Effects of Illness Representation-Focused Patient Education on Illness Representations and Self-care in Patients with Heart Failure: A Randomized Clinical Trial.

AIMS AND OBJECTIVES To examine the effect of an illness representation-focused patient education intervention on illness representations and self-care behaviours in patients with heart failure three months after discharge from the hospital. BACKGROUND Few intervention studies have examined the effect of illness representation-focused interventions on illness representations and self-care in patients with heart failure. DESIGN A randomized clinical trial based on the Consolidated Standard of Reporting Trials -CONSORT 2010 guidelines was employed. The Clinical Trial Registry number is TCTR20190903002. METHODS One hundred seven participants were randomly assigned to 2 groups, and 62 participants (n = 30 in the intervention group and n = 32 in the usual care group) completed the baseline and one- and three-month post-discharge follow-up assessments. The instruments included the Survey of Illness Beliefs in Heart Failure and the Self-care of Heart Failure Index. The intervention group received illness representation-focused patient education while hospitalized and telephone follow-ups after discharge. Data were analysed with linear mixed-effects model analysis. RESULTS The 107 participants had a mean age of 62.17 years and a mean left ventricular ejection of 53.03%. At baseline, the two groups tended to have accurate illness beliefs but insufficient self-care confidence and self-care maintenance. The analysis showed no significant differences between groups in the illness representation total scores, dimension scores or self-care maintenance scores but did show a significant difference in the self-care confidence scores (F = 3.42, p < .05) over the three months. CONCLUSION The study did not show an effect of the intervention on illness representations or self-care maintenance behaviours. However, the intervention did maintain participants' self-care confidence three months after discharge. RELEVANCE TO CLINICAL PRACTICE It is necessary to conduct long-term follow-ups of patients' illness representations, discuss the implementation of self-care behaviours with patients, enhance patients' self-care confidence, and involve family members or caregivers in self-care practices when needed.