-
Copyright © 2015 Revista Latino-Americana de EnfermagemThis is
an Open Access article distributed under the terms of the Creative
Commons Attribution Non-Commercial License (CC BY-NC).This license
lets others distribute, remix, tweak, and build upon your work
non-commercially, and although their new works must also
acknowledge you and be non-commercial, they don’t have to license
their derivative works on the same terms.
Corresponding Author:Maria Cecilia GallaniUniversité Laval.
Faculté des sciences infirmières1050 avenue de la MédécinePavillon
Ferdinand-VandryQuébec, QC, CanadaE-mail:
[email protected]
1 Supported by Réseau de recherche en interventions en sciences
infirmières du Québec (RRISIQ), Canada.2 Master’s student, Faculté
des sciences infirmières, Université Laval, Québec, QC, Canada.3
Doctoral student, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for
Nursing Research
Development, Ribeirão Preto, SP, Brazil.4 MSc, APN, Institut
universitaire de cardiologie et pneumologie de Québec, Québec, QC,
Canada.5 PhD, Full Professor, Faculté des sciences infirmières,
Université Laval, Québec, QC, Canada.
An integrative literature review on nursing interventions aimed
at
increasing self-care among heart failure patients1
Sophie Boisvert2
Alexandra Proulx-Belhumeur2
Natalia Gonçalves3
Michel Doré2
Julie Francoeur4
Maria Cecilia Gallani5
753
Objective: to analyze and summarize knowledge concerning
critical components of interventions
that have been proposed and implemented by nurses with the aim
of optimizing self-care by heart
failure patients. Methods: PubMed and CINAHL were the electronic
databases used to search full
peer-reviewed papers, presenting descriptions of nursing
interventions directed to patients or to
patients and their families and designed to optimize self-care.
Forty-two studies were included
in the final sample (n=4,799 patients). Results: this review
pointed to a variety and complexity
of nursing interventions. As self-care encompasses several
behaviors, interventions targeted an
average of 3.6 behaviors. Educational/counselling activities
were combined or not with cognitive
behavioral strategies, but only about half of the studies used a
theoretical background to guide
interventions. Clinical assessment and management were
frequently associated with self-care
interventions, which varied in number of sessions (1 to 30);
length of follow-up (2 weeks to 12
months) and endpoints. Conclusions: these findings may be useful
to inform nurses about further
research in self-care interventions in order to propose the
comparison of different modalities of
intervention, the use of theoretical background and the
establishment of endpoints to evaluate
their effectiveness.
Descriptors: Heart Failure; Self-Care; Nursing; Intervention;
Review.
Rev. Latino-Am. Enfermagem2015 July-Aug.;23(4):753-68DOI:
10.1590/0104-1169.0370.2612
www.eerp.usp.br/rlae
Review Article
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Rev. Latino-Am. Enfermagem 2015 July-Aug.;23(4):753-68.
Introduction
The context of heart failure (HF) exemplifies par
excellence the critical role that nurses have to play
in meeting health and social care challenges facing
an aging population and an important increase in
the prevalence of chronic diseases(1). HF is a global
phenomenon. Nearly 6.5 million people in Europe,
5 million people in the USA and 2.4 million people in
Japan currently suffer from heart failure (HF) and one
million new cases are diagnosed every year worldwide.
In Latin America, decompensated HF is the main cause
of cardiovascular hospitalization. Indeed, Latin America
is under the paradox of having the HF risk factors and
HF epidemiology of developed countries with the added
factors of Chagas Disease and rheumatic fever(2). Three-
quarters of all patients hospitalized for the first time
with HF will die within 5 years, making its survival rate
comparable to that of cancer(3). The syndrome has also
a high prevalence of comorbidities and multiple chronic
conditions(4), making these HF patients very complex,
with a high risk of decompensation and frequent hospital
admissions. Among patients aged 65 years or older, HF is
the most frequent cause of hospitalization, and hospital
care accounts for 65-75% of the expenditure on HF(5).
Continuous clinical follow-up of HF patients is recognized
as a class 1 recommendation in the recent guideline for the
management of HF(4), and successful patient self-care is one
of the strategies highlighted as imperative within their
plan
of care. According to the Self-care of Heart Failure
Model(6),
self-care is defined as “a naturalistic decision-making
process involving the choice of behaviors that maintain
physiologic stability (maintenance) and the response to
symptoms when they occur (management)”. Self-care
encompasses a range of health-related behaviors and is
influenced by several individual, social and environmental
factors(7). Thus, the development of nursing interventions,
targeting the patient’s needs, demands careful planning
(including an accurate evaluation of the needs), the choice
for the best approach and0 a rigorous evaluation of its
effectiveness in optimizing the practice of self-care and
its
translation into clinical outcomes.
A recent integrative review on self-care in HF
aimed at identifying successfully implemented nursing
interventions included only studies with experimental
design(7), considering that the randomized controlled trial
(RCT) is the gold standard for research into the effects
of interventions. Despite the importance of such results,
this review did not represent all nursing interventions
that have been proposed in this context. Therefore, the
purpose of the present study was to conduct a broader
integrative review aimed at identifying the critical
components of interventions that have been proposed
and implemented by nurses with the aim of at optimizing
self-care by HF patients. Finally, we intended to further
refine propositions for research and clinical practice.
Methods
The steps for the integrative review used in
this study were: problem identification (question
formulation), literature search, data evaluation, data
analysis and reporting(8). For question formulation in
the first step, we were inspired by the PICO strategy,
defining population as “HF patients” and intervention
as “nursing intervention aimed at promoting self-care”.
The comparison criterion was not applied and outcome
was analyzed in an exploratory perspective. Step 1 -
Problem identification: the central question of this
integrative review was: “What are the main attributes
of nursing interventions that have been described to
optimize self-care behaviors among HF patients?” The
aspects analyzed were: comprehensiveness of the
intervention; nature of the intervention (educational
only or including clinical assessments/interventions); if
they were theory-based; how they were applied (e.g.,
individually/in group; in person/by phone); who was the
target population (patients only or patients and families/
caregivers); the targeted self-care behaviors and the
primary and secondary endpoints used to evaluate the
intervention. Step 2 - Literature search: an extensive
electronic search of literature was conducted in the
databases PubMed and Cumulative Index of Nursing
and Allied Health Literature (CINAHL), from January 1,
2001 to December 31, 2013. The following key words
were used: Heart Failure AND Self-Care AND Nursing
Intervention. MeSH (Medical Subject Heading) Major
Topics were used for the research in PubMed. Studies
included met the following criteria: full peer-reviewed
papers, describing experimental, quasi-experimental,
descriptive and pilot studies that should necessarily
present a clear proposition or implementation of a
nursing intervention aimed at optimizing self-care,
targeting patients or patients and families. Papers
should be written in English, French, Spanish or
Portuguese. Only published papers were considered.
Reviews and dissertations or unpublished papers were
not included(8-9). Step 3 - Data evaluation: 97 studies
were found in PubMed and 45 in CINAHL. First, duplicate
articles were discarded. Subsequently, title and abstracts
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Boisvert S, Proulx-Belhumeur A, Gonçalves N, Doré M, Francoeur
J, Gallani MC.
were reviewed for content. Five independent reviewers
validated the process of evaluation and retention of the
studies. Finally, 42 studies were included in the review.
For details, see the flowchart (Figure 1).
Figure 1 - Flowchart of the methodological steps undertaken in
the integrative review
Step 4 - Data analysis: a research instrument was
developed for data extraction and analysis from the
included studies. The instrument comprised the following
items: (1) Data regarding article information; (2)
Characteristics of the sample (outpatient/inpatient, age,
sample size, gender); (3) Study design; (4) Intervention
description (educational activity, theoretical background,
clinical assessment/intervention; intervention dose and
length of follow-up); (5) Strategy for intervention delivery
(verbal/written/use of information and communication
technology, in person/by phone, individual/group, patient/
dyad); (6) Targeted self-care behaviors; (7) Endpoints.
This step was performed by four reviewers divided into
two independent groups and revised by a fifth reviewer.
Results
The reviewed articles were mostly published in
nursing journals (64.3%). Medical and multidisciplinary
journals accounted for 19.0% and 16.7% of the studies,
respectively. The number of publications was distributed
throughout the years, with a slight concentration in 2005
and 2012 (16.7% and 19.0%). North America was the
continent with the greatest number of articles (50.0%),
followed by Europe (26.2%); South America (11.9%);
Asia (9.5%) and Oceania (2.4%). The 42 articles included
a total of 4,799 patients, with sample sizes varying
from 10 to 406 patients. Patients were in average 68.6
years old and mostly male (61.9%). In the 22 studies
reporting New York Heart Association (NYHA) Functional
Class specifically (n=2,562), it varied from I up to IV,
but the majority of patients were in Class II (36.6%)
or III (45.6%). Concerning the moment of transition,
26 studies targeted patients during their clinical follow-
up, 2 studies targeted hospitalized patients, 13 studies
targeted patients in the transition from hospital to
home and 1 study did not mention it clearly. Most of
the reviewed studies (31/42) adopted RCT design, but
from those, 6 were pilot studies with small samples. The
studies analyzed are summarized in Figure 2.
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Rev. Latino-Am. Enfermagem 2015 July-Aug.;23(4):753-68.
Aut
hor C
ontin
ent
Jour
nal D
esig
nSa
mpl
eIn
terv
entio
n de
scrip
tion
Inte
rven
tion
deta
ilsTa
rget
sel
f-car
eEn
dpoi
nt
1. A
gren
et a
l.,
2012
(10)
Eur
ope
Mul
tidis
cipl
inar
yR
CT‡
Out
patie
ntA
ge: 7
1.2
n=15
5 dy
ads
(71/
IG* ;
84/C
G† )
- Edu
catio
nal a
nd p
sych
osoc
ial s
uppo
rt; P
robl
em-s
olvi
ng
skill
s- T
heor
y: S
hare
d C
are
Mod
el- C
A§ :
no /
CI‖
: no
- 3 s
essi
ons;
1 h
; FU
p¶: 3
and
12
mon
ths
- Inf
orm
atio
n: v
erba
l, w
ritte
n, IC
T** (
CD
-R
OM
pro
gram
)- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l/dya
ds- P
artic
ipan
ts: p
atie
nts
DW
‖‖
‖; S
ympM
on§§
§ ;M
edA
dh**
* ; D
iet§§
;PA
††† ;
Vacc
‖‖
‖‖
Prim
ary:
HR
QoL
¶¶ (S
F-36
); de
pres
sive
sy
mpt
oms
(BD
I-II);
per
ceiv
ed c
ontro
l (C
AS
); se
lf-ca
re b
ehav
iors
(EH
FscB
S);
care
give
r bur
den
(CB
S)
2. A
rred
onto
-Hol
guín
et
al.,
201
2(11
)
Sou
th A
mer
ica
Nur
sing
Qua
si-e
xper
imen
tal
Out
patie
ntA
ge: 6
5.0
n=29
(26/
IG;
no C
G)
Mal
e: 1
3
- Edu
catio
nal a
ctiv
ities
: dis
ease
, sel
f-car
e, li
ving
with
HF,
em
pow
erin
g an
d m
otiv
atio
n. P
atie
nts
& fa
mili
es.
- The
ory:
Sel
f-car
e D
efici
t The
ory
- CA
: no
/ CI:
no- 2
mee
tings
, 6 te
lenu
rsin
g se
ssio
ns, 2
hom
e vi
sits
and
2
grou
p se
ssio
ns;
- FU
p: 9
mon
ths
- Inf
orm
atio
n: v
erba
l, w
ritte
n, IC
T (te
lenu
rsin
g)- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l and
gro
up- P
artic
ipan
ts: p
atie
nts
& fa
mili
es
Med
Adh
;S
ympM
anag
‡‡‡
Prim
ary:
sel
f-car
e be
havi
ors
(HFS
CB
S)
3. A
ustin
et a
l.,
2012
(12)
Nor
th A
mer
ica
Nur
sing
Qua
si-e
xper
imen
tal
In/O
utpa
tA
ge: 6
4.5
n=60
(60/
IG;
no C
G)
Mal
e: 2
3
- Stre
ngth
enin
g of
sel
f-car
e pr
actic
es th
roug
h en
cour
agin
g m
essa
ges
for t
he m
anag
emen
t of H
F- N
o th
eory
- CA
: no
/ CI:
no- 1
0 m
essa
ges;
3 to
5 m
in, d
aily
voi
ced
mes
sage
s; 6
0 se
cond
s;
- FU
p: 3
0 da
ys
- Inf
orm
atio
n: v
erba
l, IC
T (in
tera
ctiv
e vo
ice
resp
onse
sys
tem
)- D
eliv
ery:
by
phon
e- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
& fa
mili
es
Med
Adh
;D
iet;
DW
;S
ympM
anag
Prim
ary:
read
mis
sion
s
4. B
arna
son
et a
l.,
2010
(13)
Nor
th A
mer
ica
Nur
sing
Pilo
t Stu
dy (R
CT)
In/O
utpa
tA
ge: 7
6.9
n=40
(20/
IG; 2
0/C
G)
Mal
e: 2
6
- Hos
pita
l tra
nsiti
on m
odul
es (s
elf-c
are
skill
s, s
elf-r
egul
atio
n of
HF,
man
agin
g ba
rrie
rs) a
nd c
ouns
elin
g- T
heor
y: S
ocia
l Cog
nitiv
e Th
eory
and
Med
icat
ion
Adh
eren
ce
Con
cept
ual F
ram
ewor
k- C
A: n
o / C
I: no
- 2 s
essi
ons;
20
to 3
0 m
in; F
Up:
3 m
onth
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n, n
o IC
T- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
Med
Adh
;S
ympM
anag
Prim
ary:
med
icat
ion
use
(BM
Q, D
RU
GS
); se
lf-ef
ficac
y fo
r HF
self-
care
(KC
CQ
); H
RQ
oL (K
CC
Q)
5. B
oyde
et a
l.,
2013
,(14)
Oce
ania
Nur
sing
Qua
si-e
xper
imen
tal
In/O
utpa
t: N
M.
Age
:65
-74
n=38
(38/
IG)
Mal
e: 2
7
- Foc
us o
n on
e to
pic
each
wee
k in
the
man
ual o
n H
F; fo
cus
grou
p in
the
conc
ludi
ng s
essi
on- N
o th
eory
- CA
: no
/ CI:
no- 8
wee
ks- F
Up:
afte
r 8 w
eeks
- Inf
orm
atio
n: v
erba
l, w
ritte
n, IC
T (D
VD
)- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l and
gro
up- P
artic
ipan
ts: p
atie
nts
Sym
pMon
;M
edA
dh;
Die
t; PA
;D
W; R
est a
nd
rela
xatio
n
Prim
ary:
kno
wle
dge
(DH
FKS
), se
lf-ca
re
abili
ties
(SC
HFI
)
6. B
rand
on e
t al.,
20
09(1
5)
Nor
th A
mer
ica
Nur
sing
Pilo
t stu
dy (R
CT)
Out
patie
ntA
ge: 6
0.0
n=20
(10/
IG;
10/C
G)
Mal
e: 9
- AP
Nα -
led
tele
phon
e in
terv
entio
n; e
duca
tion
abou
t HF
path
ophy
siol
ogy
and
self-
care
- The
ory:
Ore
m’s
Sel
f-Car
e D
efici
t- C
A: n
o / C
I: no
- Onc
e ev
ery
2 w
eeks
; 7 p
hone
cal
ls; 5
to 3
0 m
ins;
FU
p: 6
m
onth
s
- Inf
orm
atio
n: v
erba
l, no
ICT
- Del
iver
y: in
per
son
and
by p
hone
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s
Die
t; Va
cc;
Sym
pMan
ag;
Med
Adh
;S
mok
ing
cess
atio
n
Prim
ary:
read
mis
sion
s; H
RQ
oL (M
LHFQ
); se
lf-ca
re b
ehav
iors
(29-
item
SC
B s
cale
)
7. B
renn
an e
t al.,
20
10(1
6)
Nor
th A
mer
ica
Nur
sing
RC
T
Out
patie
ntA
ge: 6
4.0
n=28
1(1
46/IG
;13
5/C
G)
Mal
e: 1
71
- Tec
hnol
ogy
prac
tice
to m
eet i
ndiv
idua
l car
e go
als;
focu
s on
ed
ucat
ion,
sym
ptom
s an
d co
mm
unic
atio
n- N
o th
eory
- CA
: no
/ CI:
no- V
aria
ble
dura
tion
of s
essi
ons
- FU
p: 2
4 w
eeks
- Inf
orm
atio
n: v
erba
l, w
ritte
n, IC
T (w
ebsi
te, C
D, w
ebca
m)
- Del
iver
y: in
per
son
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
DW
; PA
; Die
t;S
ympM
onP
rimar
y: H
RQ
oL (S
F-12
; MIL
Q),
self-
man
agem
ent (
SC
HFI
)S
econ
dary
: sat
isfa
ctio
n w
ith n
ursi
ng c
are
(org
aniz
atio
n-sp
ecifi
c su
rvey
), se
rvic
e us
e
(The
Figure
2 c
ontinue
in t
he
nex
t pag
e...
)
-
757
www.eerp.usp.br/rlae
Boisvert S, Proulx-Belhumeur A, Gonçalves N, Doré M, Francoeur
J, Gallani MC.
Aut
hor C
ontin
ent
Jour
nal D
esig
nSa
mpl
eIn
terv
entio
n de
scrip
tion
Inte
rven
tion
deta
ilsTa
rget
sel
f-car
eEn
dpoi
nt
8. B
rodi
e et
al.,
20
08(1
7)
Eur
ope
Nur
sing
RC
T
Out
patie
ntA
ge: 7
7.7
n=60
(18/
IG1;
22/
IG2;
20/C
G)
Mal
e: N
M
- Life
styl
e in
terv
entio
n ba
sed
on m
otiv
atio
nal i
nter
view
ing;
ph
ysic
al a
ctiv
ity- T
heor
y: M
otiv
atio
nal I
nter
view
ing
- CA
: no
/ CI:
no- 8
ses
sion
s; 1
h- F
Up:
5 m
onth
s
- Inf
orm
atio
n: v
erba
l- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
PAP
rimar
y: H
RQ
oL (S
F-36
, LH
FQ);
mot
ivat
iona
l rea
dine
ss fo
r phy
sica
l act
ivity
(R
eadi
ness
-to C
hang
e-R
uler
)
9. C
aldw
ell e
t al.,
20
05(1
8)
Nor
th A
mer
ica
Med
ical
Pilo
t stu
dy (R
CT)
Out
patie
ntA
ge: 7
0.8
n=36
(20/
IG;
16/C
G)
Mal
e: 2
5
- Inf
orm
atio
n ab
out H
F ca
uses
and
mec
hani
sms,
sig
ns a
nd
sym
ptom
s; im
porta
nce
of s
elf-c
are/
pote
ntia
l bar
riers
- No
theo
ry- C
A: y
es /
CI:
no- 1
ses
sion
and
1 p
hone
cal
l;- F
Up:
3 m
onth
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
DW
; Sym
pMan
agP
rimar
y: k
now
ledg
e ab
out H
F (s
tudy
-sp
ecifi
c qu
estio
nnai
re);
self-
care
be
havi
ors
(EH
FSC
BS
); B
NP
10. C
lark
et a
l.,
2003
(19)
Nor
th A
mer
ica
Nur
sing
Pilo
t stu
dy
(des
crip
tive)
NM
Age
: NM
n=32
dya
ds(3
2/IG
;no
CG
) Mal
e:
NM
- Dis
cuss
ions
abo
ut li
ving
with
a fa
mily
mem
ber w
ith H
F,
posi
tive
resu
lts fr
om o
ther
pat
ient
s, ro
le-p
layi
ng- T
heor
y: M
otiv
atio
n an
d S
elf-D
eter
min
atio
n Th
eory
- CA
: no
/ CI:
no- 2
ses
sion
s; 2
h;
- FU
p: N
M
- Inf
orm
atio
n: v
erba
l, w
ritte
n- D
eliv
ery:
in p
erso
n- G
roup
- Par
ticip
ants
: pat
ient
s &
fam
ilies
Die
t; PA
;D
W; M
edA
dhP
rimar
y: a
ccep
tabi
lity
and
feas
ibili
ty o
f the
in
terv
entio
n
11. D
ansk
y et
al.,
20
08(2
0)
Nor
th A
mer
ica
Nur
sing
RC
T
Out
patie
ntA
ge: 7
7.0
n=28
4(IG
/CG
: not
cl
ear)
Mal
e: N
M
- Clin
ical
info
rmat
ion
syst
em tr
ansm
ittin
g da
ta o
ver
tele
phon
e lin
es fo
r pat
ient
s to
com
mun
icat
e el
ectro
nica
lly
with
hea
lth c
are
prov
ider
s; e
mph
asis
on
sym
ptom
s- T
heor
y: T
he S
elf-C
are
Mod
el- C
A: y
es /
CI:
no- D
aily
inte
rven
tion,
tele
heal
th s
yste
m fo
r 62
days
; FU
p: 1
20
days
- Inf
orm
atio
n: v
erba
l, IC
T (te
lehe
alth
)- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
& fa
mili
es
DW
; PA
; Die
t; Va
cc;
Med
Adh
;S
ympM
anag
Prim
ary:
con
fiden
ce, s
elf-c
are
mai
nten
ance
and
man
agem
ent b
ehav
iors
(S
CH
FI)
12. D
e la
Por
te e
t al.,
20
07(2
1)
Eur
ope
Mul
tidis
cipl
inar
yR
CT
Out
patie
ntA
ge: 7
0.5
n=24
0(1
18/IG
;12
2/C
G)
Mal
e: 1
74
- Edu
catio
n ab
out t
he d
isea
se, i
ts e
tiolo
gy, a
nd s
elf-
care
beh
avio
rs; d
iscu
ssio
n ab
out m
edic
al a
nd s
ocia
l ci
rcum
stan
ces;
app
oint
men
t with
a d
ietic
ian
- No
theo
ry- C
A: y
es /
CI:
yes
- 9 s
essi
ons;
FU
p: 1
2 m
onth
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
Med
Adh
;D
iet;
DW
; Sym
pMon
;S
ympM
anag
; PA
; R
est
Prim
ary:
read
mis
sion
s; a
ll-ca
use
mor
talit
y;S
econ
dary
: NY
HA
clas
s; H
RQ
oL (S
F-36
, LH
FQ);
BN
P; s
elf-c
are
beha
vior
(E
HS
cBS
); co
st; H
F m
edic
atio
n
13. D
illes
et a
l.,
2011
(22)
Eur
ope
Nur
sing
Qua
si-e
xper
imen
tal
Inpa
tient
Age
: 72.
8n=
37(2
1/IG
;16
/CG
)M
ale:
26
- Com
pute
r-as
sist
ed le
arni
ng p
rogr
am w
ith 8
mod
ules
: ci
rcul
ator
y sy
stem
, HF,
sym
ptom
s, d
iagn
osis
, med
icat
ion,
se
lf-ca
re, f
requ
ent q
uest
ions
, sel
f-tes
t- N
o th
eory
- CA
: no
/ CI:
no- 1
ses
sion
; 30-
45 m
in; F
Up:
3 m
onth
s
- Inf
orm
atio
n: v
erba
l, IC
T (in
tera
ctiv
e C
D-R
OM
on
HF)
- Del
iver
y: b
y co
mpu
ter
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s
NM
Prim
ary:
kno
wle
dge
(Dut
ch H
F kn
owle
dge
scal
e); s
elf-c
are
(EH
FScB
S)
Sec
onda
ry: s
atis
fact
ion
with
the
prog
ram
(s
tudy
-spe
cific
que
stio
nnai
re)
(The
Figure
2 c
ontinue
in t
he
nex
t pag
e...
)
-
758
www.eerp.usp.br/rlae
Rev. Latino-Am. Enfermagem 2015 July-Aug.;23(4):753-68.
Aut
hor C
ontin
ent
Jour
nal D
esig
nSa
mpl
eIn
terv
entio
n de
scrip
tion
Inte
rven
tion
deta
ilsTa
rget
sel
f-car
eEn
dpoi
nt
14. D
omin
gues
et a
l.,
2011
(23)
Sou
th A
mer
ica
Med
ical
RC
T
In/O
utpa
tA
ge: 6
2.6
n=11
1(4
8/IG
;63
/CG
)M
ale:
64
- Inf
orm
atio
n on
HF,
pha
rmac
olog
ical
and
non
-ph
arm
acol
ogic
al tr
eatm
ent
- No
theo
ry- C
A: n
o / C
I: ye
s- 5
ses
sion
s; 3
0-40
min
; and
8 c
alls
;- F
Up:
3 m
onth
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n, n
o IC
T- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
& c
areg
iver
s
Sym
pMon
Prim
ary:
HF
awar
enes
s an
d se
lf-ca
re
know
ledg
e (H
F an
d se
lf-ca
re in
form
atio
n qu
estio
nnai
re)
Sec
onda
ry: e
mer
genc
y vi
sits
; dea
th;
read
mis
sion
s
15. D
unag
an e
t al.,
20
05(2
4)
Nor
th A
mer
ica
Mul
tidis
cipl
inar
yR
CT
In/O
utpa
tA
ge: 7
0.0
n=15
1(7
6/IG
;75
/CG
)M
ale:
66
- Edu
catio
n on
HF,
pro
mot
ing
self-
man
agem
ent s
kills
, pa
tient
s en
cour
aged
to c
onta
ct p
rogr
am n
urse
s an
y tim
e th
ey n
eede
d- N
o th
eory
- CA
: yes
/ C
I: ye
s- W
eekl
y ph
one
calls
for 2
wee
ks, d
epen
ding
on
clin
ical
ev
alua
tion
- FU
p: 6
and
12
mon
ths
- Inf
orm
atio
n: N
M, n
o IC
T- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
Die
t;M
edA
dhP
rimar
y: re
adm
issi
ons;
emer
genc
y vi
sits
Sec
onda
ry: H
RQ
oL (S
F-12
, MLH
FQ);
cost
; dea
th; s
atis
fact
ion
(Stu
dy-s
peci
fic
13-it
em q
uest
ionn
aire
)
16. D
unba
r et a
l.,
2005
(25)
Nor
th A
mer
ica
Nur
sing
RC
T
Out
patie
ntA
ge: 6
1.0
n=61
(29/
IG1;
32/IG
2;N
o C
G)
Mal
e: 3
3
- Pat
ient
s pa
rtici
pate
d in
ses
sion
s fo
cusi
ng o
n en
hanc
ing
fam
ily s
uppo
rt an
d pa
tient
cho
ice
thro
ugh
com
mun
icat
ion,
ca
se s
cena
rios,
dis
cuss
ion,
role
-pla
ying
- The
ory:
Aut
onom
y S
uppo
rt Th
eory
- CA
: no
/ CI:
no- 1
h 3
0 m
in to
2 h
; FU
p: 3
mon
ths
- Inf
orm
atio
n: v
erba
l, w
ritte
n, IC
T (v
ideo
on
HF
care
)- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l and
gro
up- P
artic
ipan
ts: p
atie
nts
& fa
mili
es
Die
tP
rimar
y: N
a in
take
(Sel
f-rep
orte
d an
d ur
inar
y N
a)S
econ
dary
: fam
ily fu
nctio
ning
(Fam
ily
AP
GA
R);
depr
essi
ve s
ympt
oms
(BD
I-II);
au
tono
my
supp
ort (
FCC
Q-P
)
17. H
oban
et a
l.,
2013
(26)
Nor
th A
mer
ica
Nur
sing
RC
T
Out
patie
ntA
ge: 7
8.4
n=80
(40/
IG;
40/C
G)
Mal
e: 2
9
- Ins
truct
ions
on
mon
itorin
g at
bas
elin
e an
d te
lem
onito
ring
of
patie
nts
by a
car
diac
nur
sing
team
;- N
o th
eory
- CA
: no
/ CI:
no- 1
ses
sion
at b
asel
ine;
FU
p: 3
0, 6
0 an
d 90
day
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n, IC
T (te
lem
onito
ring)
- Del
iver
y: in
per
son
and
ICT
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s
Med
Adh
; Die
t; D
W;
PAP
rimar
y: s
elf-c
are
beha
vior
s (S
CH
FI);
HR
QoL
(MLH
FQ);
read
mis
sion
rate
s
18. K
arls
son
et a
l.,
2005
(27)
Eur
ope
Mul
tidis
cilin
ary
RC
T
In/O
utpa
tA
ge: 7
6.0
n=14
6(7
2/IG
;74
/CG
)M
ale:
82
- Inf
orm
atio
n gi
ven
on H
F an
d se
lf-ca
re, i
nter
view
with
a
spec
ially
trai
ned
nurs
e- N
o th
eory
- CA
: yes
/ C
I: ye
s- N
umbe
r of s
essi
ons:
NM
- FU
p: 6
mon
ths
- Inf
orm
atio
n: v
erba
l, w
ritte
n, IC
T (in
tera
ctiv
e co
mpu
ter p
rogr
am a
nd
vide
o)- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
Med
Adh
;D
iet;
Sym
pMon
Prim
ary:
kno
wle
dge
abou
t HF
and
self-
care
(HF
know
ledg
e qu
estio
nnai
re);
cogn
itive
func
tion
(MM
SE
)
19. K
imm
elst
iel e
t al.,
20
04(2
8)
Nor
th A
mer
ica
Med
ical
RC
T
Out
patie
ntA
ge: 7
2.1
n=20
0(9
7/IG
; 103
/CG
)M
ale:
116
- Inf
orm
atio
n on
HF,
sel
f-car
e m
anag
emen
t, ba
rrie
rs
iden
tifica
tion
and
rein
forc
emen
t of c
ompl
ianc
e- N
o th
eory
- CA
: yes
/ C
I: no
- 45-
90 m
in; F
Up:
3 a
nd 6
mon
ths
- Inf
orm
atio
n: v
erba
l, w
ritte
n- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
& fa
mili
es
Die
t; M
edA
dh; D
W;
Sym
pMon
Prim
ary:
read
mis
sion
s; d
ays
of
hosp
italiz
atio
n
(The
Figure
2 c
ontinue
in t
he
nex
t pag
e...
)
-
759
www.eerp.usp.br/rlae
Boisvert S, Proulx-Belhumeur A, Gonçalves N, Doré M, Francoeur
J, Gallani MC.
Aut
hor C
ontin
ent
Jour
nal D
esig
nSa
mpl
eIn
terv
entio
n de
scrip
tion
Inte
rven
tion
deta
ilsTa
rget
sel
f-car
eEn
dpoi
nt
20. K
oelli
ng e
t al.,
20
05(2
9)
Nor
th A
mer
ica
Med
ical
RC
T
Inpa
tient
Age
: 64.
8n=
223
(107
/IG;
116/
CG
)M
ale:
129
- Inf
orm
atio
n on
HF
path
ophy
siol
ogy
deco
mpe
nsat
ion,
sel
f-ca
re (r
egim
en o
f diu
retic
s, fl
uid
and
salt
rest
rictio
n)- N
o th
eory
- CA
: no
/ CI:
no- 1
ses
sion
; 60
min
; FU
p: 6
mon
ths
- Inf
orm
atio
n: v
erba
l, w
ritte
n, n
o IC
T- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
Die
t; M
edA
dh;
Avoi
danc
e of
alc
ohol
; D
W;
Sym
pMon
;S
mok
ing
cess
atio
n
Prim
ary:
read
mis
sion
s; d
ays
of
hosp
italiz
atio
n; d
eath
Sec
onda
ry: c
osts
, HR
QoL
(MLH
F)
21. K
omm
uri e
t al.,
20
12(3
0)
Nor
thA
mer
ica
Mul
tidis
cipl
inar
yR
CT
In/O
utpa
tA
ge: 6
7.0
n=26
5(1
28/IG
;13
7/C
G)
Mal
e: 1
62
- An
educ
atio
n se
ssio
n w
as o
ffere
d to
em
phas
ize
the
mos
t im
porta
nt s
elf-c
are
beha
vior
s in
the
man
agem
ent o
f HF
- No
theo
ry- C
A: n
o / C
I: no
- 1 s
essi
on; 1
h- F
Up:
6 m
onth
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n, n
o IC
T- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
Die
t; D
W; M
edA
dh;
Sym
pMon
; Sm
okin
g ce
ssat
ion;
Avoi
danc
e of
alc
ohol
Prim
ary:
HF
know
ledg
e (H
FKQ
)S
econ
dary
: clin
ical
eve
nt; d
eath
; re
adm
issi
ons
22. L
ee e
t al.,
201
3(31
)
Nor
th A
mer
ica
Mul
tidis
cipl
inar
yP
ilot S
tudy
(RC
T)
In/O
utpa
tA
ge: 6
0n=
44(2
3/IG
;21
/CG
)M
ale:
23
- Fac
e-to
-face
edu
catio
n an
d co
unse
ling
sess
ion
to
intro
duce
the
hous
ehol
d us
e of
a s
ympt
om d
iary
- No
theo
ry- C
A: n
o / C
I: no
- 1 in
-per
son
sess
ion
at b
asel
ine
and
5 bi
wee
kly
boos
ter
sess
ions
by
phon
e ca
lls (s
uppo
rt an
d re
view
of e
duca
tion)
; FU
p: 5
mon
ths
- Inf
orm
atio
n: v
erba
l, w
ritte
n (s
ympt
om
diar
y)- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l and
in g
roup
- Par
ticip
ants
: pat
ient
s
Die
t; D
W;
Sym
ptom
reco
gniti
onP
rimar
y: e
vent
-free
sur
viva
l; H
RQ
OL
(MLH
FQ);
fluid
inta
ke (S
CH
FI: 2
item
s)
23. L
even
thal
et a
l.,
2011
(32)
Eur
ope
Med
ical
RC
T
Out
patie
ntA
ge: 7
7.1
n=42
(22/
IG;
20/C
G)
Mal
e: 2
6
- Edu
catio
nal a
nd s
uppo
rtive
car
e to
bui
ld s
elf-c
are
abili
ties
and
indi
vidu
aliz
ed p
atie
nt g
oal s
ettin
g- N
o th
eory
- CA
: yes
/ C
I: ye
s- 1
hom
e vi
sit a
nd 1
7 ph
one
calls
- FU
p: 1
2 m
onth
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n, n
o IC
T- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
Sym
pMon
; Med
Adh
;S
ympM
anag
;D
W; D
iet
Prim
ary:
read
mis
sion
s; d
eath
Sec
onda
ry: H
RQ
oL (E
Q-5
D, M
LHF)
24. L
upon
et a
l.,
2008
(33)
Eur
ope
Nur
sing
Qua
si-e
xper
imen
tal
Out
patie
ntA
ge: 6
5.4
n=15
1(1
51/IG
;no
CG
)M
ale:
111
- Sup
ervi
sion
and
rein
forc
emen
t of s
elf-c
are
beha
vior
s,
info
rmat
ion
on H
F; e
ncou
rage
men
t of f
amily
par
ticip
atio
n- N
o th
eory
- CA
: no
/ CI:
no- 4
ses
sion
s, e
very
3 m
onth
s- F
Up:
12
mon
ths
- Inf
orm
atio
n: v
erba
l, no
ICT
- Del
iver
y: in
per
son
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s &
fam
ilies
Die
t; PA
; Med
Adh
; D
W;
Sm
okin
g ce
ssat
ion;
Avoi
danc
e of
alc
ohol
Prim
ary:
sel
f-car
e (E
HS
cBS
)S
econ
dary
: dea
th; r
eadm
issi
ons
25. M
årte
nsso
n et
al.,
20
05(3
4)
Eur
ope
Med
ical
RC
T
Out
patie
ntA
ge: 7
9.0
n=15
3(7
8/IG
;75
/CG
)M
ale:
83
- Foc
us o
n pa
tient
’s u
nder
stan
ding
of H
F an
d im
prov
emen
t of
sel
f-man
agem
ent;
focu
s on
pat
ient
’s n
eeds
and
ski
lls- N
o th
eory
- CA
: no
/ CI:
no- 1
ses
sion
; 2 h
- FU
p: 1
2 m
onth
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n, IC
T (C
D-
RO
M)
- Del
iver
y: in
per
son
and
by p
hone
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s &
fam
ilies
Die
t; D
W;
Sym
pMon
;S
ympM
anag
Prim
ary:
HR
QoL
(SF-
36, M
LWH
F);
depr
essi
on (S
DS
)
(The
Figure
2 c
ontinue
in t
he
nex
t pag
e...
)
-
760
www.eerp.usp.br/rlae
Rev. Latino-Am. Enfermagem 2015 July-Aug.;23(4):753-68.
Aut
hor C
ontin
ent
Jour
nal D
esig
nSa
mpl
eIn
terv
entio
n de
scrip
tion
Inte
rven
tion
deta
ilsTa
rget
sel
f-car
eEn
dpoi
nt
26. M
ussi
et a
l. (2
013)
(35)
Sou
th A
mer
ica
Nur
sing
RC
T
Out
patie
ntA
ge: 6
2.9
n=20
0(1
01/IG
;99
/CG
)M
ale:
126
- Edu
cativ
e nu
rsin
g in
terv
entio
n- N
o th
eory
- CA
: no
/ CI:
no- 4
hom
e vi
sits
(10,
30,
60
and
120
days
afte
r dis
char
ge)
and
4 te
leph
one
calls
for r
einf
orce
men
t.- F
Up:
6 m
onth
s
- Inf
orm
atio
n: v
erba
l- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
and
care
give
rs
(whe
n pr
esen
t)
Sym
pMan
ag; D
iet;
DW
; PA
; Med
Adh
; Va
cc
Prim
ary:
kno
wle
dge
abou
t HF(
Kno
wle
dge
Que
stio
nnai
re o
n H
F); s
elf-c
are
(EH
FScB
); tre
atm
ent a
dher
ence
27. O
tsu
et a
l.,
2011
(36)
Asi
aN
ursi
ngR
CT
Out
patie
ntA
ge: 7
3.1
n=96
(49/
IG;
47/C
G)
Mal
e: 6
1
- Foc
us o
n im
prov
emen
t of s
elf-c
are
and
emot
ion
man
agem
ent
- The
ory:
Cog
nitiv
e B
ehav
iora
l The
ory
- CA
: yes
/ C
I: no
- 1 s
essi
on; 3
0 m
in, e
very
mon
th- F
Up:
6 m
onth
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n, n
o IC
T- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
& fa
mili
es
Die
t; M
edA
dh; P
A;
Sm
okin
g ce
ssat
ion;
Av
oida
nce
of a
lcoh
ol
Prim
ary:
dea
th, r
eadm
issi
ons;
BN
P;
NY
HA
clas
s; w
eigh
t; bl
ood
pres
sure
; sy
mpt
oms
Sec
onda
ry: H
RQ
oL (L
HFQ
); in
dica
tors
of
self-
care
beh
avio
rs
28. P
arad
is e
t al.,
20
10(3
7)
Nor
th A
mer
ica
Nur
sing
Pilo
t stu
dy(R
CT)
Out
patie
ntA
ge: 7
0.5
n=30
(15/
IG;
15/C
G)
Mal
e: 2
2
- Int
erve
ntio
n ba
sed
on s
tage
s of
cha
nge,
dep
endi
ng o
n th
e le
vel o
f con
vict
ion
and
confi
denc
e in
per
form
ing
self-
care
- The
ory:
Tra
nsth
eore
tical
Mod
el- C
A: n
o / C
I: no
- 3 s
essi
ons;
5 to
10
min
, for
15
days
- FU
p: 1
mon
th
- Inf
orm
atio
n: v
erba
l, no
ICT
- Del
iver
y: in
per
son
and
by p
hone
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s
Die
t; D
W; P
A;
Med
Adh
Prim
ary:
sel
f-car
e (S
CH
FI),
gene
ral s
elf-
care
man
agem
ent (
12-it
em th
erap
eutic
se
lf-ca
re s
cale
); co
nfide
nce
and
conv
ictio
n to
per
form
gen
eral
sel
f-car
e (C
&C
)
29. R
iege
l et a
l.,
2006
(38)
Nor
th A
mer
ica
Nur
sing
Qua
si-e
xper
imen
tal
In/O
utpa
tA
ge: 5
9.7
n=15
(15/
IG;
no C
G)
Mal
e: 6
- Foc
us o
n en
cour
agem
ent o
f HF
man
agem
ent a
nd
decr
easi
ng b
arrie
rs to
sel
f-car
e- T
heor
y: D
ecis
ion-
Mak
ing
Fram
ewor
k- C
A: n
o / C
I: no
- Wee
kly
phon
e ca
ll, m
onth
ly v
isit
- FU
p: 3
mon
ths
- Inf
orm
atio
n: v
erba
l, no
ICT
- Del
iver
y: in
per
son
and
by p
hone
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s &
fam
ilies
Die
t;M
edA
dh;
Sym
pMan
ag
Prim
ary:
sel
f-car
e (S
CH
FI)
Sec
onda
ry: k
now
ledg
e ab
out H
F (r
epre
sent
atio
ns)
30. R
odríg
uez-
Gás
quez
et a
l.,
2012
(39)
Sou
th A
mer
ica
Nur
sing
RC
T
Out
patie
ntA
ge: 6
7.8
n=63
(33/
IG;
30/C
G)
Mal
e: 3
1
- Em
phas
is o
n em
pow
erm
ent a
nd m
otiv
atio
n fo
r the
ad
apta
tion
to li
ving
with
HF
- The
ory:
Ore
m’s
Sel
f-Car
e D
efici
t- C
A: n
o / C
I: no
- 2 h
ome
visi
ts a
nd 6
tele
nurs
ing
sess
ions
;- F
Up:
9 m
onth
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n, IC
T (te
lenu
rsin
g)- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
& fa
mili
es
Med
Adh
;S
ympM
anag
Prim
ary:
sel
f-car
e be
havi
ors
(HFS
CB
S)
31. R
ojas
et a
l. (2
013)
(40)
Sou
th A
mer
ica
Nur
sing
Qua
si-e
xper
imen
tal
In/O
utpa
tA
ge: 6
7.0
n=21
(one
sam
ple)
Mal
e: 1
2
- Mot
ivat
iona
l int
ervi
ewin
g pa
tient
-cen
tere
d in
terv
entio
n- T
heor
y: M
otiv
atio
nal I
nter
view
ing
- CA
: no
/ CI:
no- 1
in-p
erso
n m
otiv
atio
nal i
nter
view
ing
sess
ion
(30-
40
min
utes
) and
one
tele
phon
e ca
ll fo
r rei
nfor
cem
ent
- FU
p: n
ot c
lear
- Inf
orm
atio
n: v
erba
l- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
Sel
f-car
e (ta
rget
be
havi
or n
ot
spec
ifica
lly
men
tione
d)
Prim
ary:
sel
f-car
e (E
HFS
cB)
32. S
eber
n et
al.,
20
12(4
1)
Nor
th A
mer
ica
Nur
sing
Qua
si-e
xper
imen
tal
Out
patie
ntA
ge: 7
0.5
n=22
(22/
IG;
no C
G)
Mal
e: 7
- The
sha
red
care
dya
dic
inte
rven
tion
(SC
DI)
was
use
d to
im
prov
e sp
ecifi
c re
latio
nshi
p pr
oces
ses
to e
xcha
nge
care
an
d as
sist
ance
- The
ory:
Sha
red
Car
e C
once
ptua
l Mod
el- C
A: n
o / C
I: no
- 7 s
essi
ons;
60
to 1
20 m
in- F
Up:
12
wee
ks
- Inf
orm
atio
n: v
erba
l, w
ritte
n- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l/dya
ds- P
artic
ipan
ts: p
atie
nts
Die
t; PA
; Med
Adh
; D
WP
rimar
y: s
elf-c
are
(SC
HFI
), re
latio
nshi
p qu
ality
(DR
S);
HR
QoL
: pat
ient
(KC
CQ
) an
d ca
regi
ver (
SF-
36)
Sec
onda
ry: a
nxie
ty (S
TAI);
dep
ress
ive
sym
ptom
s (P
HQ
-9);
emer
genc
y vi
sits
(The
Figure
2 c
ontinue
in t
he
nex
t pag
e...
)
-
761
www.eerp.usp.br/rlae
Boisvert S, Proulx-Belhumeur A, Gonçalves N, Doré M, Francoeur
J, Gallani MC.
Aut
hor C
ontin
ent
Jour
nal D
esig
nSa
mpl
eIn
terv
entio
n de
scrip
tion
Inte
rven
tion
deta
ilsTa
rget
sel
f-car
eEn
dpoi
nt
33. S
hao
et a
l. (2
013)
(42)
Asi
aN
ursi
ngR
CT
Out
patie
ntA
ge: 7
2.0
n=10
8(5
4/IG
;54
/CG
)M
ale:
73
- Sel
f-man
agem
ent p
rogr
am p
rom
otin
g th
e m
onito
ring
of
sodi
um a
nd fl
uid
inta
ke a
nd H
F sy
mpt
oms.
- The
ory:
Ban
dura
’s S
ocia
l Cog
nitiv
e Th
eory
- CA
: no
/ CI:
no- 5
ses
sion
s: 1
hom
e vi
sit a
nd 4
tele
phon
e ca
lls a
t 1, 3
, 7
and
11 w
eeks
;- F
Up:
12
wee
ks
- Inf
orm
atio
n: v
erba
l- D
eliv
ery:
in p
erso
n an
d by
pho
ne,
no IC
T- I
ndiv
idua
l and
fam
ily- P
artic
ipan
ts: p
atie
nts
Sym
pMan
ag;
Die
t;D
W
Prim
ary:
sel
f-car
e (E
HFS
cB-1
2 w
ith 2
de
lete
d ite
ms)
; sel
f-effi
cacy
for s
alt a
nd
fluid
con
trol (
SeS
FC);
heal
th s
ervi
ce u
se
and
HF-
rela
ted
sym
ptom
dis
tress
(HFS
D)
34. S
hear
er e
t al.,
20
07(4
3)
Nor
th A
mer
ica
Nur
sing
RC
T
In/O
utpa
tA
ge: 7
6.0
n=87
(42/
IG;
45/C
G)
Mal
e: 5
6
- Tel
epho
ne-d
eliv
ered
sup
port
and
info
rmat
ion;
faci
litat
ion
to
atta
in v
alue
d go
als;
sel
f-man
agem
ent a
nd im
prov
emen
t in
func
tiona
l hea
lth- T
heor
y: R
oger
s’ S
cien
ce o
f Uni
tary
Hum
an B
eing
s pe
rson
-en
viro
nmen
t pro
cess
- CA
: no
/ CI:
no- 6
pho
nes
calls
; FU
p: 1
2 w
eeks
- Inf
orm
atio
n: v
erba
l, no
ICT
- Del
iver
y: b
y ph
one
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s
NM
(dep
ende
d on
th
e pa
tient
val
ued
goal
s)
Prim
ary:
pur
pose
ful p
artic
ipat
ion
in
atta
inin
g he
alth
goa
ls (P
KP
CT)
; HR
QoL
(S
F-36
); se
lf-m
anag
emen
t (S
MH
F)
35. S
hive
ly e
t al.,
20
13,(4
4) E
pud
2012
Nor
th A
mer
ica
Nur
sing
-RC
T
Out
patie
ntA
ge: 6
6.1
n=84
(43/
IG;
41/C
G)
Mal
e: 8
3
- Pro
gram
dev
elop
ed to
enh
ance
sel
f-man
agem
ent w
ith s
elf-
sele
cted
goa
ls, w
ith e
mph
asis
on
PA a
nd D
iet
- The
ory:
Act
ivat
ion
Theo
ry- C
A: n
o / C
I: no
- 6 s
essi
ons;
- FU
p: 6
mon
ths
- Inf
orm
atio
n: v
erba
l, w
ritte
n, IC
T (D
VD
on
HF
self-
man
agem
ent)
- Del
iver
y: in
per
son
and
by p
hone
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s
PA; D
iet
Prim
ary:
pat
ient
act
ivat
ion
(PA
M);
self-
man
agem
ent (
SC
HFI
); m
edic
al o
utco
mes
(M
OS
)S
econ
dary
: rea
dmis
sion
s; e
mer
genc
y vi
sits
36. S
isk
et a
l.,
2006
(45)
Nor
th A
mer
ica
Med
ical
RC
T
Out
patie
ntA
ge: 5
9.4
n=40
6(2
03/IG
;20
3/C
G)
Mal
e: 2
18
- Inf
orm
atio
n on
HF;
info
rmat
ion
and
coun
selin
g on
sel
f-car
e be
havi
ors
- No
theo
ry- C
A: n
o / C
I: ye
s- 1
mee
ting
and
5 ph
one
calls
;- F
Up:
12
mon
ths
- Inf
orm
atio
n: v
erba
l, w
ritte
n- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
DW
; Alc
ohol
av
oida
nce;
Med
Adh
; PA
;D
iet;
Sm
okin
g ce
ssat
ion;
Sym
pMon
Prim
ary:
HR
QoL
(SF-
12, M
LHF)
, re
adm
issi
on
37. S
meu
lder
s et
al.,
20
09(4
6)
Eur
ope
Med
ical
RC
T
Out
patie
ntA
ge: 6
6.7
n=31
7(1
86/IG
;13
1/C
G)
Mal
e: 2
30
- Chr
onic
dis
ease
sel
f-man
agem
ent p
rogr
am, i
ncor
pora
ting
goal
set
ting,
act
ion
plan
ning
, mod
elin
g an
d so
cial
pe
rsua
sion
, int
erpr
etat
ion
of s
ympt
oms
- The
ory:
Ban
dura
’s S
ocia
l Cog
nitiv
e Th
eory
- CA
: no
/ CI:
no- 6
ses
sion
s; 1
h 3
0 m
in; F
Up:
12
mon
ths
- Inf
orm
atio
n: v
erba
l, w
ritte
n- D
eliv
ery:
in p
erso
n an
d by
pho
ne- G
roup
- Par
ticip
ants
: pat
ient
s &
fam
ilies
PA; S
mok
ing
cess
atio
n;A
lcoh
ol a
void
ance
Prim
ary:
sel
f-car
e (p
hysi
cal a
ctiv
ity s
cale
, dr
inki
ng, s
mok
ing)
; BM
I††; r
eadm
issi
on;
cont
act w
ith p
rofe
ssio
nal;
days
of
hosp
italiz
atio
n; e
mer
genc
y vi
sits
38. S
mith
et a
l.,
2005
(47)
Nor
th A
mer
ica
Nur
sing
Pilo
t stu
dy
(des
crip
tive)
In/O
utpa
tA
ge: 6
7.0
n=10
(10/
IG;
no C
G)
Mal
e: 6
- Edu
catio
nal i
nter
vent
ion
on H
F kn
owle
dge
and
to e
stab
lish
a ro
utin
e fo
r sym
ptom
mon
itorin
g; d
iscu
ssio
n on
cha
lleng
es
and
succ
ess
in m
anag
ing
HF
- The
ory:
Tria
ndis
Mod
el o
f Hea
lth B
ehav
ior;
Sm
ith’s
Fam
ily
Car
e Th
eory
- CA
: no
/ CI :
no
- 4 w
eeks
; FU
p: 6
0 da
ys
- Inf
orm
atio
n: v
erba
l, w
ritte
n, IC
T (e
duca
tiona
l vid
eota
pe)
- Del
iver
y: in
per
son
and
by p
hone
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s
DW
; Med
Adh
;D
iet;
PA;
Sym
pMon
;S
tress
redu
ctio
n;S
mok
ing
cess
atio
n
Prim
ary:
HF
know
ledg
e (H
FKQ
); sy
mpt
om re
porti
ng (v
ideo
tape
beh
avio
ural
ou
tcom
es c
heck
lists
); fu
nctio
nal s
tatu
s (H
F fu
nctio
nal s
tatu
s as
sess
men
t qu
estio
nnai
re)
(The
Figure
2 c
ontinue
in t
he
nex
t pag
e...
)
-
762
www.eerp.usp.br/rlae
Rev. Latino-Am. Enfermagem 2015 July-Aug.;23(4):753-68.
Aut
hor C
ontin
ent
Jour
nal D
esig
nSa
mpl
eIn
terv
entio
n de
scrip
tion
Inte
rven
tion
deta
ilsTa
rget
sel
f-car
eEn
dpoi
nt
39. S
trom
berg
et a
l.,
2006
(48)
Eur
ope
Mul
tidis
cipl
inar
yR
CT
Out
patie
ntA
ge: 7
0.0
n=15
4(8
2/IG
;72
/CG
)M
ale:
109
- Nur
se-le
d, c
ompu
ter-
assi
sted
pro
gram
with
7 m
odul
es
cove
ring
educ
atio
nal t
opic
s on
HF
and
one
mod
ule
with
a
self-
test
- No
theo
ry- C
A: n
o / C
I: no
- 1 s
essi
on; 3
0-45
min
; FU
p: 6
mon
ths
- Inf
orm
atio
n: v
erba
l, IC
T (e
duca
tiona
l C
D-R
OM
on
HF)
- Del
iver
y: in
per
son
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s
Sym
pMon
Prim
ary:
kno
wle
dge
and
com
plia
nce
on s
elf-c
are
beha
vior
(stu
dy-s
peci
fic
ques
tionn
aire
); H
RQ
oL (E
Q-5
D)
40. S
trom
berg
et a
l.,
2003
(49)
Eur
ope
Med
ical
RC
T
Out
patie
ntA
ge: 7
7.5
n=10
6(5
2/IG
;54
/CG
)M
ale:
65
- Ass
istin
g pa
tient
s in
impr
ovin
g se
lf-ca
re, p
sych
osoc
ial
supp
ort,
info
rmat
ion
on H
F sy
mpt
oms
and
treat
men
t- N
o th
eory
- CA
: yes
/ C
I: ye
s- 1
to 8
vis
its; 1
h; F
Up:
3 a
nd 1
2 m
onth
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n- D
eliv
ery:
in p
erso
n- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
& fa
mili
es
Die
t; D
W;
Sym
pMon
; S
ympM
anag
Prim
ary:
all-
caus
e m
orta
lity
Sec
onda
ry: r
eadm
issi
on; d
ays
of
hosp
italiz
atio
n; s
elf-c
are
beha
vior
(E
HFs
cB)
41. T
ung
et a
l. (2
013)
50)
Asi
aN
ursi
ngQ
uasi
-exp
erim
enta
l –hi
stor
ical
com
paris
on
Out
patie
ntA
ge: 6
5.1
n=82
(40/
IG;
42/C
G)
Mal
e: 6
1
- Sel
f-man
agem
ent i
nter
vent
ion
with
3 c
ompo
nent
s: s
elf-
man
agem
ent b
ook,
in-p
erso
n se
lf-m
anag
emen
t tra
inin
g an
d on
goin
g fe
edba
ck re
gard
ing
adhe
renc
e- T
heor
y: s
ituat
ion-
spec
ific
theo
ry o
f HF
self-
care
- CA
: no
/ CI:
no- 4
ses
sion
s, tw
ice
a w
eek
for 2
wee
ks; w
eekl
y (1
st m
onth
) an
d bi
wee
kly
(2nd
mon
th) t
elep
hone
cal
ls; F
Up:
2 m
onth
s
- Inf
orm
atio
n: v
erba
l, w
ritte
n (b
ook)
, no
ICT
- Del
iver
y: in
per
son
and
by p
hone
- Ind
ivid
ual
- Par
ticip
ants
: pat
ient
s
Die
t; PA
;M
edA
dh;
Sym
pMan
ag
Prim
ary:
Sel
f-car
e be
havi
ors
(SC
HFI
) and
H
RQ
oL (M
LHFQ
)
42. W
ang
et a
l.,
2011
(51)
Asi
aN
ursi
ngP
ilot s
tudy
(RC
T)
In/O
utpa
tA
ge: 7
1.5
n=27
(14/
IG;
13/C
G) M
ale:
21
- Inf
orm
atio
n on
HF
path
ophy
siol
ogy
and
stre
ngth
enin
g of
se
lf-ca
re- N
o th
eory
- CA
: yes
/ C
I: no
- Num
ber a
nd d
urat
ion
of s
essi
ons:
NM
- FU
p: 3
mon
ths
- Inf
orm
atio
n: v
erba
l, w
ritte
n, n
o IC
T- D
eliv
ery:
in p
erso
n an
d by
pho
ne- I
ndiv
idua
l- P
artic
ipan
ts: p
atie
nts
& fa
mili
es
Die
t; M
edA
dh; D
W;
PA; S
ympM
onP
rimar
y: s
ympt
om d
istre
ss (S
DQ
), ac
tivity
to
lera
nce
(SM
WT)
, HR
QoL
(SF-
36)
Sec
onda
ry: e
mer
genc
y vi
sits
, rea
dmis
sion
* I
G:
inte
rven
tion g
roup;
† CG
: co
ntr
ol gro
up;
‡ RCT:
ran
dom
ized
contr
ol tr
ial;
§ C
A:
clin
ical
ass
essm
ent;
‖ C
I: c
linic
al inte
rven
tion;
¶ FU
p:
follo
w-u
p;
** I
CT:
info
rmat
ion a
nd c
om
munic
atio
n t
echnolo
gy;
††
BM
I: b
ody
mas
s in
dex
;
BN
P: B
-typ
e nat
riure
tic
pep
tide;
§§
Die
t: s
alt
and fl
uid
res
tric
tion;
‖‖
‖ D
W:
dai
ly w
eight;
¶¶
HRQ
oL:
hea
lth-r
elat
ed q
ual
ity
of lif
e; **
* Med
Adh:
med
icat
ion a
dher
ence
; ††
† PA
: phys
ical
act
ivity;
‡‡‡
Sym
pM
anag
: sy
mpto
m m
anag
emen
t;
§§§
Sym
pM
on:
sym
pto
m m
onitoring;
‖‖
‖‖
Vac
c: v
acci
nat
ion;
αAPN
: ad
vance
d p
ract
ice
nurs
e
Figure
2 -
Syn
thes
is o
f th
e re
view
ed a
rtic
les
-
763
www.eerp.usp.br/rlae
Boisvert S, Proulx-Belhumeur A, Gonçalves N, Doré M, Francoeur
J, Gallani MC.
Target participants: The majority of the studies
targeted patients only (26/42), but 16 studies were
centered also on the family or caregiver.
Target self-care: In general, studies targeted between
3 and 4 self-care behaviors (mean = 3.6; median =
4 behaviors). The behaviors most frequently targeted
in descending order were diet (reduction of salt intake
alone or associated with fluid restriction and/or healthy
eating) mentioned in 31/42 studies; adherence to
medication, in 27/42; daily weight (25/42); physical
activity (19/42) as well as monitoring (17/42) and
management (14/42) of signs and symptoms of HF
decompensation. Less targeted behaviors were smoking
(8/42) and alcohol cessation (6/42); vaccination (4/42)
and stress control/relaxation (2/42).
Intervention activities: All the studies included
educational/counselling activities in their interventions.
In 14 studies, interventions used cognitive behavioral
strategies: mastering the management of self-care
behaviors, discussions and exchanges of experiences
with self-care behaviors, action planning, modeling
and social persuasion, awareness of physical and
emotional states, motivational interviewing or
empowerment and managing barriers. Finally, 10
studies mentioned a combination of information
and cognitive behavioral strategies. In 18 studies,
educational interventions were mostly based on
information about the cardiovascular system, the HF
pathophysiology, symptoms and treatment as well as
expected self-care behaviors.
Theoretical background: The majority of the 18
studies focused on information did not use theoretical
background to guide their intervention. Only two
studies based on information mentioned the use of
theoretical background, and the Self-Care Model
and Orem’s Self-Care Theory were used to define
the concepts under study. As a rule, the 14 studies
using cognitive behavioral strategies were based on
a theoretical background. The models used were
Activation Theory; Motivation and Self-Determination
Theory; Transtheoretical Model; Bandura’s Social
Cognitive Theory; Self-Determination Theory;
Cognitive Behavior Theory; Orem’s Self-Care Deficit
Theory; Shared Care Conceptual Model; Motivational
Interviewing; situation-specific theory of HF and
Decision-Making Framework. Only one study did
not use theoretical background for the intervention
centered on behavior change. Among the 10 studies
whose interventions included both information and
changing behavior strategies, five used theories to
guide the intervention: Rogers’ Science of Unitary
Human Being’s Process; the Self-Care Deficit Theory;
the Shared Care Model; the Autonomy Support Theory
and the Triandis Model. Four studies did not use any
theoretical background.
Type of intervention delivery: All studies used
verbal information in their interventions. Twenty-
eight of them also used written information and 15
used information and communication technologies
(ICT). Among ICT, the main tools were CD-ROM, DVD
and video, alone or in combination. Fifty-four studies
mentioned the use of telehealth or telenursing, and
one study developed a website. Interventions were
delivered individually (35/42), in group (2/42) or
combining individual and group meetings (5/42).
The majority of the interventions were delivered in
person (39/42). From those, 19 combined in-person
interventions with telephone calls. Two studies used
only telephone calls and one used only CD-ROM to
deliver the intervention.
Dose of intervention: The number of sessions
to deliver the intervention varied from one to 30,
with a mean of 5.6 sessions, but five articles did
not clearly mention it. The duration of the sessions
varied between five to 120 minutes, with a mean of
61.7 minutes, but again, 22 articles did not report
this information. Finally, the duration of the follow-
up ranged from 2 weeks up to 12 months, with an
average of 5.8 months. Two studies were not clear
about the length of the follow-up.
Inclusion of clinical assessment and intervention:
In 12 studies, educational interventions were provided
along with the clinical assessment of the patient, using
anamnesis associated or not to physical examination
(heart and lung auscultation and inspection of edema).
In seven of these studies, the clinical evaluation
was followed by therapeutic optimization, with
management of the medication by the nurses involved
in the study according to preestablished protocols
and/or by referring to the cardiologist.
Endpoints: All studies established primary endpoints,
with an average of 1.8 criteria (median=2). Self-care
measures were the most frequent primary endpoints,
-
764
www.eerp.usp.br/rlae
Rev. Latino-Am. Enfermagem 2015 July-Aug.;23(4):753-68.
measured in 57% of the studies (24/42). Different
measures of self-care were used: self-care scales
(19/24) or specific measures of the targeted behavior
(5/24). Other primary endpoints were: readmissions
(12/42); health-related quality of life (13/42); other
psychosocial measures related to the strategies of
intervention (10/42) and knowledge (9/42). The
primary endpoints less frequently used were: clinical
data regarding signs of decompensation/stabilization
of HF (6/42), mortality (5/42), hospital days (3/42)
and visits to the emergency department (2/42).
Acceptability/feasibility was evaluated in one out of six
pilot studies. Under half of the studies (18/42) used
secondary endpoints. For those studies, in average
2.1 criteria were used (median=2). Secondary
admission (6/18), HRQoL (6/18), visits to emergency
departments (5/18), psychosocial variables (5/18),
cost (2/18), knowledge (1/18), hospital days (1/18)
and clinical data (1/18) were the criteria assessed.
Discussion
In this review, we aimed at evaluating the main
features of the interventions implemented by nurses
to promote self-care among HF patients. Our results
confirmed the variety and the complexity of the
interventions that have been proposed.
All the studies were founded on educational/
counselling activities and it is noteworthy that a
significant number of interventions were based only
on information. It is widely recognized that, despite
the importance of knowledge about the health-related
condition, it is not sufficient to help individuals change
their behaviors. Moreover, the majority of the studies
based only on information had not used theoretical
background guiding the content and the strategy of
educational intervention as well as the rational used to
evaluate its results. The use of theoretical backgrounds
is important to understand results and how inventions
worked, enabling further improvements in the
effectiveness of behavioral interventions(52).
In 28% of the studies, self-care interventions
were combined with clinical assessment and
therapeutic optimization, which is a troubling point
for the evaluation of the effectiveness of self-care
behaviors by themselves on clinical outcomes. The
development and application of clear protocols as well
the evaluation of the degree of adherence to each of
them is essential to build a theoretical understanding
of the process of change(53).
Self-care is defined as a set of health-related
behaviors that can be divided in maintenance,
monitoring and managing behaviors(6). Thus,
interventions are anyhow often complex because more
than one behavior is targeted. Behaviors contributing
to the stability of the clinical profile, the maintenance
behaviors diet, medication and physical activity, were
the most frequently targeted, along with the monitoring
behaviors of daily weight and observation of signs
and symptoms of HF decompensation. Management
behaviors are far less targeted in interventions.
Regarding the strategies used to deliver the
intervention, it is important to note the frequent use
of phone calls as well as ICT. These strategies may
result in an increased accessibility to interventions,
considering mainly the impaired and fragile health
condition of HF patients. Research is needed to
demonstrate the added value of such strategies.
However, it is important to note that important
information regarding intervention dose and length
of follow-up were not mentioned in seven studies,
while the duration of intervention sessions was not
mentioned in 22. Studies on nursing interventions
need to describe this information carefully, permitting
further replication or comparison.
Interventions targeted patients or patients &
families, individually or in group. Interventional
strategies involving social referents are increasing
in nursing studies, based on the assumption of the
importance of social referents for the support of
change and maintenance of health-related behaviors.
Further studies must be done in order to explore if
the inclusion of the caregivers optimizes the results of
the intervention in this
