A heart failure self-management program for patients of all literacy levels: A randomized, controlled trial [ISRCTN11535170]

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  • Dewalt, Darren
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology
  • Malone, Robert M.
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology
  • Bryant, Mary E.
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology
  • Kosnar, Margaret C.
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology
  • Corr, Kelly E.
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology
  • Rothman, Russell L.
    • Other Affiliation: Center for Health Services Research, Division of General Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
  • Sueta, Carla A.
    • Affiliation: School of Medicine, Department of Medicine
  • Pignone, Michael
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology
Abstract
  • Background: Self-management programs for patients with heart failure can reduce hospitalizations and mortality. However, no programs have analyzed their usefulness for patients with low literacy. We compared the efficacy of a heart failure self-management program designed for patients with low literacy versus usual care. Methods: We performed a 12-month randomized controlled trial. From November 2001 to April 2003, we enrolled participants aged 30–80, who had heart failure and took furosemide. Intervention patients received education on self-care emphasizing daily weight measurement, diuretic dose self-adjustment, and symptom recognition and response. Picture-based educational materials, a digital scale, and scheduled telephone follow-up were provided to reinforce adherence. Control patients received a generic heart failure brochure and usual care. Primary outcomes were combined hospitalization or death, and heart failure-related quality of life. Results: 123 patients (64 control, 59 intervention) participated; 41% had inadequate literacy. Patients in the intervention group had a lower rate of hospitalization or death (crude incidence rate ratio (IRR) = 0.69; CI 0.4, 1.2; adjusted IRR = 0.53; CI 0.32, 0.89). This difference was larger for patients with low literacy (IRR = 0.39; CI 0.16, 0.91) than for higher literacy (IRR = 0.56; CI 0.3, 1.04), but the interaction was not statistically significant. At 12 months, more patients in the intervention group reported monitoring weights daily (79% vs. 29%, p < 0.0001). After adjusting for baseline demographic and treatment differences, we found no difference in heart failure-related quality of life at 12 months (difference = -2; CI -5, +9). Conclusion: A primary care-based heart failure self-management program designed for patients with low literacy reduces the risk of hospitalizations or death.
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Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Darren A DeWalt et al.; licensee BioMed Central Ltd.
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Journal title
  • BMC Health Services Research
Journal volume
  • 6
Journal issue
  • 1
Page start
  • 30
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1472-6963
Bibliographic citation
  • BMC Health Services Research. 2006 Mar 13;6(1):30
Publisher
  • BioMed Central Ltd
Access right
  • Open Access
Date uploaded
  • September 5, 2012

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