Author/year/

country

Design

Sample (n)

population

Purpose

Key Variables and Instruments

Findings / Significance

Similarities / Differences

Lyons et al., 2015

Italy

Cross-sectional

N=1192

Outpatient HF

Identify individual and dyadic determinants of patient and caregiver HF self-care confidence using multilevel modeling

·                     Confidence

·                     Heart Failure Index

·                     Mini Mental State Examination (MMSE).

·                     Minnesota Living with Heart Failure Questionnaire

·                     Carers of Older People in Europe (COPE) Index

·                     Caregiver Burden Inventory

·                     COPE Index

·                     Dyadic HF Confidence: patients and the caregivers reported moderate levels of HF self-care confidence.

·                     Patient and caregiver levels of confidence were significantly higher when the patient rated the quality of the relationship higher, the caregiver experienced greater mental health, and the patient had lower levels of cognitive impairment (p=0.001).

Self-care confidence of the patients:Men with HF reported lower levels of confidence than women.

Patients may be risk for some low of lower confidence whey cared for by spouse. In this study souse caregiver had significantly poorer physical health than adult-child caregiver. Spouse caregiver may focus on their own health and are not likely engage in patient self-management.

Deek et al., 2017

Lebanon

RCT

N=260

intervention=126

control=130

Evaluate effectiveness of family focused approach to improve heart failure care in Lebanon quality intervention (FAMILY) study on patient outcomes

·                     Self-care of heart failure index (A-SCHFI)

·                     Medical Outcome Study Short Form SF-12v2

·                     SHARE Index

Self-care: Improvement in self-care maintenance and confidence, fewer major vascular events and health care utilization in the intervention group (p=0.01).

Readmission rate: Significant reduction in readmission (P=0.02).

Major vascular event (heart attack, cerebral vascular accident and peripheral vascular event): Statistically significant in control group for 30 days period (P= .01)

QOL: No significant difference in physical and mental health among groups (p=.77, .25,) respectively.

Bidwell et al., 2017

Italy

Secondary analysis of a subset of data from a multi-site observational study

N=183

outpatient cardiovascular clinics across 82 Italian provenances

Quantify the influence of patient and caregiver characteristics on patient clinical-event risk in HF.

SF12 Scale

Italian Self-Care of HF Index version 6.2

·                     Caregiver strain: Higher caregiver strain significantly associated with lower patient clinical events. (P=<.001).

·                     Caregiver mental health: Better self-reported caregiver mental health status was associated with lower patient clinical event risk (P=0.02)

·                     Caregiver contribution to HF self-care: Higher caregiver contributions to self-care maintenance were associated with better patient event-free survival (P=0.04)

·                     10 % decrease or increase in mortality for each 10-point shift in caregiver contributions to self-care maintenance or management

·                     Non-spousal caregiver did not have statistical significance on HF patients clinical event outcomes (p=.44)

Bidwell et al., 2015

Italy

Cross-sectional

Secondary data analysis

N= 364

(a) characterize HF maintenance and management behaviors within a dyadic context,

(b) identify individual-and dyad-level determinants of both patient and caregiver contributions to HF self-care maintenance and management behaviors

·                     Quality of life.

·                     Function activities: The Barthel Index

·                     Mini-Mental State Examination Tools

·                     Caregiver strain: CBI measurement

·                     perceived social support: COPE Index.

·                     HF self-care

·                     Caregiver and patient quality of life: QOL related to physical symptoms of HF was not a determinant of patient self-care or caregiver contributions to patient self-care. QOL related to emotional symptoms of HF was a significant determinant of better self-care maintenance for patients and higher contributions to patient self-care maintenance from caregivers (β=0.42).

·                     Gender and self-care: Female caregiver gender were a significant determinant of better patient self-care maintenance (β=3.45

·                     Patient cognition: Patients cognition was significant predictor of caregiver contribution to patient self-care (β=0.30*).

·                     Caregiver strain was not a predictor of caregiver contribution to patient self-care.

·                     Social support were predictors of caregiver contribution to patient self-care.

Stamp et al., 2016

USA

Randomized study

N=117

Examine (1) association of family functioning and the self-care antecedents of perceived confidence and treatment self-regulation (autonomous and controlled) and (2) whether participants exposed to an FPI had greater confidence scores for diet, medications and treatment self-regulation at baseline, four and eight months compared to participants exposed to patient–family education (PFE) intervention or usual care (UC)

·                     Family support

·                     Perceived confidence: PCS

Family function:Family functioning was related to self-care confidence for diet (p=0.02).

·                     The family partnership intervention group significantly improved confidence (p=0.05) and motivation (medications (p=0.004; diet p=0.012) at four months; patient–family education group and usual care did not change.

Dunbar et al., 2016

USA

Secondary data analysis of randomized study to patient and family education (PFE), family partnership intervention (FPI), or usual care (UC)

N=117

Determine if family functioning influences response to family-focused interventions aimed at reducing dietary sodium by heart failure (HF) patients.

·                     Family function: The Family Assessment Device Questionnaire

·                     Depressive symptoms: (BDI-II)

Family Function: In the poor family functioning groups, FPI and PFE had lower mean urine sodium than UC (p < .05) at 4 months, and FPI remained lower than UC at 8 months (p < .05).
For good family functioning groups, FPI and PFE had lower mean sodium levels by 3-day food record at 4 and 8 months compared to the UC group.

Depression: Those who have poor family function have higher depressive symptoms and higher level of NA.

Hooker et al., 2018

USA

Cross-sectional

N=99

Examine the associations among mutuality, patient self-care confidence (beliefs in abilities to engage in self-care behaviors) and maintenance (behaviors such as medication adherence, activity, and low salt intake), caregiver confidence in and maintenance of patient care, and caregiver perceived burden

·                     Mutuality: Mutuality Scale of the Family Caregiving Inventory

·                     Self-care: SCHFI.

·                     The Caregiver Contributions to self-care:

·                     Perceived caregiver burden: ZBI-SF.

·                     The more likely mutual care the more confident level  (r=.33*).

·                     Patients and caregivers who perceived better mutuality also reported more confidence in patient self-care, and for patients, those who were more confident also reported better maintenance.

Lee et al., 2015

Italy

Secondary data analysis of cross-sectional data collecting during a study of Italian heart failure patients and their caregivers

 N= 509

·                     Identify and characterize archetypes (i.e., naturally occurring patterns) of heart failure patient-caregiver dyads with respect to patient and caregiver contributions to self-care.

·                     Identify additional patient caregiver- and dyadic-level factors that were helpful in determining which of the observed archetypes the dyad was most likely to embody.N=509

·                     Patient and caregiver contributions to self-care: CCSCHFI

·                     Patient comorbidities: Charlson comorbidity index

·                     Patient cognitive function: Mini mental state examination

·                     Patient activities of daily living: Barthel index

·                     Patient physical and emotional quality of life: Minnesota living with heart failure questionnaire

·                     Caregiver quality of life: SF 12

·                     Caregiver strain: CBI

·                     Novice and complementary heart failure dyadic archetype: patients in this archetype reported greater contributions to self-care maintenance than their caregivers. In contrast, caregivers reported greater contributions than patients to self-care management (i.e., complementary contributions). Older patient age, better emotional QOL, fewer limitations to the patient’s activities of daily living, and dyads predominantly comprising patients and their adult child caregivers were additional attributes of the novice and complementary dyadic archetype of contributions to heart failure self-care (p=0.044, 0.023, 0.035), respectively.

·                     Patients in the inconsistent and compensatory dyadic archetype of contributions to heart failure self-care had fewest limitations in performing activities of daily living and more of them had hospitalizations for heart failure in the past year, compared with the other archetypes. (p=0.035).

·                     Expert and collaborative heart failure dyadic archetype: Patients of this archetype also had the worst mental and physical QOL and the greatest limitations to activities of daily living compared with the other archetypes.

Srisuk et al., 2016

Thailand

RCT

N= 83

·                     Develop and evaluate a family-based education program for patients with HF and their carers residing in rural Thailand

·                     HF knowledge: DHFKS.

·                     Career perceived control over managing patient HF symptoms: CAS-R

·                     Self-care: SCHFI

·                     HF QOL: MLHF

·                     HF knowledge: Patients in education group had a 2.2-point higher DHFKS score than those in usual care group at three months [95% CI (1.06, 3.34), P < 0.001] and a 1.7- point higher score at six months [95% CI (0.64, 2.87), P = 0.002].

·                     Career perceived control over managing patient HF symptoms: The fixed effects revealed that carers perceived control over managing patient HF symptoms, as measured by the CASR, changed significantly with time [F (2/91) = 11.80, P < 0.001] and there was significant interaction between groups and time [F (2/91) = 6.53, P < 0.001].

·                     Self-care: The fixed effects revealed that mean self-care maintenance [F (2/88) = 22.7 001], self-care management [F (2/56)= 16.26, P < 0.001] and self-care confidence [F (2/93) = 75.68, P < 0.001] scores changed significantly with time.

·                     HF QOL: The fixed effects revealed that the emotional dimension of health-related quality of life, as measured by the MLHF, showed significant differences between the patient groups [F (2/99) = 5.01, P = 0.027]. patients in the education group had a 1.7-point lower MLHF emotional dimension score (lower scores indicate better quality of life) than those in the usual care group [95% CI (-3. 05, -0.35), P = 0.014.

Bidwell et al., 2018

USA

Secondary data of cross-sectional data analysis.

N=114

·                     Identify configurations of shared HF knowledge in patient-caregiver dyads

·                     Characterize dyads within each configuration by comparing sociodemographic factors, HF characteristics, and psychosocial factors

·                     Quantify the relationship between configurations and patient self-care adherence to managing dietary sodium and HF medications

·                     Heart failure knowledge: AHFKT

·                     Autonomy support: (FCCQ-P, FCCQ-F)

·                     Depressive symptoms: BDI-II

·                     Patient quality of life: MLHFQ

·                     Caregiver quality of life: SF-12 PCS

·                     Sodium intake: Self-report and 3DFR

·                     Medication adherence: MEMS

·                     Dyadic HF knowledge and depressive symptoms: Lower ejection fraction and higher depressive symptoms were associated with poorer dyadic knowledge.

·                     Autonomy support: HF patients in the “Knowledgeable Together” group perceived greater autonomy supportive communication from their family caregiver.

·                     Caregiver QOL: Caregiver health related QOL in this sample was generally lower than national norms, and especially low in the “Knowledge Gap” group.

Vellone et al., 2018

Italy

RCT

N=366

Evaluate the influence of mutuality as a whole and of its dimensions on self-care maintenance, management, and confidence in HF patient–caregiver dyads.

·                     Patient and caregiver mutuality

·                     Patient self-care and caregiver contribution to self-care: Self-Care of Heart Failure Index

·                     For the Mutuality Scale as a whole and for the dimensions of shared pleasurable activities and reciprocity, patients scored significantly higher than their caregivers

·                     Caregivers, however, scored higher than patients on the love and affection dimension

·                     In the patient version, the strongest correlations were between the Shared Pleasurable Activities and Reciprocity dimensions (r = .826); the lowest correlations was between Love and Affection and Shared Values dimensions (r = .613).

·                     In the caregiver version the strongest correlation was between Shared

·                     Pleasurable Activities and Reciprocity dimensions (r = .814); but the lowest correlation was between Love and Affection and Reciprocity (r = .508).

·                     Regarding the love and affection dimension, the only actor effect that we found was on self-care confidence; a higher score on the love and affection dimension was associated with higher caregiver self-care confidence (B = 7.369, p < .001).

·                     In respect of scores on the shared values dimension, we observed a partner effect on patient self-care maintenance (B = 2.542, p = .006)

Wu et al., 2017

USA

RCT- secondary data analysis

N= 113 Pairs

Explore how health literacy levels of patients with HF and their FMs influence HF knowledge and self-care behaviors (i.e., medication adherence and sodium intake).

·                     Health literacy: Rapid Estimate of Adult Literacy in Medicine

·                     HF knowledge: Atlanta Heart Failure Knowledge Test

·                     Self-care behaviors

·                     Medication adherence: MMAS- 8 Scale

·                     Sodium intake: A self-report measure, 3-day food record.

·                     Patients with LHL had significantly lower HF knowledge (p < .001) and their FMs also had significantly lower HF knowledge (p = .001) than those with HHL.

·                     Patients with LHL also trended to have lower medication adherence (p = .077), and their 24-hr urinary sodium levels were higher by 650.4 mg compared with patients with HHL, although both did not reach significant level (p = .072).

·                     When both patient and FM had LHL, both the patient and FM HF knowledge was significantly lower (both ps< .001), and the patient medication adherence was significantly lower (p = .026) than the HHL and DHL groups.

·                     It is possible that when both HF patients and FMs have LHL, they both have less understanding of HF and treatment that cause more difficulty understanding and following medication instructions and which may be one factor leading to patient medication nonadherence.