Developing a Patient-Centred Management Program for People with Heart Failure in Jordan
Date
2019
Authors
Alkouri, Osama Ahmad
Editors
Advisors
Schultz, Tim
Magarey, Judy
Hendriks, Jeroen
Magarey, Judy
Hendriks, Jeroen
Journal Title
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Thesis
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Abstract
Despite the medical advancement in heart failure (HF) management strategies, HF remains a condition that has significant physical, psychological, and social negative impacts on patients. Previous heart failure management programs have produced inconsistent results, and failed to determine an effective intervention that attains clinical stability. While the effectiveness of therapeutic options / elements for HF has been determined, a practice gap exists around how best to structure and deliver the therapeutic options. As a developing country Jordan has a limited health budget and infrastructure, as well as a lack of well-structured health care services for chronic diseases. In addition, there have been dramatic increases in prevalence of ischemic heart disease, diabetes, and hypertension, and other risk factors for heart failure (HF) attributed to sedentary lifestyles and dietary shifts. Therefore, an effective HF management program that is contextualised and feasible is needed. According to the literature, patient-centred care can be effective in improving HF knowledge, adherence to self-care, communication between patients and healthcare provider, and psychological status. Tailoring interventions is an important part of patient empowerment or patient centredness in which the interventions are specifically designed for patients based on careful assessments. This mixed methods study proposes a patient-centred HF management program that is tailored to the Jordanian context and patients’ needs. It involved two studies. The first study was a cross sectional survey. The second study comprised two components: a Delphi study of clinicians and focus groups for patients. The cross sectional study (survey) was conducted with a convenience sample of 300 Jordanian patients with HF. The outcomes that were measured included: (i) heart failure knowledge, (ii) self-care, (iii) treatment adherence, and (iv) quality of life (QOL). The Delphi study utilised seven clinicians and policy makers. The two focus groups included the same seven HF patients recruited from cardiac out-patient clinics. The main purpose for study two was to derive consensus from clinicians (using the Delphi method) and understand the perspectives of patients (using focus groups) on a more patient-centred model of HF management. Study I (quantitative study) showed that Jordanian HF patients had a moderate level of knowledge, a moderate self-care, poor adherence, and moderate quality of life. Males had higher knowledge than females. Only 3% of patients were informed to weigh themselves every day, and to watch the fluid status. Regarding self-care, most patients disagreed that they would contact their doctor or nurse if they gained 2 kg in one week (92%), and 83% disagreed with monitoring their weight every day. Unmarried and illiterate patients had poorer self-care than their counterparts. Activities with the lowest levels of adherence were: reducing or quitting smoking, and self-weighing. The predictors of quality of life were insomnia, marital status, previous hospitalisation, and employment. Regarding patients’ focus groups, eight themes emerged from the first focus group, including emotional impact of HF, Motivation to change lifestyle, Adjustment to treatment, Physical impact of HF, Loss of social interaction, and Impact of religion. Three themes emerged from the second focus group, involving the effectiveness of teaching sessions in cardiac clinic, suggestions for improving the educational program, and appropriateness of educational material. The Delphi study found consensus for the feasibility of different HF components: lifestyle brochure, nutrition card, and follow up phone call program, cardiac rehabilitation program, and group discussion session. The mixed methods study revealed that there were increased HF risk factors and sedentary behaviours for people with HF in Jordan, poor HF education, psychological distress, social isolation, and ineffective communication between patients and healthcare providers. The Jordanian healthcare system will need to implement a patient-centred heart failure management program that is tailored to Jordan context and patient’s needs. The proposed program from this study was determined to be feasible, appropriate, and applicable in Jordan, embracing three main elements that should be delivered to patients across the whole continuum of care process. These were targeted education, psychological support, and social support.
School/Discipline
Adelaide Nursing School
Dissertation Note
Thesis (Ph.D.) -- University of Adelaide, Adelaide Nursing School, 2020
Provenance
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