Background

Insufficient self-care behaviors, low self-efficacy, depression, and poor illness perceptions are obstacles to the management of people with heart failure, leading to adverse patient outcomes. Self-care interventions are strategies used to support individuals in self-care. Currently, evidence on the effects of nurse-led self-care interventions on self-care behaviors and the correlates (self-efficacy, depression, and illness perceptions) in people with heart failure is scarce.

Objectives

This review aims to systematically synthesize current evidence to determine the effectiveness of nurse-led self-care interventions on self-care behaviors, self-efficacy, depression, and illness perceptions among people with heart failure and identify the optimal characteristics of effective nurse-led heart failure self-care programs.

Methods

MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, and PsycINFO were electrically searched for relevant articles from the inception to December 2021. Randomized controlled trials examining the effects of nurse-led self-care interventions on self-care behaviors, self-efficacy, depression, and illness perceptions among people with heart failure published in the English language were included. The quality appraisal of included studies was performed using the revised Cochrane tool for assessment of the risk of bias in randomized controlled trials (RoB 2.0). The meta-analysis was conducted using statistical software R. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results

Twenty-four trials with 2488 participants were identified in this review. The results of our study revealed that nurse-led self-care interventions improved self-care maintenance (mean difference [MD]: 9.58, 95% confidence interval [CI]: 5.96 to 13.20, moderate certainty of evidence), self-care management (MD: 12.08, 95% CI: 8.05 to 16.11, high certainty of evidence), self-efficacy (standardized mean difference [SMD]: 0.98, 95% CI: 0.42 to 1.54, moderate certainty of evidence), and depression (SMD: 0.55, 95% CI: 0.34 to 0.77, high certainty of evidence) among people with heart failure. Moreover, subgroup analyses indicated that the ideal intervention duration to enhance self-care behaviors and self-efficacy was 1 to 3 months and to reduce depression was within 1 month.

Conclusions

This review revealed the beneficial effects of the nurse-led self-care interventions on self-care behaviors, self-efficacy, and depression among people with heart failure. The duration of the intervention is one of the factors that may affect the intervention effects. Further well-designed randomized controlled trials are recommended to strengthen the current evidence.

Registration number (PROSPERO): CRD42022299754.

中文翻译：

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护士主导的自我保健干预对心力衰竭患者自我保健行为、自我效能、抑郁和疾病感知的有效性：系统评价和荟萃分析

背景

自我保健行为不足、自我效能低下、抑郁和疾病认知差是心力衰竭患者管理的障碍，导致患者预后不良。自我保健干预是用于支持个人进行自我保健的策略。目前，关于护士主导的自我保健干预对心力衰竭患者自我保健行为及其相关因素（自我效能、抑郁和疾病认知）影响的证据很少。

目标

本综述旨在系统地综合现有证据，以确定护士主导的自我保健干预对心力衰竭患者自我保健行为、自我效能、抑郁和疾病感知的有效性，并确定有效的护士主导的自我保健干预措施的最佳特征心力衰竭自我保健计划。

方法

从开始到 2021 年 12 月，对 MEDLINE、Embase、Web of Science、CENTRAL、CINAHL 和 PsycINFO 的相关文章进行了电子搜索。检查护士主导的自我保健干预对自我保健行为、自我效能的影响的随机对照试验包括以英语发表的心力衰竭患者的抑郁症和疾病认知。纳入研究的质量评估使用修订后的 Cochrane 工具进行，用于评估随机对照试验中的偏倚风险（RoB 2.0）。荟萃分析使用统计软件 R 进行。证据的确定性使用推荐分级评估、开发和评估 (GRADE) 方法进行评级。

结果

本综述确定了 24 项试验，共有 2488 名参与者。我们的研究结果表明，护士主导的自我保健干预改善了自我保健维持（平均差 [MD]：9.58，95% 置信区间 [CI]：5.96 至 13.20，中等质量证据）、自我保健管理（MD：12.08，95% CI：8.05 至 16.11，证据质量高），自我效能（标准化平均差 [S​​MD]：0.98，95% CI：0.42 至 1.54，中等质量证据）和抑郁（SMD : 0.55, 95% CI: 0.34 to 0.77, 高确定性证据）在心力衰竭患者中。此外，亚组分析表明，提高自我保健行为和自我效能感的理想干预时间为 1 至 3 个月，减少抑郁症的理想干预时间为 1 个月内。

结论

这篇综述揭示了护士主导的自我保健干预对心力衰竭患者的自我保健行为、自我效能和抑郁的有益影响。干预的持续时间是影响干预效果的因素之一。建议进行进一步精心设计的随机对照试验，以加强现有证据。

注册号（PROSPERO）：CRD42022299754。