Impact of Self-Management Education on Self-care Behaviors, Quality of Life and, Readmission in Heart Failure Patients: A Randomized Controlled Trial

Document Type : Original Article

Authors

1 Iranian Research Center on Healthy Aging, Sabzevar University of Medical Sciences, Sabzevar, Iran;

2 Department of Nursing, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran;

3 Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran;

4 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran;

5 Department of Health Information Technology, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran;

6 Department of Interventional Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran;

7 Pariona, Engineering The Future, Brisbane, Queensland, Australia

10.30476/ijcbnm.2026.103856.2588

Abstract

Background: Heart failure (HF) is a prevalent chronic condition that requires ongoing self-management. This study aimed to evaluate the effects of mobile videocast–based self-management education on self-care behaviors, quality of life, and hospital readmission in patients with HF.
Methods: A randomized clinical trial was conducted from December 2019 to January 2021, involving 38 patients with HF who were referred to Imam Khomeini Hospital in Tehran. Participants were allocated to control (n=19) and intervention (n=19) groups using block randomization. Demographic data form, the nine-item European Heart Failure Self-care Behavior scale, the Minnesota Living with Heart Failure Questionnaire, and a form to record readmission were used for data collection. Both groups received routine care; additionally, the intervention group received four weekly videocasts. Self-care behaviors and quality of life were measured in the baseline and two months after completion of the intervention. The readmission occurrence was checked two months after completing the intervention. Data were analyzed using chi-square, Fisher’s exact test, Paired t-test, independent t-test, and Mann-Whitney U test in SPSS version 25. In all tests, p value less than 0.05 was considered statistically significant.
Results: Data from 35 participants (18 control, 17 intervention) were analyzed. Post-intervention, a statically significant difference was observed in self-care behavior scores (Intervention: 17.70±4.51 vs. Control: 27.66±8.19; P=0.001) and quality of life scores (Intervention: 20.76±14.63 vs. Control: 42.00±24.32; P=0.004). During the two-month follow-up, 27.78% of the control group patients were hospitalized compared to none in the intervention group (RR 2.30, 95% CI: 1.53-3.47).
Conclusion: Self-management education in patients with HF via videocasts can improve self-care, quality of life, and lower readmission rates in these patients. Accordingly, the use of videocast-based self-management education is recommended as a supportive strategy to improve self-care and quality of life and potentially reduce readmission rates.
Trial Registration Number: IRCT20190717044249N1.

Keywords


1.    Arrigo M, Jessup M, Mullens W, et al. Acute heart failure. Nat Rev Dis Prim. 2020;6:16.
2.    Savarese G, Becher PM, Lund LH, et al. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023;118:3272-87.
3.    Johansson I, Joseph P, Balasubramanian K, et al. Health-related quality of life and mortality in heart failure: the global congestive heart failure study of 23 000 patients from 40 countries. Circulation. 2021;143:2129-42.
4.    Virani SS, Alonso A, Aparicio HJ, et al. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021;143(8):e254-e743. 
5.    Khan MS, Sreenivasan J, Lateef N, et al. Trends in 30-and 90-day readmission rates for heart failure. Circ Hear Fail. 2021;14:e008335.
6.    Osenenko KM, Kuti E, Deighton AM, et al. Burden of hospitalization for heart failure in the United States: a systematic literature review. J Manag care Spec Pharm. 2022;28:157-67.
7.    Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141:e139-e596.
8.    Khajehpoor MH, Shahrbabaki PM, Nouhi E. Effects of a home-based palliative heart failure program on quality of life among the elderly: a clinical trial study. BMC Palliat Care. 2023;22:130.
9.    Moradi M, Daneshi F, Behzadmehr R, et al. Quality of life of chronic heart failure patients: a systematic review and meta-analysis. Heart Fail Rev. 2020;25:993-1006. 
10.    Silavanich V, Nathisuwan S, Phrommintikul A, et al. Relationship of medication adherence and quality of life among heart failure patients. Hear Lung. 2019;48:105-10.
11.    Seid SS, Amendoeira J, Ferreira MR. Self-Care and Quality of Life Among Adult Patients with Heart Failure: Scoping Review. SAGE Open Nurs. 2023;9:23779608231193719.
12.    Aghajanloo A, Negarandeh R, Janani L, et al. Self-care status in patients with heart failure: Systematic review and meta-analysis. Nurs Open. 2021;8:2235-48. 
13.    Jaarsma T, Hill L, Bayes-Genis A, et al. Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2021;23:157. 
14.    Yoong SQ, Wang W, Seah ACW, et al. Study of the Self-Care Status and Factors Related to It in Heart Failure Patients. Journal of Integrative Nursing and Palliative Care. 2022;3:31-5.
15.    Santero M, Song Y, Beltran J, et al. Effectiveness and Cost-Effectiveness of Self-Management Interventions for Adults Living with Heart Failure to Improve Patient-Important Outcomes: An Evidence Map of Randomized Controlled Trials. In: Healthcare(Basel). 2024;12:302.
16.    Centers for Disease Control and Prevention. What Is Self-Management Education? US: Centers for Disease Control and Prevention; 2018.
17.    Niksadat N, Ghaffari M, Ramezankhani A, et al. Experiences of patient education among people affected by cardiovascular disease: a qualitative study based on Andragogy model. BMC Health Serv Res. 2023;23:708.
18.    Nicolaou C, Matsiola M, Kalliris G. Technology-enhanced learning and teaching methodologies through audiovisual media. Educ Sci. 2019;9:196.
19.    Ramtin S, Yazdani Z, Tanha K, Negarandeh R. The impact of distance education on readmission of patients with heart failure: A systematic review and meta-analysis. Nurs Open. 2023;10:4205-15.
20.    Movahedi M, Khamseh F, Ebadi A, et al. Comparison of group motivational interviewing and multimedia education on elderly lifestyle. J Educ Health Promot. 2018;7:133. 
21.    Reid KRY, Reid K, Esquivel JH, et al. Using video education to improve outcomes in heart failure. Heart Lung. 2019;48:386-94. 
22.    Negarandeh R, Zolfaghari M, Bashi N, et al. Evaluating the Effect of Monitoring through Telephone (Tele-Monitoring) on Self-Care Behaviors and Readmission of Patients with Heart Failure after Discharge. Appl Clin Inform. 2019;10:261-268. 
23.    Jaarsma T, Årestedt KF, Mårtensson J, et al. The European Heart Failure Self-care Behaviour scale revised into a nine-item scale (EHFScB-9): a reliable and valid international instrument. Eur J Heart Fail. 2009;11:99-105. 
24.    Rector TS, Kubo SH, Cohn JN. Patients self-assessment of their congestive heart failure. content, reliability and validity of a new measure, the Minnesota living with heart failure questionnaire. Hear Fail. 1987;3:198-219.
25.    Negarandeh R, Ghasemi E, Janani L. Psychometric evaluation of the nine-item heart failure self-care behavior scale (9-EHFScBS). Nurs Pract Today. 2022;9:46-53. 
26.    Bilbao A, Escobar A, García-Perez L, Navarro G, Quirós R. The Minnesota living with heart failure questionnaire: comparison of different factor structures. Health Qual Life Outcomes. 2016;14:23.
27.    Somayeh Eskandari, Marzieh Heravi-Karimooi, Nahid Rejeh, et al. Translation and validation study of the Iranian version of Minnesota Living With Heart Failure Questionnaire. Payesh (Health Monit). 2015;14:475-484.[ In Persian]
28.    MedlinePlus. Heart Failure. US: MedlinePlus; 2025. [Cited 2 Jan 2026]. Available from: https://medlineplus.gov/heartfailure.html
29.    Yanicelli LM, Goy CB, González V del C, et al. Non-invasive home telemonitoring system for heart failure patients: a randomized clinical trial. J Telemed Telecare. 2021;27:553-61.
30.    Wonggom P, Nolan P, Clark RA, et al. Effectiveness of an avatar educational application for improving heart failure patients’ knowledge and self-care behaviors: A pragmatic randomized controlled trial. J Adv Nurs. 2020;76:2401-15. 
31.    Galinier M, Roubille F, Berdague P, et al. Telemonitoring versus standard care in heart failure: a randomised multicentre trial. Eur J Heart Fail. 2020;22:985-94. 
32.    Hägglund E, Lyngå P, Frie F, et al. Patient-centred home-based management of heart failure. Findings from a randomised clinical trial evaluating a tablet computer for self-care, quality of life and effects on knowledge. Scand Cardiovasc J. 2015;49:193-99. 
33.    Abbasi A, Najafi Ghezeljeh T, Ashghali Farahani M, Naderi N. Effects of the self-management education program using the multi-method approach and multimedia on the quality of life of patients with chronic heart failure: A non-randomized controlled clinical trial. Contemp Nurse. 2018;54:409-20. 
34.    Meng K, Musekamp G, Schuler M, et al. The impact of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation. Patient Educ Couns. 2016;99:1190-7. 
35.    Toback M, Clark N. Strategies to improve self-management in heart failure patients. Contemp Nurse. 2017;53:105-20.