New innovations to support self-care in persons with heart failure

Introduction: Heart failure (HF) in combination with multiple chronic conditions is increasing rapidly, mainly in the elderly. Self-care is presumed to be one of the best practices for chronic illness including HF. Most of HF-related costs are attributed to hospitalizations with poor HF selfcare as an important cause. The complexity of self-care leads to poor adherence to self-care. Mobile health (mHealth) and the use of technology has the possibility to support persons with HF and families to engage in self-care. Other strategies for improving self-care can be physical activities, known to improve cardiorespiratory and muscular fitness/strength, functional health, maintained cognitive function, reduction of anxiety and depression together with improved self-esteem. Self-care with yoga may be an alternative to exercise training and increase quality of life.

Aim: The overall aim of this thesis was to describe experiences and evaluate the effects of innovative self-care approaches such as the mHealth system and yoga among persons with heart failure.

Methods: The thesis is based on four studies using both quantitative and qualitative methods. Study I and II used an RCT design with follow-up assessment after three and six months including 82 persons with heart failure. The control group received care as usual. Data was collected using questionnaires before and after tree and six months to determine the long-term effects on selfcare, HRQoL, knowledge and hospitalization (I, II). To evaluate the experiences from the mHealth system a qualitative study with interviews where performed including 17 persons in study III. Study IV was conducted as a RCT study with 40 persons with HF, receiving either hydrotherapy or yoga. Evaluation before and after three months included HRQoL, six-minute walk test, sit-to-stand test, clinical variables, anxiety and depression.

Results: The mHealth intervention resulted in improved self-care, HRQoL and reduction in hospitalization days after both three and six months. Knowledge improved significantly after six months. Adherence to the mHealth system was high around 85%. Insight in the importance of adherence to self-care through daily weighing, was enhanced by the repeated reminder and instant feed-back from the mHealth system gathered from experiences. Technical adversities were common with a need of quick and easy support. Yoga and hydrotherapy had an equal impact on HRQoL, exercise capacity, clinical outcomes, anxiety and depression.

Conclusions: The mHealth tool strengthened adherence to weighing, improved self-care, HRQoL and reduced HF hospitalization days, together with improved HF knowledge after six months. Self2 care was obtained through understanding the deteriorating symptoms and signs, in connection to weight change and how to act. The experiences of mHealth could be determined in relation to “the situation specific theory of heart failure self-care”. Yoga could serve as a complement or alternative to exercise training such as hydrotherapy in persons with heart failure.

List of scientific papers

I. Hägglund E, Lyngå P, Frie F, Ullman B, Persson H, Melin M, Hagerman I. Patient-centered home-based management of heart failure. Findings from a randomized clinical trial evaluating a tablet computer for self-care, quality of life and effects on knowledge. Scandinavian Cardiovascular Journal. 2015;49:193-99.
https://doi.org/10.3109/14017431.2015.1035319

II. Melin M, Hägglund E, Ullman B, Persson H, Hagerman I. Effects of a tablet computer on self-care, quality of life, and knowledge: a randomized clinical trial. Journal of Cardiovascular Nursing. 2018 Jan 23.
https://doi.org/10.1097/JCN.0000000000000462

III. Hägglund E, Strömberg A, Hagerman I, Lyngå P. Experiences of persons with heart failure using mHealth system for self-care with a tablet computer wirelessly connected to a weight scale-a qualitative study. [Submitted]

IV. Hägglund E, Hagerman I, Dencker K, Strömberg A. Effects of yoga versus hydrotherapy training on health-related quality of life and exercise capacity in patients with heart failure-a randomized controlled study. European Journal of Cardiovascular Nursing. 2017;16:381-389.
https://doi.org/10.1177/1474515117690297