Heart failure self-management education: a systematic review of the evidence.

OBJECTIVE: The objective of this systematic review is to identify educational content and techniques that lead to successful patient self-management and improved outcomes in congestive heart failure education programs. METHODS: MEDLINE, CINAHL and the Cochrane Central Register of Controlled Trials, as well as reference lists of included studies and relevant reviews, were searched. Eligible studies were randomised controlled trials evaluating congestive heart failure self-management education programs with outcome measures. Two of the investigators independently abstracted descriptive information, education content topics and outcomes data. RESULTS: A total of 7413 patients participated in the 35 eligible congestive heart failure self-management education studies. The congestive heart failure self-management programs incorporated 20 education topics in four categories: (i) knowledge and self-management (diagnosis and prognosis, pathophysiology of how congestive heart failure affects the body, aims of treatment, management and symptoms, medication review and discussion of side-effects, knowing when to access/call the general practitioner, communication with the physician, follow up for assessment or reinforcement); (ii) social interaction and support (social interaction and support, stress, depression); (iii) fluids management (sodium restriction, fluid balance, daily measurement of weight, ankle circumference, self-monitoring and compliance relative to fluids); and (iv) diet and activity (dietary assessment and instructions, physical activity and exercise, alcohol intake, smoking cessation). A total of 113 unique outcomes in nine categories (satisfaction, learning, behaviour, medications, clinical status, social functioning, mortality, medical resource utilisation and cost) were measured in the studies. Sixty (53%) of the outcomes showed significant improvement in at least one study. CONCLUSION: Educational interventions should be based on scientifically sound research evidence. The education topic list developed in this review can be used by patients and clinicians to prioritise and personalise education.

Computerized learning technologies for diabetes: a systematic review.

BACKGROUND: The objective of this study was to evaluate computerized learning technology interventions that can empower patients in the self-management of diabetes and support diabetes education over a distance. METHODS: We searched Medline (1966-2006), CINAHL (1982-2006), and the Cochrane Central Register of Controlled Trials (first quarter 2007) databases. We also reviewed reference lists from included studies to identify additional studies. We included 25 articles representing 21 randomized controlled trials that evaluated a computerized learning technology and measured the outcome of patient care. We extracted patient sample, intervention, educational content topics, outcome measures, and statistical significance. RESULTS: Of 21 eligible trials, 18 trials (85.7%) reported significant positive outcomes. Almost 44% (43.8%) of the outcomes demonstrated significant improvements (49 of 112 outcomes). CONCLUSIONS: Patient self-management behaviors are important in chronic disease management, and initial evidence suggests that computerized learning technology interventions can play a significant role in the future.

Reducing risks in diabetes self-management: a systematic review of the literature.

OBJECTIVE: The purpose of this systematic review was to review published literature on risk-reducing interventions as part of diabetes self-management. DATA SOURCES: Medline (1990-2007), CINAHL (1990-2007), and Cochrane Central Register of Controlled Trials (first quarter 2007) databases were searched. Reference lists from included studies were reviewed to identify additional studies. STUDY SELECTION: Intervention studies that addressed reducing risks to help prevent or minimize diabetes complications were included. DATA EXTRACTION: Study design, sample characteristics, interventions, and outcomes were extracted. DATA SYNTHESIS: Thirty-three studies, represented by 39 articles, met the criteria for inclusion and were classified as smoking cessation (n = 3), eye examination (n = 2), foot care (n = 10), oral health (n = 2), vaccination (n = 1), cardiovascular risk reduction (n = 9), and comprehensive risk reduction (n = 6). Only 46.3% of the 283 outcomes measured in the 33 studies were significantly improved. CONCLUSIONS: Reducing risks involves implementing effective risk reduction behaviors to prevent or slow the progression of diabetes complications. Recognizing risk factors for complications and what constitutes optimal preventive care is an important part of managing diabetes. Intervention studies are lacking in some areas of reducing risks. Further studies are needed to test specific interventions to reduce the risks of diabetes complications.

Congestive heart failure consumer information on the Web: how accessible is the evidence?

The objective of this pilot study was to assess the accessibility of congestive heart failure consumer information on the web. Twenty-seven education trials involving 5589 patients with congestive heart failure were analyzed. Education topics and outcomes were abstracted. Twenty education topics were linked to outcomes. A sample of 15 websites missed 56.7% of education topics and 61.8% of technical website characteristics that have suggested accuracy, reliability, and timeliness of content.

Computer-aided diabetes education: a synthesis of randomized controlled trials.

Computer-aided diabetes education is the application of technology to provide information on diabetes self-management as well as test the users' knowledge and provide feedback. The objective of this paper was to evaluate the impact of computer-aided diabetes education in improving health outcomes. We identified reports of randomized controlled trials through systematic electronic database searches. Three eligibility criteria were applied: randomized controlled trial; evaluation of a computerized diabetes education program; and assessment measured on the outcome of patient care. We abstracted data by using a standardized form. Of 19 eligible trials, 16 trials (84.2%) reported significant positive outcomes. A total of 112 outcomes were identified. Forty-two percent (42.0%) of the outcomes demonstrated significant improvements (47 of 112 outcomes). Considering the importance of patient self-management behaviors in chronic disease management, initial evidence suggests computer-aided diabetes education can play a more significant role in the future.