Effectiveness of health education in the self-care and adherence of patients with heart failure: a meta-analysis

Tinoco, Juliana de Melo Vellozo Pereira; Figueiredo, Lyvia da Silva; Flores, Paula Vanessa Peclat; Padua, Bruna Lins Rocha de; Mesquita, Evandro Tinoco; Cavalcanti, Ana Carla Dantas

doi:10.1590/1518.8345.4281.3389

Juliana de Melo Vellozo Pereira Tinoco

Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Niterói, RJ, Brazil.

http://orcid.org/0000-0002-2418-6984

Lyvia da Silva Figueiredo

Universidade Federal Fluminense, Niterói, RJ, Brazil.

Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.

http://orcid.org/0000-0003-1591-422X

Paula Vanessa Peclat Flores

Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Niterói, RJ, Brazil.

http://orcid.org/0000-0002-9726-5229

Bruna Lins Rocha de Padua

Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Niterói, RJ, Brazil.

http://orcid.org/0000-0002-9993-5337

Evandro Tinoco Mesquita

Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Niterói, RJ, Brazil.

http://orcid.org/0000-0002-7452-3870

Ana Carla Dantas Cavalcanti Corresponding author: Ana Carla Dantas Cavalcanti. E-mail: anacarladc.uff@gmail.com

Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Niterói, RJ, Brazil.

http://orcid.org/0000-0003-3531-4694

Corresponding author: Ana Carla Dantas Cavalcanti. E-mail: anacarladc.uff@gmail.com

Associate Editor: Maria Lúcia Zanetti

Authors’ contribution:Study concept and design: Juliana de Melo Vellozo Pereira Tinoco, Lyvia da Silva Figueiredo, Paula Vanessa Peclat Flores, Evandro Tinoco Mesquita, Ana Carla Dantas Cavalcanti. Obtaining data: Juliana de Melo Vellozo Pereira Tinoco, Lyvia da Silva Figueiredo, Paula Vanessa Peclat Flores, Bruna Lins Rocha de Padua. Data analysis and interpretation: Juliana de Melo Vellozo Pereira Tinoco, Bruna Lins Rocha de Padua, Evandro Tinoco Mesquita, Ana Carla Dantas Cavalcanti. Drafting the manuscript: Juliana de Melo Vellozo Pereira Tinoco, Lyvia da Silva Figueiredo, Paula Vanessa Peclat Flores, Bruna Lins Rocha de Padua, Evandro Tinoco Mesquita, Ana Carla Dantas Cavalcanti. Critical review of the manuscript as to its relevant intellectual content: Juliana de Melo Vellozo Pereira Tinoco, Lyvia da Silva Figueiredo, Paula Vanessa Peclat Flores, Bruna Lins Rocha de Padua, Evandro Tinoco Mesquita, Ana Carla Dantas Cavalcanti. All authors approved the final version of the text.

Conflict of interest: the authors have declared that there is no conflict of interest.

Study/ Country/ Year	Intervention/Professional	Type of study	Self-care Scales		Adherence Scale				JBI score^ JBI = Joanna Briggs Institute;
Study/ Country/ Year	Intervention/Professional	Type of study	EHFSCBC^* * EHFSCBC = European Heart Failure Self-care Behaviour Scale;	SCHFI^† † SCHFI = Self-Care of Heart Failure Index;	MARC^‡ ‡ MARC = Medication Adherence Report Scale;	MMAC^§ § MMAC = Morisky Medication Adherence Scale;	MOSSAS-3HF^\|\| \|\| MOSSAS-3HF = Medical Outcomes Study Specific Adherence Scale modified for HF;	QA-26^¶ ¶ QA-26 = 26-point adherence questionnaire;	JBI score^ JBI = Joanna Briggs Institute;
Study 1(²⁶26 Davis KK, Mintzer M, Himmelfarb CRD, Hayat M, Rotman S, Allen J. Targeted intervention improves knowledge but not self-care or readmissions in heart failure patients with mild cognitive impairment. Eur J Heart Fail. [Internet]. 2012 [cited Dec 30, 2019];14(9):1041-9. Available from: https://doi.org/10.1093/eurjhf/hfs096 https://doi.org/10.1093/eurjhf/hfs096... ) USA, 2012	Cognitive training. Nurse	RCT^†† †† RCT = Randomized Clinical Trial;		X					12
Study 2(²⁷27 Boyde M, Song S, Peters R, Turner C, Thompson DR, Stewart S. Pilot testing of a self-care education intervention for patients with heart failure. Eur J Cardiovasc Nurs . [Internet]. 2013 [cited Dec 15, 2019];12(1):39-46. Available from: https://doi.org/10.1177/1474515111430881 https://doi.org/10.1177/1474515111430881... ) Netherlands, 2013	Nursing consultation + Telemonitoring. Nurse	RCT^†† †† RCT = Randomized Clinical Trial;	X						12
Study 3(²⁸28 Deek H, Chang S, Newton PJ, Noureddine S, Inglis SC, Arab GA, et al. An evaluation of involving family caregivers in the self-care of heart failure patients on hospital readmission: Randomised controlled trial (the FAMILY study). Int J Nurs Stud. [Internet]. 2017 [cited Dec 3, 2019];75:101-11. Available from: https://doi.org/10.1177/1474515111430881 https://doi.org/10.1177/1474515111430881... ) USA, 2017	Education for self-care/cultural adaptations + Phone consultation. Nurse	RCT^†† †† RCT = Randomized Clinical Trial;		X					12
Study 4(²⁹29 Masterson CR, Patey M, Lee CS, Kuan A, Jurgens C, Riegel B. Motivational interviewing to improve self-care for patients with chronic heart failure: MITI-HF randomized controlled trial. Patient Educ Couns. [Internet]. 2016 [cited Dec 15, 2019];99(2):256-64. Available from: https://doi.org/10.1016/j.pec.2015.08.031 https://doi.org/10.1016/j.pec.2015.08.03... ) USA, 2015	Home Visit + Phone consultation by motivational interview. Nurse	RCT^†† †† RCT = Randomized Clinical Trial;		X					12
Study 5(³⁰30 Yu DS, Lee DT, Stewart S, Thompson DR, Choi KC, Yu CM. Cognitive Behavior Therapy for Depression and Self-Care in Heart Failure Patients: A Randomized Clinical Trial. J Am Geriatr Soc. [Internet]. 2015 [cited Dec 15, 2019];63(8):1583-93. Available from: 10.1001/jamainternmed.2015.5220 10.1001/jamainternmed.2015.5220... ) China, 2015	Transitional care. Nurse	RCT^†† †† RCT = Randomized Clinical Trial;		X					11
Study 6(³¹31 Clark AM, Spaling M, Harkness K, Spiers J, Strachan PH, Thompson DR, et al. Determinants of effective heart failure self-care: a systematic review of patients' and caregivers' perceptions. Heart. [Internet]. 2014 [cited Sep 15, 2019];100:716-21. Available from: http://dx.doi.org/10.1136/heartjnl-2013-304852 http://dx.doi.org/10.1136/heartjnl-2013-... ) Australia, 2015	Electronic resource/Cultural adaptation. Indigenous researcher	QE^‡‡ †† RCT = Randomized Clinical Trial;		X					07
Study 7(³²32 Dickson VV, Melkus GD, Katz S, Levine-Wong A, Dillworth J, Cleland CM, et al. Building skill in heart failure self-care among community dwelling older adults: results of a pilot study. Patient Educ Couns . [Internet]. 2014 [cited Dec 15, 2019];96(2):188-96. Available from: https://doi.org/10.1016/j.pec.2014.04.018 https://doi.org/10.1016/j.pec.2014.04.01... ) USA, 2014	Group guidance + Lifestyle coaching. Health educator	RCT^†† †† RCT = Randomized Clinical Trial;		X					11
Study 8(³³33 Zamanzadeh V, Valizadeh L, Howard AF, Jamshidi F. A supportive-educational intervention for heart failure patients in Iran: the effect on self-care behaviours. Nurs Res Pract. [Internet]. 2013 [cited Dec 10, 2019];2013:01-7. Available from: http://dx.doi.org/10.1155/2013/492729 http://dx.doi.org/10.1155/2013/492729... ) Iran, 2013	Education for self-care after discharge + Phone consultation. Nurse	RCT^†† †† RCT = Randomized Clinical Trial;		X					13
Study 9(³⁴34 Navidian A, Mobaraki H, Shakiba M. The effect of education through motivational interviewing compared with conventional education on self-care behaviors in heart failure patients with depression. Patient Educ Couns . [Internet]. 2017 [cited Sep 10, 2019];100(8):1499-504. Available from: https://doi.org/10.1016/j.pec.2017.02.023 https://doi.org/10.1016/j.pec.2017.02.02... ) Iran, 2017	Education for self-care by Motivational Interview. Nurse	RCT^†† †† RCT = Randomized Clinical Trial;		X					11
Study 10(³⁵35 Freedland KE, Carney RM, Rich MW, Steinmeyer BC, Rubin EH. Cognitive Behavior Therapy for Depression and Self-Care in Heart Failure Patients: a Randomized Clinical Trial. JAMA Intern Med. [Internet]. 2015 [cited Sep 10, 2019];175(11):1773-82. Available from: http://doi.org/10.1001/jamainternmed.2015.5220 http://doi.org/10.1001/jamainternmed.201... ) USA, 2015	Cognitive Behavioral Therapy	RCT^†† †† RCT = Randomized Clinical Trial;		X					11
Study 11(³⁶36 Moon MK, Yim J, Jeon MY. The effect of a telephone-based self-management program led by nurses on selfcare behavior, biological index for cardiac function and depression in ambulatory heart failure patients. Asian Nurs Res (Korean Soc Nurs Sci). [Internet]. 2018 [cited Sep 10, 2019];12(4):251-7. Available from: https://doi.org/10.1016/j.anr.2018.10.001 https://doi.org/10.1016/j.anr.2018.10.00... ) Korea, 2018	Nursing consultation + Phone consultation. Nurse	QE^‡‡ †† RCT = Randomized Clinical Trial;	X						09
Study 12(³⁷37 Khaledi GH, Mostafavi F, Eslami AA, Rooh Afza H, Mostafavi F, Akbar H. Evaluation of the effect of perceived social support on promoting self care behaviors of heart failure patients referred to the cardiovascular research center of Isfahan. Iran Red Crescent Med J. [Internet]. 2015 [cited Sep 15, 2019];17(6):e22525. Available from: http://doi.org/10.5812/ircmj.22525v2 http://doi.org/10.5812/ircmj.22525v2... ) Iran, 2015	Support group for patients and family members. Nurse	QE^‡‡ †† RCT = Randomized Clinical Trial;	X						12
Study 13(³⁸38 Boyne JJ, Vrijhoef HJ, Spreeuwenberg M, De Weerd G, Kragten J, Gorgels AP. Effects of tailored telemonitoring on heart failure patients knowledge, self-care, self efficacy and adherence: a randomized controlled trial. Eur J Cardiovasc Nurs . [Internet]. 2014 [cited Oct 10, 2019];13(3):243-52. Available from: https://doi.org/10.1177/1474515113487464 https://doi.org/10.1177/1474515113487464... ) Netherlands, 2014	Telemonitoring system (Health Buddy^®) + Usual care. Nurse	RCT^†† †† RCT = Randomized Clinical Trial;	X						12
Study 14(³⁹39 Mussi CM, Ruschel K, Souza EN, Lopes ANM, Trojahn MM, Paraboni CC, et al. Home visit improves knowledge, self-care and adhesion in heart failure: Randomized Clinical Trial HELEN-I1Rev. Latino-Am. Enfermagem . [Internet]. 2013 [cited Oct 15, 2019];21(Spec). Available from: http://dx.doi.org/10.1590/S0104-11692013000700004 http://dx.doi.org/10.1590/S0104-11692013... ) Brazil, 2013	Home visit after hospital discharge + Phone consultation. Nurse	RCT^†† †† RCT = Randomized Clinical Trial;	X					X	12
Study 15(⁴⁰40 Köberich S, Lohrmann C, Mittag O, Dassen T. Effects of a hospital-based education programme on selfcare behaviour, care dependency and quality of life in patients with heart failure - a randomized controlled trial. J Clin Nurs. [Internet]. 2015 [cited Oct 15, 2019];24(11-12):1643-55. Available from: https://doi.org/10.1111/jocn.12766 https://doi.org/10.1111/jocn.12766... ) USA, 2015	Education for self-care + Phone consultation + Usual care. Nurse	RCT^†† †† RCT = Randomized Clinical Trial;	X						13
Study 16(⁴¹41 Meng K, Musekamp G, Schuler M, Seekatz B, Glatz J, Karger G, et al. The impact of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation. Patient Educ Couns . [Internet]. 2016 [cited Oct 25, 2019];99(7):1190-7. Available from: https://doi.org/10.1016/j.pec.2016.02.010 https://doi.org/10.1016/j.pec.2016.02.01... ) Germany, 2016	Self-managed educational group. Multi-professional team (physician, nurse, psychologist, and physiotherapist)	RCT^†† †† RCT = Randomized Clinical Trial;			X				11
Study 17(⁴²42 Yu DS, Lee DT, Thompson DR, Woo J, Leung E. Assessing self-care behaviour of heart failure patients: cross-cultural adaptation of two heart failure selfcare instruments. Hong Kong Med J. [Internet]. 2010 [cited Oct 20, 2019];16(3):13-6. Available from: https://www.hkmj.org/system/files/hkm1006sp3p13.pdf https://www.hkmj.org/system/files/hkm100... ) China, 2015	Health education booklet + Phone consultation. Physician and nurses	RCT^†† †† RCT = Randomized Clinical Trial;				X			11
Study 18(⁴³43 Athar MW, Record JD, Martire C, Hellmann DB, Ziegelstein RC. The effect of a personalized approach to patient education on heart failure self-management. J Pers Med. [Internet]. 2018 [cited Oct 15, 2019];8(4):01-10. Available from: https://doi.org/10.3390/jpm8040039 https://doi.org/10.3390/jpm8040039... ) USA, 2018	Guidance through ultrasound of the inferior vena cava. Nurse	RCT^†† †† RCT = Randomized Clinical Trial;					X		11
Study 19(⁴⁴44 Wang XH, Qiu JB, Ju Y, Chen GC, Yang JH, Pang JH, et al. Reduction of heart failure rehospitalization using a weight management education intervention. J Cardiovasc Nurs . [Internet]. 2014 [cited Oct 15, 2019];29(6):528-34. Available from: http://doi.org/10.1097/JCN.0000000000000092 http://doi.org/10.1097/JCN.0000000000000... ) China, 2014	Home visit + Phone consultation. Nurse	RCT_††						X	12

Model	Estimate	95% confidence interval	z-value	p-value
Outcome: Self-care
Fixed	0.0063	(-0.0903; 0.1028)	0.13	0.8986
Random	0.6799	(0.1690; 1.1907)	2.61	0.0091
Outcome: Adherence
Fixed	0.3841	(0.2533; 0.5147)	5.76	< 0.001
Random	0.7604	(0.0038; 1.5170)	1.97	0.0489

No. of the study	Study design	Risk of bias^* * Risk of bias = A quasi-experimental study with no allocation between control/intervention;	Inconsistency^† † Inconsistency = 96% heterogeneity;	Uncertainty if the evidence is direct	Imprecision^‡ ‡ Imprecision = There are initial studies and with a small number of events;	Publication bias	Quality	Importance
Outcome: Self-care (Follow-up: 30 to 365 days, assessed by the following scales: EHFSCBC^§ § EHFSCBC = European Heart Failure Self-care Behaviour Scale; and SCHIFI^\|\| \|\| SCHFI = Self-Care of Heart Failure Index; )
15	Randomized Clinical Trial	Important	Important	Not important	Important	No	Low	Important
Outcome: Adherence (Follow-up: 30 to 180 days, assessed by the following scales: MARC^¶ MMAC = Morisky Medication Adherence Scale; , MMAC^ ** MMAC = Morisky Medication Adherence Scale; , MOSSAS-3HF^†† †† MOSSAS-3HF = Medical Outcomes Study Specific Adherence Scale modified for HF; and QA-26^‡‡ ‡‡ QA-26 = 26-point adherence questionnaire )
5	Randomized Clinical Trial	Not important	Important	Not important	Important	No	Low	Important

[1] Corresponding author: Ana Carla Dantas Cavalcanti. E-mail: anacarladc.uff@gmail.com

Brasil

Brasil

Effectiveness of health education in the self-care and adherence of patients with heart failure: a meta-analysis

Objective:

Method:

Results:

Conclusion: