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Measuring Self-care in Chronic Heart Failure: A Review of the Psychometric Properties of Clinical Instruments

Cameron, Jan MHSc; Worrall-Carter, Linda PhD; Driscoll, Andrea PhD; Stewart, Simon PhD

The Journal of Cardiovascular Nursing: November-December 2009 - Volume 24 - Issue 6 - p E10-E22
doi: 10.1097/JCN.0b013e3181b5660f
ARTICLES: Research Design and Methods
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Background: Improved self-care skills and behaviors are an important outcome of patient education and counseling. Both researchers and health professionals need to utilize instruments that are reliable and valid at measuring this outcome to advance our understanding as to the efficacy of clinical practice directed toward improving self-care.

Objective: The aim of this study was to identify instruments that measure chronic heart failure (CHF) self-care and demonstrate their psychometric properties.

Methods: A search of Medline, Cumulative Index to Nursing and Allied Health Literature, Medline, PsycArticles, Psychology and Behavioral Sciences Collection, and PsycINFO databases elucidated studies published between January 1980 and February 2009 that measure CHF self-care. The clinical instruments selected were disease-specific measures of CHF self-care behaviors that are promoted in best practice guidelines. Only instruments that reported estimates of reliability and validity were included in this review. Psychometric properties of the instruments were evaluated according to practice guidelines.

Results: The literature search identified 14 instruments published in peer-reviewed journals that measured constructs that predict or correlate to self-care rather than self-care itself. Only 2 disease-specific measures of self-care were identified (Self-care Heart Failure Index [SCHFI] and European Heart Failure Self-care Behavior Scale [EHFScBS]) that have undergone rigorous psychometric testing in CHF populations. Five aspects of validity had been demonstrated with EHFScBS, and 6 aspects of validity had been demonstrated with SCHFI. Two of 3 aspects of reliability have been demonstrated in both instruments.

Conclusion: Only 2 reliable and valid tools have been developed to specifically measure CHF self-care. Further use of these instruments in the research arena may reduce gaps in our understanding of CHF self-care and further shape clinical practice directed at improving it.

Background: Improved self-care skills and behaviors are an important outcome of patient education and counseling. Both researchers and health professionals need to utilize instruments that are reliable and valid at measuring this outcome to advance our understanding as to the efficacy of clinical practice directed toward improving self-care. Objective: The aim of this study was to identify instruments that measure chronic heart failure (CHF) self-care and demonstrate their psychometric properties. Methods: A search of Medline, Cumulative Index to Nursing and Allied Health Literature, Medline, PsycArticles, Psychology and Behavioral Sciences Collection, and PsycINFO databases elucidated studies published between January 1980 and February 2009 that measure CHF self-care. The clinical instruments selected were disease-specific measures of CHF self-care behaviors that are promoted in best practice guidelines. Only instruments that reported estimates of reliability and validity were included in this review. Psychometric properties of the instruments were evaluated according to practice guidelines. Results: The literature search identified 14 instruments published in peer-reviewed journals that measured constructs that predict or correlate to self-care rather than self-care itself. Only 2 disease-specific measures of self-care were identified (Self-care Heart Failure Index [SCHFI] and European Heart Failure Self-care Behavior Scale [EHFScBS]) that have undergone rigorous psychometric testing in CHF populations. Five aspects of validity had been demonstrated with EHFScBS, and 6 aspects of validity had been demonstrated with SCHFI. Two of 3 aspects of reliability have been demonstrated in both instruments. Conclusion: Only 2 reliable and valid tools have been developed to specifically measure CHF self-care. Further use of these instruments in the research arena may reduce gaps in our understanding of CHF self-care and further shape clinical practice directed at improving it. www.jcnjournal.com

Jan Cameron, MHSc School of Nursing and Midwifery (Victoria), Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia.

Linda Worrall-Carter, PhD School of Nursing and Midwifery (Victoria), Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia.

Andrea Driscoll, PhD Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.

Simon Stewart, PhD Preventative Cardiology, Baker IDI Heart and Diabetes, Melbourne, Australia.

J. Cameron is supported by a National Health & Medical Research Council/National Heart Foundation Public Health Post Graduate Scholarship.

S. Stewart is supported by an NH&MRC Senior Research Fellowship.

A. Driscoll is supported by a National Health and Medical Research Council Postdoctoral Fellowship.

Corresponding author Jan Cameron, MHSc, St Vincent's Health/Australian Catholic University National Centre for Nursing Research, PO Box 2900, Fitzroy Victoria, Australia 3065 (S00072101@myacu.edu.au).

© 2009 Lippincott Williams & Wilkins, Inc.