Identifying priority learning needs to improve adherence to self-management regimens among individuals with chronic heart failure: Developing a clinic-based screening instrument.

摘要

Chronic Heart Failure (CHF) has emerged as one of the costliest and most debilitating of all types of cardiovascular disease. CHF patients educated about their disease are in a better position to participate in their care and maximize the therapeutic benefits of treatment regimens. The purpose of this study was to develop a valid, reliable instrument that would enable healthcare providers to efficiently assess patients' priority learning needs in order to more effectively educate CHF patients. A review of the literature indicated that knowledge, positive outcome expectations, perceived self-efficacy, and decision-making capabilities enable successful self-management of chronic conditions. A logic model was created to guide the study in which decision-making was the dependent variable, and knowledge, self-efficacy, and outcome expectations were the independent variables. Four scales were developed to measure these variables using validated instruments as models, self-management research findings, constructs from social cognitive theory, and one-on-one interviews with CHF patients. Clinical experts assessed content validity. CHF patient interviews were conducted to assess face validity. Psychometric testing of the developed instrument was accomplished using data collected from a convenience sample of 100 CHF patients treated within The Kirklin Clinic at the University of Alabama at Birmingham. The internal reliability of the knowledge, self-efficacy, and outcome expectations scales was assessed with Cronbach's alpha. Factor analysis was used to verify that the variables on the self-efficacy and outcome expectations scales reflect the categories of self-management described by Clark, Janz, Lorig, Rakowski, and Anderson (1991). To test construct validity, Pearson's Correlation Coefficient and regression analysis were used to examine the relationships between participant scores on each scale. Cronbach's alpha of the knowledge, self-efficacy, and outcome expectations scales were 0.71, 0.88, and 0.79, respectively. Patient and expert responses were consistent with face and content validity. Pearson's Correlation Coefficient demonstrated positive, linear relationships between all variables, except knowledge and decision-making. Regression analysis indicated the relationship between the dependent variable (decision-making) and independent variables (knowledge, self-efficacy, and outcome expectations) was not statistically significant. The psychometric properties of the Chronic Heart Failure-Self Management Ability Assessment (CHF-SMAA) indicate the instrument is pragmatic and warrants further testing.