Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 5, Number 3-4, August 2014, pages 91-100

A Culturally Appropriate Educational Intervention Can Improve Self-Care in Hispanic Patients With Heart Failure: A Pilot Randomized Controlled Trial

**Table 1.** Components of the Intervention
1-on-1 education	Presentation on laptop & written materials
Scale, spices and recipes	Daily weights done upon awakening No-salt, chili-based spices Low-salt Latin-American recipes in large text format
Script	Word for word description of how to talk with their health care provider in English and Spanish
Diary/calendar	Patients recorded daily weights and symptoms
Telephone follow-up	Warning signs for action

Table 1. Components of the Intervention

1-on-1 education

Presentation on laptop & written materials

Scale, spices and recipes

Daily weights done upon awakening
No-salt, chili-based spices
Low-salt Latin-American recipes in large text format

Script

Word for word description of how to talk with their health care provider in English and Spanish

Diary/calendar

Patients recorded daily weights and symptoms

Telephone follow-up

Warning signs for action

**Table 2.** Teach-Back Questions
Teach-back question	Area of focus
At the conclusion of the teaching each patient was asked four teach-back questions.
What is the name of your water pill?	Medications
How much weight gain would you want to report to your MD?	Self-monitoring skills
What high-salt foods do you need to avoid/be aware of?	Diet modification
Please name 3 - 4 symptoms or warning signs of when you want to call the MD?	Warning signs for action

Table 2. Teach-Back Questions

Teach-back question

Area of focus

At the conclusion of the teaching each patient was asked four teach-back questions.

What is the name of your water pill?

Medications

How much weight gain would you want to report to your MD?

Self-monitoring skills

What high-salt foods do you need to avoid/be aware of?

Diet modification

Please name 3 - 4 symptoms or warning signs of when you want to call the MD?

Warning signs for action

**Table 3.** Baseline Sociodemographic, Clinical and Psychological Characteristics (N = 42)
	Usual care group (n = 20)	Intervention group (n = 22)	P
Data are presented as mean ± SD, n (%), P < 0.05. ^aBased on short acculturation score for Hispanics (less than 2.99 is less acculturated). ^bSahlsa, short assessment of health literacy for Spanish adults. ^cBased on patient health questionnaire-8 (range 0 - 24, 10 or greater indicates depression). ^dBased on brief symptom inventory subscale for anxiety (range 0 - 4, higher score indicates anxiety). ^eBased on multi-dimensional scale of social support (range 7 - 84, 69 - 84 indicates high perceived levels of support). NYHA: New York Heart Association classification (range I - IV); ACE-I: angiotensin converting enzyme-inhibitor; ARB: angiotensin receptor blocker.
Age, years (range 25 - 84)	53.7 ± 12.3	60.7 ± 14.8	0.11
Gender			0.21
Female	11 (55.0)	7 (31.8)
Male	9 (45.0)	15 (68.2)
Low acculturation score^a	13 (41)	9 (60)	0.10
Living arrangement			0.39
Lives alone	3 (15.0)	2 (9.1)
Lives with 1 - 3 others	12 (60.0)	9 (40.9)
Lives with 4 - 7 others	3 (15.0)	8 (36.4)
Lives with 8 or more	2 (10.0)	3 (13.6)
Annual salary			0.23
< 20,000	19 (95.0)	20 (90.9)
20,000 - 40,000	0 (0)	2 (9.1)
40,000 - 75,000	1 (5.0)	0 (0)
Relationship status			1.0
Married	9 (45.0)	9 (40.9)
Not-married	11 (55.0)	13 (55.1)
Sahlsa^b score	40.4 ± 6.7	42 ± 6.4	0.40
Clinical characteristics
NYHA classification			0.49
NYHA I	0 (0)	1 (4.5)
NYHA II	5 (25.0)	9 (40.9)
NYHA III	12 (60.0)	10 (45.5)
NYHA IV	3 (15.0)	2 (9.1)
Hypertension	12 (60.0)	15 (68.2)	0.75
Diabetes	8 (40.0)	10 (45.5)	0.66
Ejection fraction < 40%	6 (30.0)	8 (40.0)	0.74
Taking ACE-I	11 (45.8)	13 (54.2)	1.0
Taking ARB	1 (5.0)	3 (13.6)	0.60
Psychosocial characteristics
Depression^c	10.8 ± 5.89	6.73 ± 5.85	0.03
Anxiety^d	1.13 ± 1.09	0.62 ± 0.74	0.09
Social support^e	64.7 ± 14.5	64.1 ± 13.1	0.88

Table 3. Baseline Sociodemographic, Clinical and Psychological Characteristics (N = 42)

Usual care group (n = 20)

Intervention group (n = 22)

Data are presented as mean ± SD, n (%), P < 0.05. ^aBased on short acculturation score for Hispanics (less than 2.99 is less acculturated). ^bSahlsa, short assessment of health literacy for Spanish adults. ^cBased on patient health questionnaire-8 (range 0 - 24, 10 or greater indicates depression). ^dBased on brief symptom inventory subscale for anxiety (range 0 - 4, higher score indicates anxiety). ^eBased on multi-dimensional scale of social support (range 7 - 84, 69 - 84 indicates high perceived levels of support). NYHA: New York Heart Association classification (range I - IV); ACE-I: angiotensin converting enzyme-inhibitor; ARB: angiotensin receptor blocker.

Age, years (range 25 - 84)

53.7 ± 12.3

60.7 ± 14.8

0.11

Gender

0.21

Female

11 (55.0)

7 (31.8)

Male

9 (45.0)

15 (68.2)

Low acculturation score^a

13 (41)

9 (60)

0.10

Living arrangement

0.39

Lives alone

3 (15.0)

2 (9.1)

Lives with 1 - 3 others

12 (60.0)

9 (40.9)

Lives with 4 - 7 others

3 (15.0)

8 (36.4)

Lives with 8 or more

2 (10.0)

3 (13.6)

Annual salary

0.23

< 20,000

19 (95.0)

20 (90.9)

20,000 - 40,000

0 (0)

2 (9.1)

40,000 - 75,000

1 (5.0)

0 (0)

Relationship status

1.0

Married

9 (45.0)

9 (40.9)

Not-married

11 (55.0)

13 (55.1)

Sahlsa^b score

40.4 ± 6.7

42 ± 6.4

0.40

Clinical characteristics

NYHA classification

0.49

NYHA I

0 (0)

1 (4.5)

NYHA II

5 (25.0)

9 (40.9)

NYHA III

12 (60.0)

10 (45.5)

NYHA IV

3 (15.0)

2 (9.1)

Hypertension

12 (60.0)

15 (68.2)

0.75

Diabetes

8 (40.0)

10 (45.5)

0.66

Ejection fraction < 40%

6 (30.0)

8 (40.0)

0.74

Taking ACE-I

11 (45.8)

13 (54.2)

1.0

Taking ARB

1 (5.0)

3 (13.6)

0.60

Psychosocial characteristics

Depression^c

10.8 ± 5.89

6.73 ± 5.85

0.03

Anxiety^d

1.13 ± 1.09

0.62 ± 0.74

0.09

Social support^e

64.7 ± 14.5

64.1 ± 13.1

0.88

**Table 4.** Self-Care, Teach-Back and Psychosocial Scores by Group
	Usual care group (n = 20)	Intervention group (n = 22)	P
^aBased on the self-care heart failure index. ^bBased on patient health questionnaire-8. ^cBased on brief symptom inventory subscale for anxiety. ^dBased on multidimensional scale of social support. CI: confidence interval.
Teach-back scores			0.04
Mean	3.8	3.6
Baseline	3.9	4.0
Final range	(3.8 - 3.9)	(3.9 - 4.1)
Self-care management^a			0.02
Mean	58.9	49.2
Baseline	58.0	81.0
Final	(41.9 - 74.2)	(62.7 - 99.4)
Self-care maintenance^a			0.88
Mean	56.8	63.6
Baseline	70.0	77.7
Final	(61.3 - 78.6)	(69.1 - 86.1)
Self-care confidence^a			0.79
Mean	68.5	73.5
Baseline	70.8	74.0
Final	(61.8 - 80.3)	(64.7 - 83.4)
Depression^b			0.69
Mean	10.8	6.7
Baseline	9.3	6.1
Final	(5.7 - 12.8)	(2.6 - 9.6)
Anxiety^c			0.26
Mean	1.13	0.62
Baseline	0.83	0.71
Final	(0.35 - 1.3)	(0.23 - 1.9)
Social support^d			0.57
Mean	64.7	64.1
Baseline	64.2	65.6
Final	(56.8 - 71.5)	(58.5 - 72.8)

Table 4. Self-Care, Teach-Back and Psychosocial Scores by Group

Usual care group (n = 20)

Intervention group (n = 22)

^aBased on the self-care heart failure index. ^bBased on patient health questionnaire-8. ^cBased on brief symptom inventory subscale for anxiety. ^dBased on multidimensional scale of social support. CI: confidence interval.

Teach-back scores

0.04

Mean

3.8

3.6

Baseline

3.9

4.0

Final range

(3.8 - 3.9)

(3.9 - 4.1)

Self-care management^a

0.02

Mean

58.9

49.2

Baseline

58.0

81.0

Final

(41.9 - 74.2)

(62.7 - 99.4)

Self-care maintenance^a

0.88

Mean

56.8

63.6

Baseline

70.0

77.7

Final

(61.3 - 78.6)

(69.1 - 86.1)

Self-care confidence^a

0.79

Mean

68.5

73.5

Baseline

70.8

74.0

Final

(61.8 - 80.3)

(64.7 - 83.4)

Depression^b

0.69

Mean

10.8

6.7

Baseline

9.3

6.1

Final

(5.7 - 12.8)

(2.6 - 9.6)

Anxiety^c

0.26

Mean

1.13

0.62

Baseline

0.83

0.71

Final

(0.35 - 1.3)

(0.23 - 1.9)

Social support^d

0.57

Mean

64.7

64.1

Baseline

64.2

65.6

Final

(56.8 - 71.5)

(58.5 - 72.8)

**Table 5.** Psychosocial Predictors of Self-Care and Heart Failure Knowledge (N = 42)
Baseline	SE	P	Exponent B	95% CI
SEM: standard error of mean (P < 0.05). CI: confidence interval. ^aBased on self-care heart failure index. ^bBased on patient health questionnaire-8 depression instrument. ^cBased on brief symptom inventory subscale for anxiety instrument. ^dBased on multi-dimensional scale of social support instrument.
Self-care maintenance^a
Depression^b	0.56	0.58	0.32	-0.82, 1.45
Anxiety^c	3.63	0.03	-8.20	-15.5, -0.84
Social support^d	0.19	0.08	0.35	-0.06, 0.75
Teach-back knowledge
Depression	0.017	0.284	0.018	-0.02, 0.05
Anxiety	0.108	0.327	-0.107	-0.33, 0.11
Social support	0.01	0.11	0.01	-0.00, 0.02

Table 5. Psychosocial Predictors of Self-Care and Heart Failure Knowledge (N = 42)

Baseline

Exponent B

95% CI

SEM: standard error of mean (P < 0.05). CI: confidence interval. ^aBased on self-care heart failure index. ^bBased on patient health questionnaire-8 depression instrument. ^cBased on brief symptom inventory subscale for anxiety instrument. ^dBased on multi-dimensional scale of social support instrument.

Self-care maintenance^a

Depression^b

0.56

0.58

0.32

-0.82, 1.45

Anxiety^c

3.63

0.03

-8.20

-15.5, -0.84

Social support^d

0.19

0.08

0.35

-0.06, 0.75

Teach-back knowledge

Depression

0.017

0.284

0.018

-0.02, 0.05

Anxiety

0.108

0.327

-0.107

-0.33, 0.11

Social support

0.01

0.11

0.01

-0.00, 0.02