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Open Access Highly Accessed Research article

A heart failure self-management program for patients of all literacy levels: A randomized, controlled trial [ISRCTN11535170]

Darren A DeWalt1*, Robert M Malone1, Mary E Bryant1, Margaret C Kosnar1, Kelly E Corr1, Russell L Rothman2, Carla A Sueta3 and Michael P Pignone1

Author Affiliations

1 Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA

2 Center for Health Services Research, Division of General Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

3 Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA

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BMC Health Services Research 2006, 6:30  doi:10.1186/1472-6963-6-30

Published: 13 March 2006

Abstract

Background

Self-management programs for patients with heart failure can reduce hospitalizations and mortality. However, no programs have analyzed their usefulness for patients with low literacy. We compared the efficacy of a heart failure self-management program designed for patients with low literacy versus usual care.

Methods

We performed a 12-month randomized controlled trial. From November 2001 to April 2003, we enrolled participants aged 30–80, who had heart failure and took furosemide. Intervention patients received education on self-care emphasizing daily weight measurement, diuretic dose self-adjustment, and symptom recognition and response. Picture-based educational materials, a digital scale, and scheduled telephone follow-up were provided to reinforce adherence. Control patients received a generic heart failure brochure and usual care. Primary outcomes were combined hospitalization or death, and heart failure-related quality of life.

Results

123 patients (64 control, 59 intervention) participated; 41% had inadequate literacy. Patients in the intervention group had a lower rate of hospitalization or death (crude incidence rate ratio (IRR) = 0.69; CI 0.4, 1.2; adjusted IRR = 0.53; CI 0.32, 0.89). This difference was larger for patients with low literacy (IRR = 0.39; CI 0.16, 0.91) than for higher literacy (IRR = 0.56; CI 0.3, 1.04), but the interaction was not statistically significant. At 12 months, more patients in the intervention group reported monitoring weights daily (79% vs. 29%, p < 0.0001). After adjusting for baseline demographic and treatment differences, we found no difference in heart failure-related quality of life at 12 months (difference = -2; CI -5, +9).

Conclusion

A primary care-based heart failure self-management program designed for patients with low literacy reduces the risk of hospitalizations or death.