combination of education and the use of personal diaries to promote daily weighing. There is some evidence to suggest that motivational interviewing has potential for use in the heart failure population and may be more beneficial than standard education. Furthermore education should be tailored to individual learning needs. Implications for practice Clinicians should ideally work with patients to encourage the use of tools to reinforce the importance of self-care behaviours. Tailoring interventions to suit the individual is also beneficial. Implications for Research Interventions that promote efficacy in self-care behaviours through empowerment should be investigated in future studies. Further research needs to also consider the impact of an intervention/s over an extended timeframe (e.g. more than 12 months) as the majority of the research focuses on short time periods (e.g. 3 months).