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DeNotto LA, Chung ML, Key KV, Mudd-Martin G. Management of a Dual Low Sodium and Diabetic Diet by Patient-Caregiver Dyads: A Qualitative Descriptive Study. Sci Diabetes Self Manag Care 2024; 50:520-531. [PMID: 39399972 DOI: 10.1177/26350106241285815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
PURPOSE The purpose of the study was to explore factors surrounding management of simultaneous dietary recommendations for heart failure and type 2 diabetes among patient-caregiver dyads. METHODS Qualitative description was used to explore dyad experiences managing a dual diet. Semi-structured interviews were conducted with patients with a concurrent diagnosis of type 2 diabetes and heart failure and their family caregiver. Each 60-minute interview was conducted virtually. Interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted with coding used for themes at dyadic-and individual levels. RESULTS Twelve patient-caregiver dyads (N = 24) were interviewed. The mean age was 57 years (±15 years). Most participants were white (75%); patients were predominantly male, and caregivers were predominantly female (83.3% for both). Dyadic-level themes that emerged included factors that influence simultaneous management of dual diet recommendations. Themes included shared barriers, facilitators, motivators, and strategies for dual diet management. Individual-level themes discussed by patients were barriers and motivators to dual diet management, and caregivers discussed barriers to supporting dual diet management. CONCLUSIONS Findings from the study highlight that patients and caregivers often work together and share similar barriers, facilitators, motivators, and strategies for adhering to a dual diet. The results provide insight into chronic disease management at the family level and can guide health care providers' efforts to promote family involvement with dietary recommendations for patients with multiple comorbidities.
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Affiliation(s)
- Leigh Anne DeNotto
- Grand Valley State University, Kirkhof College of Nursing, Grand Rapids, Michigan
| | - Misook L Chung
- University of Kentucky, College of Nursing, Lexington, Kentucky
| | | | - Gia Mudd-Martin
- University of Kentucky, College of Nursing, Lexington, Kentucky
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Lancey A, Slater CE. Heart failure self-management: a scoping review of interventions implemented by allied health professionals. Disabil Rehabil 2024; 46:4848-4859. [PMID: 37975543 DOI: 10.1080/09638288.2023.2283105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Heart failure (HF) is typically managed using both medical and patient self-management interventions. Individuals with HF often have frequent readmissions to hospital for medical management. Effective self-management can help to reduce the exacerbation of HF symptoms and the frequency of readmissions. METHODS A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines was conducted to identify literature on the interventions used by allied health professionals to promote HF self-management. A search strategy was implemented, and articles were reviewed by two independent reviewers. RESULTS Twenty articles met the inclusion criteria. Articles included interventions from physical therapy, nutrition, social work, and occupational therapy, as well as other health professions in team-based programs. The most common interventions were verbal education, textual information, monitoring resources, and skills practice. Interventions addressed diet/fluid control, exercise and activity, symptom monitoring, medication management, cardiovascular disease knowledge, and mental health. Many interventions were theory informed. CONCLUSION There is nascent evidence that interventions promoting HF self-management positively impact health and quality of life outcomes. HF self-management is multi-faceted and requires interprofessional collaboration. Further work is warranted exploring the impact of theory-informed interventions, and the effectiveness of interventions on self-management competence and desired health outcomes.
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Affiliation(s)
- Allyson Lancey
- Department of Occupational Therapy, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Craig E Slater
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, USA
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Brown C, Hernandez R, Ford T, Aksan N, DiVincenzo C, Muir AJ. Inadequate Dietary Education and Poor Adherence to a High Protein, Low Sodium Diet in Cirrhosis: Mixed Methods Approach. Dig Dis Sci 2024; 69:3226-3235. [PMID: 38940972 DOI: 10.1007/s10620-024-08526-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Malnutrition in cirrhosis is associated with poor outcomes, leading to guidelines for a high protein, low sodium diet; however, there is no guidance regarding the implementation of diet education in clinical practice. METHODS A mixed methods study enrolled 21 patients with cirrhosis and their caregivers. Semi-structured interviews on barriers and facilitators of dietary education and adherence were conducted. Demographic and clinical data were obtained, along with quantitative measures of dietary adherence, including 24-h food recall and spot urine sodium. Combined deductive and inductive coding was used to identify qualitative themes, along with a quantitative assessment of interviews. Quantitative data was reported using descriptive statistics with frequencies, mean and confidence intervals. RESULTS Participants were mostly male (16/21) with a mean age 57.8 years (SE 2.8) and MELD-Na 9 (SE 1.2). 4 themes emerged: 1. More than 50% of participants and caregivers endorsed no or inadequate diet education 2. They reported mostly negative experiences with dietary adherence with largest impact on social life 3. Facilitators of adherence included the presence of household support and fear of complications of cirrhosis 4. Overwhelmingly desired non-generic handouts and information. Dietary adherence was poor with only one participant meeting protein and sodium requirements based on food recall. Four participants who adhered to < 2000 mg sodium had inadequate daily caloric intake. CONCLUSIONS Dietary education is inadequate, and adherence to dietary recommendations is poor in patients with cirrhosis. Future studies should use these barriers and facilitators for intervention development.
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Affiliation(s)
- Cristal Brown
- Dell Medical School, University of Texas at Austin, 1601 Trinity St., Building B, Austin, TX, 78712, USA.
- Ascension Medical Group, 1601 Trinity St., Building B, Austin, TX, 78712, USA.
- University of Texas Health Austin, 1601 Trinity St Building A, Austin, TX, 78712, USA.
- University of Texas at Austin, Health Discovery Building 1601 Trinity St Z0900, Austin, TX, 78712, USA.
| | - Rabecca Hernandez
- Dell Medical School, University of Texas at Austin, 1601 Trinity St., Building B, Austin, TX, 78712, USA
| | - Ty Ford
- Dell Medical School, University of Texas at Austin, 1601 Trinity St., Building B, Austin, TX, 78712, USA
| | - Nazan Aksan
- Dell Medical School, University of Texas at Austin, 1601 Trinity St., Building B, Austin, TX, 78712, USA
| | - Clara DiVincenzo
- Dell Medical School, University of Texas at Austin, 1601 Trinity St., Building B, Austin, TX, 78712, USA
- Ascension Medical Group, 1601 Trinity St., Building B, Austin, TX, 78712, USA
- University of Texas Health Austin, 1601 Trinity St Building A, Austin, TX, 78712, USA
| | - Andrew J Muir
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, 300 W Morgan St., Durham, NC, 27701, USA
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Food as medicine? Exploring the impact of providing healthy foods on adherence and clinical and economic outcomes. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100129. [PMID: 35478519 PMCID: PMC9032066 DOI: 10.1016/j.rcsop.2022.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Methods Results Conclusion
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Saraiva RM, Mediano MFF, Mendes FSNS, Sperandio da Silva GM, Veloso HH, Sangenis LHC, Silva PSD, Mazzoli-Rocha F, Sousa AS, Holanda MT, Hasslocher-Moreno AM. Chagas heart disease: An overview of diagnosis, manifestations, treatment, and care. World J Cardiol 2021; 13:654-675. [PMID: 35070110 PMCID: PMC8716970 DOI: 10.4330/wjc.v13.i12.654] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/11/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
Chagas heart disease (CHD) affects approximately 30% of patients chronically infected with the protozoa Trypanosoma cruzi. CHD is classified into four stages of increasing severity according to electrocardiographic, echocardiographic, and clinical criteria. CHD presents with a myriad of clinical manifestations, but its main complications are sudden cardiac death, heart failure, and stroke. Importantly, CHD has a higher incidence of sudden cardiac death and stroke than most other cardiopathies, and patients with CHD complicated by heart failure have a higher mortality than patients with heart failure caused by other etiologies. Among patients with CHD, approximately 90% of deaths can be attributed to complications of Chagas disease. Sudden cardiac death is the most common cause of death (55%–60%), followed by heart failure (25%–30%) and stroke (10%–15%). The high morbimortality and the unique characteristics of CHD demand an individualized approach according to the stage of the disease and associated complications the patient presents with. Therefore, the management of CHD is challenging, and in this review, we present the most updated available data to help clinicians and cardiologists in the care of these patients. We describe the clinical manifestations, diagnosis and classification criteria, risk stratification, and approach to the different clinical aspects of CHD using diagnostic tools and pharmacological and non-pharmacological treatments.
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Affiliation(s)
- Roberto M Saraiva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Mauro Felippe F Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Fernanda SNS Mendes
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | | | - Henrique H Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Luiz Henrique C Sangenis
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Paula Simplício da Silva
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Flavia Mazzoli-Rocha
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Andréa S Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Marcelo T Holanda
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
| | - Alejandro M Hasslocher-Moreno
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-900, RJ, Brazil
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Heo S, Kim J, Shim JL, Barbe T, Black V, Lee MO. Experiences of and factors associated with dietary sodium adherence in heart failure from patients' and their caregivers' perspectives: A qualitative study. Geriatr Nurs 2021; 42:1190-1197. [PMID: 34419872 DOI: 10.1016/j.gerinurse.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
This study explored experiences of dietary sodium adherence among patients with heart failure and their caregivers. Qualitative data were collected from 22 patients and 18 caregivers using an interview guide and were analyzed using content analysis. Four themes were (1) lack of adherence to low-sodium diet, (2) several barriers to dietary sodium adherence, (3) a few facilitators of dietary sodium adherence, and (4) distorted perceptions of dietary education from healthcare providers. The majority of patients had poor dietary sodium adherence. Distorted perceptions, insufficient knowledge, disadvantages of dietary sodium adherence, and lack of family support were barriers to dietary sodium adherence, and family support was a facilitator. The majority of patients received dietary education from their healthcare providers but had little knowledge about the detailed content and the connection to heart failure management. More effective interventions reflecting patients' and caregivers' dietary experiences need to be developed and delivered.
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Affiliation(s)
- Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341, USA.
| | - JinShil Kim
- College of Nursing, Gachon University, 191 Hambakmeoro, Yeonsu-gu, Incheon 21936, South Korea.
| | - Jae Lan Shim
- College of Nursing, Dongguk University, 123 Dongdae-ro, Gyeongju-si, Gyeongsangbuk-do 38066, South Korea.
| | - Tammy Barbe
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341, USA.
| | - Vicki Black
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341, USA.
| | - Mee Ok Lee
- Clinical Trials Center, Gachon University Gil Medical Center, 21 Namdongdae-ro 774-gil, Namdong-gu, Incheon, South Korea.
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Heo S, Moser DK, Lennie TA, Kim J, Turrise S, Troyan PJ, Kang J, Jones HJ. Self-care strategies and interventions needed in patients with heart failure: from patient perspectives-a qualitative study. Eur J Cardiovasc Nurs 2021; 20:540-546. [PMID: 34008023 DOI: 10.1093/eurjcn/zvaa033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/29/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022]
Abstract
AIMS Most patients with heart failure (HF) have symptoms. Poor self-care has been associated with the development or worsening symptoms. Thus, to improve HF symptoms, it may be critical to understand self-care and interventions targeting improvements in HF symptoms needed from patients' perspectives. To explore patients' perceptions of self-care strategies of individual symptoms, HF symptom improvement, and interventions needed to improve HF symptoms in patients with HF. METHODS AND RESULTS Qualitative data were collected from 20 patients with HF using a semi-structured open-ended interview guide. Data were analysed using content analysis. Five themes appeared: (i) use of a variety of strategies with some knowledge deficit and inefficiency, (ii) uncertainty in symptom improvement, (iii) consideration of several possible self-care strategies, (iv) use of situation-specific strategies in seeking treatment, and (v) willingness to receive comprehensive and realistic interventions. Patients used a variety of self-care strategies, including taking medication, reducing activities, and changing diet and position, but many reported having a lack of knowledge and multiple HF symptoms. Several patients were uncertain whether symptoms could be improved, but all patients reported that they would participate in comprehensive and realistic intervention sessions to gain knowledge about their symptoms and management strategies, and to receive emotional support from healthcare providers and peer patients. CONCLUSION Patients with HF used several self-care strategies with the hope of symptom improvements but were uncertain about the effectiveness. More effective, comprehensive, and realistic interventions need to be delivered to patients with HF to enhance their ability to manage their symptoms.
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Affiliation(s)
- Seongkum Heo
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30341, USA
| | - Debra K Moser
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Terry A Lennie
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - JinShil Kim
- Gachon University, 191 Hambakmeoro, Yeonsu-gu, Incheon 21936, South Korea
| | - Stephanie Turrise
- University of North Carolina, Wilmington, School of Nursing, 601 S. College Road, Wilmington, NC 28403, USA
| | - Pattie J Troyan
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30341, USA
| | - JungHee Kang
- University of Kentucky, College of Nursing, 2201 Regency Rd, Suite, 403, Lexington, KY 40503, USA
| | - Holly J Jones
- University of Cincinnati, College of Nursing, P.O. Box 210038, Cincinnati, OH 45221-0038, USA
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Burgermaster M, Rudel R, Seres D. Dietary Sodium Restriction for Heart Failure: A Systematic Review of Intervention Outcomes and Behavioral Determinants. Am J Med 2020; 133:1391-1402. [PMID: 32682866 PMCID: PMC7704603 DOI: 10.1016/j.amjmed.2020.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022]
Abstract
The 1500 mg/d dietary sodium restriction commonly recommended for patients with heart failure has recently been questioned. Poor adherence to sodium-restricted diets makes assessing the efficacy of sodium restriction challenging. Therefore, successful behavioral interventions are needed. We reviewed sodium restriction trials and descriptive studies of sodium restriction to: 1) determine if sodium restriction was achieved in interventions among heart failure patients; and 2) characterize predictors of successful dietary sodium restriction. Among 638 identified studies, 10 intervention trials, and 25 descriptive studies met inclusion criteria. We used content analysis to extract information about sodium restriction and behavioral determinants of sodium restriction. Dietary sodium was reduced in 7 trials; none achieved 1500 mg/d (range 1938-4564 mg/d). The interventions implemented in the interventional trials emphasized knowledge, skills, and self-regulation strategies, but few addressed the determinants correlated with successful sodium restriction in the descriptive studies (eg, social/cultural norms, social support, taste preferences, food access, self-efficacy). Findings suggest that incorporating determinants predictive of successful dietary sodium restriction may improve the success of interventional trials. Without effective interventions to deploy in trials, the safety and efficacy of sodium restriction remains unknown.
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Affiliation(s)
- Marissa Burgermaster
- Departments of Nutritional Sciences and Population Health, College of Natural Sciences and Dell Medical School, University of Texas at Austin.
| | | | - David Seres
- Department of Medicine, Columbia University Medical Center, New York, NY; Institute of Human Nutrition, Columbia University, New York, NY
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Smith JL, Lennie TA, Chung ML, Mudd-Martin G. Dietary Sodium Intake is Predicted by Antihypertensive Medication Regimen in Patients With Heart Failure. J Cardiovasc Nurs 2020; 34:313-318. [PMID: 30855313 PMCID: PMC6557677 DOI: 10.1097/jcn.0000000000000570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Low-sodium diet adherence is foundational to heart failure (HF) self-management. Altered salt taste perception caused by angiotensin-converting enzyme (ACE) inhibitors commonly prescribed to patients with HF may increase sodium consumption. We hypothesized sodium intake, indicated by dietary sodium density, would be significantly higher among patients with HF prescribed ACE inhibitors compared with those not prescribed the drug. OBJECTIVE The aim of this study was to assess the association between prescribed ACE inhibitors and dietary sodium density in patients with HF. METHODS We conducted a secondary analysis of baseline data from patients with HF in an observational longitudinal study. Sodium density was derived by dividing averaged daily sodium intake from 4-day food diaries by averaged kilocalories consumed. Medical chart review was conducted to ascertain prescribed medications. Patients were categorized as prescribed and not prescribed an ACE inhibitor. t Tests were conducted to compare sodium intake between groups, and linear regression was conducted to examine whether prescribed ACE inhibitors independently predicted sodium density controlling for age, gender, New York Heart Association class, prescribed diuretics, and β-blockers. RESULTS Analyses included 255 patients with HF aged 61 ± 12 years, with 67% male, 44% New York Heart Association class III/IV, and 68% prescribed an ACE inhibitor. Compared with those not prescribed an ACE inhibitor, 13% more sodium per kilocalorie was consumed by patients prescribed an ACE inhibitor. Prescribed ACE inhibitor independently predicted dietary sodium density (β = 0.238, P = .009). CONCLUSIONS Sodium intake was higher among patients prescribed ACE inhibitors. Interventions to assist patients with HF with dietary sodium adherence can be informed by assessing medication regimens.
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Affiliation(s)
- Jennifer L Smith
- Jennifer L. Smith, PhD, RN Postdoctoral Fellow, College of Nursing, University of Kentucky, Lexington. Terry A. Lennie, PhD, RN, FAHA, FAAN Senior Associate Dean and Professor, College of Nursing, University of Kentucky, Lexington. Misook L. Chung, PhD, RN, FAHA, FAAN Professor, College of Nursing, University of Kentucky, Lexington. Gia Mudd-Martin, PhD, MPH, RN, FAHA Associate Professor, University of Kentucky, College of Nursing Lexington, Kentucky
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Sousa MMD, Gouveia BDLA, Almeida TDCF, Freire MEM, Melo FDABPD, Oliveira SHDS. Evidence related to sodium restriction in patients with heart failure. Rev Bras Enferm 2020; 73:e20180874. [PMID: 32520096 DOI: 10.1590/0034-7167-2018-0874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/15/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the scientific production about sodium restriction in patients with heart failure. METHODS integrative literature review from articles published from 2007 to 2017, located in the CINAHL and Scopus databases. RESULTS thirteen studies were analyzed. Sodium intake restriction was associated with lower unfavorable clinical outcomes in patients with marked symptomatology. The 24-hour urine sodium dosage was the main tool to assess adherence to the low sodium diet. CONCLUSIONS based on the studies included in this review, in symptomatic patients, dietary sodium restriction should be encouraged in clinical practice as a protective measure for health. However, in asymptomatic patients, it should be well studied.
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TAS2R38 Haplotype Predicts 24-Hour Urinary Sodium Excretion in Patients With Heart Failure and Their Family Caregivers. J Cardiovasc Nurs 2020; 36:238-244. [PMID: 32453275 DOI: 10.1097/jcn.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Adherence to a low-sodium diet is essential to self-care of heart failure (HF). Genetic determinants of preference for high-sodium foods may impede adherence but have not been well-studied. OBJECTIVE Our purpose was to examine if TAS2R38 haplotype predicted salt taste sensitivity and dietary sodium intake among patients with HF. METHOD This pilot study used baseline data from a large interventional randomized control trial to support adherence to a low-sodium diet in patients with HF and their family caregivers. Participants were tested for salt taste sensitivity and provided a 24-hour urinary sodium sample and a blood sample for DNA analysis at baseline. Fungiform papillae were counted. χ2 Test and 1-way analysis of variance were used to compare haplotype groups. Linear regression was performed to examine predictors of salt taste sensitivity and 24-hour urinary sodium excretion, controlling for age, gender, ethnicity, smoking status, and fungiform papillae density. RESULTS There were 42 patients with HF and their family caregivers (age, 64.6 ± 13.4 years, 46.5% male, 97.7% white, and 90.7% nonsmoker). Pronine-alanine-valine homozygous haplotype predicted lower urinary sodium excretion (b = -1780.59, t41 = -2.18, P = .036), but genotype was not a significant predictor of salt taste sensitivity. CONCLUSIONS The results of our study partially supported our hypothesis that PAV homozygous haplotype predicts 24-hour urinary sodium excretion. With our small sample size, more research is needed. Understanding genetic influences on taste can lead to development of educational interventions tailored to patients with HF and their family caregivers to better support dietary adherence.
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Abstract
BACKGROUND In patients with heart failure (HF), high dietary sodium intake is common and associated with HF symptoms, poor health-related quality of life (HRQOL), and high hospitalization rates. PURPOSE The aims of this study were to examine the feasibility of a tailored dietary intervention with a practical tool (MyFitnessPal) and to obtain preliminary data about the effects on sodium intake, factors affecting sodium intake (knowledge, skills, experiences, confidence, perceived benefits and barriers, and depressive symptoms), HF symptoms, and HRQOL. METHODS A 6-session intervention was delivered to 11 participants. Paired t tests were used to compare the baseline outcomes with those at 3 months. RESULTS Participants completed 98% of intervention sessions, and 91% used MyFitnessPal. Sodium intake was reduced, and factors affecting sodium intake, symptoms, and HRQOL were improved (all P < .05). CONCLUSION The intervention was feasible and warrants further research to test the effects of the intervention on the outcomes using larger, heterogeneous samples.
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Smith JL, Estus S, Lennie TA, Moser DK, Chung ML, Mudd-Martin G. TAS2R38 PAV Haplotype Predicts Vegetable Consumption in Community-Dwelling Caucasian Adults at Risk for Cardiovascular Disease. Biol Res Nurs 2020; 22:326-333. [PMID: 32207317 DOI: 10.1177/1099800420913935] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION A heart-healthy diet might reduce cardiovascular disease (CVD) risk. Genetic variants that affect taste are associated with food choices. This study aims to investigate the associations of the TAS2R38 haplotype with consumption of sodium, sugar, saturated fats, and vegetables. HYPOTHESIS We hypothesized that, compared to people who are alanine-valine-isoleucine (AVI) homozygous for the TAS2R38 gene, those who are heterozygous or homozygous for the proline-alanine-valine (PAV) haplotype would have (a) a higher intake of sodium, sugar, and saturated fat, and (b) a lower vegetable intake. METHODS DNA from participants at risk for CVD was genotyped, and participants were assigned to groups by haplotype. Intake for sodium, sugar, saturated fat, and vegetables was assessed using the Viocare Food Frequency Questionnaire. Intake was categorized as higher versus lower consumption, divided at the median, and examined by logistic regressions. All models controlled for age, sex, smoking status, body mass index, education level, and financial status. RESULTS The 175 participants had a mean age of 52 ± 13 years, 72.6% were female, 100% were Caucasian, 89.1% were overweight or obese, and 82.9% were nonsmokers. Participants with one or two PAVs were grouped together, as PAV is the dominant gene, and comprised a majority of the sample (80.6%). Haplotype did not predict intake of sodium, sugar, or saturated fats. Compared to AVI homozygotes, participants with PAV homozygous or heterozygous haplotype had lower odds of being in the higher vegetable intake group (95% CI [0.17, 0.92], p = .032). CONCLUSIONS PAV haplotype predicted lower consumption of vegetables. Variants of taste-related genes appear to play a role in food choices.
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Affiliation(s)
| | - Steven Estus
- Department of Physiology and Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Terry A Lennie
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Debra K Moser
- Linda C. Gill Endowed Chair of Nursing, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, Lexington, KY, USA
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Mogre V, Johnson NA, Tzelepis F, Shaw JE, Paul C. A systematic review of adherence to diabetes self‐care behaviours: Evidence from low‐ and middle‐income countries. J Adv Nurs 2019; 75:3374-3389. [DOI: 10.1111/jan.14190] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/20/2019] [Accepted: 08/05/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Victor Mogre
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Department of Health Professions Education School of Medicine and Health Sciences University for Development Studies Tamale Ghana
| | - Natalie A. Johnson
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
| | - Flora Tzelepis
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
- Hunter New England Population Health Hunter New England Local Health District Wallsend New South Wales Australia
| | | | - Christine Paul
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
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Daley C, Al-Abdulmunem M, Holden RJ. Knowledge among patients with heart failure: A narrative synthesis of qualitative research. Heart Lung 2019; 48:477-485. [PMID: 31227224 DOI: 10.1016/j.hrtlng.2019.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/15/2019] [Accepted: 05/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients' knowledge of heart failure (HF) is integral to improved outcomes. However, the HF literature has not adequately explored the nature of patients' knowledge of HF as part of their lived experience. OBJECTIVES We aimed to characterize the nature of patients' knowledge of HF, in the context of living with the disease. METHODS We conducted a narrative synthesis of qualitative studies that addressed patients' knowledge of HF. Studies were systematically searched and retrieved from MEDLINE, CINAHL, PsycINFO and PsycARTICLES databases. Findings were synthesized using an iterative coding process carried out by multiple analysts and reported following Enhancing Transparency in the Reporting of Qualitative Health Research (ENTREQ) criteria. RESULTS Analysis of 73 eligible articles produced five themes: the content that comprises HF knowledge; development of HF knowledge over time; application of HF knowledge for decision making; communication of information between clinicians and patients; and patients' experience of knowledge. CONCLUSION The nature of patients' knowledge of HF is both explicit and implicit, dynamic, and personal. This multidimensional model of knowledge-in-context calls for equally multidimensional research and intervention design.
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Affiliation(s)
- Carly Daley
- Department of BioHealth Informatics, IUPUI, Indianapolis, IN, USA; Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA.
| | | | - Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA.
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d'Almeida KSM, Barilli SLS, Souza GC, Rabelo-Silva ER. Cut-Point for Satisfactory Adherence of the Dietary Sodium Restriction Questionnaire for Patients with Heart Failure. Arq Bras Cardiol 2019; 112:165-170. [PMID: 30785581 PMCID: PMC6371818 DOI: 10.5935/abc.20190011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/02/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The low or non-adherence to reduction of sodium intake has been identified as one of the main precipitating factors of heart failure (HF). The Dietary Sodium Restriction Questionnaire (DSRQ) identifies factors that can interfere with adherence to this recommendation. However, there is still no cut-point to define adherence for this questionnaire. OBJECTIVES To identify the cut-point for satisfactory adherence to the Brazilian version of the DSRQ, (the Questionário de Restrição de Sódio na Dieta, QRSD). METHODS Multicenter study. Patients with HF in outpatient treatment (compensated) and those treated in emergency departments due to acute HF (decompensated) were included. For the cut-point definition, the DSRQ scores were compared between groups. A ROC curve was constructed for each subscale to determine the best point of sensitivity and specificity regarding adherence. A 5% significance level was adopted. RESULTS A total of 206 compensated patients and 225 decompensated were included. Compensated patients exhibited scores that showed higher adhesion in all subscales (all p <0.05). Scores ≥ 40 points of a total of 45 for the subscale of Attitude and Subjective Norm; scores ≤ eight of a total of 20 for Perceived Behavioral Control; and ≤ three of a total of 15 for Dependent Behavior Control were indicative of satisfactory adherence. CONCLUSIONS Based on the evaluation of patients in these two scenarios, it was possible to determine the cut-point for satisfactory adherence to the reduction of sodium in the diet of patients with HF. Countries with similar culture could use this cut-point, as other researchers could also use the results as a reference for further studies.
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Affiliation(s)
- Karina Sanches Machado d'Almeida
- Programa de pós-graduação em Cardiologia e Ciências Cardiovasculares da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil.,Clínica de Insuficiência Cardíaca do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Curso de Nutrição da Universidade Federal do Pampa, Itaqui, RS - Brazil
| | - Sofia Louise Santin Barilli
- Clínica de Insuficiência Cardíaca do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Programa de pós-graduação da Escola de Enfermagem da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
| | - Gabriela Corrêa Souza
- Clínica de Insuficiência Cardíaca do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Departamento de Medicina Interna da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
| | - Eneida Rejane Rabelo-Silva
- Programa de pós-graduação em Cardiologia e Ciências Cardiovasculares da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil.,Clínica de Insuficiência Cardíaca do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Programa de pós-graduação da Escola de Enfermagem da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
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Hakami R, Gillis DE, Poureslami I, FitzGerald JM. Patient and Professional Perspectives on Nutrition in Chronic Respiratory Disease Self-Management: Reflections on Nutrition and Food Literacies. Health Lit Res Pract 2018; 2:e166-e174. [PMID: 31294292 PMCID: PMC6607835 DOI: 10.3928/24748307-20180803-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/10/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Nutrition literacy (NL) and food literacy (FL) have emerged as distinct forms of the multifaceted concept of health literacy (HL). Despite convincing evidence that changes in dietary behavior can improve health, the role of nutrition in supporting self-management in patients with chronic respiratory disease tends to be overlooked. Objective: This study examined patient and key informant (health care professionals, researchers, and policymakers) perspectives on nutrition in the context of self-management practices in asthma and chronic obstructive pulmonary disease with implications for NL and FL. Methods: Data were collected during 16 focus groups with 93 English- and French-speaking patients in the Canadian Provinces of British Columbia, Ontario, and Quebec, and in-depth interviews with 45 key informants mainly from Canada. Participants' comments, including dietary perception keywords, were extracted and classified using NVivo software. Thematic analysis was applied. Key Results: Patients' perspectives on nutrition reflected three broad themes: (1) importance of nutrition knowledge in self-management, (2) applying nutrition knowledge in self-management, and (3) challenges in applying nutrition knowledge in self-management. Embedded within the third theme were six sub-themes: Limitations in “accessing nutrition information,” “understanding nutrition information,” “basic literacy skills,” and “ability to act on nutrition information,” along with “lack of supports to act on nutrition information,” and “competing daily demands in mealtime and medication management.” Although less than 10% of key informants provided nutrition-relevant comments, their comments reinforced patients' concerns about barriers to accessing, understanding, and using nutrition information in self-management. Conclusions: Our findings suggest that more attention be directed to nutrition in the self-management of chronic respiratory disease and warrant further research on the roles of NL and FL in this health practice context. Such research could also contribute to the broader agenda of understanding NL and FL and applying them as subconcepts of HL in chronic disease self-management interventions. [HLRP: Health Literacy Research and Practice. 2018;2(3):e166–e174.] Plain Language Summary: Growing evidence supporting the role of diet in chronic disease calls for more attention to nutrition literacy. This study explored patient and key informant viewpoints on engaging with nutrition information in self-management of chronic lung disease. Findings suggest patients encounter many challenges in accessing, understanding, and acting on relevant nutrition information.
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Affiliation(s)
| | | | | | - J. Mark FitzGerald
- Address correspondence to J. Mark FitzGerald, MD, The Lung Centre, Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, 7th floor, Vancouver, British Columbia, Canada V5Z 1M9;
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The Effect of the Education Program on the Adherence Intention to the Dietary Sodium Restriction and the Amount of Sodium Intake in Patients With Chronic Heart Failure. IRANIAN RED CRESCENT MEDICAL JOURNAL 2018. [DOI: 10.5812/ircmj.12925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Carrara A, Schulz PJ. The role of health literacy in predicting adherence to nutritional recommendations: A systematic review. PATIENT EDUCATION AND COUNSELING 2018; 101:16-24. [PMID: 28739178 DOI: 10.1016/j.pec.2017.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Synthesize quantitative empirical evidence on the role of health literacy in predicting adherence to dietary recommendations. METHODS A systematic search of 13 online databases resulted in 1498 articles eligible for screening. Of those, 20 met the predefined inclusion criteria and, together with 6 studies retrieved from their reference lists, were included for review. Screening of full-texts, data extraction and quality appraisal were independently performed by two reviewers. Inconsistencies regarding eligibility were resolved through discussion. RESULTS Of the 26 reviewed articles, 17 involved patients and 9 the general population. Overall, 35 associations between health literacy and various nutrition behaviours were observed. A significant direct positive association was reported in 5 cases, all of them concerning the general population. An insignificant association was reported in 20 cases, 15 of which were related to patients. The remaining associations were negative (n=2), partially mediated (n=1) or entirely mediated (n = 7). CONCLUSION Health literacy was scarcely determinant of dietary adherence and other nutrition behaviours, especially among patients. PRACTICE IMPLICATION Patients' dietary adherence is likely to be unaffected by interventions based on health literacy. Empowering approaches are expected to be more beneficial.
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Affiliation(s)
- Anna Carrara
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland.
| | - Peter J Schulz
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland
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21
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Affiliation(s)
- Mehnosh Toback
- Foothills Hospital, Libin Cardiovascular Institute of Alberta, 1403, 29 Street N.W., Calgary,ABT2N 2T9, Canada
| | - Nancy Clark
- Foothills Hospital, Libin Cardiovascular Institute of Alberta, 1403, 29 Street N.W., Calgary,ABT2N 2T9, Canada
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Płotka A, Prokop E, Migaj J, Straburzyńska–Migaj E, Grajek S. Patients' knowledge of heart failure and their perception of the disease. Patient Prefer Adherence 2017; 11:1459-1467. [PMID: 28883713 PMCID: PMC5576702 DOI: 10.2147/ppa.s126133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to gain a deeper insight into patients' perception of chronic heart failure (CHF) symptoms by analyzing their compliance with nonpharmacological recommendations. PATIENTS AND METHODS This was a prospective, single-center survey-based registry. Patients included in this study were hospitalized between December 2014 and January 2016 at the 1st Department of Cardiology, University Hospital of Lord's Transfiguration, Poznań University of Medical Sciences, and had been diagnosed with CHF at least 3 months prior to inclusion. Participants were divided according to New York Heart Association (NYHA) functional class into mild CHF (NYHA I and II) and severe CHF (NYHA III and IV), and according to age into young (<50 years), middle-aged (50-70 years) and old (>70 years). The survey included information about the patients' sex, age, education, length of the illness and 12 questions about their perception of CHF. This study included 201 patients. The mean age was 58±15 years. RESULTS The younger the patients, the more often they thought that CHF is curable. The patients presenting with severe CHF tended to think that CHF is incurable significantly more often than those with mild CHF. Most of the patients considered loss of appetite, cough and vomiting the least alarming symptoms. Significantly more patients with severe CHF exercised less and reported reduced sexual activity more often in comparison to the mild CHF patients. Most of the young patients reported no changes to their sexual activity, body mass index (BMI) or exercise after diagnosis of CHF. Most of the old patients exercised less than before diagnosis of CHF. Significantly more middle-aged patients reduced their BMI, quit smoking and reported lower sexual activity after diagnosis of CHF in comparison to the other groups. CONCLUSION Patients need to be better educated about the nature of CHF and the importance of lifestyle changes.
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Affiliation(s)
- Anna Płotka
- Medical Faculty I, Poznań University of Medical Sciences, Poznań, Poland
- Correspondence: Anna Płotka, I Department of Cardiology, University Hospital of Lord’s Transfiguration, Poznań University of Medical Sciences, Osiedle Lecha 15/59, 61–293 Poznań, Poland, Tel +48 73 413 7127, Fax +48 61 852 9472, Email
| | - Edyta Prokop
- I Department of Cardiology, University Hospital of Lord’s Transfiguration, Poznań University of Medical Sciences, Poznań, Poland
| | - Jacek Migaj
- I Department of Cardiology, University Hospital of Lord’s Transfiguration, Poznań University of Medical Sciences, Poznań, Poland
| | - Ewa Straburzyńska–Migaj
- I Department of Cardiology, University Hospital of Lord’s Transfiguration, Poznań University of Medical Sciences, Poznań, Poland
| | - Stefan Grajek
- I Department of Cardiology, University Hospital of Lord’s Transfiguration, Poznań University of Medical Sciences, Poznań, Poland
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Lofthouse C, Te Morenga L, McLean R. Sodium reduction in New Zealand requires major behaviour change. Appetite 2016; 105:721-30. [DOI: 10.1016/j.appet.2016.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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Hwang SY, Kim J. An examination of the association of cognitive functioning, adherence to sodium restriction and Na/K ratios in Korean heart failure patients. J Clin Nurs 2016; 25:1766-76. [DOI: 10.1111/jocn.13198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 01/01/2023]
Affiliation(s)
| | - JinShil Kim
- College of Nursing; Gachon University; Incheon South Korea
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25
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Karimi M, Clark AM. How do patients' values influence heart failure self-care decision-making?: A mixed-methods systematic review. Int J Nurs Stud 2016; 59:89-104. [PMID: 27222454 DOI: 10.1016/j.ijnurstu.2016.03.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 02/14/2016] [Accepted: 03/12/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Values are central to ethical and effective nursing and health care. However, in relation to heart failure, an extremely common and burdensome syndrome, the role that patients' values have in influencing self-care is poorly understood. METHODS A mixed methods systematic review was conducted using a critical meta-narrative synthesis approach to synthesizing qualitative and qualitized data. Nine databases were searched (14 March 2014). To be included in the review, studies had to contain data on heart failure patients' values and self-care behaviors, include adults aged ≥18 years with symptomatic heart failure, and be published ≥2000 as full articles or theses. Study quality was assessed using a mixed-methods appraisal tool. FINDINGS Of 6467 citations identified, 54 studies were included (30 qualitative, 8 mixed methods, and 16 quantitative; 6045 patients, 38 lay caregivers, and 96 health care professionals). The synthesis identified multiple bi-directional interactions between heart failure, patients' values, and self-care. Patients are motivated by self-related and other-related values. Self-related values are tied directly to intimate personal feelings (self-direction, pleasure, and being healthy) or related to individuals' life circumstances (maintaining a healthy lifestyle and financial balance). Other-related values, which are fundamentally socially-based, are related to benefits received from society (social recognition and socialization) and social obligations (responsibility, observing traditions, and obedience). For each decision, several values are involved; some are incompatible and some are in conflict. Patients make their self-care decision based on the values they prioritize and those that are blocked. CONCLUSION Values are integral to how patients approach and undertake HF self-care. These values both affect and respond to this self-care and the severity of HF symptoms. Values extend to those relating to the self and others and incorporate a range of personal, life, and social dimensions. Values cannot be assumed to be fixed, normative or similar to those held by nurses and other health professionals. Future interventions to improve HF self-care must address and respond to the complexity of patients' values and how they influence patient behavior in undertaking heart failure self-care.
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Affiliation(s)
- Mehri Karimi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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26
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Association between self-reported adherence to a low-sodium diet and dietary habits related to sodium intake in heart failure patients. J Cardiovasc Nurs 2015; 30:58-65. [PMID: 24598553 DOI: 10.1097/jcn.0000000000000124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sodium restriction is the primary dietary therapy in heart failure (HF); however, assessing sodium intake is challenging to clinicians, who commonly rely on patients' self-report of following a low-sodium diet to determine adherence. It is important to further explore the utility of self-reported adherence to a low-sodium diet in patients with HF. OBJECTIVES The objective of this study was to evaluate the association between patients' self-reported adherence to a low-sodium diet and dietary habits related to sodium intake in patients with chronic HF. METHODS Patients with HF seen in a tertiary care Heart Function Clinic and who have been taught on a low-sodium diet with a target of less than 2300 mg/d were included. Self-perception of compliance and dietary habits related to sodium intake was evaluated by using a dietary questionnaire. Patients were divided into 3 groups according to self-reported adherence to a low-sodium diet: never, sometimes, and always. RESULTS Overall, 237 patients (median age, 66 years, 72.6% men) were included. Compared with the other 2 groups, patients who stated always following a low-sodium diet were less likely to use salt in cooking or at the table. However, 4.2% of the patients in the always group reported eating canned or package soups every day. Moreover, the highest proportion of patients eating fast foods 1 to 3 times a week was found among those in the sometimes group (22.9%) compared with the never (9.1%) and always (6.7%) groups (P = .002). Importantly, the rest of the food items did not show any significant differences between self-reported adherence groups. CONCLUSION Self-report of adherence to a low-sodium diet is not reliable among patients with HF, who associate the idea of following a low-sodium diet mainly with not using salt for cooking or at the table but not with reducing frequency of intake of high-sodium processed foods.
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Development and Testing of the Feasibility and Acceptability of a Tailored Dietary Intervention in Patients With Heart Failure. J Cardiovasc Nurs 2015; 30:213-21. [DOI: 10.1097/jcn.0000000000000148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stamp KD, Dunbar SB, Clark PC, Reilly CM, Gary RA, Higgins M, Ryan RM. Family partner intervention influences self-care confidence and treatment self-regulation in patients with heart failure. Eur J Cardiovasc Nurs 2015; 15:317-27. [PMID: 25673525 DOI: 10.1177/1474515115572047] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 01/19/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Heart failure self-care requires confidence in one's ability and motivation to perform a recommended behavior. Most self-care occurs within a family context, yet little is known about the influence of family on heart failure self-care or motivating factors. AIMS To examine the association of family functioning and the self-care antecedents of confidence and motivation among heart failure participants and determine if a family partnership intervention would promote higher levels of perceived confidence and treatment self-regulation (motivation) at four and eight months compared to patient-family education or usual care groups. METHODS Heart failure patients (N=117) and a family member were randomized to a family partnership intervention, patient-family education or usual care groups. Measures of patient's perceived family functioning, confidence, motivation for medications and following a low-sodium diet were analyzed. Data were collected at baseline, four and eight months. RESULTS Family functioning was related to self-care confidence for diet (p=0.02) and autonomous motivation for adhering to their medications (p=0.05) and diet (p=0.2). The family partnership intervention group significantly improved confidence (p=0.05) and motivation (medications (p=0.004; diet p=0.012) at four months, whereas patient-family education group and usual care did not change. CONCLUSION Perceived confidence and motivation for self-care was enhanced by family partnership intervention, regardless of family functioning. Poor family functioning at baseline contributed to lower confidence. Family functioning should be assessed to guide tailored family-patient interventions for better outcomes.
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Affiliation(s)
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, USA
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, USA
| | | | - Rebecca A Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, USA
| | - Richard M Ryan
- Institute for Positive Psychology and Education Australian Catholic University, Australia
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Masterson Creber R, Topaz M, Lennie TA, Lee CS, Puzantian H, Riegel B. Identifying predictors of high sodium excretion in patients with heart failure: a mixed effect analysis of longitudinal data. Eur J Cardiovasc Nurs 2014; 13:549-58. [PMID: 24366985 PMCID: PMC4386996 DOI: 10.1177/1474515113517606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND A low-sodium diet is a core component of heart failure self-care but patients have difficulty following the diet. AIM The aim of this study was to identify predictors of higher than recommended sodium excretion among patients with heart failure. METHODS The World Health Organization Five Dimensions of Adherence model was used to guide analysis of existing data collected from a prospective, longitudinal study of 280 community-dwelling adults with previously or currently symptomatic heart failure. Sodium excretion was measured objectively using 24-hour urine sodium measured at three time points over six months. A mixed effect logistic model identified predictors of higher than recommended sodium excretion. RESULTS The adjusted odds of higher sodium excretion were 2.90, (95% confidence interval (CI): 1.15-4.25, p<0.001) for patients who were obese; 2.80 (95% CI: 1.33-5.89, p=0.007) for patients with diabetes; and 2.22 (95% CI: 1.09-4.53, p=0.028) for patients who were cognitively intact. CONCLUSION Three factors were associated with excess sodium excretion and two factors, obesity and diabetes, are modifiable by changing dietary food patterns.
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Affiliation(s)
| | - Maxim Topaz
- School of Nursing, University of Pennsylvania USA
| | | | | | - Houry Puzantian
- Department of Biobehavioral Health Science, University of Illinois at Chicago, USA
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Modifiable correlates of physical symptoms and health-related quality of life in patients with heart failure: A cross-sectional study. Int J Nurs Stud 2014; 51:1482-90. [DOI: 10.1016/j.ijnurstu.2014.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 03/15/2014] [Accepted: 03/19/2014] [Indexed: 01/21/2023]
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Heo S, Lennie TA, Moser DK, Kennedy RL. Types of social support and their relationships to physical and depressive symptoms and health-related quality of life in patients with heart failure. Heart Lung 2014; 43:299-305. [DOI: 10.1016/j.hrtlng.2014.04.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/14/2014] [Accepted: 04/18/2014] [Indexed: 01/01/2023]
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Stamp KD. Women with Heart Failure: Do They Require a Special Approach for Improving Adherence to Self-Care? Curr Heart Fail Rep 2014; 11:307-13. [DOI: 10.1007/s11897-014-0199-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vanstone M, Giacomini M, Smith A, Brundisini F, DeJean D, Winsor S. How diet modification challenges are magnified in vulnerable or marginalized people with diabetes and heart disease: a systematic review and qualitative meta-synthesis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2013; 13:1-40. [PMID: 24228077 PMCID: PMC3817924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Diet modification is an important part of self-management for patients with diabetes and/or heart disease (including coronary artery disease, heart failure, and atrial fibrillation). Many health care providers and community-based programs advise lifestyle and diet modification as part of care for people with these conditions. This report synthesizes qualitative information on how patients respond differently to the challenges of diet modification. Qualitative and descriptive evidence can illuminate challenges that may affect the success and equitable impact of dietary modification interventions. OBJECTIVES To (a) examine the diet modification challenges faced by diabetes and/or heart disease patients; and (b) compare and contrast the challenges faced by patients who are members of vulnerable and nonvulnerable groups as they change their diet in response to clinical recommendations. DATA SOURCES This report synthesizes 65 primary qualitative studies on the topic of dietary modification challenges encountered by patients with diabetes and/or heart disease. Included papers were published between 2002 and 2012 and studied adult patients in North America, Europe, and Australia/New Zealand. REVIEW METHODS Qualitative meta-synthesis was used to integrate findings across primary research studies. RESULTS Analysis identified 5 types of challenges that are common to both vulnerable and nonvulnerable patients: self-discipline, knowledge, coping with everyday stress, negotiating with family members, and managing the social significance of food. Vulnerable patients may experience additional barriers, many of which can magnify or exacerbate those common challenges. LIMITATIONS While qualitative insights are robust and often enlightening for understanding experiences and planning services in other settings, they are not intended to be generalizable. The findings of the studies reviewed here--and of this synthesis--do not strictly generalize to the Ontario (or any specific) population. This evidence must be interpreted and applied carefully, in light of expertise and the experiences of the relevant community. CONCLUSIONS Diet modification is not simply a matter of knowing what to eat and making the rational choice to change dietary practices. Rather, diet and eating practices should be considered as part of the situated lives of patients, requiring an individualized approach that is responsive to the conditions in which each patient is attempting to make a change. Common challenges include self-discipline, knowledge, coping with everyday stress, negotiating with family members, and managing the social significance of food. An individualized approach is particularly important when working with patients who have vulnerabilities. PLAIN LANGUAGE SUMMARY Health care providers often encourage people with diabetes and/or heart disease to change their diet. They advise people with diabetes to eat less sugar, starch, and fat. They advise people with heart disease to eat less fat and salt. However, many patients find it difficult to change what they eat. This report examines the challenges people may face when making such changes. It also examines the special challenges faced by people who are vulnerable due to other factors, such as poverty, lack of education, and difficulty speaking English. Five themes were common to all people who make diet changes: self-discipline, knowledge, coping with stress, negotiating with family members, and managing the social aspect of food. Members of vulnerable groups also reported other challenges, such as affording fresh fruit and vegetables or understanding English instructions. This report may help health care providers work with patients more effectively to make diet changes.
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Clark AM, Savard LA, Spaling MA, Heath S, Duncan AS, Spiers JA. Understanding help-seeking decisions in people with heart failure: a qualitative systematic review. Int J Nurs Stud 2012; 49:1582-97. [PMID: 22721677 DOI: 10.1016/j.ijnurstu.2012.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 04/23/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To understand the process of help-seeking among heart failure patients from the perspectives of patients, caregivers and health professionals. DESIGN Systematic review using qualitative meta-synthesis. METHODS A systematic search (20th May 2011) was conducted to identify studies published in English as full papers ≥1995 reporting primary qualitative data with extractable heart failure-specific data or themes related to help-seeking in patients, caregivers or health professionals. Databases searched were: CINAHL, Medline, PsycInfo, Social Science Citation Index, Embase, Social policy/Practice, SocIndex, Ageline, Health Source Nursing, Scopus; additionally, we consulted with experts and manually searched references. RESULTS 58 studies (990 patients; 274 female, 527 male, 189 sex not described; 229 caregivers, 79 health professionals) were included. Heart failure help-seeking was embedded in daily experiences of heart failure but ongoing symptoms were confusing, ambiguous and disruptive; little support was available from professionals to interpret the presence and significance of fluctuations in symptoms for help-seeking. Other significant barriers to help-seeking were: avoidance-based coping, fear of hospitals and misplaced reluctance to be burdensome. Help-seeking was facilitated by good involvement and frank communication between patients, caregivers and health professionals and the presence of a sense of elevated personal risk. CONCLUSION Health services should harness primary care providers and support patients and caregivers to prioritize development of objective symptom monitoring skills, recognize and personally assimilate the elevated risks of heart failure and help-seeking delays and discourage avoidance-based coping and unwarranted concerns that downplay the significance of heart failure and urgency to address symptoms.
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Hsu CP, Chen HW, Lee SY, Tsou MT. Knowledge and Attitude toward Hospice Palliative Care among Community-Dwelling Aged Taiwanese—Analysis of Related Factors. INT J GERONTOL 2012. [DOI: 10.1016/j.ijge.2012.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Stamp KD. Self-care in women with heart failure and the effectiveness of nurse-led educational interventions: a review of the literature. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1752-9824.2011.01115.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Perspectives of heart failure patients in Malaysia towards medications and disease state management: findings from a qualitative study. J Public Health (Oxf) 2011. [DOI: 10.1007/s10389-011-0415-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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